Hwe Christopher K, Dollar Krista, Hsia David W
Division of Respiratory and Critical Care Medicine, Harbor-UCLA Medical Center, Torrance, USA.
Department of Medicine, Harbor-UCLA Medical Center, Torrance, USA.
Cureus. 2022 Jan 26;14(1):e21646. doi: 10.7759/cureus.21646. eCollection 2022 Jan.
Unilateral mainstem obstruction is an uncommon cause of dyspnea in the clinic setting. However, it is identifiable on spirometry as the "two-compartment phenomenon," in which the expiratory and/or inspiratory flow is decreased, followed by a further rapid decrease, resulting in a flattened end-expiratory or end-inspiratory tail, respectively. This case report outlines a 48-year-old woman with prior subglottic stenosis who presented with recurrent dyspnea. On spirometry, she had the characteristic finding of a flattened end-expiratory tail and was confirmed on imaging to have a left-sided unilateral mainstem bronchial obstruction. Her symptoms improved following a bronchoscopic intervention, and her spirometry pattern returned to normal. Though there are numerous known causes of unilateral mainstem obstruction, the workup for this patient was unrevealing, raising the possibility of idiopathic causes of this disease process. This is a unique case of idiopathic subglottic stenosis and left-sided unilateral mainstem bronchial obstruction occurring in the same patient.
在临床环境中，单侧主支气管阻塞是导致呼吸困难的罕见原因。然而，在肺功能测定中可将其识别为“双腔现象”，即呼气和/或吸气流量降低，随后进一步快速下降，分别导致呼气末或吸气末尾部变平。本病例报告概述了一名48岁曾患声门下狭窄的女性，她出现反复呼吸困难。在肺功能测定中，她有呼气末尾部变平的特征性表现，影像学检查证实有左侧单侧主支气管阻塞。支气管镜干预后她的症状有所改善，肺功能测定模式恢复正常。虽然单侧主支气管阻塞有许多已知原因，但该患者的检查未发现异常，增加了该疾病过程为特发性原因的可能性。这是同一患者发生特发性声门下狭窄和左侧单侧主支气管阻塞的独特病例。
