Nussbaum, Eliezer

Randhawa, Inderpal

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UC IrvineUC Irvine Previously Published WorksTitleNot All That Wheezes Is Bronchial AsthmaPermalinkhttps://escholarship.org/uc/item/0kq4t7nxJournalNew England Journal of Medicine, 363(1)ISSN0028-4793AuthorsRandhawa, InderpalNussbaum, EliezerPublication Date2010-07-01DOI10.1056/nejmicm0906105Copyright InformationThis work is made available under the terms of a Creative Commons Attribution License, availalbe at https://creativecommons.org/licenses/by/4.0/ Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of Californiaimages in clinical medicineT h e  n e w  e ngl a nd  j o u r na l  o f  m e dic i n en engl j med 363;1 nejm.org july 1, 2010 e1A 10-year-old previously healthy girl presented with episodic wheezing, dyspnea, and progressive exercise intolerance, which had developed during the preceding 9 months. On physical examination, the patient had moderate bilateral expiratory wheezing. She was treated for presumed asthma with multiple courses of inhaled bronchodilators, inhaled corticosteroids, montelukast, and oral corticosteroids. Though the patient reported that her condition had im-proved somewhat, there was no demonstrable objective improvement. Further evalu-ation by spirometry revealed severe expiratory obstruction (Panel A). The patient underwent flexible fiberoptic bronchoscopy, which revealed nearly complete (>90%) occlusion of the distal trachea by a vascular mass. Computed tomographic angiog-raphy showed that the mass did not extend beyond the trachea (Panel B, arrow). The mass was ablated endoscopically with the use of a potassium titanyl phosphate laser. Pathological analysis revealed an inflammatory pseudotumor, a benign tumor com-posed of a proliferation of inflammatory cells. Rarely invasive, this type of tumor is usually cured by local excision. One month after surgery, the patient was free of symptoms and had normal results on spirometry (Panel C). Pulmonary pseudotu-mors are rarely the cause of wheezing. However, a lack of response to first-line therapies warrants further investigation, including spirographic analysis.Copyright © 2010 Massachusetts Medical Society.Not All That Wheezes Is Bronchial AsthmaInderpal Randhawa, M.D. Eliezer Nussbaum, M.D.Miller Children’s Hospital Long Beach, CA docrandhawa@verizon.netFlow (liters/sec)Flow (liters/sec)Volume (liters)Volume (liters)642−2−4−60−22−44680−61 3 41 2 32A B C39p6AUTHORFIGUREJOB: ISSUE:4-CH/TRETAKE 1st2ndSIZEICMCASEEMail LineH/TComboRevisedAUTHOR, PLEASE NOTE: Figure has been redrawn and type has been reset.Please check carefully.REG FFILLTITLE3rdEnon ARTIST:Randhawa1 of 17-1-10mst36301The New England Journal of Medicine Downloaded from nejm.org at Irvine (UCD) on January 19, 2017. For personal use only. No other uses without permission.  Copyright © 2010 Massachusetts Medical Society. All rights reserved. 

Images in clinical medicine. Not all that wheezes is bronchial asthma.

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