Version June 2024
| Disease | Clinical features | Laboratory | Pulmonary function testing | Chest imaging | Other |
| Goiter | Slowly enlarging thyroid mass | TSH | Flow volume loop may show airflow limitation depending on location/severity of compression | Neck/chest radiograph may show extrinsic airway compression, but CT usually needed to assess degree of narrowing. Thyroid tissue has characteristic appearance on CT. | Laryngoscopy or bronchoscopy may be needed to assess airway narrowing |
| Compression from mediastinal mass/lymphadenopathy | Usually gradual onset of dyspnea and wheeze, although can be more rapid with germ cell tumors and aggressive lymphomas | Testing may be helpful (eg, complete blood count, beta-HCG, alpha fetoprotein) | Flow volume loop likely to show irreversible expiratory airflow limitation | Mediastinal mass/lymphadenopathy may be visible on chest radiograph; chest CT usually needed to determine origin of mass and degree of compression | Biopsy of mass/lymphadenopathy via EBUS, EUS, mediastinoscopy, Chamberlain procedure, VATS |
| Relapsing polychondritis | Wheeze can be expiratory or inspiratory depending on location of cartilaginous damage Usually has associated involvement of cartilage of ears, nose, ribs, eyes | No available diagnostic tests Need to exclude tuberculosis, syphilis Autoantibodies may be positive (eg, ANA, ANCA, RF) | Flow volume loop shows variable intrathoracic or extrathoracic airflow limitation | Chest radiograph may show tracheal narrowing; lateral neck radiograph may show calcification of tracheal or laryngeal cartilage; inspiratory and expiratory chest CT views of trachea needed Three dimensional reconstruction of CT may also help with diagnosis MRI may differentiate inflammation from fibrosis | Patients with relapsing polychondritis should also be evaluated for involvement of cardiac valve cartilage with Doppler echocardiography |
| Respiratory papillomatosis | Typically presents in infancy but may recur in adulthood; gradual onset of dyspnea May affect larynx, vocal cords, trachea | Flow volume loop likely to show intrathoracic airflow limitation | Chest imaging | Bronchoscopy, biopsy if not previously done | |
| Tracheobronchomalacia | Predisposing factors (eg, congenital, emphysema, recurrent or prolonged intubation, external compression on the trachea, relapsing polychondritis) | Flow volume loop shows variable intrathoracic airflow limitation | Inspiratory and expiratory multidetector CT imaging | Bronchoscopy to visualize airway | |
| Tracheal stenosis | History of cannulation of trachea by endotracheal or tracheostomy tube; history of lung transplantation or blunt chest trauma | Flow volume loops if patient stable | Multidetector CT with three dimensional reconstruction may help characterize length and severity of obstruction | Bronchoscopy | |
| Tracheal and bronchial tumors | Gradual onset of dyspnea; bronchial tumor may cause focal/unilateral wheeze | Serum 5HIAA if bronchial carcinoid suspected | Flow volume loop likely to show fixed airflow limitation | Chest radiograph and chest CT | Bronchoscopy with biopsy |
| Vascular ring or aneurysm | Slowly progressive dyspnea; dyspnea may be positional or associated with exertion | Spirometry likely to show irreversible expiratory airflow limitation | Chest radiograph may show right sided aortic arch Chest CT with intravenous contrast MRI |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
