Biography
Biography: Shyam Krishnan
Abstract
A 44 year old male transferred to our facility from another hospital with a diagnosis of an asthma exacerbation which was not responding to treatment (iv steroids/bronchodilators /antibiotics). He has had 2 admissions in the past 3 months for asthma exacerbations. His complains of shortness of breath on exertion associated with wheezing, nocturnal awakening and dry cough started 6 months ago. Patient denied chest pain, weight loss, fever, chills, night sweats or hemoptysis. No significant past medical history. He was a non-smoker. No history of allergies, nasal discharge, skin disorders. Treatment with bronchodilators did not alleviate symptoms.
On examination the patient was clinically stable. A fixed monophonic wheeze could be heard over the trachea and lung fields. Blood investigations were normal. Pulmonary function studies demonstrated a moderate obstructive pattern with no significant bronchodilator response. Despite a normal chest radiograph the fixed monophonic wheeze on auscultation prompted us to do a CT scan thorax to rule out any endo bronchial pathology. CT Scan demonstrated a polypoid intra-tracheal lesion occupying a 2 cm length of trachea. There was no mediastinal extension or adenopathy. Flexible fiber-optic Bronchoscopy was done which revealed a polypoid intra-tracheal mass occluding approximately 80% of the lumen. The tumor was removed in three sessions by Flexible Bronchoscopy with Argon plasma coagulation and cryosurgery. Histopathological and immunohistochemistry analysis of the resected tumor revealed an intra-tracheal schwannoma. The patient was put on bronchoscopic surveillance for one year with no evidence of recurrence. He is currently asymptomatic.
This case reinforces the common adage that “all that wheezes is not asthma”. Apart from unravelling a rare diagnosis (intra-tracheal schwannoma) the therapeutic role of the bronchoscopic ablative procedures for treatment of intra-tracheal masses are highlighted. More importantly as a result of these advances this patient was spared a major cardiothoracic intervention.