Case history
Case history #1
A 61-year-old woman presents with progressive shortness of breath that started approximately 3 months ago and has been getting worse in the last 2 to 3 weeks. The shortness of breath used to occur after minimal to moderate exertion. However, recently she is dyspnoeic even at rest. Associated symptoms include mild chest discomfort and bloody sputum, which has occurred on only two occasions. She has a medical history of lung cancer (squamous cell carcinoma) and is currently receiving chemotherapy. The physical examination is remarkable for mild respiratory distress, tachypnoea, and tachycardia, and lung auscultation reveals decreased breath sounds and wheezing in the left hemithorax.
Case history #2
An 83-year-old man is brought to the emergency department with severe respiratory distress. The patient is a resident of a nursing home and has a history of Parkinson's disease. The emergency medical services personnel stated that, while eating, the patient had a sudden onset of coughing and choking. He is extremely anxious, with evidence of impending respiratory arrest. On physical examination, he is hypoxaemic, severely tachypnoeic, and tachycardic, with stridor and cyanosis.
Other presentations
The numerous aetiologies of malignant and non-malignant central airway obstruction cause the clinical presentation to vary widely. In general, the presentation of tracheobronchial obstruction depends on several factors, including the underlying disease, the comorbidities of the patient, the anatomical location of the obstruction, and the rate of disease progression.[2] As such, the presentation may be a gradual progression of symptoms resulting from webs related to infectious or inflammatory processes, such as tuberculosis or granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis), respectively, or a more rapid onset of respiratory failure due to endobronchial blood clots or mucous plugs obstructing the airways. Information obtained from the patient, family members, and prior medical records is of paramount importance.
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