A 33-Year-Old Woman With Breathing Difficulty, Inspiratory Wheeze, and Hemoptysis

A 33-year-old teacher from Ghana with no medical comorbidities and no relevant family history came to our pulmonology department with progressive difficulty in breathing, wheezing, and stridor for 6 months. Similar episodes had been treated previously as bronchial asthma. She was being treated with high-dose inhaled corticosteroids and bronchodilators but had no relief. The patient also described two episodes of large quantities of hemoptysis (> 150 mL) in the previous week. A general physical examination revealed a tachypneic young woman with an audible inspiratory wheeze. Her BP was 128/80 mm Hg; pulse, 90 beats/min; and respiratory rate, 32 breaths/min. There was a hard, minimally tender, nodular swelling of 3 × 3 cm in the midline neck felt just below the cricoid cartilage, moving with deglutition and protrusion of the tongue, with no retrosternal extension. There was no cervical or axillary lymphadenopathy. Laryngeal crepitus was present.