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Positional dyspnea due to excessive dynamic airway collapse: A case report
Xiaoyan Sun1, Zhenghui Cui1, Yanxiong Mao2
1Women's Hospital School of Medicine Zhejiang University, Hangzhou, China.
Medicine
|December 20, 2023
Summary
Excessive dynamic airway collapse (EDAC) can cause positional dyspnea, a rare condition. This case highlights how bronchoscopy and dynamic CT aid in diagnosing this challenging airway obstruction.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
- Diagnostic Imaging
Background:
- Excessive dynamic airway collapse (EDAC) is a dynamic central airway obstruction characterized by posterior airway wall invagination.
- It presents a diagnostic challenge, particularly when associated with a positional component.
Observation:
- A 73-year-old man with a history of left lung resections presented with dyspnea exclusively in the right recumbent position (RRP).
- Physical examination revealed bilateral rhonchi in RRP, and spirometry indicated chronic obstructive pulmonary disease (COPD).
Findings:
- Bronchoscopy and dynamic computed tomography (CT) in RRP confirmed severe inward bulging of the right main bronchus posterior membrane during expiration, consistent with EDAC.
- The EDAC was attributed to COPD, with the positional element likely exacerbated by the previous left lung surgeries.
Implications:
- This case underscores the importance of considering EDAC in patients with positional dyspnea.
- Bronchoscopy and dynamic CT are crucial tools for the dynamic evaluation of airway obstruction and diagnosing EDAC.
- A conservative management approach, including inhaled corticosteroids and long-acting bronchodilators, can effectively alleviate symptoms.
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