Case 347: Tracheobronchial Smooth Muscle Atrophy and Separation

Area of Science:

• Pulmonology
• Otolaryngology
• Radiology

Background:

• A 69-year-old woman presented with new-onset dysphonia and shortness of breath.
• Medical history includes asthma, allergic rhinitis, and gastroesophageal reflux disease.
• Patient is a current smoker with a 40-pack-year history and yearly lung cancer screening.

Purpose of the Study:

• To investigate the cause of new-onset dysphonia and shortness of breath in a patient with a history of smoking and respiratory conditions.
• To evaluate pulmonary function and laryngeal findings in the context of respiratory symptoms.

Main Methods:

• Pulmonary function tests (PFTs) including spirometry, bronchodilator response, and diffusion capacity.
• Review of serial low-dose computed tomography (CT) lung screening studies.
• Flexible laryngoscopy to assess vocal cord function and laryngeal mucosa.

Main Results:

• PFTs demonstrated severe obstructive lung disease with air trapping and reduced diffusion capacity for carbon monoxide.
• Laryngoscopy revealed pachydermatous changes in the interarytenoid fold mucosa.
• CT scans were reviewed as part of the diagnostic workup.

Conclusions:

• The patient's symptoms may be related to severe obstructive lung disease.
• Laryngeal findings suggest potential nasopharyngeal reflux or chronic infection as contributing factors.
• Multidisciplinary evaluation is crucial for managing complex respiratory and laryngeal symptoms.