Vocal cord dysfunction presenting as acute asthma in a pediatric patient

We report a pediatric patient with an acute onset of paradoxical vocal cord movement which presented as his first episode of wheezing. History and physical examination suggested the diagnosis of vocal cord dysfunction, which was confirmed by a flexible fiberoptic nasophayrngoscopic examination. This is the first report of paradoxical vocal cord movement being made on initial presentation of wheezing in the emergency department and supports earlier reports that this diagnosis can be made in the pediatric population. The practicing pediatric emergency physician should consider the diagnosis of paradoxical vocal cord dysfunction in the differential diagnosis of wheezing in the pediatric patient, especially if the patient does not have the typical historical and physical findings associated with reactive airway disease.