Idiopathic Subglottic Tracheal Stenosis Misdiagnosed As Vocal Cord Dysfunction and Successfully Treated with Laser and Controlled Radial Expansion Balloon Dilation

Abstract

Idiopathic tracheal stenosis (ITS) is a rare condition, and diagnosis of exclusion should be suspected in patients with exercise intolerance, wheezing, and dyspnea on exertion with a flow-volume loop suggestive of fixed airway obstruction. We report a case of a 32-year-old asthmatic woman with an existing diagnosis of vocal cord dysfunction and previous normal CT scan of the neck. She continued to have fixed upper airway obstruction on repeated flowvolume loops with persistent wheezing and cough along with occasional stridor and hoarseness of voice despite appropriate management of her asthma. She was finally diagnosed with ITS on a repeat CT scan of the neck for which she underwent laser surgery, steroid injection, and controlled radial expansion balloon dilation with a successful reduction of stenosis. This case illustrates the importance of clinical suspicion for early diagnosis of ITS in poorly controlled asthmatic patients and the relevance of non-surgical management of this condition.

Case report: Idiopathic subglottic stenosis in a girl; successful treatment with macrolides

“…Local corticosteroid injection was associated with significant improvement in the interval between surgeries and had no side effects ( 2 , 8 , 17 , 18 , 23 , 74 ). Similar success rates and side effects were published in a collective with mixed etiologies of subglottic and tracheal stenosis ( 2 , 10 , 18 , 75 ). Intralesional injections supressed the hypothalamo-hypophyseal axis for a few days, and systemic side effects with serial injections were not seen ( 8 , 23 , 41 , 76 ).…”

“…There is a report of paratracheal phlegmon following a steroid injection (78). Other studies could not demonstrate that surgical intervals were altered by advanced grade of stenosis, dilation technique, or steroid injection (10,21,45).…”

“…The mean time interval between onset of symptoms and diagnosis is 2–3 years ( 2 , 4 , 8 , 17 , 18 , 23 ). Most common symptoms are dyspnea ( 2 , 10 , 18 ) both in rest and during exertion ( 8 , 23 , 40 , 41 ), cough, stridor ( 18 , 42 ), hoarseness, and wheezing ( 8 , 10 , 18 , 43 , 44 ). Before establishing diagnosis, patients commonly receive an erroneous diagnosis of chronic obstructive pulmonary disease or asthma ( 10 , 24 , 45 ).…”

“…Histologic evaluation of tracheal tissue biopsies usually shows unspecific acute and chronic active inflammation with epithelial ulceration ( 5 , 13 ) and subsequent squamous metaplasia ( 5 , 8 – 10 , 13 , 44 , 57 , 58 ), scattered eosinophilic infiltration ( 13 , 57 ), normal cartilage ( 23 , 57 ), and dilatation of mucus glands and ducts ( 5 , 23 ). Taking biopsies serves mainly to exclude other inflammatory causes of tracheal stenosis ( 4 ) as histopathological findings are not pathognomonic in iSGS.…”

“…Recommendations are therefore largely based on general treatment options of tracheal stenoses. There is controversy about the initial therapy ( 10 ). The success of various therapies is difficult to compare because of differences between the treated populations, the different therapeutic strategies and the pathways followed.…”