Not Always Asthma: Clinical and Legal Consequences of Delayed Diagnosis of Laryngotracheal Stenosis

Abstract

Laryngotracheal stenosis (LTS) is a rare condition that occurs most commonly as a result of instrumentation of the airway but may also occur as a result of inflammatory conditions or idiopathically. Here, we present the case of a patient who developed LTS as a complication of granulomatosis with polyangiitis (GPA), which was misdiagnosed as asthma for 6 years. After an admission with respiratory symptoms that worsened to the extent that she required intubation, a previously well 14-year-old girl was diagnosed with GPA. Following immunosuppressive therapy, she made a good recovery and was discharged after 22 days. Over subsequent years, she developed dyspnoea and “wheeze” and a diagnosis of asthma was made. When she became pregnant, she was admitted to hospital with worsening respiratory symptoms, whereupon her “wheeze” was correctly identified as “stridor,” and subsequent investigations revealed a significant subglottic stenosis. The delay in diagnosis precluded the use of minimally invasive therapies, with the result that intermittent laser resection and open laryngotracheal reconstructive surgery were the only available treatment options. There were numerous points at which the correct diagnosis might have been made, either by proper interpretation of flow-volume loops or by calculation of the Empey or Expiratory Disproportion Indices from spirometry data.

Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran

“…The literature review and our practical experiences showed that most patients with PITS were misdiagnosed and treated for asthma for a long time (26) before finally undergoing an emergency tracheostomy to secure their airways, which actually makes the scenario worse because the treatment involves the resection and reconstruction of the trachea. Therefore, the follow-up of ICU patients with a history of endotracheal intubation is very important for diagnosing PITS, which can lead to severe complications or even death.…”

Papilomatosis traqueobronquial y pulmonar sin compromiso de la laringe tratada con bevacizumab endovenoso en un niño

“…La obstrucción de la vía aérea se puede presentar con ruidos respiratorios clínicamente difíciles de distinguir de las sibilancias. 13 La dificultad en el diagnóstico aumenta en situaciones en las que la obstrucción de la vía aérea se produce de forma insidiosa.…”

Estenosis subglótica como manifestación inicial de granulomatosis de Wegener en una adolescente. Caso clínico

“…11 La ES es una causa poco frecuente de una presentación clínica muy común (disnea de esfuerzo, ruidos respiratorios y reducción de flujo espiratorio máximo). 12 La dificultad en el diagnóstico aumenta en situaciones en las que la estenosis se produce de forma insidiosa, como en la GW. El retraso y el error diagnóstico ocurren con frecuencia, lo que puede evitarse en gran medida mediante un índice apropiado de sospecha clínica y un examen de la función pulmonar, sobre todo, si el paciente no responde a la terapia inicial de asma.…”

“…El retraso y el error diagnóstico ocurren con frecuencia, lo que puede evitarse en gran medida mediante un índice apropiado de sospecha clínica y un examen de la función pulmonar, sobre todo, si el paciente no responde a la terapia inicial de asma. 12 Las pruebas de función pulmonar son anormales en el 60% de los pacientes con ES, y se observa en la curva flujo/volumen un aplanamiento de la curva en inspiración y en espiración que conforma la curva cajón característica, presente en nuestra paciente.…”