Virginia Research Day 2025

Medical Resident Research Case Reports

12 Not All Wheezing is Asthma

Lyne A. Joseph, MD 1 ; Nistha Acharya, MD 1 ; Kimberly Bird, MD 2 Corresponding author: lyneandrau.joseph@lpnt.net

Department of Internal Medicine, Sovah Health Danville, Danville, VA Department of Internal Medicine, Division of Pulmonary and Critical Care, Sovah Health Danville

Following the procedure, upon extubation, a laryngeal vocal cord mass was incidentally found. ENT was consulted and proceeded with biopsy of the mass. Patient had been complaining of worsening shortness of breath and occasional wheezing for a few months and was being worked up for probable chronic obstructive pulmonary disease by pulmonology outpatient. He had a history of dysphagia, globulus sensation, garbled speech, and intermittent gurgling with inspiration. Wife stated she did not notice any snoring or wheezing at night, and he was scheduled to have a swallow study done next week outpatient. On physical exam, the patient was intubated and mechanically ventilated. Neck was supple with overlying saturated dressing. Patient required frequent dressing changes, silver nitrate sticks, and ultimately inhaled TXA to control the residual exudate from multiple specimen collections during the biopsy. Labs were significant for leukocytosis and elevated creatinine.

Introduction: Wheezing is a common clinical symptom often associated with asthma. However, not all instances of wheezing are attributable to asthma. This case aims to highlight a differential diagnosis that should be considered when a patient presents with wheezing, emphasizing the importance of a thorough clinical evaluation and history taking to avoid misdiagnosis and ensure appropriate management. Case: A 92-year-old male history significant for kidney stones, dysphagia, essential hypertension, insulin-dependent diabetes type 2, CKD stage 4, hypercholesterolemia, tobacco dependence presented to the emergency department with back pain radiating to both flanks, nausea, and dizziness. The patient was admitted for renal colic secondary to renal stones causing hydronephrosis and underwent a right ureteroscopic stone extraction with stent placement.

Discussion: Laryngeal masses can present with a variety of symptoms, including hoarseness, dysphagia, and respiratory distress which can sometimes be mistaken for more common conditions such as asthma or chronic bronchitis. In this case, the mass was incidentally identified following a surgical procedure. Differential diagnoses include benign lesions such as vocal cord polyps, papillomas, and cysts, as well as malignant tumors such as squamous cell carcinoma. Unfortunately, excision and biopsy of this patient’s mass showed invasive squamous cell carcinoma, and close follow up outpatient with hematology-oncology was recommended.

52