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All That Wheezes Is Not Asthma. A Wheeze Is Not Always What It Seems To Be. Wheezing =. Continuous musical sound High pitched advantitia Bronchospasm Asthma COPD Bronchitis. Wheezing. Poly-phonic Multiple notes Whale call Small airway Mono-phonic Single note Stridor
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All That Wheezes Is Not Asthma A Wheeze Is Not Always What It Seems To Be
Wheezing = • Continuous musical sound • High pitched advantitia • Bronchospasm • Asthma • COPD • Bronchitis
Wheezing • Poly-phonic • Multiple notes • Whale call • Small airway • Mono-phonic • Single note • Stridor • Large airway
Wheezing • Inspiratory • Expiratory • Focal/Local • Bronchial tumors, lymph anomolies, cysts
Stridor or Wheeze • Stridor • Harsh noise caused by turbulent flow • Inspiratory = larynx • Expiratory = trachea • Biphasic = fixed lesion in periglotticregion • Stidor heard as a wheeze
Differential diagnosis of wheezing due to upper airway diseases
Differential diagnosis of wheezing due to lower airway diseases
Physical Findings to Consider • Onset of Symptoms • Clearing of throat • Discharge/secretions • Pain • Response to BD • PFT results • FLOW VOLUME I & E • Heart burn • Changes in weight • SOB w/ exertion • Clubbing/Sx hypoxia • Smoking Hx • Short neck • Wheezing / Stridor/ Stertor • Quality • Location • Type
Lower Airway Obstruction • Asthma • COPD • Pulm Edema • Aspiration • PE • Bronchiolitis • CF • Tumor • Infection
Intrathoracic Large Airway Obstruction • Tracheal Stenosis • FBA • Tumors • Cysts • Goiter • Tracheo/bronchomegaly • Tracheal malacia • R aortic arch
Extrathoracic Upper Airway Obstruction • Sinus drip • Vocal cord dysfunction • Arytenoid dysfuction • Tonsils • Supraglottitis • Laryngeal edema / stenosis • Granuloma • 2 Intubation • Wegener’s • Tumors • Anaphylaxis • Obesity • Laryngocele
Laryngeal Disorders dilatation of right laryngeal ventricle (white arrow, C) and ante-riorpositioning of right arytenoid cartilage (black arrow, C)
Laryngeal Disorders • Laryngeal nerve paralysis • Flaccid VC
Previously Healthy • Episodic wheezing • Progressive exercise intolerance • Bilateral expir wheezes • Treated for asthma • No response
Spirometry • Bronch • 90% blockage distal trachea • Vascular Mass • CTScan
Improved Post-op Spirometry • No symptoms • Free of wheezes InderpalRandhawa, M.D., and Eliezer Nussbaum, M.D. N Engl J Med 2010; 363:e1,July 1, 2010
Foreign Body Aspiration • Initial Xray • Hyperinflation • Very subtle • Which side has the foreign object?
Foreign Body Aspiration Day 3 Nut
Foreign Body Aspiration • I and E
Neuromuscular Bulbar Weakness I < E flow volume Jagged lines (on insp) Inability to perform FIVC
Neuromuscular Bulbar Weakness • Initial visit • Unable to perform FIVC • NIF difficult • 6 mo follow up