PDF(Pubmed)
Abstract：
BACKGROUND: Excessive dynamic airway collapse (EDAC) is a form of dynamic central airway obstruction, with characteristic of excessive dynamic invagination of airway posterior wall membrane and structurally intact airway cartilage. We report a rare case of EDAC with a marked positional component.
METHODS: A 73-year-old man was admitted to our hospital owing to dyspnea in right recumbent position (RRP). Also only in RRP, strong rhonchi was auscultated bilaterally through entire respiratory phase. He had gone through 3 episodes of resections on left lung due to hemoptysis caused by bronchiectasis, so he had only segment B1 + 2 and B3 left.
METHODS: The spirometry results indicated that he had chronic obstructive pulmonary disease (COPD). The bronchoscopy revealed that in RRP, there was severe inward bulging of the posterior membrane of right main bronchus (RMB), which was worsened at expiratory phase. The EDAC of RMB was suspected, and was confirmed by an expiratory phase computed tomography (CT) in RRP. The EDAC was likely due to COPD, and the positional component was most likely to be caused by the removal of majority of his left lung.
METHODS: Considering locality of EDAC and his overall stability, he was given a conservative approach. He was prescribed with budesonide/glycopyrrolate/formoterol for COPD and followed up.
RESULTS: Two months later, the patient had relived dyspnea and weaker wheezing in RRP, and he had a good social and physical recovery.
CONCLUSIONS: Dyspnea may present as a diagnostic challenge, and it is rarely accompanied with a positional component. EDAC is an uncommon cause of dyspnea. This case illustrates the possible role of bronchoscopy and dynamic CT in dynamic evaluation of airway.
METHODS: A 73-year-old man was admitted to our hospital owing to dyspnea in right recumbent position (RRP). Also only in RRP, strong rhonchi was auscultated bilaterally through entire respiratory phase. He had gone through 3 episodes of resections on left lung due to hemoptysis caused by bronchiectasis, so he had only segment B1 + 2 and B3 left.
METHODS: The spirometry results indicated that he had chronic obstructive pulmonary disease (COPD). The bronchoscopy revealed that in RRP, there was severe inward bulging of the posterior membrane of right main bronchus (RMB), which was worsened at expiratory phase. The EDAC of RMB was suspected, and was confirmed by an expiratory phase computed tomography (CT) in RRP. The EDAC was likely due to COPD, and the positional component was most likely to be caused by the removal of majority of his left lung.
METHODS: Considering locality of EDAC and his overall stability, he was given a conservative approach. He was prescribed with budesonide/glycopyrrolate/formoterol for COPD and followed up.
RESULTS: Two months later, the patient had relived dyspnea and weaker wheezing in RRP, and he had a good social and physical recovery.
CONCLUSIONS: Dyspnea may present as a diagnostic challenge, and it is rarely accompanied with a positional component. EDAC is an uncommon cause of dyspnea. This case illustrates the possible role of bronchoscopy and dynamic CT in dynamic evaluation of airway.
摘要：
背景：过度动态气道塌陷（EDAC）是动态中央气道阻塞的一种形式，具有气道后壁膜过度动态内陷和结构完整的气道软骨的特征。我们报告了一种罕见的EDAC病例，其位置成分明显。
方法：一名73岁男子因右卧位呼吸困难（RRP）入院。也仅在RRP中，强音在整个呼吸阶段双侧听诊。由于支气管扩张引起的咯血，他经历了3次左肺切除术，所以他只剩下B1+2和B3段了。
方法：肺活量测定结果表明他患有慢性阻塞性肺疾病（COPD）。支气管镜检查显示，在RRP中，右主支气管后膜严重向内膨出（人民币元），在呼气期恶化。人民币的EDAC被怀疑，并在RRP中通过呼气相计算机断层扫描（CT）证实。EDAC可能是由于COPD，位置成分最有可能是由于切除了他的大部分左肺。
方法：考虑到EDAC的局部性和整体稳定性，他得到了保守的态度。他开了布地奈德/格隆溴铵/福莫特罗治疗COPD并随访。
结果：两个月后，患者在RRP中缓解了呼吸困难和喘息较弱，他的社交和身体恢复得很好。
结论：呼吸困难可能是一种诊断挑战，它很少伴随着位置分量。EDAC是呼吸困难的罕见原因。此病例说明了支气管镜和动态CT在气道动态评估中的可能作用。
方法：一名73岁男子因右卧位呼吸困难（RRP）入院。也仅在RRP中，强音在整个呼吸阶段双侧听诊。由于支气管扩张引起的咯血，他经历了3次左肺切除术，所以他只剩下B1+2和B3段了。
方法：肺活量测定结果表明他患有慢性阻塞性肺疾病（COPD）。支气管镜检查显示，在RRP中，右主支气管后膜严重向内膨出（人民币元），在呼气期恶化。人民币的EDAC被怀疑，并在RRP中通过呼气相计算机断层扫描（CT）证实。EDAC可能是由于COPD，位置成分最有可能是由于切除了他的大部分左肺。
方法：考虑到EDAC的局部性和整体稳定性，他得到了保守的态度。他开了布地奈德/格隆溴铵/福莫特罗治疗COPD并随访。
结果：两个月后，患者在RRP中缓解了呼吸困难和喘息较弱，他的社交和身体恢复得很好。
结论：呼吸困难可能是一种诊断挑战，它很少伴随着位置分量。EDAC是呼吸困难的罕见原因。此病例说明了支气管镜和动态CT在气道动态评估中的可能作用。
