PDF(Pubmed)
Abstract：
Tracheal stenosis and paradoxical vocal fold motion are both common laryngological diagnoses that can present with similar symptoms of dyspnea. Co-morbid psychiatric issues can complicate diagnostic accuracy and lead to logical fallacies in the attribution of symptom etiology. We present a case of a 38-year-old female who presented repeatedly to the emergency department with respiratory distress, inspiratory stridor, wheezing, and anxiety. On examination, she had stridor that appeared to correlate with episodes of elevated anxiety and bedside laryngoscopy which showed intermittent paradoxical vocal fold motion. A computed tomography scan showed 40% narrowing of the distal tracheal lumen, but symptoms were felt to be inconsistent and out of proportion to stenosis. She was seen several more times in the ED and eventually followed up in the laryngology clinic, where she had a tracheoscopy showing Cotton Meyer grade III stenosis. This unique case highlights the logical fallacies that may lead to misdiagnosis when evaluating stridorous patients with comorbid personality and anxiety disorders.
摘要：
气管狭窄和矛盾的声带运动都是常见的喉科诊断，可以表现出类似的呼吸困难症状。共病精神病可能会使诊断准确性复杂化，并导致症状病因归因的逻辑谬误。我们介绍了一名38岁的女性，她反复出现呼吸窘迫到急诊科就诊，吸气喘鸣，喘息,和焦虑。在检查中，她患有喘鸣，似乎与升高的焦虑发作和床旁喉镜检查有关，后者显示间歇性矛盾的声带运动。计算机断层扫描显示40％的远端气管腔变窄，但感觉症状不一致，与狭窄不成比例。她在急诊室又被看到了几次，最终在喉科诊所进行了随访，她的气管镜检查显示CottonMeyerIII级狭窄.这个独特的案例凸显了在评估患有并存人格和焦虑症的纹路患者时可能导致误诊的逻辑谬误。
