CRA91 MISLEADING WHEEZE: A GASP FOR LIFE

V.Shoban Raj¹, Justin Tan¹, Shobhana Sivandan², Raymund Dass¹

¹Respiratory Unit,Hospital Tuanku Ja’afar Seremban
²Radiology Department, Hospital Tuanku Ja’afar Seremban

Introduction
Wheeze is one of the most common reasons for visits to primary care clinics and emergency departments. It is frequently attributed to asthma or chronic obstructive pulmonary disease (COPD). However, clinicians must remain vigilant for uncommon causes of wheezing, particularly in cases unresponsive to standard therapy

Case Presentation
We report a case of a young gentleman who presented with worsening shortness of breath and intermittent cough for one week. He had multiple prior visits to primary care for wheezing, each treated with nebulization. On arrival at our emergency department, he showed signs of respiratory distress and was treated for acute exacerbation of bronchial asthma. He was admitted to the Intensive Care Unit (ICU), where high-flow nasal cannula (HFNC) support was initiated. Despite this, he remained tachypnoeic and tachycardic

A CT Pulmonary Angiogram (CTPA) ruled out pulmonary embolism but revealed an endoluminal soft tissue lesion at trachea causing critical airway narrowing. Due to progressive respiratory compromise, awake intubation was performed with Otolaryngology surgeon standby. A multidisciplinary team (MDT) discussion involving pulmonology, anaesthesiology, cardiothoracic surgery, and radiology team led to an emergency rigid bronchoscopy with tumour debulking. The patient was successfully extubated post-operatively and transferred out of the ICU.

Histopathological examination confirmed an inflammatory myofibroblastic tumour (IMT). Surveillance bronchoscopy showed a well-healed lesion with minimal scarring; however, follow-up CT imaging demonstrated an unclear anatomical plane between the trachea and oesophagus, raising concerns about potential tumour recurrence. Therefore, the patient was referred to the cardiothoracic team for surgical assessment for potential tracheal resection

Conclusion
This case underscores the importance of considering alternative diagnoses in wheezing patients unresponsive to standard treatment and highlights the value of early multidisciplinary involvement  guiding management.