Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis
This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the...
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Published in | Thorax Vol. 77; no. 10; pp. 1050 - 1053 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
BMJ Publishing Group Ltd and British Thoracic Society
01.10.2022
BMJ Publishing Group LTD |
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Abstract | This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the need to consider alternative or additional diagnoses if a patient does not respond to treatment or the clinical course is unexpected. We highlight the importance of follow-up X-ray to determine whether atelectasis has resolved, which was significantly delayed in this case due to COVID-19 restrictions. Though rare, an endobronchial tumour should be considered if atelectasis persists and when planning endoscopy for a presumed foreign body, especially if the clinical history and patient factors make a foreign body less likely. Greater awareness of this as a differential may expedite diagnoses for patients in future. We show how virtual, multicentre, multidisciplinary meetings can aid rapid diagnosis, surgical planning and coordination of follow-up across centres. |
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AbstractList | This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the need to consider alternative or additional diagnoses if a patient does not respond to treatment or the clinical course is unexpected. We highlight the importance of follow-up X-ray to determine whether atelectasis has resolved, which was significantly delayed in this case due to COVID-19 restrictions. Though rare, an endobronchial tumour should be considered if atelectasis persists and when planning endoscopy for a presumed foreign body, especially if the clinical history and patient factors make a foreign body less likely. Greater awareness of this as a differential may expedite diagnoses for patients in future. We show how virtual, multicentre, multidisciplinary meetings can aid rapid diagnosis, surgical planning and coordination of follow-up across centres. |
Author | Semple, Thomas Jordan, Simon Ruggins, Nigel Barclay, Mhairi Buderi, Silviu Bush, Andrew Rice, Alexandra Smyth, Alan Robert Daniel, Mat |
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Copyright | Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. 2022 Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. |
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Keywords | Bronchoscopy COVID-19 Paediatric asthma Histology/Cytology Paediatric Lung Disaese Thoracic Surgery Rare lung diseases |
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References | Murray, Foden, Lowe (R6) 2017; 1 Shlizerman, Mazzawi, Rakover (R3) 2010; 31 Eber, Antón-Pacheco, de Blic (R1) 2017; 50 Righini, Morel, Karkas (R2) 2007; 71 2023100202050726000_77.10.1050.6 2023100202050726000_77.10.1050.1 2023100202050726000_77.10.1050.3 2023100202050726000_77.10.1050.2 2023100202050726000_77.10.1050.5 2023100202050726000_77.10.1050.4 |
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SubjectTerms | Asthma Asthma - diagnosis Biopsy Bronchoscopy Calcification Case based discussion Coronaviruses COVID-19 COVID-19 - diagnosis COVID-19 Testing Diagnosis, Differential Fever Foreign bodies Foreign Bodies - diagnosis Histology Histology/Cytology Humans Medical diagnosis Paediatric asthma Paediatric Lung Disaese Pediatrics Pleural effusion Primary care Pulmonary Atelectasis Rare lung diseases Severe acute respiratory syndrome coronavirus 2 Thoracic Surgery Tomography, X-Ray Computed Transplants & implants Tumors |
Title | Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis |
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