EpistemisLocalized and fixed expiratory wheezing at the left base
Specialty: Respiratory.
Why it occurs
- Obstructive bronchogenic carcinoma of the basal segmental bronchus of the left lower lobe (the fixed and irreversible narrowing of the bronchial lumen due to tumor growth generates a single and constant whistling tone perfectly localized on auscultation of the left base, which is not modified by cough or bronchodilator treatment)
- Intrabronchial foreign body aspirated and lodged selectively in the left basal segments
- Post-infectious scar bronchial stenosis of bacterial or tuberculous origin in the left lower lobe
- Extrinsic compression of the left segmental bronchus due to metastatic lymphadenopathy or descending aortic aneurysm.
Initial workup
Computed tomography (CT) of the chest with intravenous contrast; Flexible bronchoscopy (essential for direct visualization of the left lower lobar bronchus, taking biopsies, bronchial brushing or foreign body extraction); sputum cytology; Spirometry with flow-volume curve.
red flags
Fixed localized wheezing at the left base associated with recurrent hemoptoic sputum or frank hemoptysis, progressive dyspnea on exertion, active smoking with unexplained weight loss, or image of persistent left lower lobar atelectasis on control chest x-ray.
Standard management
- Treatment with bronchodilators is not effective in resolving mechanical physical obstruction
- Methylprednisolone — 40 mg intravenously if there is associated peritumoral inflammatory mucosal edema that worsens the obstruction
- Definitive management requires endoscopic resection, balloon dilation, or bronchial endoprosthesis (stent) placement.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 3