EpistemisLocalized and fixed expiratory wheezing in the right upper lobe
Specialty: Respiratory.
Why it occurs
- Obstructive bronchogenic carcinoma of the right superior lobar or apical segmental bronchus (the fixed and irreversible narrowing of the bronchial lumen due to tumor growth generates a whistling sound with a single and constant tone perfectly localized on auscultation of the right vertex, which is not modified by cough or bronchodilator treatment)
- Intrabronchial foreign body aspirated and lodged in the right upper lobar bronchus
- Bronchial scarring stenosis of bacterial or tuberculous origin in the right pulmonary apex
- Extrinsic compression of the right segmental bronchus due to metastatic hilar or subcarinal lymphadenopathy.
Initial workup
Computed tomography (CT) of the chest with intravenous contrast; Flexible bronchoscopy (essential for direct visualization of the right upper lobar bronchus, taking biopsies, bronchial brushing or foreign body extraction); sputum cytology; Spirometry with flow-volume curve.
red flags
Fixed localized wheezing in the right upper lobe associated with recurrent hemoptoic sputum or frank hemoptysis, progressive dyspnea on exertion, active smoking with progressive weight loss, or persistent right upper lobar atelectasis on chest x-ray.
Standard management
- Treatment with standard bronchodilators is not effective in resolving mechanical obstruction
- Methylprednisolone — 40 mg intravenously if there is associated peritumoral inflammatory mucosal edema that worsens the obstruction
- Definitive management requires bronchial endoscopic intervention, dilation, or 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