EpistemisLocalized and fixed expiratory wheezing in the left upper lobe
Specialty: Respiratory.
Why it occurs
- Obstructive bronchogenic carcinoma of the left upper 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 left vertex, which is not modified by cough or bronchodilator treatment)
- Intrabronchial foreign body aspirated and lodged in the left upper lobar bronchus
- Post-tuberculosis or post-radiotherapy scarring bronchial stenosis in the left pulmonary apex
- Extrinsic compression of the left lobar bronchus due to hilar or mediastinal lymphadenopathy.
Initial workup
Computed tomography (CT) of the chest with intravenous contrast; Flexible bronchoscopy (essential for direct visualization of the left 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 left upper lobe associated with recurrent hemoptoic sputum or frank hemoptysis, progressive dyspnea on exertion, active smoking with progressive weight loss, or image of persistent left upper lobar atelectasis on control chest x-ray.
Standard management
- Treatment with regular 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 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