EpistemisFixed inspiratory wheezing of tracheal origin
Specialty: Respiratory.
Why it occurs
- Localized severe and fixed scar tracheal stenosis (narrowing of the trachea secondary to mechanical injury due to prolonged intubation that generates a high-pitched wheezing sound audible mainly during inspiration at the level of the suprasternal fossa, which does not vary with cough or with the use of beta-2 agonists)
- Squamous cell carcinoma of the trachea with intrathoracic exophytic growth
- Fixed tracheal extrinsic compression for calcified mediastinal lymphadenopathy or locally advanced esophageal cancer
- Tracheobronchial amyloidosis (deposition of amyloid material that deforms and narrows the trachea).
Initial workup
High-resolution computed tomography (CT) of the trachea with three-dimensional multiplanar reconstruction; Rigid and flexible bronchoscopy (diagnostic test of choice to evaluate the tracheal lumen and perform biopsies or mechanical dilations); Flow-volume curve by spirometry (shows characteristic bidirectional flattening).
red flags
Audible tracheal inspiratory wheeze or stridor at rest, asphyxiating inspiratory dyspnea with severe suprasternal drawing, inability to vocalize or aphonic cough, labial cyanosis, diaphoresis, or progressive loss of consciousness (extreme ventilatory urgency).
Standard management
- Management is emergency mechanical interventional — dilation, laser or stenting
- Dexamethasone — 4-8 mg intravenously immediately to reduce tracheal mucosal edema
- Inhalation of heliox (helium-oxygen mixture) to reduce the work of breathing while preparing for the endoscopic procedure.
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