Medical Student California Health Sciences University College of Osteopathic Medicine Clovis, California
Introduction: In this report, we present a remarkable and unique case of a 67-year-old male who experienced persistent dyspnea and hoarseness over a span of two years. This case stands out due to its unusual clinical presentation, which posed a diagnostic challenge. The patient's condition contributed significantly to our understanding of a rare condition and had valuable, instructive points for healthcare professionals.
Case Study: The patient's initial complaints of dyspnea and hoarseness were perplexing, as they lacked a clear-cut etiology. Despite a history of smoking, the absence of typical signs of pulmonary disease and consistently high oxygen saturation during dyspneic episodes made the diagnosis elusive. A diagnostic bronchoscopy finally revealed tracheal stenosis and striking flaccidity of cartilaginous structures, with pronounced collapse during expiration.
Tracheomalacia (TM), a condition commonly observed in infants and toddlers, is seldom encountered in adults with fully developed tracheal cartilages. Its specific incidence in adults without underlying factors remains poorly documented. In adults, TM is usually linked to acquired injuries, intubation, chronic lung diseases, goiters, tumors, or masses, primarily in middle-aged and elderly individuals.
This atypical presentation emphasizes the intricate nature of TM in adults. It underscores the importance of considering it as a differential diagnosis, particularly in male smokers who exhibit gradual, persistent dyspnea and have minimal pulmonary disease history. It also serves as a reminder for osteopathic practitioners to take rare anatomical abnormalities into account and acknowledge the profound interrelationship between structure and function in the human body.
Discussion: Tracheomalacia is usually associated with acquired factors, and our patient's case deviated from this norm. This underscores the significance of considering rare anatomical abnormalities when evaluating patients with unexplained symptoms.
The case's rarity and the diagnostic journey it entailed provide a compelling rationale for its reporting. Looking to the future, this case prompts consideration of alternative diagnostic and management approaches for similar presentations. It encourages healthcare practitioners to be more vigilant in their evaluation of dyspnea, taking into account the nature of symptoms, constant versus exertional, and considering tracheomalacia, especially in cases where patients have a history of smoking and minimal pulmonary disease. This report is a valuable educational resource, offering insights into the complexity of adult tracheomalacia and the importance of keeping it in mind during clinical assessments.
