CHEST Guidelines-A-67-Year-Old-Woman-With-a-“Shrunken”

A-67-Year-Old-Woman-With-a-“Shrunken”

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The document describes a case of a 67-year-old woman who experienced recurrent pneumonia and a "shrunken" left lung. She had a history of a severe car accident at age 19, which involved blunt chest trauma resulting in two left-sided chest tubes, broken ribs, and a prolonged recovery including a tracheostomy. Decades later, she presented with symptoms of nonresolving pneumonia, exertional dyspnea, and abnormal chest imaging revealing left lung volume loss.<br /><br />Her current symptoms, including fever, dry cough, and chest pain, led to an initial diagnosis of bilateral pneumonia and subsequent treatment with azithromycin, which did not resolve her fever. Upon further investigation, a chest CT scan revealed airway abnormalities, sparking a suspicion of delayed bronchial stenosis, a condition potentially dating back to her past trauma.<br /><br />The diagnosis was delayed airway stenosis with postobstructive pneumonia due to her earlier blunt chest trauma. The recommended diagnostic study was bronchoscopy, which confirmed the stenosis and provided an opportunity for therapeutic intervention. Treatment involved airway dilation and the placement of an airway stent, which led to substantial improvement in the patient’s symptoms, such as reduced exertional dyspnea and better mucus clearance.<br /><br />This case underlines the importance of considering historical trauma in patients with unexplained lung issues and utilizing bronchoscopy for definitive diagnosis and management of airway stenosis. Long-term management included repeated bronchoscopies, balloon dilation, and stent placement to maintain airway patency and facilitate airway remodeling. Despite a recurrence of stenosis requiring further intervention, the patient's condition significantly improved post-procedure, showcasing the success of the endoscopic treatment approach.

Keywords

recurrent pneumonia

shrunken lung

blunt chest trauma

bronchial stenosis

airway dilation

bronchoscopy

airway stent

exertional dyspnea

postobstructive pneumonia

endoscopic treatment