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Schwannoma in primary neurogenic tumors of the trachea is an extremely rare disease. A 21-year-old male patient with stridor was followed up with a diagnosis of asthma for two years. While no lesion was observed in the chest X-ray, tracheal schwannoma was diagnosed in the case who underwent tracheotomy due to the lesion obstructing the trachea almost completely on chest CT. The clinical findings of the patient improved ultimately in the postoperative period. We aimed to discuss the approach and follow-up of the disease with our case, although it is rare that schwannoma might be in the differential diagnosis of masses with upper airway obstruction.

A 41-year-old male presented to the Department of Pulmonary Medicine, with shortness of breath for 1 year. Though on treatment for bronchial asthma, he was not responding. The chest radiograph was normal (Fig. 1). On spirometric examination, the flow-volume curve showed flattening of the expiratory limb, suggesting variable intrathoracic obstruction. Fiber-optic bronchoscopy was, hence, done and it revealed a growth in the trachea (Fig. 2). Biopsy was deferred due to the risk of bleeding. Computed tomography (CT) of the chest also showed tracheal growth (Fig. 3). The patient was planned for rigid bronchoscopy. Meanwhile, the patient presented with expectoration of a piece of that growth. Histopathological examination revealed an adenoid cystic carcinoma (Fig. 4)., (© Journal of the Association of Physicians of India 2023.)

A 34-year-old pregnant woman in the 34th week of gestation with uncontrolled asthma was admitted because of asthma exacerbation. Although she received bronchodilators and systemic corticosteroids, respiratory failure rapidly progressed. Chest computed tomography revealed a mass occluding approximately 80% of the tracheal lumen. After urgent Caesarean section, endobronchial resection was performed. The pathological findings of the resected tumor were compatible with tracheal glomus tumor. Tracheal tumors are often misdiagnosed as asthma, but its complication with asthma is rare. Even if the diagnosis of asthma is definitive, clinicians should consider coexisting diseases, including tracheal tumors, when asthma control is poor.

Introduction: Tracheal tumors are rare, they are most often malignant and can manifest themselves by a non-specific respiratory symptomatology with progressively increasing dyspnea orienting in the first place towards a COPD or even an asthma. Among them, tracheal lipoma is exceptional. Its management is based on removal by rigid bronchoscopy., Observation: We report the case of a 73-year-old male patient who presented with non-specific dyspnea that progressively worsened over several months. The EFR showed a flattening of the flow-volume curves, the CT scan showed an anterolateral oval tracheal tumor with fatty density, the bronchial endoscopy showed a tumor lesion with stenosis of about 90% of the airway. Management consisted of a rigid bronchoscopy to delete obtruction with biopsies. Anatomopathology concluded to a tracheal lipoma., Conclusion: Progressively worsening dyspnea, especially if there are signs of inspiratory dyspnea, required a systematic bronchial endoscopy to avoid the possibility of a tracheal tumor., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Rationale: Inflammatory myofibroblastic tumor (IMT) is an uncommon neoplastic entity with a tendency of local recurrence and a low risk of distant metastasis. Involvement of trachea is extremely rare., Patient Concerns: A 34-week pregnant woman previously diagnosed with asthma for 2 months was admitted with persistent wheezing and hemoptysis. A computed tomography scan and bronchoscopy revealed a gigantic polyp in the trachea., Diagnoses: Tracheal inflammatory myofibroblastic tumor., Interventions: The mass was removed with an electrocautery snare and identified histologically as an IMT. Further immunochemical staining showed strong positive staining for smooth muscle actin and platelet-derived growth factor receptor α (PDGFRA), weak positive staining for caldesmon, and negative staining for anaplastic lymphoma kinase (ALK)1, desmin, S-100, and CD34. The tracheal IMT strongly expressed estrogen receptor-α (ER-α), which indicated that the development of this rare IMT might have been associated with hormone fluctuations that occurred during the pregnancy., Outcomes: Follow-up and histological analyses revealed no evidence of recurrence and metastasis., Lessons: This report describes an extremely rare case of a tracheal IMT that presented a diagnostic dilemma for the clinician and the pathologist. Tracheal IMT is a challenge for the clinician in diagnosis due to the nonspecific clinical presentation. Histology and immunohistochemistry are required to reach an accurate diagnosis of IMT.

Introduction: Tracheal papilloma presenting as asthma is a rare occurrence., Case Study: We report a case of a 32-year-old male patient who presented with features of asthma. Flexible bronchoscopy demonstrated a large growth arising from the lower end of the trachea. Successful treatment using snare loop and argon plasma coagulation (APC) of the polyploidal growth was performed via flexible bronchoscope., Results: The patient had immediate relief of airway obstruction and histopathological examination of the neoplasm demonstrated features of papilloma., Conclusion: Primary tracheal papilloma is mimicker of asthma, CT scan should be considered in patients with persistent chronic cough, or stridor. Endoscopic papillectomy is a safe and effective treatment and should be considered as first-line therapy for tracheal papilloma.

Background: Asthma is a very common disease, but primary tracheal tumors are extremely rare in children. Wheezing is not pathognomonic, but is the typical presentation of asthma and could also be found in patients with tracheal tumors., Clinical Findings: This report describes a 12-year-old boy with a previous history of frequent asthma attacks and experienced responses to antiasthma treatment. He was admitted to the hospital due to persistent wheezing and progressive dyspnea. Hyperinflation in the bilateral lungs was detected on chest x-ray, but without other significant findings. Chest computed tomography revealed a mass at the carina. Tracheal mucoepidermoid carcinoma was diagnosed by histopathological assessment., Conclusion: Despite the rarity of tracheal tumors, chest computed tomography scans should be performed in the first place for children presenting persistent wheezing and having poor response to antiasthma treatment to rule out the other alternative diagnosis. Coexistence of other diseases such as tracheal tumor in asthmatic patients should be considered.

Background: Exhaled aerosol patterns, also called aerosol fingerprints, provide clues to the health of the lung and can be used to detect disease-modified airway structures. The key is how to decode the exhaled aerosol fingerprints and retrieve the lung structural information for a non-invasive identification of respiratory diseases., Objective and Methods: In this study, a CFD-fractal analysis method was developed to quantify exhaled aerosol fingerprints and applied it to one benign and three malign conditions: a tracheal carina tumor, a bronchial tumor, and asthma. Respirations of tracer aerosols of 1 µm at a flow rate of 30 L/min were simulated, with exhaled distributions recorded at the mouth. Large eddy simulations and a Lagrangian tracking approach were used to simulate respiratory airflows and aerosol dynamics. Aerosol morphometric measures such as concentration disparity, spatial distributions, and fractal analysis were applied to distinguish various exhaled aerosol patterns., Findings: Utilizing physiology-based modeling, we demonstrated substantial differences in exhaled aerosol distributions among normal and pathological airways, which were suggestive of the disease location and extent. With fractal analysis, we also demonstrated that exhaled aerosol patterns exhibited fractal behavior in both the entire image and selected regions of interest. Each exhaled aerosol fingerprint exhibited distinct pattern parameters such as spatial probability, fractal dimension, lacunarity, and multifractal spectrum. Furthermore, a correlation of the diseased location and exhaled aerosol spatial distribution was established for asthma., Conclusion: Aerosol-fingerprint-based breath tests disclose clues about the site and severity of lung diseases and appear to be sensitive enough to be a practical tool for diagnosis and prognosis of respiratory diseases with structural abnormalities.

A young woman was admitted with respiratory failure. Prior to her admission, she had been treated for clinical bronchial asthma for about 2 years for recurrent wheezing. Endotracheal intubation was difficult. A fibroptic bronchoscopy, while the patient was ventilated, revealed a central tracheal tumour compromising >90% of the tracheal lumen. The tumour was cored out during rigid bronchoscopy while ventilating the patient through tracheostomy. Histopathology of the tumour was suggestive of adenoid cystic carcinoma.

A 3-year-old boy presented with severe airway obstruction which was diagnosed as asthma. He improved but had repeated episodes of severe airway obstruction. On clinical examination, he had a tracheal cough and monophonic wheezing. Imaging revealed a large lesion in the distal part of the trachea which was confirmed by bronchoscopy. The lesion was surgically removed. Histology revealed features characteristic of an inflammatory myofibroblastic tumour. Following the resection there is no recurrence of the lesion.

Primary tracheal tumours are rare and less frequently observed than bronchial tumours. Primary neurogenic tumours of the trachea as schwannomas or neurilemmomas are extremely uncommon. We report a tracheal schwannoma in a female patient who presented with breathlessness and wheeze, and she was being treated for asthma. Flexible bronchoscopy revealed a large pedunculated tracheal mass and biopsy confirmed schwannoma. She was treated with laser ablation with partial reduction of the tumour. Subsequently, she was lost to follow-up, although resection of the tumour with tracheal reconstruction was planned.

Primary tumors of the tracheobronchial tree are rare, and benign tumors are even rarer. Patients with tracheobronchial tumors are at times wrongly diagnosed with asthma. A 77-year-old woman presented to our Emergency Department with increasing dyspnea and stridor. She had been treated for bronchial asthma for the last 7 years. Due to the presence of the stridor, a cervical soft tissue computed tomography scan was performed. It revealed a tracheal polyp at the level of the thyroidal isthmus. Polyp excision with rigid bronchoscopy was performed by a thoracic surgeon. This case demonstrates that intratracheal masses should be considered in patients with dyspnea and stridor or in patients with asthma refractory to usual treatment., (Copyright © 2010 Elsevier Inc. All rights reserved.)

In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.

Benign tracheal tumors are rare, recurrent papillomatosis being the most common. They often simulate obstructive pulmonary diseases, such as asthma and chronic obstructive pulmonary disease, and patients with benign tracheal tumors often undergo long-term treatment for such diseases, without any improvement, Therefore, these tumors should be included in the differential diagnosis in patients presenting tracheobronchial tree obstruction. This report describes the case of a patient with a tracheal polyp. The patient presented symptoms for three years, and the spirometry findings suggested intrathoracic obstruction. The patient presented complete clinical and spirometric recovery after bronchoscopic resection of the tumor.

Dyspnea, wheezing, and decreased FEV1 with bronchodilator response are characteristic of asthma. However, when standard asthma therapy fails, a broad differential must be considered to avoid a catastrophic outcome. This article presents a case report of a 48-year-old Filipino woman, who was referred for evaluation of cough, dyspnea and wheezy respiration, changes in voice quality, nasal and palatal pruritus, and postnasal drainage. She was found to have mold spore hypersensitivity and abnormal spirometry with an obstructive pattern and a 15% reversibility postnebulized albuterol. An initial diagnosis of allergic rhinitis and adult-onset asthma was made, and therapy was initiated which included: salmeterol, budesonide, montelukast, and pirbuterol. Her symptoms persisted and rabeprazole was added to treat possible laryngopharyngeal reflux. Repeat spirometry demonstrated worsening obstruction. There was no improvement with systemic corticosteroids. High-resolution computed tomography of the chest demonstrated a left paratracheal mass, obstructing 60% of the airway. Bronchoscopy revealed a tumor 4-5 cm below the vocal cords with the appearance of adenoid cystic carcinoma, which was confirmed by pathology. All symptoms resolved and spirometry normalized with resection of mass and radiation therapy. Adenoid cystic carcinoma (ACC) is an uncommon form of malignant neoplasm that arises from salivary glands. Tracheobronchial ACC typically presents with symptoms of cough, dyspnea, and hoarseness. ACC has a relatively indolent course. Standard therapy is surgical resection often followed by radiotherapy. In patients who fail conventional therapies for asthma, it is important to consider other diagnoses to avoid fatal outcomes.

Large airway obstruction can present with symptoms typically associated with asthma, including cough, dyspnea, or wheezing. Obstruction of the large airways should be considered in the differential diagnosis of patients with difficult to manage asthma, particularly those with known risk factors for tracheal disease, atypical clinical features, or lack of response to standard asthma therapy. Spirometry and flow volume loops are valuable diagnostic tools in this evaluation. This article discusses two cases in which large airway obstruction mimicked asthma and reviews the characteristic flow volume loop patterns associated with large airway lesions.

Asthma is a common disease. Wheezing is not pathognomonic of asthma, however. One must be alert when appropriate asthmatic treatment does not provide adequate control. Other causes of airway obstruction must be considered, especially when stridor is heard. This report describes an elderly patient who had been managed as having asthma but had an endotracheal tumour.

Tracheal tumors are often overlooked as a cause of pulmonary symptoms until they reach an advanced state. They are often presented with a prolonged cough and shortness of breath. Most tracheal tumors in adults are cancerous (80% to 90%). Benign tracheal tumors are rare in adult patients. A case history is presented of a 19-year-old patient with a rare tracheal neurilemmoma. He was treated as having bronchial asthma initially, but his signs and symptoms did not improve with traditional therapy. The possibility of the presence of an upper airway obstruction was not raised until the typical "inspiratory tubular sound" was heard. Flow-volume loop testing, bronchoscopy, and three-dimensional computed tomography (3-D CT) confirmed the diagnosis of upper airway obstruction caused by a tracheal tumor. Therefore, surgical intervention rather than bronchoscopic removal was performed without difficulty. The patient was leading a stable life 8 months after a surgical resection. The presence of an upper airway obstruction can be proven by flow-volume loop testing and 3-D CT. Further pathologic confirmation can be accomplished by bronchoscopy. High suspicion of an upper airway obstruction such as a tracheal lesion should be raised when bronchial asthma patients fail to respond to conventional treatment.

Bronchotracheal, adenoid, cystic carcinoma is a very rare tumor. Most of its symptoms relate to airway obstruction. We report a 45-year-old woman with a carinal, adenoid, cystic carcinoma who presented with symptoms suggestive of bronchial asthma 2 years prior to diagnosis. No inspiratory flow-volume curve was performed at that time and the patient was treated with inhalation of beta-2 agonists. Early diagnosis of adenoid, cystic carcinoma is important because appropriate surgical treatment results in an excellent prognosis.

Primary tumours of the trachea are rare and most of the symptoms relate to obstruction of the air passage leading to inspiratory and expiratory stridor. Unfortunately, the inclusion of malignant tracheal neoplasms in the differential diagnosis of onset of wheeze in adults is even more rare than the tumours themselves. We report a case where a tracheal adenoid cystic carcinoma presented symptoms suggestive of bronchial asthma. It is emphasized that delay by the physician in diagnosing tracheal tumours is the principal problem, and that adult patients who experience onset of stridor and dyspnoe and do not respond to accepted medical treatment deserve systematic radiographic and endoscopic evaluation of the entire air passage.

Benign ectopic thyroid tissue within the trachea is a rare cause of upper airway obstruction. Nevertheless, it may present considerable difficulties in diagnosis and management, and can be mistaken for bronchial asthma. Thorough history taking and careful physical examination in patients assumed to be asthmatics but not responding to bronchodilator therapy may be the key to establishing diagnosis of diseases simulating asthma. The following case report illustrates this point and emphasizes the fact that not all wheezes are asthma.

A 40-year-old woman was admitted with upper airway obstruction; chest roentgenogram with tomograms, laryngoscopy, and bronchoscopy verified the presence of a subglottic tumor. Spirometry disclosed a maximum inspiratory flow rate more reduced than in the maximum expiratory flow rate, suggestive of upper airway obstruction. The pathologic conditions were consistent with cystic adenoid carcinoma (cylindroma) of the trachea. The patient underwent tracheostomy and total laryngectomy with an uneventful recovery. No evidence of local extension or distant metastases were evident at time of surgery.

A case is reported in which a tracheal tumour presented with symptoms suggestive of bronchial asthma. In the assessment and management of airways obstruction and wheeze, it is important to bear in mind that disease other than asthma and chronic bronchitis may present in this way.