ALL THAT WHEEZES ISN'T ASTHMA

TOPIC: Obstructive Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Asthma and chronic obstructive lung disease are among the most common causes of wheezing. However, a multitude pathologies, either external, or internal to airway, could cause wheezing, catch an unsuspecting physician off-guard. Although adult-onset asthma tends more severe, poor treatment response should raise suspicion regarding other etiologies. We present case goiter induced critical airway narrowing misdiagnosed as presenting with acute respiratory failure. CASE PRESENTATION: A 45-year-old female history recent (3 months prior), bronchodilator response, was brought emergency room for failure requiring intubation in field. She seen primary care office on day admission dyspnea cough, found have albuterol prescription renewed. Of note, no diagnostic pulmonary function testing performed previously confirm asthma. On physical examination, patient tachycardic, cyanotic, obtunded, oxygen saturation 40%. Esophageal discovered 2 failed attempts at re-intubation prompting difficult team (DART) activation. After successful over bougie, chest radiograph demonstrated left-sided infiltrates tracheal deviation (figure 1). Auscultation revealed decreased breath sounds posterior left fields but wheezing audible. Computed tomography neck revealing asymmetric thyromegaly (right lobe 7.0 x 4.0 4.3 cm) scattered foci calcification, mediastinal extension causing 2). The lumen deemed be same size endotracheal tube level thoracic inlet. subsequently underwent total thyroidectomy pathology confirming multi-focal papillary thyroid carcinoma. successfully extubated post-op discharged off bronchodilators. DISCUSSION: There many mimickers that dyspnea, Our experienced due compression concurrent pneumonia. Poor outpatient montelukast, intubation, imaging prompted us consider further imaging. CONCLUSIONS: differentials broad is important consider. In particular, therapy new-onset despite appropriate prompt thorough investigation. test must demonstrate reversible obstruction. Early identification clearly may prevent near-fatal outcomes by this case. REFERENCE #1: Johnson, J., Abraham, T., Sandhu, M., Jhaveri, D., Hostoffer, R., & Sher, T. (2019). Differential Diagnosis Asthma. Allergy And Asthma, 383-400. doi: 10.1007/978-3-030-05147-1_17 #2: Chung, K., Wenzel, S., Brozek, Bush, A., Castro, Sterk, P. et al. (2013). International ERS/ATS guidelines definition, evaluation severe European Respiratory Journal, 43(2), 343-373. 10.1183/09031936.00202013 #3: Gherasim, Dao, Bernstein, J. (2018). Confounders asthma: diagnoses when symptoms persist optimal therapy. World Organization 11, 29. 10.1186/s40413-018-0207-2 DISCLOSURES: No relevant relationships Sandeep Randhawa, source=Web Response Jihun Yeo,