A young man with dyspnoea and audible expiration: the loops never lie

Abstract

Spirometry provides clues to solving this puzzle of dyspnoea and wheeze in a young nonsmoker-the loops never lie! http://ow.ly/YC9zI A 10 s recording of expiratory sounds from this case can be found at: http://ow.ly/UVVu300moD1.

Figure 1

Chest radiograph at the time of initial presentation with cough and audible breath sounds. Note the lack of obvious volume loss or visible lesion.

Figure 2

Serial measurement of lung function via spirometry with accompanying flow–volume loops.

Figure 3

Bronchoscopic view of left mainstem bronchus showing a polypoid mass with subtotal airway obstruction (bubbles reflect expiratory air flow).

Figure 4

Histopathology of the endobronchial mass following bronchoscopic resection. At 200× magnification, note the infiltrating population of tumour cells with varying phenotypes including mucin-secreting cells (single arrow) and others with more squamoid morphology (double arrow).