Cases reported "Respiratory Sounds"

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1/29. Understanding airway disease in infants.

    Large airway diseases manifest in ways distinct from those of small airway diseases. Noisy breathing that begins early in life suggests a congenital lesion of the large airways. The findings of elevated respiratory rate, in conjunction with subcostal retractions, hyperinflation to percussion, and musical wheezes, are diagnostic of small airway obstruction. Differentiating large from small airway disease is crucial, because each disease has a distinct diagnosis, and treatment of the 2 disease types can be quite different. When these principles are applied to a patient with wheezing or other signs of airway compromise, it becomes fairly easy to differentiate large from small airway disease. The treatment of patients with large airway disease can be substantially different from that of patients with small airway disease. Being able to differentiate the two is critically important. With the use of the history, physical examination, and radiographic evaluations described earlier, nearly every patient can be given an accurate diagnosis and treated appropriately.
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2/29. An unusual case of stridor due to osteophytes of the cervical spine: (Forestier's disease).

    Stridor is a noisy breathing caused by compromised airway in the larynx and trachea. The causes can either be due to intrinsic or extrinsic compression. Stridor resulting from extrinsic compression due to anterior cervical osteophytes is rare. We report an unusual case of acute stridor due to an osteophytic mass in the cervical vertebrae resulting in a mechanical upper airway obstruction. The underlying pathology was Forestier's disease or diffuse idiopathic skeletal hyperostosis (DISH). Stridor is a rare manifestation of DISH and it certainly represents the most life-threatening one. Only a few cases have been reported in the English literature and are mainly secondary to impaired function of the vocal folds, or postcricoid ulceration and oedema. We present such a case, in that stridor was the result of direct airway obstruction by the osteophytic mass and an emergency tracheostomy had to be performed to establish an airway.
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3/29. A case of Joubert's syndrome with extensive cerebral malformations.

    Joubert's syndrome is a relatively rare, autosomal-recessive syndrome defined by vermis hypoplasia, hypotonia, developmental delay and at least one of two additional manifestations: abnormal breathing pattern or abnormal eye movements. Detailed descriptions of the neuropathological findings in this syndrome are scarce. We present a radiological and pathological correlation of a case of Joubert's syndrome in which, apart from the classic vermis aplasia and some malformations of the brain stem and the spinal cord, extensive malformations of the cerebrum were found. The dentate nuclei were broken into islands and showed a few heterotopias within the superior cerebellar pedunculi, the inferior olives were plump and dysplastic, and an almost complete absence of the pyramidal decussation was found. In the spinal cord, the dorsal columns were located in a dorsal position within the spinal grey matter. In the cerebrum, absence of the corpus callosum was found. Many nodular heterotopias of the cerebral cortex and of the basal ganglia, the amygdala and the diencephalon were observed. The present case is compared to previous pathological descriptions of the Joubert syndrome and to other syndromes with comparable malformations of the posterior fossa.
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4/29. Paradoxical vocal cord motion causing stridor after thyroidectomy.

    Two women developed stridor immediately after thyroidectomy as a result of paradoxical vocal cord motion. In both cases the cord function showed a normal pattern during vocalisation but paradoxical movement was seen at laryngoscopy during tidal breathing. The abnormality improved in both patients over time with speech therapy. Whilst the syndrome of paradoxical vocal cord motion is classically thought to have a largely psychological aetiology, subtle interference with laryngeal innervation at surgery is more likely to have been the cause in these cases.
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5/29. The radiographic evaluation of infants with stridor.

    In the elective evaluation of infant stridor, inspiratory plain radiographs of the neck and chest are routinely obtained with fluoroscopy and a barium swallow when indicated. Several factors, including patient positioning, roentgenographic technique, and the phase of respiration, may significantly alter the appearance of the airway, reducing the diagnostic accuracy of this modality and leading to misinterpretation of the pathologic changes.
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6/29. Bilateral vocal fold paresis and multiple system atrophy.

    OBJECTIVE: To review a case series of patients with systemic neurodegenerative disease presenting to a laryngologist for workup of dysphonia and found to have bilateral vocal fold paresis. DESIGN: Case series. SETTING: Tertiary care voice center. patients: Series of patients with neurodegenerative disorders examined for dysphonia. MAIN OUTCOME MEASURES: history and physical examination including fiberoptic laryngoscopy were performed on all patients. Some patients underwent polysomnography. RESULTS: Seven patients during a 2-year period were noted to have bilateral abductor vocal fold paresis. Five of 7 (71%) had the diagnosis of multiple system atrophy proposed by the laryngologist. All 7 patients described sleep-disordered breathing with stridor. CONCLUSIONS: patients with systemic neurodegenerative disorders such as parkinson disease should be examined for multiple system atrophy and for evidence of bilateral vocal fold paresis. Workup for stridor should include polysomnography. Treatment of glottic obstruction in these patients includes constant positive airway pressure at night or tracheotomy. The finding of bilateral vocal fold paresis can be life threatening.
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7/29. Late-onset respiratory distress after inhalation of laundry detergent.

    Accidental poisoning with household cleaning products can pose significant risks to children. Exposure to granular laundry detergents accounts for a number of calls each year to poison control centers, though few of these exposures result in hospitalization. While caustic gastrointestinal injury resulting from ingestion of these highly alkaline cleaning agents is well-recognized, few reports address the potential damage to the respiratory tract that can occur following ingestion or inhalation of granular laundry detergent. We present a previously healthy 1-year-old who presented to the emergency department with Late-onset stridor and increased work of breathing following presumed inhalation of granular laundry detergent. parents, primary care providers, and emergency department physicians need to be aware of the potential toxicity of these widely used household products.
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8/29. Grunting respirations: chest or abdominal pathology?

    A large percentage of misdiagnosed appendicitis cases occur during childhood. Misdiagnosed patients have increased morbidity and mortality from the diagnostic delay. The patients excused from an emergency facility who are ultimately shown to suffer from appendicitis have higher rates of perforation with attendant abscess formation, peritonitis, sepsis, and potential death. The patients with misdiagnosed appendicitis are young and likely to have atypical signs and symptoms. Grunting respirations incorrectly attributed to respiratory infection may serve as a pathway for a misdiagnosed case of appendicitis.
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9/29. anesthesia induction for a difficult intubation infant with a laryngeal cyst.

    We report a case of difficult airway in a 37-day-old female with a laryngeal cyst during induction of general anesthesia. This case illustrates that upper airway obstruction can occur during induction of anesthesia with an unusual infantile aryepiglottic fold cyst. In this case, successful orotracheal intubation was achieved with spontaneous respiration, and preoperative information on orientation of the lesion assisted in positioning the patient to minimize the degree of dynamic obstruction.
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10/29. life-threatening vocal cord paralysis in a patient with group A xeroderma pigmentosum.

    We report a 19-year-old male with group A xeroderma pigmentosum who presented life-threatening vocal cord paralysis. At 3 months of age, he became sensitive to sunlight, and at the age of 4 years he was diagnosed with group A xeroderma pigmentosum. The neurologic symptoms progressed slowly thereafter. From the age of 18 years, he reported the development of occasional episodic inspiratory stridor and dyspnea, but the cause remained unknown. At the age of 19, he had a common cold and became severely dyspneic and cyanotic. Immediate examination of the glottis upon arrival by an otorhinolaryngologist using a fibroscope indicated complete paralysis of both vocal cords, and tracheal intubation resulted in marked improvement of respiration. tracheostomy was performed thereafter. Inspiratory stridor and dyspnea are the common symptoms in this disease, and some patients with group A xeroderma pigmentosum undergo a tracheostomy, but the pathogenesis remains unknown. To our knowledge, vocal cord paralysis has never been reported in patients with group A xeroderma pigmentosum. This case is presented to illustrate the importance of fibroscopy in the examination of vocal cords in patients with group A xeroderma pigmentosum before the development of life-threatening events.
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