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A persistent wheeze

Bruno de Aguiar Mendes, Joana Duarte Santos, Carlos Lopes Figueiredo, Mariana Calheiros Cabral, Rita Luísa Santos Gerardo, Maria Alexandra Mineiro, João Abel Dantas Cardoso
Breathe 2021 17: 210036; DOI: 10.1183/20734735.0036-2021
Bruno de Aguiar Mendes
1Serviço de Pneumologia – Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
2NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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  • ORCID record for Bruno de Aguiar Mendes
  • For correspondence: mendes.bruno@campus.ul.pt
Joana Duarte Santos
3Serviço de Anatomia Patológica – Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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Carlos Lopes Figueiredo
1Serviço de Pneumologia – Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
2NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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Mariana Calheiros Cabral
1Serviço de Pneumologia – Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
2NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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Rita Luísa Santos Gerardo
1Serviço de Pneumologia – Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
2NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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Maria Alexandra Mineiro
1Serviço de Pneumologia – Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
2NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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João Abel Dantas Cardoso
1Serviço de Pneumologia – Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
2NOVA Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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    Figure 1

    Posteroanterior chest radiograph.

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    Figure 2

    CT scan with a) narrowing of the lumina of the trachea, b) narrowing of the right upper lobe entrance, and c) calcified “finger-in-glove opacities” pattern.

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    Figure 3

    a) Infiltration of the trachea submucosa with yellow material and b) obstruction of the right upper lobe entrance with the same material.

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    Figure 4

    Benign bronchial mucosa with deposition of amorphous hyaline material that stains with Congo red, compatible with amyloidosis.

Tables

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  • Table 1

    Key differences between tracheobronchial diseases

    Granulomatosis with polyangiitisTracheobronchial amyloidosisTracheopathia osteochondroplasticaTracheobronchial papillomatosisRelapsing polychondritis
    CauseVasculitis of uncertain cause (probable hypersensitivity reaction)Idiopathic or associated with various inflammatory, hereditary or neoplastic pathogensIdiopathic benign diseaseInfection of the upper respiratory tract by the human papillomavirusAutoimmune
    RadiologyCircumferential mucosal thickening of the trachea and central bronchi; may appear with subglottic stenosisCircumferential nodular or regular thickening of trachea, central bronchi and pharynx; may have calcificationUsually calcified nodules sparing the posterior wall of the trachea; frequently in the inferior two-thirds of the trachea and proximal bronchiMultiple non-calcified polypoid lesions narrowing the airway; more frequent in larynx; rarely affects small airwaysRegular thickening sparing the posterior wall of the trachea; affects upper trachea and larynx most frequently
    PresentationGlomerulonephritis, systemic vasculitis, oral ulcer, myalgias; respiratory symptoms usually appear laterAsymptomatic, dyspnoea, cough, recurrent infection, wheezing; variable symptoms according to affected organAsymptomatic, cough, dyspnoea, recurrent infection, wheezing, haemoptysisHoarseness, choking episodes, cough, dyspnoea, stridorAuricular and nasal chondritis, ocular inflammation, polyarthritis, audio vestibular damage, tracheomalacia
    HistologyMucosal and submucosal inflammatory infiltrate and ulcer; poorly formed granulomasSubmucosal deposits of proteinaceous material (amyloid) that stain with Congo redSubmucosal osteocartilaginous nodules; may display a connection to the perichondrium of a tracheal ringMild to moderate dysplasia; papillomatosis and basal hyperplasiaInflammation and destruction of the cartilaginous rings
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A persistent wheeze
Bruno de Aguiar Mendes, Joana Duarte Santos, Carlos Lopes Figueiredo, Mariana Calheiros Cabral, Rita Luísa Santos Gerardo, Maria Alexandra Mineiro, João Abel Dantas Cardoso
Breathe Jun 2021, 17 (2) 210036; DOI: 10.1183/20734735.0036-2021

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A persistent wheeze
Bruno de Aguiar Mendes, Joana Duarte Santos, Carlos Lopes Figueiredo, Mariana Calheiros Cabral, Rita Luísa Santos Gerardo, Maria Alexandra Mineiro, João Abel Dantas Cardoso
Breathe Jun 2021, 17 (2) 210036; DOI: 10.1183/20734735.0036-2021
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