A lateral view provides better exposure, without interference from the thoracic spine and sternum. 2 However, the intrathoracic location of our patient’s tumour lowered its visibility on the posteroanterior view of the chest radiograph. Most pleomorphic adenomas are located in the upper third of the trachea. A lateral chest radiograph is helpful for assessing tracheal tumours in these locations. However, it is a relatively poor tool for identifying tumours situated distally in the anterior or posterior tracheal wall. The posteroanterior chest radiograph is an appropriate initial imaging study for assessing dyspnea. 1 Because our patient’s tumour stalk emerged from the anterior tracheal wall, part of the tumour approached the opposing membranous portion and occluded the lumen when she lay down ( Figure 4). Tracheal tumours, as in our patient, are a rare cause of orthopnea.
Orthopnea is often associated with congestive heart failure, chronic obstructive pulmonary disease, anterior mediastinal tumours and diaphragmatic weakness. The tracheal air column was not deviated, and no conspicuous lesions were noted. Her flow–volume loop showed slowing and flattening in the expiratory limb ( Figure 1), which led us to re-examine her chest radiograph taken on admission ( Figure 2). A pulmonary function test showed a forced expiratory volume in the first second of expiration (FEV 1) of 17.5% of predicted, a forced vital capacity (FVC) of 75.7% and an FEV 1/FVC ratio of 20.4% of predicted. Her distress when lying down occurred even though her oxygen saturation remained above 98% on 2 L of oxygen per minute via nasal cannula. She had not mentioned this symptom to her treating physicians. We noticed that she had orthopnea and had to use three pillows for relief. She had diffuse wheezing on expiration and during the first half of inspiration. She had a temperature of 36.5☌, a pulse rate of 90 beats/min, a respiratory rate of 22 breaths/min and a blood pressure of 116/64 mm Hg.
On admission, the patient was in mild respiratory distress. Her history included allergic rhinitis and an eight pack-year history of smoking, which she had stopped since her diagnosis of asthma. She had received a diagnosis of bronchial asthma six months earlier, for which treatment with steroids and bronchodilators had been ineffective. Platypnea refers to breathlessness that occurs in the upright position and is relieved with recumbency.Ĭopyright © 1990, Butterworth Publishers, a division of Reed Publishing.A 36-year-old woman with a six-month history of worsening shortness of breath was admitted to hospital for investigation. Trepopnea is dyspnea that occurs in one lateral decubitus position as opposed to the other. Two uncommon types of breathlessness are trepopnea and platypnea. Paroxysmal nocturnal dyspnea (PND) is a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position. Orthopnea is the sensation of breathlessness in the recumbent position, relieved by sitting or standing. These conditions may not always be associated with dyspnea. Tachypnea is an increase in the respiratory rate above normal hyperventilation is increased minute ventilation relative to metabolic need, and hyperpnea is a disproportionate rise in minute ventilation relative to an increase in metabolic level. Dyspnea should be differentiated from tachypnea, hyperventilation, and hyperpnea, which refer to respiratory variations regardless of the patients" subjective sensations.
Dyspnea on exertion (DOE) may occur normally, but is considered indicative of disease when it occurs at a level of activity that is usually well tolerated. It is a subjective experience perceived and reported by an affected patient. Dyspnea refers to the sensation of difficult or uncomfortable breathing.
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