UNUSUAL PATIENT-2.

  When I saw Mary for the first time , there was nothing uncommon or unusual about her or her history. She was  34yrs old white woman  with history of asthma . She had it since childhood.,was treated by her pediatrician and as she grew older was followed by primary care M.D. She had lot of allergies and so with 'bad ' asthma was refer ed to allergist. After doing allergy testings she was refer ed to me .For me asthma and cough and cold are very common re feral . So there was nothing unusual about it . ( I sometimes call " cough" and " cold " as my " bread " and " butter " . )She had bad cough and she told me that it 'never' goes away. Her physical examination was unremarkable., except for 'harsh ' breath sounds. I reviewed  her old records.
     I ordered chest x-ray and complete pulmonary function test. I was not sure that any change in medications at this stage was needed .
     When I saw her pulmonary function tests I was surprised . I noticed that her flow volume loop , which part of  pulmonary test was abnormal ,. I had noticed the abnormality in previous test but had not paid attention thinking that it was technical variation. With history of asthma from " birth " I was concerned . I was suspicious of some kind of obstruction in upper airway , as there was flattening of flow volume loop . I was concerned , but also thought that it is impossible to have this not detected in last 34 years . I had to rule it out ( or rule it in )
     I ordered CT scan of trachea . and decided to do endoscopy . CT scan came back with report of 'Trachial steno sis with at one point trachea was 8 mm. ;' ( normal size is 20 mm. ) So my thinking was correct . I called several thoracic surgeons  . With the cat scan findings no one wanted to do surgery.
      I called around got tel no. of Tracheal specialist in Boston . He agreed to look at the ct scan and see patient . He wanted  me to do video bronchoscopy and mail him the cassette . I did it .
      She was seen by him and operated by him  and then came to me . Her 'asthma ' was cured .
       During her development she had abnormal blood vessel and it  was crossing over the trachea , it got scared--fibrosed and the pressure from it caused the narrowing of the trachea .