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Pulmonary puzzles
Flow–volume loop: window to a smooth diagnosis?
  1. C Orton1,
  2. S Ward1,
  3. S Jordan2,
  4. A Menzies-Gow1,
  5. J H Hull1
  1. 1Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
  2. 2Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK
  1. Correspondence to Dr C Orton, Department of Respiratory Medicine, Royal Brompton Hospital, London SW3 6HP, UK; chrisorton{at}doctors.org.uk

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CLINICAL PRESENTATION

A 50-year-old woman was referred with a three-year history of cough, difficulty clearing secretions and intermittent wheeze. Examination revealed normal breath sounds and a chest radiograph was normal.

Clinic spirometry revealed a normal volume–time spirogram (figure 1A) with supra-normal indices: FEV1 3.4 L (119% predicted) and FVC 4.1 L (123% predicted).

Figure 1

(A) Volume–time spirograph. (B) Reproducible early expiratory notch (red arrow) on flow–volume loops.

Full lung function testing was arranged and the flow–volume loop was immediately flagged as abnormal; demonstrating a reproducible notch in the early forced expiratory phase of the manoeuvre (figure 1B).

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