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A 64-year-old female patient was referred to the pulmonary outpatient clinic with a 3-year history of non-productive cough and intermittent wheezing. The cough was mainly present during the day and could be triggered by talking or drinking cold drinks. She also mentioned seasonal rhinoconjunctivitis during spring and summertime. Clinical examination was unremarkable. Chest X-ray and pulmonary function tests were normal. A histamine provocation test was borderline positive (PD20=0.37 mg). Laboratory analysis showed positive radioallergosorbent tests for grass and tree pollen. A diagnosis of cough-predominant, atopic asthma was made and inhaled corticosteroids (fluticasone) were prescribed. Three months later, the patient returned for a follow-up visit. Her cough had only partially improved. She now mentioned that her cough could also be triggered by rotating her head to the left or by touching the right side of her neck, where she occasionally had noticed a swelling of fluctuating dimensions. On clinical examination, no mass was palpable but the cough could indeed be elicited by touching the …
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