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Case based discussion
Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis
  1. Mhairi Barclay1,
  2. Silviu Buderi2,
  3. Andrew Bush3,4,5,
  4. Mat Daniel6,
  5. Simon Jordan2,
  6. Alexandra Rice7,
  7. Nigel Ruggins8,
  8. Thomas Semple3,4,9,
  9. Alan Robert Smyth10,11
  1. 1 Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2 Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3 Imperial Centre for Paediatrics and Child Health, Imperial College, London, UK
  4. 4 National Heart and Lung Institute, Imperial College, London, UK
  5. 5 Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  6. 6 Ear, Nose & Throat Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
  7. 7 Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  8. 8 Derbyshire Children's Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  9. 9 Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  10. 10 Lifespan and Population Health, University of Nottingham School of Medicine, Nottingham, UK
  11. 11 NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, UK
  1. Correspondence to Dr Mhairi Barclay, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; mhairi.barclay{at}nhs.net

Abstract

This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the need to consider alternative or additional diagnoses if a patient does not respond to treatment or the clinical course is unexpected. We highlight the importance of follow-up X-ray to determine whether atelectasis has resolved, which was significantly delayed in this case due to COVID-19 restrictions. Though rare, an endobronchial tumour should be considered if atelectasis persists and when planning endoscopy for a presumed foreign body, especially if the clinical history and patient factors make a foreign body less likely. Greater awareness of this as a differential may expedite diagnoses for patients in future. We show how virtual, multicentre, multidisciplinary meetings can aid rapid diagnosis, surgical planning and coordination of follow-up across centres.

  • Bronchoscopy
  • COVID-19
  • Histology/Cytology
  • Paediatric Lung Disaese
  • Paediatric asthma
  • Rare lung diseases
  • Thoracic Surgery

https://doi.org/10.1136/thoraxjnl-2021-218526

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    Footnotes

    • Contributors MB prepared the manuscript and oversaw the formatting, editing and review of the manuscript in its final form. ARS was the supervising consultant who supported MB. ARS and AB provided content input, edited the manuscript and reviewed it in its final form. TS and AR provided content input, provided and formatted radiology and pathology figures, respectively, edited the manuscript and reviewed it in its final form. SB provided content input, bronchoscopy images and reviewed the manuscript in its final form. SJ, MD and NR were responsible for the care of the patient and reviewed the manuscript in its final form. All authors were involved in the patient’s care.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests ARS reports grants and speaker honoraria from Vertex as well as expenses and personal fees from Vertex, outside the submitted work. In addition, ARS has a patent issued 'alkyl quinolones as biomarkers of Pseudomonas aeruginosa infection and uses thereof'. The other authors had no competing interests to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.