Excessive Dynamic Airway Collapse Resulting from Massive Bilateral Pleural Effusion in a Patient with COPD and Congestive Heart Failure

肋膜腔積水併發動態性呼吸道塌陷：病例報告

董安修(An-Shiou Don) ； 郭炳宏(Ping-Hung Kuo) ； 余忠仁(Chong-Jen Yu)

《胸腔醫學》 32卷1期 (2017/02) Pp. 37-44

摘要

Tracheobronchomalacia (TBM) is a condition associated with weakness of the tracheobronchial cartilage. Excessive dynamic airway collapse (EDAC) refers to excessive bulging of the posterior membrane into the airway lumen during exhalation. Patients with EDAC/TBM may present with dyspnea and refractory wheezing, mimicking the presentations of chronic obstructive pulmonary disease (COPD) and asthma exacerbations. TBM and EDAC should be listed in the differential diagnosis of expiratory wheezing. Here, we present the case of a patient with COPD and bilateral pleural effusion due to diastolic heart failure who developed severe expiratory wheezing in the central airways. The wheezing was refractory to inhaled bronchodilators and systemic steroids. Bronchoscopy showed TBM and EDAC, which could be gradually relieved by increasing the levels of positive end-expiratory pressure (PEEP). The central wheezing almost completely disappeared after drainage of the bilateral pleural effusion. The follow-up bronchoscopy revealed no evidence of TBM or EDAC. Experience with this case suggests that EDAC may result from massive bilateral pleural effusion in patients with COPD.

關鍵字

tracheobronchomalacia (TBM) ； excessive dynamic airway collapse (EDAC) ； chronic obstructive pulmonary disease (COPD) ； pleural effusion

並列摘要

動態性呼吸道塌陷起因於吐氣時氣管和支氣管後壁朝管腔內凹陷，造成吐氣時呼吸道狹窄以及呼吸道阻力的上升，臨床上和慢性阻塞性肺病變不易區分。本篇文章探討一位82 歲男性，診斷慢性阻塞性肺病變和心衰竭，因喘鳴和高碳酸血症性呼吸衰竭而接受氣管內插管和呼吸器治療。胸腔X光顯示雙側肋膜腔積水，支氣管鏡顯示動態性呼吸道塌陷。病患在接受雙側肋膜液穿放術之後，動態性呼吸道塌陷改善。顯示肋膜積水是動態性呼吸道塌陷加劇原因之一。

並列關鍵字

氣管支氣管軟化 ； 動態性呼吸道塌陷 ； 慢性阻塞性肺病變 ； 肋膜腔積液