The FEV1 35% predicted. FEV25-75% 29% predicted. There was evidence of restrictive lung defect and suggestion of a mild to moderate obstructive airflow limitation with partial reversibility with bronchodilator.
WHAT GOES AGAINST THE DIAGNOSIS OF ASTHMA FROM THE HISTORY?
There
was no history of exacerbations or need for systemic steroids, and there
was no response to well administered inhaled corticosteroids nor beta-adrenergic
medications.
WHAT DIFFERENTIAL DIAGNOSIS MIGHT BE BASED ON THE PFT FINDINGS?
We
thought of chest wall deformity, scoliosis, pleural disease or mediastinal
mass. After history and examination of the patient, mediastinal mass was
on the top of the differential.
WHAT INVESTIGATIONS WOULD YOU LIKE TO DO?
CXR,
AP & Lat. views were done immediately followed by CT chest.
The
CXR's are presented below.
Enlarge the LEFT
CXR, enlarge the RIGHT
CXR.
WHAT IS YOUR INTERPRETATION?