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Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia?

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Pulmonologist
Practicing since : 2003
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hey Dr.

Sorry to bother you again. I just had a question about my trachea. ever since this happened, it feels different in my throat. It seems as if i could have tracheamalacia. The ENT Dr. no sign when they scoped me, only minor inflammation in my arytnoids, but maybe the evidence could be lower? Would thracheamalacia show on my previous xray?

I still have that whistle noise occasionally when i exhale and the feeling that food wants to go down the wrong hole.

Could it just be a minor case, and possibly go away with time?

How else could they diagnose it?
Posted Fri, 19 Jul 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for the follow up.

1. Tracheomalacia if present would have been picked up on ct scan.

2. The wheezing sounds are due to airway involvement and may be an oral bronchodilator needs to be added to the inhaled therapy. Please consult your doctor regarding this.

3. If your doctor agrrees, then you may go in for a bronchoscopy.

4. Your symptoms will subside with time.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 27 hours later
Hi Dr.

You mentioned before about my probably having one lesion on the next CT scan. Can that stay as just one lesion for the rest of my life, or can it continue to form others like chronic silicosis? Granted i stay away from dust for the rest of my life.

Besides that im still healing up. still a little tight in my back and chest but its much less and seems to be going away.

I was always talking about my hollow dry feeling before, it is was my throat. It is sore to the touch at maybe two rings below my XXXXXXX XXXXXXX It seems better but still funny breathing because of it. I am not sure what the dr can even do, hopefully it will heal up on its own.


Thanks,

 
 
Answered by Dr. Gyanshankar Mishra 8 hours later
Hi,
Thanks for follow up.

1. If the lesion on CT scan is static for 2 years then the expected outcome is that it should stay that way in future also unless there is some other additional pathology eg. recurrent respiratory infections.

2. The inhaled therapy should help you with your respiratory symptoms of the airways / windpipe.

3. From your history, it is clearly apparent that you are symptomatically improving.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 41 hours later
Hey Dr.,

I think i might have a tracheal bronchial injury. It seems like that or trachealmalacia. How do i tell the difference between the two?

And how do i tell if i have just a wheeze or stridor?
I can still make that whistle noise on an exhale sometimes. Getting better but still there.

Also, I was reading about shunt and blood gas barrier. So many delicate things that can be damaged. How do i know if and when i am completely healed, and if things are still working properly? Will the pft show all of that. I am also curious if and when i can exert and maybe jog again someday. I have tried short distances and it seems ok now, but...i hope i can jog a couple miles again someday.

I am feeling better with no pains and just a fair amount of tightness it feels in my diaphragm and lower back below my rib cage. I keep worrying now that it is my parenchyma that is making it tight.

My breathing feels funny still but now i think slot of it is my throat. I am not sure if i told you , but i think it was two months ago, about that I had this continuous feeling of dust in my trachea. I was coughing hard to get it out and i am afraid i may have damaged it then. It made a funny feeling and noise. The ENT Dr. didn't see anything but i am not sure if i should wait till the next Ct scan or if i should convince them to do a bronchoscopy. I just dont know if it is damaged bad and if it would heal on its own or could be life threatening.

Other then that I am reading that lung inflammation may or may not lead to acute silicosis? I do not know what i had but i felt pretty inflammed to me. It must of just went away before the first CT? Still no mucus but no dry cough either. I wish i could start hacking up mucus tho. I wish i could just catch a cold and that might help.




 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for the follow up.

1. Exhalation sound that you are hearing is wheeze in all probability. As stated previously an oral bronchodilator in consultation with your doctor would help.

2. Decision regarding bronchoscopy should be done after CT scan.

3. An advanced pulmonary function test include DLCO if available will help recognise early functional damage at the respiratory gas exchange level of the alveolus.

4. The most important thing however remains that you are improving symptomatically.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 26 hours later
Hi Dr.

I just wanted to let you know that the Dr. here is going to do another CT next week.

I do hope that everything looks good, the same. I still have some tightness in my back lower rib cage, but i think it is residual symptoms from the initial inflammation. i hope it is not my kidneys, but it seems kind of higher up for it to be my kidneys.

anyways, Wish me luck.

Thanks again for everything
 
 
Answered by Dr. Gyanshankar Mishra 39 minutes later
Hi,

Don't worry. Good luck for the ct. The findings will be pretty much localised.

Kidneys do not seem to be involved. Prior to CT do get your kidney function tests if contrast is tobe used. That will also clear your doubts regarding any kidney involvement as kft will be normal!

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 10 hours later
hi,

Are you still thinking one fibrotic scar?

What do you mean by kidney function test if contrast is to be used? They can scan the kidneys also?

I am glad that you are so confident in my recovery and health. i honestly feel like a wreck still. much better but.... I cant believe I am still alive. i am torn because i want to know what is wrong with me, but I do not really want anything to be wrong with me.

My body has been through a lot. between my lungs, airways, throat, possibly kindeys, some heart sensations during all this, i cant believe i am still alive.

I will be 37 in a couple weeks and I hope I am still young enough to heal from all this.

Do you think the dust is cleared out of my airways and lungs by now, and its just residual inflammation still? I can still taste that dust occasionally. I feel like i had so many toxins in me. I hope my body can eventually cleanse itself from all of that.

I just hope i can heal up and put this behind me after two years. have good health again. Its something how we can lose it so fast.



 
 
Answered by Dr. Gyanshankar Mishra 51 minutes later
Hi,

1. Yes there are high chances of the localised fibrotic scar seen on last ct.

2. KFT - kidney function test (blood test) needs to be done as a protocol prior to doing contrast ct in all patients.

3. Since most of your symptoms are resolved , you are on your road to recovery.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 2 days later
Hi Dr.

I know you said rads this whole time, but i just dont understand how it can be rads if silica is the large part of the dust.

So I can have the bad inflammation and heavy symptoms after a very heavy exposure, and still heal up and be ok?

Do you think maybe there was a very small amount of dust that entered my lungs but still created that inflammation? I always have been sensitive to stuff. I guess I am lucky with nothing showing on the first Ct. I dont understand how it did not show inflammation as it still felt inflammed to me still when i went in for it. There was alot of that dust in the house, but im not sure how much of it was respirable or non respirable.

This Ct should hopefully give me some confidence that i am going to be ok, and hopefully keep healing. They are also giving me another pft on the same day. I hope they are both good and I can give you copy of them.

Thanks
 
 
Answered by Dr. Gyanshankar Mishra 40 minutes later
Hi,

1. You did have air way symptoms like breathlessness and sometime musical sounds /wheezes. That signifies that airway was involved. It is not that it is 100% RADS but your initial picture looked like the same and hence more chances of RADS. Definitely silica exposure was there and symptoms after confirmed silica exposure can be labelled as silicosis but there is no water tight comprtment between the two and symptoms do overlap. The important thing is that there was no demonstrable morphologic or functional damage and hence the chances of healing up are quiet bright.

2. I too am waiting for your CT and pft reports. Good luck for the tests and hope, it turns out to be good.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 46 hours later
hi Dr.

It just seems that everything i read about silica is that the damage progresses with time. Maybe the frst ct was just too soon? I do not understand how the first ct was fine if i felt heavy symptoms and still feel restriction in my chest?

It seems to be getting better, but I still can not expand my chest all the way. Do you think with time that will improve? And should I be trying to expand it occasionally now, like deep breathing or let it rest?

Do you think the damage in my bronchi and trachea from the silica would have shown on the first ct scan and pft? It just seems that maybe that is where it all ended up. I am afraid that maybe I have bronchieacstasis, or chronic bronchitis?
I think the hospital is finally diagnosing me with something, chemical bronchitis. I hope that is true as good chance of healing, but does not explain that inflammation i had.

Can you recommend a good over the counter anti inflammatory pain medicine? I was taking aspirin but it did not seem to really help.
I just have that restriction that hurts when i try to breath deep, and little dull pain here and there in my chest still.

So people get rads from chlorine and ammonia and other gasses and they heal with time? what is worse those harmful gasses or silica dust?

i dont know if you see this.

http://ijms.sums.ac.ir/index.php/ijms/article/view/1012

Also, I feel less dry in my airways and lungs but still no mucus after all this time. Can I have damaged some mucus membranes? or when will they begin to work again?

thanks,



 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Hi,
Thanks for the follow up.

1. Silica exposure does not cause increasing fibrogenic damage in all exposed individuals. That the ct was normal indicates that no demonstrable lesion in lungs was present at that time.

2. Incentive spirometry should help with lung expansion.

3. Chances of bronchiectasis as the first finding on ct is less likely. Chemical brinchitis is airway involvement secondary to chemical exposure by inhaled route.

4. The case report is intersting and recent. It is always the clinical correlation that is important.

5. Actually gases are worse as they can be life threatening in a short period if the exposure is not stopped in time.

6. Apparent feeling of dryness is seen as residual symptoms in RADS. It will heal with time. Continue the inhaler therapy.

7. Diclofenac sodium / Ibuprofen can be taken as analgesic and anti inflammatory medicines in consultation with your physician.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 46 minutes later
I know that is why i dont understand why drs seem so confident after my first ct. Even you said my chances of healing are quite high?

I am not sure about the case report correlation as i probably had a heavier exposure.

What do you mean, chemical bronchitis is airway involvementn secondary to chemical exposure by inhaled route?
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for the follow up.

1. Considering your initial evaluation reports, your chances of complete symptomatic relief are definitely quiet high.

2. Your duration of exposure is more as compared to the case but the concventration of inhaled dust is a very important factor and that needs to be known.

3. Chemical bronchitis : Bronchitis = inflammation of bronchi or airways. Thus chemical bronchitis is airway involvement secondary to any chemical exposure by inhaled route. It is a term very less often used and rather if airways symtoms are predominant the term RADS is used considering the fulfilment of its defining criteria.

4. I am waiting for your CT report.

Regards
Dr. Mishra

Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 38 hours later
HI Dr.

When you say that the lesions will be pretty much localized, by lesions you mean silicotic nodule(s). If that is the case will they diagnose me with silicosis?

When the initial inflammation happened, it felt like i had two breaths, a very shallow and a deep breath. It now feels like it is one smooth breath again. My sternum felt like it was almost detached from the rest of my lungs. It now feels like it is working with the rest of them smoothly. I guess the ct would have shown any sternum abnormalities?

I keep reading about inflammatory markers caused by silica. Do they turn off with time and my tissues make some sort of recovery?

Do you think it dissolves with time?

Thanks,
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up.

1. The localised findings on CT means the same fibrotic changes. Its very unlikely that nodules will appear now.

2. Yes, CT does pick up bony abnormalities if present.

3. Inflammatory markers are currently used for experimental purposes only and their role in clical management has yet to be substantiated.

4. Yes, chances of you having a fairly good normal health again are quiet high and very probable.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 5 minutes later
oh sorry, i said sternum, i meant diaphragm. can the ct see the diaphragm?
 
 
Answered by Dr. Gyanshankar Mishra 21 minutes later
Hi,
Thanks for the follow up.

Yes CT can comment on the diaphragm.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 5 hours later

Hi Dr.

When you say nodules very unlikely now, do you mean they an appear in the near or long term future?

Also, what has had me worried this whole time is that initial inflammation. Does it signify lung disease or could it just be a bad reaction and that is all? This does seem like a long time to heal from it but it was pretty intense so i suppose if it takes up to a year.

Is it true that some Drs. diagnose Rads until another diagnosis becomes clearer?
 
 
Answered by Dr. Gyanshankar Mishra 12 minutes later
Hi,
Thanks for the follow up.

1. It is too late for the nodules to appear now considering your history of exposure. But 2 years of observation is required.

2. Symptoms without any evidence on investigations are just the post inflammatory effect and subside with time.

3. RADS was a provisional diagnosis and only after definitive investigations and observation can we confirm a final diagnosis (eg. biopsy from abnormal area - but that is too invasive for patient's comfort hence not frequently advised unless absolutely indicated).


Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 17 minutes later
Hi,

so the final diagnosis could be that i am fine and nothing is wrong with me?

Maybe they will just follow me for the two years and if I am ok then I can move on with me life.

Could it be the start of ILD?

Do you think the inflammation could just be a bad reaction and not necessarily a lung disease?

Thanks,
 
 
Answered by Dr. Gyanshankar Mishra 4 hours later
Hi,
Thanks for the follow up.

1. Yes, there is a very high possibility that you are absolutely normal.

2. If there is no evidence of any disease during 2 years of observation, it is very unlikely that ILD couls be initiated at a later stage due to the current exposure.

3. The symptoms are currently the residual effects of the initial exposure.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Have whistle noise when exhale. Uncomfortable while swallowing food. Thracheamalacia? 2 days later
Hey Dr.

Tests were good. The Ct was the same as before, and pft improved a little.

I had records mail me copies, as were not ready to be released today. I will upload here as soon as i get them. A second opinion is always nice.

He wants me back in one month for a simple breath test. I will probably do another xray at least, in a year and a half to two years. Just to make sure everything is still ok.

My symptoms seem to be resolving still little by little. I can see myself being pretty much healed up in the next couple to few months, or even sooner.

Other then that, I tried to move back into the house a couple times and i can still taste the dust in the air. I have all the windows open and fans going and air purifiers and I still can not stay in there. Oh well. i am living in a tent for the rest of summer, as the fresh air will do me some good.

Thanks again for everything.
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for the follow up.

1. its good news that the CT is the same as before.
2. You are symptomatically improving.
3. You are healing and should be normal in due course of time.
4. Avoid any type of dust inhalation in near future.
5. Continue the inhalers and chest physiotherapy.

Regards
Dr. Mishra
Above answer was peer-reviewed by
 
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