Abstract
A case of central airway obstruction caused by bilateral vocal cord paralysis is reported. A 74-year-old man was hospitalized with a chief complaint of severe dyspnea and hypercapnea. For six years prior to his admission, he had been bothered with intermittent dyspnea and wheezing, and had been treated for bronchial asthma and pulmonary emphysema at several other hospitals. On examination inspiratory and expiratory wheezes were audible over both lung fields and the trachea. The arterial blood gas analysis disclosed the PaO_2 was 61.5 torr, PaCO_2 60.6 torr, and pH 7.43. The pulmonary-function test revealed normal vital capacity and normal forced one-second expiratory volume, but the flow-volume curve showed decreased peak expiratory flow and markedly reduced maximal inspiratory flow. Bronchoscopic examination demonstrated that bilateral vocal cords were immobilized in the midline position. A diagnosis of idiopathic bilateral vocal cord paralysis was made after further examinations. the patient received tracheotomy, and the PaCO_2 returned to normal immediately after the operation, and PaO_2 in three weeks. This case emphasizes that idiopathic vocal cord paralysis can be important cause of central airway obstruction, and careful evaluation of patient history, physical examination and pulmonary function test is essential in establishing the diagnosis.
