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Congenital Tracheal Stenosis Masquerading as Asthma in an Adolescent: The Value of Spirometry

montelukast and fluticasone proprionate by her primary care physician. Her symptoms gradually worsened despite treatment; she began to complain to her parents that it was becoming difficult to walk around in her home and very difficult to climb stairs. She was referred to our asthma clinic at 13 years of age. Physical examination was unremarkable; her lungs were clear to auscultation. Spirometry was performed. Values for relevant flows and volumes are found in Table 1. Visual inspection of the flowvolume curve showed a marked “squaring off” of the expiratory and inspiratory limbs (Figure 1A). Because of these findings, an obstruction of the central airway was suspected, and a computed tomography scan of the thorax was ordered. This scan revealed a focal area of tracheal narrowing near the thoracic inlet (Figure 2A). Rigid bronchoscopy confirmed the stenosis, which was noted to be spiral in nature, causing an approximately 60% narrowing over 13 mm (Figure 2B). She subsequently underwent tracheoplasty, using a costal cartilage graft to enlarge the lumen of the affected area. At a clinic visit 5 months postrepair, she reported that she was without respiratory symptoms and off all daily asthma medications. Spirometry at that follow-up visit demonstrated a significant Congenital tracheal stenosis is a rare condition with a variable age of presentation. Severe stenosis results in significant respiratory symptoms during infancy and prompt diagnosis. However, milder cases may result in a delay in diagnosis until much later in life. Typical symptoms in older patients include cough, stridor, and wheezing. These individuals may be misdiagnosed as having asthma and improperly treated with asthma medications. We report the case of a 13-year-old female who presented in the clinic with a diagnosis of asthma. Spirometry was a critical part of arriving at the correct diagnosis of tracheal stenosis.