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This question was answered on Mon 16, Jun 2008 07:51pm by Dr Paul S, MD
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I have seen multiple specialists for a sudden episode of wheezing/upper respiratory symptoms & no firm diagnosis. Please help.



Asked by Unregistered (Female; 55; sinusitis multiple sore throats & colds as child through eary adult-20's r maxillary mucocele removed
2006; Relevant drugs:Pristiq )
on Mon 16, Jun 2008 04:37pm :

18 months ago, i suddenly developed wheezing, moderate shortness of breath, severe tightness all on the left lung & chest. After multiple tests including bronchoscopy & 3 specialists, I still have no definitive diagnosis. Asthma was ruled out by methalcholine challenge. Another specialist did High resolution CT scan which showed mild patchy air trapping especially left lung. He thought it was possibly bronchiolitis but never did any further follow up. an Infection control specialist states he thinks it may be copd. Again no follow up. my o2 sats have nearly always been very normal. No lab samples were taken by my local pulmonologist during bronchoscopy because he said everything looks good. The seattle pulmonologist thought at least samples of bronchial washings would have shed light on sm.bronchiole status but he too has not followed through. I'm very frustrated that all the time,money, & loads of corticosteroids-mostly inhalers & 2-short courses of oral cortisone as well as multiplle oral antibiotics had no effect. all doctors acknowledge the wheeze on left lung & that something is going on. What is your opinion? Both seattle pulmonoligist & infection controll doctor advised to stop all medications r/t treatment of asthma. I have.
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Answer by Dr Paul S, MD (doctor) on Mon 16, Jun 2008 07:51pm:

Hi there. From what you have described it seems to me that you have a rare unusual condition that may be causing some permanent narrowing on some parts of the air spaces causing these wheezing. Other possibilities would include a rare condition called carcinoid syndrome which is due to a tumor releasing substances that can cause the wheezing. The usual location of these carcinoids would include the bronchi themselves, and the GI tract especially in the appendix. An octreotide scan may pinpoint the presence of the location of the carcinoid. However, this is just a possibility, and working you up for it would need to be discussed with all your able doctors. I may also suggest that you ask your doctors to present your case in their hospital conferences, where a lot of doctors attend, so that all their inputs can aid in the diagnosis. Regards and God bless.

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