What is your diagnostic approach to a 62 year old man in respiratory distress with UNILATERAL wheeze?
Monophonic wheeze suggests large airway – ETT malposition, foreign body, blood, secretions, tumour, compression by lymph nodes, aortic aneurysm
Polyphonic wheeze suggests smaller airway and multiple sites – aspiration, unilateral emphysema, contralateral pneumothorax, asthma in a pneumonectomised lung
1. History of depressed conscious state, trauma, previous lung disease
2. Examination for tracheal position, contralateral signs, position ETT, clubbing, lymphadenopathy elsewhere
a. Consider complications such as intrinsic PEEP, depressed venous return and hypotension, pneumothorax
3. CXR for ETT position, contralateral disease, foreign body
4. Bronchoscopy for luminal pathology such as blood clot, foreign body, tumour, compression
5. CT chest if necessary
The differential diagnosis of a unilateral wheeze really comes down to how many different ways of obstructing a main bronchus you can think of.
This question could benefit from a systematic answer.
Differential diagnosis of unilateral wheeze: