Exertional dyspnoea and audible wheezing.

Chief Complaint A 56 year old presents with exertional dyspnoea and audible wheezing. History He is non-smoker and non alcoholic. Investigations Cardiac & pulmonary evolution, and chest x-ray negative. CT shows bilateral lower right middle lobe air trapped on expiratory image only without decrease in caliber of trachea. Audible expiratory wheezing centered over the mid trachea during exercise. Flexible bronchoscopy was done immediately after peak exercise which shows nearly complete collapse of lower trachea posterior membrane with extension into the right broncusintermedius. Treatment Can you please comment on the diagnosis and treatment.

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Middle lobe Syndrome ? Extrabronchial compression, malignancy, ? TB ? Endobronchial compression ,? Malignancy ,? TB Bronchoscopic lavage for AFB AND CBNATT and cytology

Likely exbronchial compression Search for mediastinal lesions such as lymphadenopathy or lymphomas sos malignancy

This will be due to tracheobronchial tumor & Trachea Injury