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Large endotracheal tumour presenting as severe COPD: flow–volume loop analysis, not always a straightforward diagnostic test
  1. Iliya P Amaza1,
  2. Swan Lee2,
  3. Rolando Sanchez1
  1. 1Department of Internal Medicine - Division of Pulmonary and Critical Care Medicine, University of Iowa - Carver College of Medicine, Iowa City, IA, USA
  2. 2Department of Internal Medicine, University of Chicago (NorthShore), Evanston, IL, USA
  1. Correspondence to Dr Rolando Sanchez, rolando-sanchez{at}


The flow–volume loop (FVL) analysis is typically helpful in establishing the diagnosis of airway obstruction caused by endobronchial lesions. In this report, we describe a patient with emphysema and tobacco abuse who presented with chronic dry cough and severe chronic obstructive pulmonary disease (COPD) refractory to standard therapy. The initial FVL showed a relatively normal forced expiratory peak flow shape followed by a smooth flattening of the expiratory curve on spirometry, a pattern consistent with distal airway obstruction as seen in severe asthma or COPD. The patient was later found to have a large endotracheal mass. This atypical presentation, along with the unusual FVL, led to a significant delay in the diagnosis of the tracheal mass. A high level of suspicion is needed to diagnose variable intrathoracic airway obstruction in patients presenting with severe asthma or COPD who fail to improve with standard therapy.

  • respiratory cancer
  • respiratory medicine
  • lung function

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  • Contributors IPA and RS were involved in the care of the patient and writing the case description. IPA, SL and RS contributed to the literature review and writing of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.