After a healthy woman in her early 70s developed a wheeze that kept getting worse, doctors couldn't figure out what was wrong with her — until one radiologist noticed something strange in her CT scan, Lisa Sanders reports for  New York Times Magazine.

A strange wheeze

One of the first things the woman noticed was her constant need to clear her throat every few minutes. She also noticed that almost any exertion could trigger a harsh-sounding wheeze.

The woman visited her primary care doctor who said her lungs were clear and her oxygen saturation was fine. A cardiologist examined her heart and said, following a vigorous stress test, that she was in good shape.

But the woman's wheeze continued to get worse, Sanders reports. During a trip to Europe with her granddaughter, she was able to walk 20,000 steps a day on the mostly flat streets of Paris, but noticed the hilly streets of Montmartre left her out of breath.

When she from the trip, she intended to go to the doctor, but the COVID-19 pandemic started, keeping her at home. She got used to developing a harsh wheeze when walking up the stairs at her home, and eventually she felt out of breath by the time she got to the top, Sanders reports. Then, the woman had to stop halfway up the stairs, then it became after just a few steps.

After the pandemic eased, the woman visited her primary care doctor and a variety of specialists. Her lungs sounded normal and a chest X-ray came back normal as well. She was prescribed inhalers and an antihistamine, both of which were ineffective.

Doctors then examined her nose and throat with a small scope, finding nothing. A CT scan of her lungs came back slightly off, as doctors noticed the woman had a few small nodules, so she had another scan seven months later to see if any of the nodules had changed. Since they hadn't, doctors figured they were scars from a previous infection.

Not just an ordinary wheeze

The woman's husband, who is a surgeon, asked his friend James Wolfe, a lung doctor and allergy specialist, about his wife's condition.

Wolfe noticed the woman's wheeze wasn't an ordinary wheeze, as it was noisiest when she inhaled rather than exhaled, a type of wheeze known as stridor. Stridor is usually caused by a blockage in the upper airway, including from vocal cord dysfunction or swollen tissues in the nose or throat.

The patient took a second breathing test and compared it to the one she had done a year earlier that had come back normal. The new breathing test had some subtle changes — specifically, the amount of air the woman could get out in a forced exhalation was less than it was in the previous test.

Wolfe considered whether the problem was caused by a bacterium called mycobacterium avium complex, a cousin of tuberculosis that can cause coughing, shortness of breath, and phlegm production mostly seen in older women. The nodules that showed up in the woman's CT scan could be the earliest signs of an infection, so Wolfe ordered another scan to be done to see if the nodules had changed since her previous scan.

Emily Tsai, a radiologist who specializes in imaging of the chest at Stanford University School of Medicine, reviewed the woman's CT scan and noticed her trachea was strangely narrow at its top. The same narrowing was present in all three of the woman's CT scans, so Tsai made a note of it, suggesting it could be contributing to the patient's symptoms.

When Wolfe saw this, he realized the narrowed trachea was likely the cause of all the woman's symptoms, diagnosing her with idiopathic subglottic stenosis. Idiopathic signifies that the cause of the condition is unknown, and subglottic identifies the location within the trachea, just below the vocal cords, Sanders reports. The disorder is rare and mostly seen in middle-aged women.

Wolfe sent the patient to a surgeon who used a balloon to open her narrowed trachea. The patient told Sanders she was able to feel a difference as soon as she woke up, and in the eight months since the procedure, she's regained everything she lost. (Sanders, New York Times Magazine, 4/6)