Photoclinic 1

A 35- year-old female patient was presented to our hospital with complaints of wheezing and dyspnea on efforts of three years duration. She did not have any personal history of atopy and never smoked. Her physical examination was normal. The chest X-ray demonstrated an abnormality in the right paratracheal region with absence of the aortic knuckle on the left side (Figure 1). It was reported by the spirometry technician that the patient underwent a presyncopal episode after the spirometry test, so that intravenous fluid treatment was started. After the treatment finished, her dyspnea got worse although her symptoms related to the presyncopal episode were improved. It was therefore repeated. While the flow-volume curve was showing expiratory flattening before the fluid treatment, it showed both inspiratory and expiratory flattening after the fluid treatment (Figure 2a and 2b). The diagnosis was confirmed by computed tomography (CT) scan (Figure 3).