Vocal Cord Dysfunction (VCD ) or PARADOXICAL VOCAL CORD MOVEMENT (PVCM)

▪Inappropriate adduction of true vocal cords, mostly during inspiration. This results in dyspnoea and strider during inspiration. Rarely it may happen during expiration also.

▪15 Y F presenting with acute respiratory distress for 48 hours. For the past 2 years she was on inhaled bronchodialtors and steroids with short cources of oral/IV steroids for bronchial asthma. There was history of 4 hospital admissions and several emergency visits for symptoms attributed to asthma. Examination revealed apprehensive, tachycardic, tachpnoic girl with accessory muscle use and widespread rhonchi bilaterally, SPO2 93% on room air. Other systemic examination were normal.
She was started on inhalation therapy but her conditioned worsened. Oxygen saturation felled to 78% ON 10 L face mask, ABG revealed pH 7.53, PaO2 58, PaCO2 28. She was intubated emergency and shifted TO ICU.
She was treated as life threatening attack of bronchial asthma. She improved dramatically and successfully extubated in 48 hours.

▪Bronchoscopy was done which showed inspiratory adduction of true vocal cords with glottic opening narrowed to diamond shaped posterior chink.

▪Pulmonary Function Test (PFT): flow volume loop showed flattening of inspiratory limb, consistent with variable extrathoracic obstruction.

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