Severe Excessive Dynamic Airway Collapse in a Patient With Primary Sjogren's Syndrome

Airway and cystic lung diseases can be observed in patients with Sjogren's syndrome. We report a case of such a patient suffering from respiratory failure due to recurrent episodes of right pneu- mothorax, requiring invasive mechanical ventilation. Despite thoracic drainage and adequate pneu- mothorax management, the patient could not be weaned from the ventilator. Fiberoptic bronchos- copy revealed severe central excessive dynamic airway collapse of the lower part of the trachea and proximal bronchi. The severity of airway collapse was maximal at the intermediate bronchus level, with a near-complete obstruction during expiration. Inspiratory and expiratory computed tomog- raphy studies confirmed the fiberoptic findings and suggested a possible expiratory posterior compression of the intermediate bronchus by parenchymal lung cysts. Stenting was considered, but the patient died from ventilator-associated pneumonia before the procedure could be performed. This case is the first description of severe central excessive dynamic airway collapse in a patient with primary Sjogren's syndrome complicated by diffuse airway and cystic lung disease. Key words: respiratory failure; expiratory dynamic airway collapse; Sjogren's syndrome; bronchoscopy; lung cysts; inspiratory and expiratory ct. (Respir Care 2014;59(10):e156-e159. © 2014 Daedalus Enterprises)