Bronchoscopy: The Last Hope When Radiology Fails to Illuminate, A Case of Subglottic Stricture

Abstract

Background: Subglottic stricture is a rare cause of upper airway obstruction in adults and is often misdiagnosed as asthma or chronic obstructive pulmonary disease due to nonspecific symptoms and normal routine imaging.
Case Presentation: A 55-year-old female presented with progressive shortness of breath and wheezing for three months. Routine blood investigations, chest radiography, and contrast-enhanced computed tomography of the thorax were unremarkable. Spirometry revealed flattened inspiratory and expiratory limbs on the flow–volume loop, suggestive of fixed airway obstruction, with a reduced FEV₁/FVC ratio and preserved forced vital capacity. Flexible bronchoscopy subsequently demonstrated a subglottic stricture, confirming the diagnosis.
Conclusion: This case emphasizes the importance of recognizing spirometric patterns of fixed airway obstruction and the role of bronchoscopy in diagnosing subglottic stricture when routine imaging is normal. Early identification allows appropriate management and improved outcomes.