• Xiaoyan Sun, Zhenghui Cui, and Yanxiong Mao.
• Women's Hospital School of Medicine Zhejiang University, Hangzhou, China.
• Medicine (Baltimore). 2023 Dec 15; 102 (50): e36325e36325.

RationaleExcessive dynamic airway collapse (EDAC) is a form of dynamic central airway obstruction, with characteristic of excessive dynamic invagination of airway posterior wall membrane and structurally intact airway cartilage. We report a rare case of EDAC with a marked positional component.Patient ConcernsA 73-year-old man was admitted to our hospital owing to dyspnea in right recumbent position (RRP). Also only in RRP, strong rhonchi was auscultated bilaterally through entire respiratory phase. He had gone through 3 episodes of resections on left lung due to hemoptysis caused by bronchiectasis, so he had only segment B1 + 2 and B3 left.DiagnosesThe spirometry results indicated that he had chronic obstructive pulmonary disease (COPD). The bronchoscopy revealed that in RRP, there was severe inward bulging of the posterior membrane of right main bronchus (RMB), which was worsened at expiratory phase. The EDAC of RMB was suspected, and was confirmed by an expiratory phase computed tomography (CT) in RRP. The EDAC was likely due to COPD, and the positional component was most likely to be caused by the removal of majority of his left lung.InterventionsConsidering locality of EDAC and his overall stability, he was given a conservative approach. He was prescribed with budesonide/glycopyrrolate/formoterol for COPD and followed up.OutcomesTwo months later, the patient had relived dyspnea and weaker wheezing in RRP, and he had a good social and physical recovery.LessonsDyspnea may present as a diagnostic challenge, and it is rarely accompanied with a positional component. EDAC is an uncommon cause of dyspnea. This case illustrates the possible role of bronchoscopy and dynamic CT in dynamic evaluation of airway.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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