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Abstract

KEY CLINICAL MESSAGE: Persistent dyspnea unresponsive to optimized asthma therapy should raise suspicion for structural airway obstruction. This case illustrates the importance of considering rare causes such as aortic arch malformations, highlighting the need for multidisciplinary assessment to achieve accurate diagnosis and safe management.

Airway obstruction in adults can arise from both structural and functional causes, sometimes mimicking common conditions such as asthma. We describe a 33-year-old woman referred to Immunoallergology for presumed uncontrolled asthma, who persisted with dyspnea and nasal obstruction despite optimized therapy. Pulmonary function testing suggested upper airway obstruction. Imaging revealed a right-sided aortic arch causing extrinsic tracheal compression and lingual tonsil hypertrophy contributing to retrobasilingual narrowing. Flexible nasoendoscopy confirmed turbinate and tongue-base hypertrophy with preserved laryngeal mobility. Multidisciplinary evaluation by Otorhinolaryngology, Pulmonology, Cardiology, and Thoracic Surgery deemed vascular surgery too high-risk, and conservative management with optimized medical therapy was recommended. This case illustrates the importance of considering rare structural anomalies in adults with refractory airway symptoms. A multidisciplinary, individualized approach is essential to achieve accurate diagnosis and safe management.