Hidden Danger in the Airway: Biphasic Stridor Revealing Malignant Central Airway Obstruction from Bronchogenic Carcinoma

Introduction:Stridor is a high-pitched respiratory sound due to turbulent airflow in a narrowed upper airway, classified based on the phase of respiration affected.Biphasic stridor, heard during both inspiration and expiration, typically suggests a fixed central airway obstruction.While stridor is often due to benign etiologies, the possibility of an underlying malignancy should not be overlooked, particularly in the context of centrally located bronchogenic carcinoma resulting in malignant central airway obstruction (MCAO).Case description: A 50-year-old woman presented with progressive dyspnea and frequent dry cough for 1 month.Clinical examination revealed audible biphasic stridor and supraclavicular lymphadenopathy.Chest radiography demonstrated an opacity in the right upper lobe with bronchial narrowing.Contrast-enhanced computed tomography (CECT) revealed a spiculated mass in the right upper lobe with mediastinal and hilar extension, along with a necrotic right paratracheal lymph node compressing the airway.Histology from both endobronchial biopsy and supraclavicular lymph node confirmed squamous cell carcinoma.Bronchoscopy confirmed an obstructive endobronchial lesion with carinal widening.In collaboration with the thoracic surgical team, the patient underwent rigid bronchoscopy with stenting and was initiated on corticosteroid therapy, followed by referral for oncological care.Discussion: MCAO due to bronchogenic carcinoma is life-threatening, yet often underdiagnosed.Endoluminal tumor proliferation, extrinsic compression, or both-as seen in this patient-can cause significant airway obstruction.Flow-volume loop spirometry indicated fixed airway obstruction and could have served as an early screening tool.Diagnosis was confirmed through imaging and bronchoscopy.Management required a multidisciplinary approach, with bronchoscopic stenting providing rapid airway stabilization and symptom relief.Though typically palliative, such interventions are crucial for improving quality of life and enabling further oncologic treatment. Conclusion:In adults, biphasic stridor should raise suspicion for central airway malignancies.Early detection, imaging, and airway intervention are essential to prevent respiratory compromise and to initiate appropriate cancer therapy.