An Algorithm for the Diagnosis of Wheezing and Stridor



Stridor: Louder, constant-pitch sound over central airways

Wheezing: Musical sound produced primarily during expiration



Inspiratory Stridor (Supraglottic):

 • Extraluminal Compression: Goiter, Retropharyngeal abscess

 • Intraluminal Compression: Malignancy, Foreign body

 • Inflammatory: Anaphylaxis, Angioedema, Epiglottitis

Biphasic Stridor (Glottic/Subglottic):

 • Functional: Vocal fold paralysis, Paradoxical vocal fold motion

 • Extraluminal Compression: Malignancy, Vascular ring, aneurysm

 • Intraluminal Compression: Foreign body

 • Stenosis: Iatrogenic, Endotracheal intubation

Expiratory (Tracheal) Stridor:

 • Extraluminal Compression: Malignancy, Mediastinal mass, Vascular ring, aneurysm

 • intraluminal Compression: Foreign body

 • Stenosis

   - Iatrogenic: Endotracheal intubation, Tracheostomy

   - Structural weakness: Tracheomalacia, Connective tissue disorder, GERD

   - Autoimmune: GPA

Lower Airway Wheezing (Intrathoracic):

 • Bronchoconstriction: Asthma, COPD, Anaphylaxis, Carcinoid

 • Compression: Extraluminal - Peribronchial pulmonary edema

 • Infectious: Bronchitis, Bronchiolitis, Parasite

 • Focal: Mass, Foreign body, Consolidation (Infection, Infarction)



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