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Image challenge
Concurrent stridor and Horner syndrome
  1. M Adam Ali
  1. Barnet Hospital, Department of Elderly Medicine, Royal Free London NHS Foundation Trust, Barnet, UK
  1. Correspondence to Dr M Adam Ali, Barnet Hospital, Department of Elderly Medicine, Royal Free London NHS Foundation Trust, Barnet, London, EN5 3DJ, UK; mohamed.adamali{at}live.co.uk

https://doi.org/10.1136/emermed-2021-211257

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    Clinical introduction

    An 82-year-old woman presented to the ED with unintentional weight loss and progressive difficulty breathing and swallowing over several months. Her dyspnoea was worse when sitting upright. On examination, there was audible stridor at rest, (online supplemental file 1 (video)), which disappeared when she was reclined at 45°, and when flat. Neurological examination showed partial blepharoptosis and pupillary miosis on the right, findings compatible with right-sided Horner syndrome (figure 1). There was non-tender swelling of the entire right arm present (figure 2).

    Supplementary video

    [emermed-2021-211257supp001.MOV]
    Figure 1

    Examination revealed right-sided Horner syndrome, with right-sided partial blepharoptosis and pupillary miosis.

    Figure 2

    Non-tender swelling of the entire right arm, likely due to obstruction of lymphatic and venous drainage …

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    Footnotes

    • Contributors MAA cared for the patient clinically, selected the relevant radiological images, consented for and conducted clinical photography and produced the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.