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Quincke's Disease

Mizuho Morrison, DO and Mike Weinstock, MD
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16:38
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Tag ENT

Uvular Angioedema is when the uvula is enlarged and causes a potential airway obstruction. Eosinophilia in the peripheral blood suggests an allergic reaction as the etiology, however there are other causes. Miz and Mike review a case of uvular angioedema and discuss management and treatment of this disease.

 

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Anna A., MD -

Great case. I have seen a couple of mild cases of this in patients using CPAP, and thought of it as a mechanical "pulling" causing stretching and swelling of the uvula from the positive pressure. I treated it with outpatient steroids, but will be using dexamethasone ( and epi if severe) the next time I see this, rather than just the usual steroid taper.

Mike W., MD -

Thx for your comments Anna - interesting stuff!

Megan B., PA -

IM or PO dex?

Mizuho M., DO -

either. I like to give the IV version orally (tastes better).

Megan B., PA -

Saw a case of this yesterday, for the 1st time, and was able to recognize it and pull up this episode for a quick DDX and treatment reminder!

Mizuho M., DO -

YAY!!! So awesome to hear! This is the whole goal of this program. Strong work Megan! ~Miz

Rich H. -

Just got an urgent consult to the maternity ward along with anesthesia on a 29-year-old G2P1001 at 38 weeks gestation for angioedema of her uvula. Anesthesia was getting ready to fiber-optically intubate her for airway protection. Aside from inability to swallow, she was stable. When I looked in her throat, I quickly recognized this as Quincke's dz and told anesthesia to hold on. I looked up this article and presented to anesthesia. Patient has had a hx of heavy snoring over the past 3 days. Anesthesia was convinced enough to not intubate. We treated her with H1/H2 blockers, Dex, and racemic epi and she is doing great.

Thank you for this great article!

Mizuho M., DO -

HOLY SMOKES RICH!!!! This is incredible!!! Strong work intervening! You saved this poor woman an unnecessary intubation! :) Incredible work. Thanks for the feedback! ~Miz

Mike W., MD -

Rich, thx SO much for sharing - makes it all worthwhile!!
M

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Dissecting Into The Heart Of The Matter Full episode audio for MD edition 191:45 min - 90 MB - M4AHippo Urgent Care RAP - September 2017 Written Summary 293 KB - PDF