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JAMA Clinical Challenge
February 17, 2015

Shortness of Breath After a Choking Incident

Author Affiliations
  • 1Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
  • 2Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois
JAMA. 2015;313(7):721-722. doi:10.1001/jama.2014.17182

A 67-year-old woman presented to the emergency department with increasing dyspnea and chest wall tenderness. Two hours prior to presentation, she choked on her food while at dinner and received repeated attempts at the Heimlich maneuver with successful dislodgement of a piece of ham. The choking episode lasted for approximately 10 seconds, during which the patient was unable to speak. She has a history of hypertension and gastroesophageal reflux disease but no history of smoking. On arrival, she was dyspneic and in respiratory distress. Oxygen saturation was 80% with ambient air and improved to 99% with supplemental oxygen delivered via nasal cannula. A 12-lead electrocardiogram showed normal sinus rhythm without acute ST or T-wave changes. Brain natriuretic peptide level was 84 pg/mL. The patient received a chest radiograph and a computed tomographic scan of the chest (Figure). Transthoracic echocardiography demonstrated preserved systolic function, with no evidence of valve disease.