Abstract Introduction Schwannomas are benign tumors that arise from Schwann cells of the peripheral nervous system. While commonly associated with intracranial masses, they can occur anywhere along peripheral nerves including within lungs. Mediastinal schwannomas are exceedingly rare and typically present with nonspecific respiratory symptoms that may be refractory to standard therapy. For this reason, they are frequently misdiagnosed as common respiratory diseases like asthma or COPD. We present the case of a mediastinal schwannoma initially misdiagnosed and managed as mild asthma. Case Description A 70-year-old female with no significant medical history presented with a 10-year history of chronic cough, intermittent wheezing, and exertional dyspnea. She was previously diagnosed with mild intermittent asthma and treated with an inhaled corticosteroid/long-acting β2-agonist without symptom improvement. The patient relocated for 12-18 months due to concerns for environmental triggers, but symptoms persisted despite this change. Subsequent pulmonary evaluation revealed a right paraspinal mediastinal lesion with CT-guided biopsy confirming the diagnosis of a mediastinal schwannoma. The patient underwent surgical mass resection and at 8-month follow-up, the patient reported complete resolution of symptoms with imaging showing no evidence of recurrence. Novelty and Importance This case highlights the importance of maintaining a broad differential diagnosis for patients with refractory respiratory complaints and underscores the need to consider rare causes such as intrathoracic schwannomas. The prolonged misdiagnosis of asthma in this patient highlights the need to consider alternative causes of chronic cough and wheezing in non-smokers unresponsive to conventional therapy. Clinicians should maintain an index of suspicion for alternative diagnoses and obtain chest radiograph in patients with refractory respiratory symptoms. This abstract is funded by: None
Haq et al. (Fri,) studied this question.