Development of effective rescue countermeasures for toxic inhalational industrial chemicals, such as methyl isocyanate (MIC), has been an emerging interest. Nonetheless, current methods for studying toxin-induced airway injuries are limited by cost, labor time, or accuracy, and only provide indirect or localized information. Optical Coherence Tomography (OCT) endoscopic probes have previously been used to visualize the 3-D airway structure. However, gathering such information in small animal models, such as rat airways after toxic gas exposure, remains a challenge due to the required probe size necessary for accessing the small, narrow, and partially obstructed tracheas. In this study, we have designed a 0.4 mm miniature endoscopic probe and investigated the structural changes in rat trachea after MIC inhalation. An automated 3D segmentation algorithm was implemented so that anatomical changes, such as tracheal lumen volume and cross-sectional areas, could be quantified. The tracheal region of rats exposed to MIC by inhalation showed significant airway narrowing, especially within the upper trachea, as a result of epithelial detachment and extravascular coagulation within the airway. This imaging and automated reconstruction technique is capable of rapid and minimally-invasive identification of airway obstruction. This method can be applied to large-scale quantitative analysis of in vivo animal models.

Chondrosarcoma is a cancer of cartilage cells, and despite being a common primary bone tumor, tracheal chondrosarcoma is rare with only 18 cases reported in the literature prior to mid-2016. A 60-year-old gentleman presented with progressively increasing cough, severe stridor, and production of phlegm for approximately 2 years. On admission to our tertiary care hospital, he developed complete obstructive apnea within an hour, and was intubated. A tracheal biopsy was performed, followed by resection. Histopathology confirmed chondrosarcoma of the trachea. The patient tolerated the procedure very well and is currently symptom-free on follow-up, with no signs of recurrence.

An 83-year-old woman, with a background of treated squamous cell oesophageal cancer, presented with a 3-week history of stridor. Of note, the patient had no risk factors for oesophageal cancer other than age. Clinical examination was unremarkable apart from stridor. Laboratory investigations, including arterial blood gas on room air, were unremarkable. Radiological examination revealed a 4.5×3.5×3.6 cm mass involving the posterior trachea and invading the tracheal orifice. Oesophagogastroduodenoscopy and rigid bronchoscopy confirmed an extensive tumour arising from the lower oesophagus and invading the trachea, causing 90% airway obstruction for a 6 mm length ending 1.5 cm above the carina. Biopsy revealed a poorly differentiated carcinoma with foci of squamous cell carcinoma. Unfortunately, the patient passed away 2 months after palliative tracheal stent placement.

Objective: To explore the clinical value of MDCT and post-processing in children with suspected foreign body in trachea.Method:Two hundred patients with suspected tracheal foreign body were treated with 64-slice spiral CT (MDCT) and simulated endoscopic imaging,then compared with seen in bronchoscopy; Compare the results of MDCT and post-processing with the coincidence of intraoperative findings.Result:One hundred and eighty-four cases of positive children were examined by MDCT postprocessing technique and bronchoscopy,179 cases were obstructed by exogenous foreign body,5 cases were phlegm thrombosis (endogenous foreign body) obstruction; 16 cases of children with no foreign body diagnosed by MDCT post-processing technique were also examined by bronchoscopy. The results showed that there was a foreign body in 1 case,and the foreign body was located in the pharyngeal cleft (watermelon spermoderm),and the remaining 15 cases had no foreign body. MDCT and post-treatment techniques for children with tracheal foreign body diagnosis of 99.4% sensitivity,specificity of 75%.There was no significant difference in the detection rate of foreign body between the two techniques of MDCT and post-processing technique and bronchoscopy (P>0.05). Examed by MDCT and postprocessing,we can understand the specific location and size of foreign body,nature,shape preoperatively.Conclusion: Although MDCT and post-processing techniques can not be used to treat tracheal foreign bodies,but the diagnostic rate of bronchial foreign bodies is comparable to that of bronchoscopy. We could apply MDCT examination and post processing before the bronchoscopy,for foreign body inhalation history is not clear,or suspected airway foreign body. We can improve the level of diagnosis and treatment through guiding the operation of bronchoscopy focus.

Choking or foreign body airway obstruction occurs when a foreign body such as food, coins, or toys partially or completely obstruct the passage of air from the upper airway into the trachea. Choking affects either in the very young or the elderly. In the young, the foreign body is likely to be food or a toy, while in the elderly it is almost always food. There is a bimodal distribution in the ages of patients, affecting primarily the young between the ages of 1 to 3 years and the elderly who are greater than 60 years. In 2015, 5,051 people died from choking. Of those, 2,848 (56%) were older than 74. Choking is the fourth leading cause of unintentional death,  the leading cause of infantile death, and the fourth leading cause of death among preschool children. The most common objects on which children choke are food, coins, balloons, and other toys. In a Center for Disease Control review of nonfatal choking episodes in children that were treated in the emergency department, 13% of choking episodes were associated with coins and 19% were caused by candy or gum. Latex balloons are the most likely fatal aspirated foreign body, accounting for 29% of deaths by foreign body aspiration between 1972 and 1992. In the same time period, hot dogs were the most fatal food aspiration, accounting for 17% of food-related aspiration fatalities  Of the adult fatalities associated with choking, there is a strong association with dementia (including Alzheimer disease) and Parkinson disease. Decreased salivation in the elderly is also implicated as this impairs the ability to transfer food during swallowing.

Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children younger than five years. Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. Many patients experience low-grade fevers, but fever is not necessary for diagnosis. Less commonly, stridor can be associated with acute epiglottitis, bacterial tracheitis, and foreign body airway obstruction. Laboratory studies are seldom needed for diagnosis of croup. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization.

The etymology of the word tracheotomy derives from two Ancient Greek words: the word trachea (Greek τραχɛία tracheía) and the word stoma (Greek στóμα stóma) meaning "mouth," and refers to the making of an opening. It is believed that an early tracheostomy was performed by the Greek physician Asclepiades of Bithynia, in order to treat upper airway obstruction. A secure airway in the intraoperative and early postoperative period is of paramount importance for a number patients undergoing head and neck cancer surgery. We describe a modification of the Bjork flap used in tracheostomies for head and neck cancer patients, which allows tracheal outline reconstitution and significantly decreases the risk of respiratory obstruction and clinically evident tracheal stenosis, as our results have shown, at least five years after the last patient was discharged.

Airway obstruction and pulmonary mechanics remain understudied despite lung disease being the third cause of death in the United States. Lack of relevant data has lead computational pulmonary models to infer mechanical properties from available material data for the trachea. Additionally, the time-dependent, viscoelastic behaviors of airways have been largely overlooked, despite the potential physiologic relevance and utility as metrics of tissue remodeling and disease progression. Here we address the clear need for airway-specific material characterization to inform biophysical studies of the bronchial tree. Specimens from three airway levels (trachea, large bronchi, and small bronchi) and two orientations (axial and circumferential) were prepared from five fresh pig lungs. Uniaxial tensile tests revealed substantial heterogeneity and anisotropy. Overall, the linear pseudoelastic modulus was significantly higher axially than circumferentially (30.5{plus minus}3.1kPa vs. 8.4{plus minus}1.1kPa), and significantly higher among circumferential samples for small bronchi than for the trachea and large bronchi (12.5{plus minus}1.9kPa vs. 6.0{plus minus}0.6 kPa and 6.6{plus minus}0.9kPa). Circumferential samples exhibited greater percent stress relaxation over 300s than their axial counterparts (38.0{plus minus}1.4% vs. 23.1{plus minus}1.5%). Axial and circumferential trachea samples displayed greater percent stress relaxation (26.4{plus minus}1.6% and 42.5{plus minus}1.7%) than corresponding large and small bronchi. This ex vivo pseudoelastic and viscoelastic characterization reveals novel anisotropic and heterogeneous behaviors, and equips us to construct airway-specific constitutive relations. Our results establish necessary fundamentals for airway mechanics, laying the groundwork for future studies to extend to clinical questions surrounding lung injury, and further directly enables computational tools for lung disease obstruction predictions.