Primary tracheobronchial tumors are rare and are frequently diagnosed late because their presenting symptoms are nonspecific and may mimic more common respiratory conditions. We report a case of a 74-year-old man with a significant smoking history who presented with progressive dyspnea, cough, hemoptysis, and stridor, initially treated with multiple courses of antibiotics and corticosteroids, without improvement. Chest radiography was reportedly normal, but a contrast-enhanced CT demonstrated an endoluminal soft tissue mass centered at the distal trachea/carina with extension into the bilateral mainstem bronchi, causing near-complete obstruction of the left mainstem bronchus and moderate-to-severe narrowing of the right mainstem bronchus. Coronal FDG PET/CT demonstrated intense metabolic activity centered at the carina. Predebulking bronchoscopy confirmed a verrucous fungating carinal mass causing severe central airway compromise, whereas postdebulking bronchoscopy showed marked restoration of airway patency. Histopathologic evaluation established squamous cell carcinoma. This case highlights the diagnostic limitations of chest radiography and the essential role of CT, FDG PET/CT, and bronchoscopy in evaluating malignant central airway obstruction.

Pulmonary mucoepidermoid carcinoma (MEC) is a rare salivary gland-type tumour often associated with delayed diagnosis due to nonspecific findings. We report a 75-year-old woman with chronic respiratory symptoms initially treated as asthma without improvement. Computed tomography showed a left hilar lesion with post-obstructive changes and apparent compression of the left main and lower bronchi, suggesting extensive hilar involvement. Bronchoscopic and endobronchial ultrasound-guided biopsies were nondiagnostic despite persistent airway obstruction. Surgical exploration revealed a localized intrabronchial tumour arising from the left lower lobe bronchus. A left lower sleeve lobectomy with preservation of the upper lobe was successfully performed, avoiding pneumonectomy. Histopathology confirmed a 22-mm low-grade MEC with negative margins and no nodal involvement. The postoperative recovery was favorable. This case highlights the diagnostic challenges of pulmonary MEC and the value of parenchymal-sparing surgery in selected patients with central airway tumours.

Acute hypoxemic respiratory failure in toddlers is most commonly associated with severe pneumonia, bronchiolitis, or foreign body aspiration. Complete obstruction of a main bronchus by mucus plugs is an uncommon but potentially life-threatening cause of unilateral lung collapse and severe hypoxemia. We report the case of a previously healthy 17-month-old boy who presented with severe respiratory distress after 3 days of fever and cough. Physical examination revealed marked respiratory distress with absent breath sounds over the left hemithorax. Chest radiography and computed tomography demonstrated complete left lung collapse without evidence of pleural effusion or foreign body. Due to rapidly worsening hypoxemia and suspected central airway obstruction, emergency flexible bronchoscopy was performed under general anesthesia via endotracheal intubation. Complete occlusion of the left main bronchus by thick mucus plugs was identified and successfully removed using suction and bronchoscopic forceps, resulting in immediate improvement in oxygenation and rapid radiologic lung re-expansion. The patient recovered fully and was discharged in 5 days without complications. This case highlights the importance of considering mucus plug-induced bronchial obstruction in toddlers presenting with sudden unilateral lung collapse and severe hypoxemia, particularly when foreign body aspiration remains a differential diagnosis. Early bronchoscopic intervention can be lifesaving and may prevent prolonged respiratory failure and associated complications.

Backgroud: Pathologies of the trachea and large bronchi are a heterogeneous group of rare structural disorders of the airway wall that are frequently underdiagnosed because their symptoms overlap with common respiratory diseases. Methods: We present three patients with chronic cough and dyspnea lasting approximately three years who had previously received multiple incorrect diagnoses, including COPD, asthma, gastroesophageal reflux, and acute bronchitis. Case Description: Following hospitalization for acute respiratory failure, comprehensive differential diagnostic workups revealed Mounier-Kuhn syndrome (tracheobronchomegaly) in Case 1, idiopathic tracheobronchomalacia in Case 2, and tracheobronchopathia osteochondroplastica in Case 3. Tracheobronchomegaly involves marked dilatation of the trachea and main bronchi; tracheobronchomalacia is characterized by expiratory airway collapse due to loss of cartilage stability; and tracheobronchopathia osteochondroplastica is a disease of unknown etiology featuring abnormal submucosal chondrification and ossification with luminal obstruction. All three impair mucociliary clearance and predispose to recurrent infections and progressive respiratory dysfunction. Conclusions: Through these cases we underscore the diagnostic challenges, characteristic radiological findings, and diverse management strategies of these conditions, emphasizing the critical need to consider tracheobronchial anomalies in patients with chronic respiratory symptoms and the key role of computed tomography in establishing an accurate diagnosis.

We report the case of a 30-year-old female, non-smoker, with no known allergies or occupational exposures, presenting with a two-year history of recurrent stridor and wheezing, recently exacerbating over the past two months. Physical examination and routine laboratory tests were largely unremarkable. Pulmonary function tests were within normal limits, with no significant bronchodilator response. Chest CT revealed a 15 × 13 mm perihilar right-sided lesion adjacent to the right pulmonary artery. Bronchoscopy identified a nearly obstructive, highly vascularized endobronchial lesion at the origin of the right lower lobe bronchus, with involvement of the carina between the right middle and lower lobe bronchi. Histopathology confirmed a typical bronchial carcinoid. The patient underwent open right middle and lower lobe bilobectomy. What renders this case unusual is the combination of a prolonged two-year diagnostic delay with initial misdiagnosis as asthma, the critical anatomical location of the tumor at the bronchus intermedius with early involvement of the right middle lobe carina, and the consequent necessity of bilobectomy despite an otherwise low-risk, typical carcinoid histology. This case underscores the importance of considering endobronchial neoplasms in young, non-smoking patients with refractory or atypical airway symptoms, and highlights the role of integrated imaging and bronchoscopic evaluation in guiding individualized surgical planning.

Inflammatory myofibroblastic tumour (IMT) is a rare mesenchymal neoplasm of intermediate biological potential, most commonly affecting children and young adults, with the lung being one of the the most common sites. Its variable clinical, radiological and pathological features often mimic malignancy, making diagnosis challenging. We report a middle-aged man in his early 50s presenting with life-threatening haemoptysis and found to have a right main bronchus mass causing central airway obstruction. Emergency rigid bronchoscopy with cryo-debulking was performed for airway stabilisation and tissue diagnosis. Histopathology confirmed IMT. Immunohistochemistry was anaplastic lymphoma kinase negative, while molecular analysis demonstrated ROS proto-oncogene 1, receptor tyrosine kinase (ROS1) positivity, highlighting the molecular heterogeneity of IMT. Following multidisciplinary tumour board discussion, the patient was initiated on targeted therapy with crizotinib, with planned reassessment for surgical resection. This case emphasises the importance of early tissue diagnosis, molecular profiling and multidisciplinary decision-making in achieving personalised and potentially lung-sparing treatment.

Endobronchial spindle cell tumors are rare pulmonary neoplasms that may arise from peripheral nerve sheath elements such as schwannoma or neurofibroma. We report a 69-year-old nonsmoking female from a hilly region presenting with progressive breathlessness for 3 months. She had a significant environmental exposure history of 45 years to biomass fuel combustion from bonfires and fireplace use for cooking and heating. Contrast-enhanced computed tomography (CT) revealed atelectasis with microcalcification in the lateral segment of the right middle lobe and extensive mediastinal lymphadenopathy. F18-fluorodeoxyglucose (FDG) positron emission tomography-CT showed FDG-avid soft tissue in the right middle lobe bronchus (maximum standardized uptake value: 9.17) with multiple FDG-avid lymph nodes. Bronchoscopy demonstrated narrowing of the right middle lobe bronchus with endobronchial obstruction. Histopathology and immunohistochemistry confirmed a low-grade spindle cell tumor of neurogenic origin (neurofibroma/schwannoma) with coexisting anthracofibrosis. The patient was managed using a multidisciplinary approach after comprehensive staging. This case highlights a rare presentation of an endobronchial spindle cell tumor in a nonsmoking female with associated bronchial anthracofibrosis. The unusual endobronchial location and neurogenic origin distinguish it from typical spindle cell tumors. It underscores the importance of considering rare tumors in patients with airway obstruction, the value of detailed exposure history, and the crucial role of bronchoscopic and histopathological evaluation in diagnosis. Early and accurate diagnosis enables appropriate management and is associated with a favorable prognosis.

Aspiration is the unintentional passage of material from the oropharynx or gastrointestinal tract into the larynx, tracheobronchial tree, or lung parenchyma. Aspirated material may include saliva, oral secretions, food, liquids, gastric contents, bile, blood, or foreign material. Although small-volume aspiration may occur without clinically apparent disease, aspiration can cause airway obstruction, chemical pneumonitis, bacterial pneumonia, acute hypoxemic respiratory failure, acute respiratory distress syndrome, lung abscess, empyema, bronchiectasis, or chronic aspiration-related lung disease. Normal swallowing requires coordinated oral, pharyngeal, and esophageal phases. During the pharyngeal phase, elevation of the larynx, epiglottic inversion, vocal-fold closure, pharyngeal contraction, and an effective cough reflex help prevent material from entering the lower respiratory tract. Dysfunction at any stage may impair airway protection. Aspiration risk is therefore increased in patients with oropharyngeal dysphagia, neurologic disease, impaired consciousness, sedative exposure, neuromuscular weakness, structural head and neck disease, esophageal dysmotility, gastroesophageal reflux, vomiting, or delayed gastric emptying. Aspiration syndromes are classified according to aspirate composition, volume, bacterial burden, site of deposition, and temporal pattern. Macroaspiration refers to the inhalation of a clinically significant volume of material and may cause abrupt airway obstruction or acute lung injury. Microaspiration is often recurrent and clinically silent but may contribute to aspiration pneumonia or chronic airway injury in susceptible patients. Aspiration pneumonitis is an acute inflammatory lung injury caused by inhalation of noxious material, most often acidic gastric contents. In contrast, aspiration pneumonia is an infectious process that follows aspiration of colonized oropharyngeal secretions or gastrointestinal contents into the lower respiratory tract. These syndromes may overlap, particularly when partially digested gastric contents contain both acidic material and bacteria. The clinical course ranges from asymptomatic aspiration to rapidly progressive respiratory compromise. Chemical pneumonitis typically develops soon after a witnessed macroaspiration event, whereas aspiration pneumonia may develop more insidiously after unwitnessed or recurrent aspiration. Older adults and patients with frailty, stroke, dementia, Parkinson disease, critical illness, or impaired swallowing are disproportionately affected and may have recurrent events with substantial morbidity and mortality. Aspiration-related lung injury generally follows gravity-dependent bronchopulmonary segments. In patients who aspirate while upright, infiltrates commonly involve the basal lower-lobe segments. In recumbent patients, the posterior upper lobes and superior segments of the lower lobes are more often affected. The right lung is frequently involved because of the more vertical course of the right main bronchus, although bilateral or nondependent disease may occur depending on body position, aspirate volume, and underlying lung disease. Recognition of aspiration risk and early differentiation among airway obstruction, aspiration pneumonitis, and aspiration pneumonia are essential, as diagnostic evaluation, airway management, antimicrobial therapy, and preventive interventions should be individualized to the clinical setting and suspected aspirate.

Extrinsic airway compression secondary to vertebral osteophytes is a rare clinical entity. We report a case of an elderly patient presenting with pneumonia where a subsequent chest CT scan showed right main bronchus compression caused by lower thoracic vertebral osteoarthritis-related osteophytes. There were additional incidental findings of sclerotic skeletal lesions prompting a new diagnosis of metastatic prostate cancer. The pneumonia improved with antibiotic therapy. Interventional management of airway compression was not pursued in this patient given his poor functional state and advanced metastatic malignancy. The patient was later readmitted with recurrent pneumonia as expected. Clinicians should be aware of this rare entity as a potential cause of airway compression identifiable on CT chest.

Almost all patients with mucopolysaccharidosis (MPS) develop respiratory dysfunction of varying severity during disease progression. While respiratory disease in MPS has traditionally been attributed to upper airway obstruction caused by glycosaminoglycan (GAG) accumulation in the trachea and bronchi, involvement of the intrapulmonary conducting airways and lung parenchyma remains poorly defined. Here, we characterised lung disease in a mouse model of MPS I using a combination of non-invasive X-ray Velocimetry (XV) functional lung imaging and gold-standard flexiVent respiratory mechanics testing, complemented by lung volume measurements and histological analysis. XV provides regional ventilation information across the entire lung during tidal breathing. MPS I mice demonstrated reduced mean specific ventilation (the average regional expansion of lung tissue across the respiratory cycle), driven predominantly by reduced ventilation in the inner (mediastinal-adjacent) lung regions, with evidence of spatially heterogeneous ventilation distribution. Lung mechanics testing showed increased conducting airway resistance, increased respiratory system compliance and reduced tissue elastance, consistent with impaired elastic recoil and expiratory flow limitation. Lung volume analysis revealed reduced opening pressure following degassing together with increased residual volume, functional residual capacity and vital capacity. Histological analysis demonstrated heterogeneous parenchymal architecture with regions of enlarged airspaces. Together, these findings demonstrate that respiratory dysfunction in MPS I is not limited to upper airway obstruction but also involves intrinsic abnormalities of the intrapulmonary conducting airways and lung parenchyma. This intrinsic pulmonary pathology likely contributes to obstructive lung disease and may underlie the susceptibility to respiratory failure observed in patients with MPS I.

Tracheobronchopathia osteochondroplastica (TBPO) is a rare condition characterized by the abnormal growth of cartilage within the trachea and main bronchi, leading to airway obstruction. The exact cause of TBPO is unknown, but it is thought to be associated with chronic inflammation of the airways and abnormal cartilage metabolism. Since there is not a standardization, the treatment of the condition depends on disease symptoms, infection status and the severity of the airway obstruction. Here, we aimed to present three cases of severe TBPO successfully managed in our interventional pulmonology unit applying argon plasma coagulation and mechanical debulking with rigid bronchoscopy, as well as the literature review.