Invasive tracheal mucormycosis is a rare but rapidly progressive central airway fungal infection associated with high mortality. Its early clinical manifestations and radiological features are often nonspecific, which may result in delayed diagnosis. We report a case of invasive tracheal mucormycosis in a patient with diabetic ketosis. The patient underwent emergency tracheostomy for necrotizing upper airway obstruction. Bronchoscopic examination revealed extensive white necrotic tissue in the subglottic region and trachea. Broad, ribbon-like, pauci-septate hyphae were identified in both bronchoalveolar lavage fluid and biopsy specimens, establishing the diagnosis. Following systemic antifungal therapy with amphotericin B, adjunctive nebulized local treatment, and repeated bronchoscopic interventions, the infection was controlled, and maintenance therapy was sequentially transitioned to oral isavuconazole. However, the patient ultimately developed irreversible glottic closure and severe subglottic stenosis, resulting in long-term tracheostomy dependence. This case highlights that mucormycosis should be considered early in the differential diagnosis of patients with diabetes, particularly those with diabetic ketosis, who present with necrotizing or pseudomembranous airway lesions on bronchoscopy and non response to broad spectrum antibiotics. Deep respiratory specimens should be obtained promptly to establish etiological and histopathological diagnoses, while adequate antifungal therapy and correction of metabolic disturbances should be initiated simultaneously to improve outcomes. Nevertheless, even after infection control is achieved, patients may still be left with severe structural airway damage. Therefore, airway function preservation and long-term prognostic assessment should also be emphasized in clinical management.

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.

Congenital high airway obstruction syndrome (CHAOS) is a rare, life-threatening condition involving complete or near-complete airway obstruction. Fetal laryngoscopy enables direct airway endoluminal visualization of the airway, thereby complementing prenatal imaging to enhance diagnosis and counseling. In this case, CHAOS was diagnosed at 17 weeks of gestation following ultrasound and fetal magnetic resonance imaging, which revealed tracheal dilation and echogenic lungs. Diagnostic fetal laryngoscopy performed at 24 weeks demonstrated a blind-ended trachea that was not amenable to fetal decompression. Despite counseling regarding the limited feasibility of airway establishment, emergent delivery with an ex utero intrapartum treatment (EXIT) procedure was performed at 30 weeks. Airway establishment was unsuccessful, and the neonate died shortly after birth. Significant maternal hemorrhage occurred after delivery, requiring transfusion. This case underscores the complexity of prenatal counseling and family-centered decision-making. Fetal laryngoscopy may be considered an adjunct to improve diagnostic evaluation and counseling, potentially aiding prenatal decision-making in selected cases of CHAOS.

Neodymium-doped yttrium aluminum garnet (Nd:YAG) LASER bronchoscopy has emerged as an important modality in the management of central airway obstruction, particularly in resource-limited settings. We retrospectively reviewed patients who underwent Nd:YAG LASER bronchoscopy between 2021 and 2024 at a tertiary care referral center in Nepal. Demographic characteristics, lesion profile, procedural details, complications, and outcomes were analyzed. Twenty three patients (86.9% male, median age 34.5 years) underwent 33 LASER sessions during the study period. Shortness of breath on exertion (86.9%) was the most common symptom and median symptom duration before presenting to us was 3 months. Patients were referred from centers across Nepal (73.9% from tertiary and 26.1% from district hospitals). The trachea was the most common site of lesion (48%). Benign lesions (60.9%) were frequent, with post-intubation tracheal stenosis being the most common diagnosis (21.7%). Use of laryngeal mask airway for airway access increased (75%) while rigid bronchoscopy decreased (75%) over the course of four years. A statistically significant reduction in the Cotton-Myer grade was observed following the intervention (p < 0.001). Sixteen of 19 (84.8%) intubated patients were extubated immediately after the procedure. Minor hypoxia, major hypoxia, and minor bleeding occurred in eight (24%), one (3%), and seven sessions (21%), respectively. No airway fire, major hemorrhage, or 30-day mortality occurred. Nd:YAG LASER bronchoscopy is a safe and effective intervention for diverse airway lesions and demonstrates feasibility in a tertiary care center setting.

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.

Central airway obstruction can be caused by lung cancer and may severely diminish respiratory function to necessitate airway stenting. However, the mechanical properties of airway tissues remain poorly characterized, leading to a mismatch between stent mechanical behavior and airway compliance, which can reduce stent biocompatibility and clinical effectiveness. Such mismatches can result in abnormal stress transfer at the stent-airway interface and cause stent migration, local tissue irritation or inflammation, and impaired long-term performance. Predictive models are often used in treatment planning, however, without a comprehensive understanding of airway properties, advancements in modeling remain highly limited. In this study, we develop an experimental to numerical pipeline for identifying the mechanical properties of the human airway branching network, specifically the trachea, right bronchus, and left bronchus tissues. Biaxial planar tensile tests are used to capture the tissues' unique, anisotropic mechanical response in order to inform the computational routine-where inverse finite element analysis is employed to calibrate a Holzapfel-Gasser-Ogden constitutive model. To overcome the computational burden of traditional IFEA, a neural network (NN) surrogate model is trained to enable rapid material identification. We identify parameter values for the various tissues, such as C10 = 0.53 ± 0.25 kPa, k1 = 0.17 ± 0.30 kPa, k2 = 6.1 ± 2.0, and κ = 0.08 ± 0.01 for the trachea. Notably, this NN-approach reduced computational time from weeks to mere minutes, enabling fast material characterization. Thus, we also provide an efficient modeling framework and user-friendly MATLAB application for future studies. Ultimately, the findings here critically contribute to our current understanding of airway biomechanics and provide essential data for accurate modeling and optimization of airway stenting strategies.

Tracheoinnominate artery fistula (TIF) is a life-threatening complication associated with tracheostomy placement. It is characterized by the development of a connection from the tracheal lumen to the innominate artery. We describe the multidisciplinary management of a patient who developed innominate artery compression syndrome as a sequela of endovascular stenting of a TIF, and the subsequent surgical repair that ultimately led to relief of airway obstruction, allowing for tracheostomy decannulation. A 17-year-old male underwent percutaneous tracheostomy after suffering a gunshot wound to the head. On the sixth postoperative day, he developed massive hemoptysis. Work-up suggested TIF and this was confirmed with interventional angiography. To urgently address this situation innominate artery stenting with an endovascular graft was successfully performed. Bronchoscopy performed at 4 months follow-up noted near-complete tracheal obstruction distal to the tracheostomy tube from extrinsic pressure exerted by the graft. Based on the tracheal obstruction and risk for additional erosion/fistula formation in the presence of two foreign bodies immediately adjacent to each other, he underwent excision of the stented innominate artery with vascular bypass grafting, along with exclusion of the tracheal fistula and primary repair of the trachea without the use of mechanical circulatory support. Prompt diagnosis and treatment of TIF in a patient with risk factors is crucial in preventing mortality and is optimally managed in a multidisciplinary fashion. Clinicians should exercise a high index of suspicion when encountering patients with a tracheostomy and development of hemoptysis. We present a successful surgical repair of innominate artery compression syndrome secondary to an endovascular graft used to urgently treat a TIF without resultant neurocognitive deficits.

Diagnosing intrathoracic tuberculosis (TB) in children under five years of age remains challenging. Clinical symptoms often overlap with those of other common childhood illnesses, and microbiological confirmation is frequently difficult to obtain in this age group. Despite advances in diagnostic technologies, few studies focus specifically on children younger than five years, the population in whom diagnosis is most complex. Intrathoracic lymphadenopathy on chest X-ray (CXR) is the hallmark radiological features of TB in this age group, but identification by trained physicians currently demonstrates only moderate diagnostic performance, with reported sensitivities ranging from 67% to 74% and specificities between 39% and 59%.