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%.

Airway obstruction resulting from both malignant and non-malignant etiologies is a growing challenge in pulmonary diseases and critical care medicine, particularly after the COVID-19 pandemic. Conventional silicone and metallic airway stents may be indicated in airway obstructions that lead to palliative relief, but they may lead to complications such as migration, inflammatory reaction to the adjacent tissue, and granulation tissue overgrowth. We conducted this animal pilot study to investigate the biocompatibility of a next-generation nanocomposite silicone airway stent, engineered with 3wt% hydrophobic nano-silica reinforcement. Innovative characteristics of the stent include improved biocompatibility and reduced mucus adhesion due to its hydrophobic properties. A refined stenting technique was applied to implant the stent in the trachea of two sheep models by assembling two endotracheal tubes, Ambu, and the stent. After a two-month follow-up, high-resolution computed tomography imaging, 3D virtual bronchoscopy, bronchoscopy, and biopsy of the tracheal wall were done. Histopathologic assessment demonstrated an inflammatory infiltrate dominated by lymphocytes, without stromal reactions, mucosal and submucosal thickening, or granulation, confirming a favorable tissue tolerance. These preliminary outcomes emphasize the stent's potential as a transformative therapeutic option; however, the study's limited sample size and absence of comparative controls highlight the necessity for further preclinical trials with quantitative airflow parameters to elucidate the clinical translatability of this innovative biomaterial solution for airway obstructions. Additionally, the findings of this study can address the unmet needs in managing complex airway obstructions, particularly for patients refractory to current therapeutic options in the future.

Optimizing pulmonary exogenous surfactant delivery remains a critical challenge in neonatal care, particularly for achieving uniform distal lung deposition while minimizing airway obstruction. This study aimed to establish a preclinical imaging framework for quantitative assessment of exogenous surfactant lung distribution in vivo using contrast-enhanced ultrashort echo time (UTE) MRI and to evaluate the impact of physiological processes on surfactant retention and localization. Six juvenile rabbits received intratracheal instillation of a gadolinium-enhanced surfactant solution under clinically relevant conditions. High-resolution, motion-robust 3D UTE MRI datasets were acquired, enabling voxel-wise quantification of signal enhancement, gadolinium concentration, and spatial surfactant lung distribution. Peripheral volume fraction, laterality index, and distality index were computed to characterize deposition homogeneity and distal penetration. In vivo measurements were compared with previously reported ex vivo data from isolated rabbit thoraces. Quantitative MRI enabled precise mapping of surfactant within peripheral alveolar regions. Forty-two percent of the instilled dose was retained in vivo, compared with 93.5% ex vivo. Laterality indices confirmed balanced right-left distribution, while distality indices demonstrated consistent peripheral deposition. The radial UTE sequence minimized motion artifacts and enabled robust voxel-wise quantification under physiological breathing conditions. Quantitative in vivo MRI provides a sensitive and reliable method for assessing pulmonary surfactant delivery, spatial distribution, distal penetration, and homogeneity of deposition. Comparison with ex vivo data underscores the role of physiological processes in surfactant retention. This framework supports optimization of administration strategies in preclinical models and may be extended to other intrapulmonary therapies, establishing a versatile imaging platform for translational research.

Tracheostomy, a surgical procedure creating an artificial airway in the trachea, has evolved significantly since 1999 in pediatric care, driven by technological advancements and a deeper understanding of pediatric respiratory physiology. While once reserved for emergency situations or as a last resort for airway obstruction, its role has expanded to encompass long-term respiratory support, chronic aspiration management, and improved quality of life for children with complex medical conditions. The aim of this review, although not systematic, is to provide insight for pediatric surgeons, pulmonologists, critical care physicians, and other healthcare professionals involved in the care of children with tracheostomies.

Teratocarcinosarcoma (TCS) is a rare, highly aggressive malignant neoplasm composed of epithelial, mesenchymal and neuroectodermal elements, occurring almost exclusively in the sinonasal region. Primary involvement of the tracheobronchial tree or carina has not been previously reported. We describe a 55-year-old male chronic smoker who presented with cough, progressive dyspnea and haemoptysis. Computed tomography revealed a lobulated soft-tissue mass in the distal trachea overhanging the carina, extending into both main bronchi, causing significant airway obstruction. Bronchoscopy demonstrated greater than 80% bilateral luminal occlusion, necessitating urgent endobronchial debulking using rigid bronchoscopy, snare electrocautery, and cryotherapy. Histopathology with immunohistochemistry confirmed teratocarcinosarcoma. Positron emission tomography-computed tomography (PET-CT) showed metabolically active mediastinal and hilar lymph nodes. The patient was treated with chemoradiotherapy. Follow-up bronchoscopy at 6 months showed no recurrence, and the patient remains asymptomatic under surveillance for 4 years. This case represents the first reported carinal presentation of teratocarcinosarcoma, expands the anatomical spectrum of TCS and emphasizes the value of multimodality treatment for sustained disease control.

A 70-year-old man with a primary tracheal adenoid cystic carcinoma (TACC) located at 5 cm of the tracheal process.

Tracheostomy is one of the oldest known surgical procedures. In 1718, Lorenz Heister coined the term tracheostomy to describe the creation of an opening in the neck and the insertion of a tube into the trachea. Pediatric tracheostomies are performed by otolaryngologists and pediatric surgeons working within healthcare teams that provide essential support for long-term stoma care, family education, equipment supply, and mechanical ventilation when indicated. Care pathways may differ between hospitals; however, consensus guidelines have been established to standardize management across disciplines. Modern tracheostomy techniques can be traced back to Armand Trousseau, who used the procedure to treat diphtheria-induced respiratory distress in the mid-1800s. Chevalier Jackson later standardized the tracheostomy process in the early 1900s. The procedure poses risks to all age groups; however, it has historically had higher morbidity and mortality in the pediatric population. This increased risk reflected the greater medical complexity of premature and syndromic infants compared to that of adult tracheostomy recipients. Historical use of tracheostomy as a last-resort airway intervention for patients with end-stage infectious airway obstruction, such as acute diphtheria, also contributed to elevated morbidity and mortality. Advances in the management of congenital anomalies, effective immunization protocols, and improved perioperative care algorithms have significantly increased survival rates among pediatric tracheostomy recipients. This activity focuses on general knowledge, operative considerations, wound care recommendations, and long-term strategies for pediatric tracheostomy based on current literature. This activity also addresses controversies surrounding decannulation protocols and highlights the role of the interprofessional team in caring for patients who undergo this procedure.

Primary amyloidosis is characterized by extracellular deposition of misfolded immunoglobulin light chains, commonly involving the respiratory tract in its systemic form. Symptomatic, localized manifestations such as primary tracheobronchial amyloidosis are rare and often present with non-specific symptoms including cough, dyspnea, hoarseness, and airway obstruction, frequently leading to diagnostic confusion with asthma, chronic obstructive pulmonary disease, or endobronchial malignancy. We report an atypical case of a 41-year-old female with primary tracheobronchial amyloidosis. Computed tomography demonstrated diffuse bilateral thickening of the tracheal wall with sparing of the posterior wall with stippled calcifications in the tracheobronchial tree. Radiotherapy was employed as management, leading to stable disease with no signs of progression or regression. This case highlights the diagnostic challenges posed by uncommon imaging features, such as posterior wall sparing, and underscores the importance of integrating multimodality imaging with laboratory and pathological correlation. Early recognition of characteristic and atypical imaging findings is essential for accurate diagnosis and management of this rare but potentially treatable entity.