Objectives: Tracheobronchial foreign-body aspiration is a clinically significant condition in adults. Although classical teaching attributes the right-sided predominance to the steeper, shorter, and wider morphology of the right main bronchus, this explanation has not been empirically validated in patients with confirmed foreign-body aspiration. Methods: This retrospective study included adult patients (≥18 years) who underwent bronchoscopic removal of foreign bodies from the right or left main bronchus between 2012 and 2025. Only individuals with available preoperative chest radiographs were analyzed. Measurements included tracheobronchial angles, bronchial and tracheal diameters, bronchial lengths, and estimated airway volumes calculated under cylindrical assumptions. Results: Of 35 included patients, 26 (74.3%) had right-sided and 9 (25.7%) had left-sided bronchial foreign bodies. At the population level, the right main bronchus was significantly steeper, wider, and shorter than the left; however, these anatomical differences did not distinguish patients with right- versus left-sided foreign bodies. Tracheobronchial angles, tracheal dimensions, bronchial diameters, and diameter ratios were all similar between the two groups (p > 0.05). In contrast, right bronchial length and volume were significantly greater in patients with right-sided foreign bodies (p = 0.004 for both). Exploratory ROC analysis further suggested that a right bronchial length exceeding 23.28 mm may be associated with an increased tendency toward right-sided migration within this cohort. Conclusions: Increased right bronchial length and volume may facilitate a preferential pathway for airflow continuity toward the right bronchial tree. These findings challenge long-standing anatomical assumptions and highlight the need to incorporate geometric and airflow-dynamic factors into future models of aspiration mechanics.

Background/Objectives: Foreign-body aspiration (FBA) is a common and largely preventable pediatric emergency, yet current safety standards and risk assessments rely predominantly on object size and on anecdotal descriptions and bronchoscopy findings. We propose a clinically oriented proof-of-concept workflow that combines high-resolution three-dimensional (3D) scanning and calibrated two-dimensional (2D) imaging of retrieved objects with radiomic shape descriptors and large language model (LLM) reasoning to support aspiration risk assessment and guide prevention. Methods: Objects were obtained from the Susy Safe registry and historical series from the University Clinical Centre Tuzla. Each object was digitized with 3D scanning and photographed with a ruler. Morphometric descriptors-including volume, surface area, sphericity, elongation, flatness, curvature and convexity-were computed from stereolithography (STL) meshes; silhouette area, perimeter and Feret diameters were extracted from 2D photographs. Normative airway dimensions from radiographic and computed tomography (CT) studies provided anatomical context. A sharp, irregular metallic object recovered from a child's laryngo-tracheal tract served as an illustrative case. Results: The object's major axis approximated the anteroposterior glottic diameter, suggesting potential traversal when longitudinally oriented, whereas its irregular shape increased the likelihood of mucosal laceration and lodging. LLM-based synthesis provided a structured narrative interpretation consistent with a high-risk profile and highlighted preventive implications. Conclusions: Combining 2D/3D morphometry with LLM reasoning provides objective assessment of FBA hazards and may support safer product design, injury-prevention policies, and caregiver education.

Pulmonary actinomycosis is a chronic respiratory infection caused by Actinomyces. Actinomyces graevenitzii is a rare species of Actinomyces with rare cases of infections. Herein, we report a case of endobronchial actinomycosis due to foreign-body aspiration in which A . graevenitzii was identified. The patient was a 48-year-old woman with a prior history of childhood asthma. She presented with a three-month history of hemoptysis, green sputum, and cough. Plain computed tomography of the chest revealed an elongated foreign body at the left inferior lobar bronchus, with infiltrative opacities extending from the foreign body to the peripheral regions and bronchial mucus plugs. Further inquiry revealed that she had choked while eating fish five years prior, followed by a persistent dry cough. She attributed this to her childhood asthma history. The foreign body retrieved during bronchoscopy showed histological features consistent with those of a bone. Thin, filamentous gram-positive bacilli were detected in the endobronchial lavage fluid and identified as A. graevenitzii by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF/MS). Symptoms resolved after bronchoscopy. These findings indicate that A. graevenitzii can cause endobronchial actinomycosis following foreign-body aspiration and support the value of MALDI-TOF/MS for identifying the causative organism in endobronchial actinomycosis. The widespread adoption of MALDI-TOF/MS will facilitate the identification of previously difficult-to-identify Actinomyces, further improving understanding of their clinical characteristics and potentially informing treatment strategies.

The anesthesiological management of a sharp object in the upper airway is highly challenging due to the shared high-risk anatomy. Thorough preparation, including CT scan and fiberoptic assessment, combined with interdisciplinary planning among surgeons, anesthesiologists, and intensive care specialists, enables a structured approach that anticipates complications and ensures safe patient care.

Pediatric airway foreign bodies are common and potentially life-threatening situations. Ingestion of organic material in children under 3 is the most common clinical situation. Typical cases have a history suspicious for a sudden aspiration event supported by physical findings of wheezing or diminished breath sounds with radiological evidence of air-trapping. Rigid bronchoscopy remains the gold standard for diagnosis and treatment and providers should have a low threshold to proceed to the operating room if the clinical suspicion for aspiration is high. Computed tomography (CT) scans may be helpful to further guide decision-making in cases where there is low or intermediate suspicion.

Allergic bronchopulmonary aspergillosis (ABPA) develops in patients through type I or type III hypersensitivity reactions to the filamentous fungi Aspergillus. There is a wide spectrum of radiological presentations of ABPA, including fleeting alveolar opacities, centrilobular nodules, bronchiectasis, mucoid impaction resulting in bronchocele, cavitation, and pulmonary fibrosis. This study aims to identify the pattern of radiological presentation in our community and its implications in the clinical diagnosis of the disease. We conducted a descriptive, cross-sectional study. The study was conducted at the Department of Radiology, Combined Military Hospital, Bahawalpur, between 4th April 2021 and 3rd October 2021. A total of 85 asthmatic patients between the ages of 18 and 60 years with a clinical diagnosis of ABPA reporting for high-resolution computed tomography (HRCT) were included. Patients with bronchiectasis other than ABPA, such as tuberculosis, foreign body, recurrent aspiration, and malignancy, were excluded. All the patients underwent an HRCT scan of the chest. In this study, the frequency of different radiological presentations of ABPA in adult asthmatic patients was as follows: mucus plug in 47 (55.29%) patients, centrilobular nodules in 49 (57.65%) patients, central bronchiectasis in 35 (41.18%) patients, and patchy air space consolidation in 37 (43.53%) patients. This study concluded that centrilobular nodules are the most common radiological presentation of ABPA in adult asthmatic patients, followed by the mucus plug, patchy air space consolidation, and central bronchiectasis.