Foreign body aspiration, particularly involving complex metallic objects with sharp projections like fishhooks, presents a formidable therapeutic challenge, often leading to complications such as mucosal impaction and obstructive pneumonia. We report a challenging case of a metallic fishhook-shaped foreign body deeply embedded within the distal bronchial wall, where initial attempts at retrieval using standard biopsy and foreign body forceps via flexible bronchoscopy were unsuccessful due to significant mucosal oedema and impaction. The successful management involved a novel, multi-modal endoscopic strategy that sequentially integrated the stability of a rigid bronchoscope, the precise navigation of an ultrathin bronchoscope for direct visualisation of the embedded tip and the controlled dissection using a high-frequency electrocautery knife to safely release the object, followed by its retrieval. This case demonstrates a reproducible, stepwise surgical strategy for the safe extraction of similarly complex, impacted sharp foreign bodies, thereby minimising the risk of iatrogenic injury.

In infants with suspected foreign body aspiration and radiographic tension pneumothorax, failure to improve after appropriate decompression should prompt immediate diagnostic reconsideration. Early CT or advanced imaging may identify congenital lung anomalies such as CPAM, particularly when positive-pressure ventilation creates misleading radiographic findings.

Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014-30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51-72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.

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.