This paper reports a rare adult case of a 64-year-old female with interrupted pulmonary artery in the right middle and lower lobes, complicated by a branch aneurysm at the origin of the right subclavian artery. The patient was admitted for "depressed mood." And she experienced intermittent chest tightness and mild shortness of breath after physical activity. Elevated D-dimer levels were detected, and CT pulmonary angiography confirmed congenital interruption of the right middle and lower lobe pulmonary arteries, accompanied by extensive collateral circulation formation and pulmonary hypertension. This condition originates from abnormal development of the sixth aortic arch during embryogenesis and may clinically mimic chronic pulmonary embolism. Imaging evaluation is central to diagnosis, and treatment requires individualization: asymptomatic patients should undergo conservative follow-up, while those developing hemoptysis or progressive pulmonary hypertension may require interventional embolization or surgical intervention. This case underscores the need for vigilance regarding such rare vascular anomalies, where early recognition and long-term follow-up are crucial for improving patient prognosis.

Rheumatic mitral stenosis remains a significant cause of cardiovascular morbidity in young adults worldwide, yet its diagnosis can be challenging when clinical presentation overlaps with concurrent infections. We present a case of a woman in her 30s who presented with dyspnoea, fever, and haemoptysis, initially attributed to community-acquired pneumonia with concurrent viral and bacterial infection. She received appropriate treatment and was discharged; however, her symptoms persisted, and she developed alveolar haemorrhage, prompting further investigations, which ultimately revealed severe mitral stenosis secondary to rheumatic heart disease. This case underscores the diagnostic complexity of mitral stenosis in the setting of overlapping pulmonary infections and highlights the critical importance of maintaining a broad differential diagnosis and pursuing thorough cardiac assessment in patients with unexplained haemoptysis.

Vascular and interventional radiology (VIR) has expanded to include the periprocedural and inpatient management of critically ill patients. Acute respiratory failure and airway compromise in VIR settings may arise from a range of causes, including oversedation, pneumothorax, massive hemoptysis, pulmonary edema, anaphylaxis, or exacerbations of pre-existing respiratory conditions. The ability to promptly assess and treat acutely decompensating patients is essential for interventional radiologists. The management of acute respiratory failure begins with a rapid assessment of airway, breathing, and circulation, in conjunction with evaluation of vital signs, pulse oximetry, end-tidal CO2, arterial or venous blood gases, all while determining the underlying etiology. This review provides a concise overview of the mechanisms underlying respiratory failure, the devices used for monitoring and management, and a focused approach to treating patients with acute respiratory failure.

Upper gastrointestinal bleeding (UGIB) is a frequent cause of emergency department admission and is most commonly attributed to peptic ulcer disease or portal hypertension-related varices. In critically ill patients, however, pulmonary bleeding may be misinterpreted as hematemesis when blood is swallowed or expelled during retching or airway compromise. In patients undergoing long-term hemodialysis, catheter-related central venous thrombosis can precipitate atypical bleeding presentations. We report the case of a 45-year-old man with chronic kidney disease on maintenance hemodialysis who presented with sudden-onset recurrent hematemesis and hemodynamic instability. Initial evaluation suggested severe UGIB, prompting endotracheal intubation, vasopressor support, and urgent upper endoscopy. Endoscopy demonstrated small esophageal varices and erosive gastropathy without evidence of active bleeding. Subsequent chest computed tomography revealed superior vena cava thrombosis with extensive mediastinal collateral circulation and imaging findings consistent with pulmonary hemorrhage. Bronchoscopy confirmed active bleeding originating from the right bronchial tree, establishing the diagnosis of pulmonary hemorrhage secondary to superior vena cava thrombosis. This case underscores an important diagnostic pitfall: severe pulmonary hemorrhage may mimic UGIB, particularly when initial endoscopic evaluation is non-diagnostic. In hemodialysis patients, superior vena cava thrombosis and collateral vessel formation should be considered as potential mechanisms of airway bleeding even in the absence of classic superior vena cava syndrome. Early thoracic imaging and bronchoscopy are essential when endoscopic findings do not account for persistent or severe hematemesis to prevent diagnostic delays and inappropriate gastrointestinal interventions.

Congenital lung malformations (CLMs) are developmental conditions characterized by overlapping clinical and imaging features, with hybrid lesions that combine congenital pulmonary airway malformation (CPAM) and bronchopulmonary sequestration (BPS) becoming increasingly recognized by multidetector CT (MDCT). We present the case of a six-year-old girl with a one-year history of recurrent low-volume hemoptysis. Her chest radiograph indicated a subtle opacity in the right basal area. Thoracic CT angiography revealed parenchymal consolidation in the right lower lobe, characterized by an air bronchogram that did not connect with the tracheobronchial tree and was accompanied by a well-defined thin-walled cystic lesion. This lesion was vascularized by a systemic artery originating from the anterior descending thoracic aorta and drained anomalously into the left atrium, a finding consistent with a hybrid congenital pulmonary airway malformation and sequestration. This case emphasizes the critical importance of MDCT angiography in accurately delineating parenchymal and cystic components, detecting blind-ending noncommunicating bronchi, and charting anomalous arterial supply and venous drainage, consequently differentiating hybrid CLMs from other congenital or acquired disorders and offering a vital vascular framework for surgical planning. In pediatric patients exhibiting unexplained hemoptysis or chronic focal pulmonary opacities, early CT angiography is therefore recommended to detect and accurately characterize CLMs and guide multidisciplinary management.

Pulmonary infarction (PI) often mimics lobar pneumonia. A 23-year-old man with prostatitis presented with pleuritic pain and hemoptysis. Despite high inflammatory markers, consolidation was refractory to antibiotic treatment. Retrospectively, the initial opacities represented the hyperacute hemorrhagic phase of PI. Thoracentesis revealed bloody effusion, and contrast-enhanced computed tomography (CECT) confirmed pulmonary thromboembolism with characteristic "central lucencies." Anticoagulation therapy led to his recovery. PI should be considered in young patients with refractory pneumonia. Bloody effusion and central lucencies are critical diagnostic clues. Combined localized infection and transient stressors (dehydration/immobility) can trigger venous thromboembolism, even in the absence of hereditary thrombophilia. Early CECT can prevent unnecessary invasive procedures.

Laryngeal mucormycosis is an uncommon form of fungal laryngitis that typically affects immunocompromised individuals. We report a rare such case in a male in his 40s who had recently recovered from severe acute respiratory syndrome-coronavirus disease-19 (SARS CoV-2 infection-COVID 19) and presented with a 1-month history of worsening hoarseness, haemoptysis, and noisy breathing. A chewing gum-like subglottic necrotic mass was biopsied. The rarity of the diagnosis was aided by histopathological and microbial study of the mass, which confirmed mucormycosis. Management included surgical debulking, intravenous liposomal amphotericin B and oral posaconazole followed by staged management of subglottic stenosis.

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.