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The field of pediatric bronchoscopy is rapidly expanding and enables diagnostic tests and therapeutic maneuvers, benefiting many children suffering from respiratory disease. However, due to a paucity of pediatric providers trained in bronchoscopy, many institutions rely on adult interventionalists collaborating with pediatric care teams to complete these procedures. In this article, we address the adult interventionalist taking on these cases and offer insight into key differences in pediatric anatomy and physiology, unique challenges encountered in this population and explore the equipment available in pediatric sizes. We also consider the future of the field, including broadening pediatric training to enhance capacity to complete these necessary procedures.

Red blood cells (RBCs), which are enucleated and mitochondria‐deficient, have traditionally been considered essential for gas exchange and systemic metabolic regulation. Here, an unrecognized role for RBCs in promoting lung cancer progression is identified. In a cohort of 226 lung cancer patients and 239 healthy controls, significantly elevated levels of miR‐93‐5p are observed in RBCs and RBC‐derived exosomes, but not in plasma, with higher levels correlating with advanced stage and poor prognosis. Functional assays demonstrate that RBC‐derived exosomal miR‐93‐5p is transferred to tumor cells, where it suppresses PTEN and enhances proliferation, migration, and invasion. Conversely, exosomes released by lung cancer cells deliver miR‐93‐5p to RBCs, thereby augmenting its abundance within RBCs. Inhibition of miR‐93‐5p or restoration of PTEN abrogates these effects. In both subcutaneous and orthotopic mouse models, RBC‐derived exosomal miR‐93‐5p accelerates tumor growth and reduces survival, whereas therapeutic delivery of antisense oligonucleotides targeting miR‐93‐5p suppresses tumor burden, reduces metastasis, and prolongs survival. Together, the novel function of RBCs as active participants in tumorigenesis is reported through exosomal transfer of oncogenic miR‐93‐5p, establishing a bidirectional tumor‐RBC‐tumor communication axis that promotes malignancy and offers new diagnostic and therapeutic opportunities in lung cancer. Red blood cell (RBC)‐derived exosomal miR‐93‐5p is elevated in lung cancer patients and correlates with poor outcomes. Exosomal miR‐93‐5p suppresses PTEN in cancer cells, enhancing proliferation, migration, and invasion. In mouse models, therapeutic inhibition with ASO‐miR‐93 5p reduces tumor growth, highlighting a bidirectional tumor‐RBC‐tumor axis and promising diagnostic and therapeutic targets.

Hemoptysis can complicate seizures, albeit rarely. This unfamiliar presentation, reported infrequently in adults, can also affect children. This remains a rare clinical entity in pediatrics and we report one such case and its association with sterol carrier protein (SCP) gene mutation. We present a case of a 16-year-old male with recurrent episodes of hemoptysis following seizures. The diagnostic workup for etiology of the hemoptysis was unrevealing and he was ultimately treated for neurogenic pulmonary edema as a diagnosis of exclusion. He achieved complete resolution with supportive care and diuretics. Our case report describes the clinical and radiological presentation and overall management of post-ictal pulmonary hemorrhage and edema in a pediatric patient. In addition, it reports a new finding of possible association with sterol carrier protein (SCP2) carrier status. It also highlights a rare but potentially life-threatening consequence of inadequate seizure control in pediatric patients.

A 55-year old woman with a history of relapsed T-cell ALL presented with right pleuritic chest pain and decreased breath sounds over the right hemithorax. Imaging of the chest showed loculated effusions. Tube thoracostomy was performed with intrapleural application of alteplase and dorse alpha over a 3-day period. Repeat imaging demonstrated a marked decrease in the volume of the effusion. In most prior published cases of pleural cryptococcosis, surgical draige was required in addition to prolonged antifungal agents. More than 50% of patients with cryptococcal infection have severe underlying disease or immunodeficiency state making them high risk for surgery. This is the first case to our knowledge of cryptococcal empyema successfully treated with tube thoracostomy and intrapleural fibrinolysis.

The spectrum of eosinophilic lung diseases comprises a diverse group of pulmory disorders associated with tissue or peripheral eosinophilia. [Acute eosinophilic pneumonia (AEP)] is an uncommon eosinophilic lung disease that can be idiopathic, but identifiable causes include medications, inhalatiol exposures and infections. Most cases in the literature are associated with first-time cigarette smoking or resuming smoking. Herein, we present a case of AEP in an elderly man triggered by exposure to secondhand tobacco smoke, in whom a transbronchial biopsy was diagnostic. The patient recovered fully with glucocorticoid therapy without recurrence after avoiding further secondhand smoke.

Kaposi sarcoma (KS) is the most common neoplasm associated with Acquired Immune Deficiency Syndrome (AIDS), but antiretroviral therapy has reduced its incidence dramatically. Endobronchial KS is usually associated with concurrent mucocutaneous lesions and is highly vascular; so biopsy generally is not recommended. The use of advanced bronchoscopic techniques for evaluation of endobronchial KS may mitigate the bleeding risks but has not been described previously. We describe an unusual case of KS, which presented as an isolated obstructing endobronchial tumor that was effectively resected using electrocautery snare and argon plasma coagulation (APC) during bronchoscopy.

A 74‐year‐old woman presented with chest pain and dyspnoea following endobronchial ultrasound (EBUS)‐guided transbronchial needle aspiration (TBNA) for presumed malignancy. Computed tomography angiography revealed a left‐sided pleural effusion with hypertrophied and tortuous bronchial arteries (BAs) with contrast blush into the left lung hilum. Tube thoracostomy and pleural fluid analysis confirmed the diagnosis of haemothorax. The mechanism of injury was determined to be BA laceration during EBUS‐TBNA and drainage led to rapid improvement in the patient's symptoms. This is the first reported case of haemothorax due to BA injury during EBUS‐TBNA. Haemothorax following an endobronchial ultrasound‐guided guided transbronchial needle aspiration (EBUS‐TBNA) as a result of bronchial artery laceration resolved with small‐bore chest tube drainage.

Multiple myeloma is a plasma cell dyscrasia accounting for 10% of haematologic malignancies. Lenalidomide is an immunomodulatory drug analogous to thalidomide that is approved for use in patients with myelodysplastic syndrome, and in combination with dexamethasone for refractory or relapsed multiple myeloma. Lenalidomide is preferred to thalidomide because of reduced toxicity, and pulmonary side effects are considered rare. We present, to our knowledge, an unusual and first reported case of a patient with relapsed multiple myeloma who received lenalidomide after autologous stem cell transplant, then developed eosinophilic pneumonia presenting as dyspnoea, peripheral eosinophilia, and bilateral pulmonary opacities. Bronchoscopy with bronchoalveolar lavage was negative for infection, and transbronchial lung biopsies showed eosinophilic pneumonia. After discontinuation of lenalidomide and initiation of prednisone therapy, his dyspnoea improved and eosinophilia resolved; however, symptoms recurred when the drug was restarted at a lower dose, confirming its causative role. In the absence of infection, clinicians should always bear in mind drug toxicity in the differential diagnosis of patients receiving lenalidomide and related agents. Lenalidomide‐induced pulmonary toxicity is previously reported; however, eosinophilic pneumonia as a distinct pathological entity is a unique presentation and we report such a case along with a review of the literature.

Description A woman in her 80s with ventilator-dependent respiratory failure due to severe cardiomyopathy and critical illness myopathy was transferred to our hospital after experiencing recurrent episodes of ventricular fibrillation cardiac arrest requiring cardiopulmonary resuscitation.