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A 46-year-old man with Behcet's disease was admitted because of acute hemoptysis. Seven years earlier, the patient had been diagnosed with an aneurysm of the left lower lobe segmental pulmonary artery (Figure 1A) and had undergone transcatheter embolization with metallic coils for the aneurysm.

Spontaneous rupture of a congenital bronchial diverticulum resulting in total lung collapse and chronic empyema thoracis is a rare condition that presents considerable challenges in preoperative diagnosis and perioperative management. Thorough interpretation of imaging studies and bronchoscopy is crucial for effective surgical planning. This article describes a successful surgical intervention employing primary repair in conjunction with decortication.

An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.

Laryngotracheal involvement is a major cause of morbidity and mortality.1 An average of 2·9 years elapses from onset to diagnosis, and identifying relapsing polychondritis can be challenging, especially in the absence of typical auricular or nasal involvement.2 When the symptoms are only prolonged fever and cough with no pulmonary abnormalities on CT, the differential diagnosis includes extrapulmonary airway disorders such as sinusitis, relapsing polychondritis, sarcoidosis, and asthma due to eosinophilic granulomatous polyangiitis, intravascular lymphoma, which can be hard to diagnose even on high-resolution CT,3 and large vessel vasculitis.4 Tracheal tenderness is suggestive of relapsing polychondritis1 and our patient had tracheal wall thickening visible on CT, but because relapsing polychondritis restricted to the airways is a rare presentation of a rare disease we did further investigations to exclude other causes.

Background Granulomatosis with polyangiitis and relapsing polychondritis are rare, multisystemic and potentially life-threatening connective tissue diseases. We present two cases of severe endobronchial obstruction in the aforementioned conditions and discuss difficulties with detection and treatment. Despite differing underlying pathophysiologies, endobronchial disease is a less frequently reported but serious complication of both conditions. Case presentation Case 1, a 31-year-old South Asian woman with relapsing polychondritis, required partial tracheal resection and reconstruction in combination with immunosuppressive therapy to achieve respiratory recovery following collapse of her right main bronchus and a stricture in her left main bronchus. Case 2, a 22-year-old Caucasian male with granulomatosis with polyangiitis, underwent surgical resection of an endobronchial growth causing occlusion of his right main bronchus. Although his respiratory status was initially stabilised with increased immunosuppression, he continues to have disease progression in spite of this. Conclusions Our cases highlight the importance of a multidisciplinary approach combining immunosuppression with supportive care and judicious use of surgical interventions in select cases. A further review of the literature shows endobronchial obstruction is potentially under-reported due to overlap in connective tissue disease symptomatology and there is no consensus on best practice.

A 68-year-old woman presented with fever, shortness of breath, and wheezing. Computed tomography revealed an obstructing broncholith and postobstructive pneumonia.

Endobronchial tuberculosis (EBTB), of which the incidence has been increasing in recent years, is a special type of pulmonary tuberculosis. The endobronchial tuberculose focuses often injure the tracheobronchial wall and lead to tracheobronchial stenosis. The tracheobronchial stenosis may cause intractable tuberculosis and make patients become chronic infection sources of tuberculosis, or may even cause pulmonary complications and result in death. The etiological confirmation of Mycobacterium tuberculosis is most substantial for diagnosis. However, because the positive rate of acid-fast bacillus staining for sputum smears is low and the clinical and radiological findings are usually nondistinctive, the diagnosis of EBTB is often mistaken and delayed. For early diagnosis, a high index of awareness of this disease is required and the bronchoscopy should be performed as soon as possible in suspected patients. The eradication of Mycobacterium tuberculosis and the prevention of tracheobronchial stenosis are two most substantial treatment goals. To get treatment goals, the diagnosis must be established early and aggressive treatments must be performed before the disease progresses too far.