Explore the vast range of titles available.

Background A 51-year-old woman was referred to our department due to chronic dry cough lasting six years without an etiological diagnosis. The patient suffered from chronic deterioration in her quality of life due to a persistent cough that sounded like a barking seal. Case presentation A severe form of malacia involving the inferior third of trachea and the main bronchi was diagnosed. According to our protocol, a self-expandable prothesis was placed in the distal portion of the trachea via rigid bronchoscopy with excellent results in cough relief. The patient was subsequently scheduled for tracheobronchoplastic surgery with a polypropylene matrix. Two and a half years after surgery the patient had a significant improvement in quality of life with a complete resolution of her symptoms. Conclusion This report demonstrated that tracheobronchomalacia can be difficult to diagnose with a serious impact on the patient’s life. Referral to a specialized center is essential in the diagnostic and therapeutic management of this disease. Surgical treatment by tracheobronchoplasty may represent a good solution in selected patients.

ObjectivesTo describe the findings, resulting changes in management, and safety profile of flexible bronchoscopy in the neonates with severe bronchopulmonary dysplasia.Study designThis was a retrospective case series of twenty-seven neonates with severe bronchopulmonary dysplasia who underwent flexible bronchoscopy in the neonatal intensive care unit.ResultsFlexible bronchoscopy revealed airway pathology in 20/27 (74%) patients. Tracheomalacia 13/27 (48%), bronchomalacia 11/27 (40.7%), and airway edema 13/27 (48%) were the most common findings. Bronchoalveolar lavage (BAL) was performed in 17 patients. BAL culture revealed a microorganism in 12/17 (70.5%) cases. Findings from bronchoscopy resulted in change in clinical management in 17/27 (63%) patients. Common interventions included initiation of antibiotics (37%) and treatment of tracheobronchomalacia with bethanechol (22.2%), atrovent (18.5%), and PEEP titration (18.5%). Bronchoscopy was performed without significant complication in 26/27 (97%) patients.ConclusionFlexible bronchoscopy can be a safe and useful tool for the management of neonates with severe bronchopulmonary dysplasia.

An infant with localized bronchial malacia was treated with a computer-printed bioresorbable three-dimensional splint. Placement of the splint resulted in improved ventilation. To the Editor: Tracheobronchomalacia in newborns, which manifests with dynamic airway collapse and respiratory insufficiency, is difficult to treat. 1 , 2 In an infant with tracheobronchomalacia, we implanted a customized, bioresorbable tracheal splint, created with a computer-aided design based on a computed tomographic image of the patient's airway and fabricated with the use of laser-based three-dimensional printing, to treat this life-threatening condition. At birth at 35 weeks' gestation, the patient did not have respiratory distress and otherwise appeared to be in normal health. At 6 weeks of age, he had chest-wall retractions and difficulty feeding. By 2 months of age, his . . .

BACKGROUND: Airway collapse is a common finding in dogs with chronic cough, yet the diagnosis can be difficult to confirm without specialty equipment. HYPOTHESIS: Bronchoscopic documentation of tracheobronchial collapse will show better agreement with fluoroscopic imaging than with standard radiography. ANIMALS: Forty‐two dogs prospectively evaluated for chronic cough. METHODS: In this prospective study, three‐view thoracic radiographs were obtained followed by fluoroscopy during tidal respiration and fluoroscopy during induction of cough. Digital images were assessed for the presence or absence of collapse at the trachea and each lobar bronchus. Bronchoscopy was performed under general anesthesia for identification of tracheobronchial collapse at each lung segment. Agreement of imaging tests with bronchoscopy was evaluated along with sensitivity and specificity of imaging modalities as compared to bronchoscopy. RESULTS: Airway collapse was identified in 41/42 dogs via 1 or more testing modalities. Percent agreement between pairs of tests varied between 49 and 87% with poor–moderate agreement at most bronchial sites. Sensitivity for the detection of bronchoscopically identified collapse was highest for radiography at the trachea, left lobar bronchi, and the right middle bronchus, although specificity was relatively low. Detection of airway collapse was increased when fluoroscopy was performed after induction of cough compared to during tidal respiration. CONCLUSIONS: Radiography and fluoroscopy are complementary imaging techniques useful in the documentation of bronchial collapse in dogs. Confirming the presence or absence of tracheal or bronchial collapse can require multiple imaging modalities as well as bronchoscopy.

Tracheobronchomalacia (TBM) presents diagnostic challenges due to its nonspecific symptoms and variability in diagnostic methods. This study evaluates physician concordance in TBM diagnosis and phenotyping using chest computed tomography (CT) scans with dynamic expiratory views. We conducted a retrospective cross-sectional study at Mayo Clinic Rochester, analyzing 150 patients with dynamic expiratory CT scans. Three specialists—a thoracic radiologist, a bronchoscopist, and a pulmonologist—reviewed identical CT scans, blinded to prior interpretations. Inter-rater agreement was assessed using Fleiss’s Kappa for TBM diagnosis and Cohen’s Kappa for TBM phenotype classification into six categories: No TBM, Excessive Dynamic Airway Collapse (EDAC), Crescent Type, Circumferential Type, Saber-Sheath Type, and Mixed Type. Among the 150 patients, 54 (36%) were diagnosed with TBM or EDAC. TBM was more prevalent in males, older individuals, and smokers. Agreement among specialists was substantial for TBM diagnosis (Fleiss’s Kappa = 0.61, p  < 0.001) but moderate for phenotype classification (Fleiss’s Kappa = 0.52, p  < 0.001). The highest concordance was between the thoracic radiologist and the pulmonologist (Cohen’s Kappa = 0.68), while the lowest was between the bronchoscopist and other specialists. There is substantial agreement in TBM diagnosis using chest CT scans with dynamic expiratory views, but moderate variability in phenotyping. Standardizing criteria and integrating pulmonary function testing could enhance diagnostic consistency and clinical relevance.

Dyspnea, cough, sputum production, and recurrent respiratory infections are frequently encountered clinical concerns leading patients to seek medical care. It is not unusual for a well-defined etiology to remain elusive or for the therapeutics of a presumed etiology to be incompletely effective. Either scenario should prompt consideration of central airway pathology as a contributor to clinical manifestations. Over the past decade, recognition of dynamic central airway collapse during respiration associated with multiple respiratory symptoms has become more commonly appreciated. Expiratory central airway collapse may represent the answer to this diagnostic void. Expiratory central airway collapse is an underdiagnosed disorder that can coexist with and mimic asthma, chronic obstructive pulmonary disease, and bronchiectasis. Awareness of expiratory central airway collapse and its spectrum of symptoms is paramount to its recognition. This review includes clear definitions, diagnostics, and therapeutics for this challenging condition. We performed a narrative review through the PubMed (MEDLINE) database using the following MeSH terms: airway collapse, tracheobronchomalacia, tracheomalacia, and bronchomalacia. We include reports from systematic reviews, narrative reviews, clinical trials, and observational studies from 2005 to 2020. Two reviewers evaluated potential references. No systematic reviews were found. A total of 28 references were included into our review. Included studies report experience in the diagnosis and/or treatment of dynamic central airway collapse; case reports and non-English or non-Spanish studies were excluded. We describe the current diagnostic dilemma, highlighting the role of dynamic bronchoscopy and tracheobronchial stent trial; outline the complex therapeutic options (eg, tracheobronchoplasty); and present future directions and challenges.

Anatomically complex airway stenosis (ACAS) represents a challenging situation in which commercially available stents often result in migration or granulation tissue reaction due to poor congruence. This proof-of-concept clinical trial investigated the feasibility and safety of computer-assisted designed (CAD) and manufactured personalised three-dimensional (3D) stents in patients with ACAS from various origins. After CAD of a virtual stent from a CT scan, a mould is manufactured using a 3D computer numerical control machine, from which a medical-grade silicone stent is made. Complication rate, dyspnoea, quality of life and respiratory function were followed after implantation. The congruence of the stent was assessed peroperatively and at 1 week postimplantation (CT scan). The stent could be implanted in all 10 patients. The 3-month complication rate was 40%, including one benign mucus plugging, one stent removal due to intense cough and two stent migrations. 9 of 10 stents showed great congruence within the airways, and 8 of 10 induced significant improvement in dyspnoea, quality of life and respiratory function. These promising outcomes in highly complex situations support further investigation on the subject, including technological improvements.​Trial registration number NCT02889029.

Tracheobronchomalacia (TBM) is a progressive weakening of the airways, leading to collapse and dyspnoea. TBM can be misdiagnosed when multiple chronic conditions accompany it. Tracheobronchoplasty (TBP) is indicated for severe symptomatic TBM, diagnosed by bronchoscopy and CT thorax. We report the case of a patient who underwent tracheal resection and reconstruction for continuing dyspnoea post argon therapy, TBP and a failure to tolerate extracorporeal membrane oxygenation-assisted Y-stent insertion. Relevant background history includes asthma, sleep apnoea, reflux, cardiomyopathy and a high body mass index. Bronchoscopy postreconstruction showed patent airways. Airway reconstruction was a viable management option for this patient’s TBM. TBP is a treatment option for TBM. In this case, tracheal resection was required to sustain benefit. In addition, surveillance bronchoscopies will be carried out every year.

Objective To identify the incidence and characteristics of airway diseases in very low birth weight infants (VLBWIs). Methods A retrospective study of 214 inborn VLBWIs admitted to our NICU between April 2009 and March 2022 (approval no: 2023-0008). Neonatologists ourselves performed bronchoscopy to diagnose airway diseases. Results Symptomatic airway diseases were present in 36/214 (16.8%) of VLBWIs. Common airway diseases were tracheobronchomalacia (TBM) and pharyngomalacia. Infants with airway diseases had shorter gestational age, lower birth weight, more boys, and more moderate/severe bronchopulmonary dysplasia (BPD). Regarding treatment, more infants with airway diseases required intubation were intubated longer, used more dexamethasone, were on ventilators and oxygen longer, and were hospitalized longer. Conclusion We found that VLBWIs were more frequently complicated with airway diseases, especially TBM. We also observed many pharyngeal lesions, which have not been previously reported. Intensity of prematurity, BPD, and the need for stronger respiratory management were risks for airway diseases. In VLBWIs, bronchoscopy should be actively performed because airway diseases are important complications.