Early rehabilitation trajectories and influencing factors in elderly patients with severe pneumonia and sarcopenia after bronchoscopy treatment: A single-center retrospective cohort study.

Introduction: Endobronchial tuberculosis (EBTB) is a microbial and histopathologically proven tuberculosis (TB) infection of the tracheobronchial tree. Because bronchoscopy is not routinely performed in all patients with TB, we aimed to investigate the incidence of EBTB in patients who underwent bronchoscopy in our clinic. Materials and Methods: We investigated the frequency of EBTB in 483 patients who underwent fiberoptic bronchoscopy (FOB) in our clinic between January 1, 2021, and July 11, 2023. Routinely, at each FOB, cytology, acid-resistant bacteria (ARB) staining, and mycobacteria culture are requested from the bronchoscopic lavage material. We analyzed the clinical, radiologic, and bronchoscopic features and treatment processes of EBTB cases. Results: The frequency of EBTB in patients who underwent FOB was 0.62%. EBTB was diagnosed by mycobacterial culture of bronchoscopic lavage material. The general characteristics of our patients were advanced age, 2/3 of them were male, they had never had TB before, and 2 of them had malignancy (1 of them had concurrent lung cancer). Conclusions: EBTB cases may present at an advanced age, in patients presenting with nonspecific symptoms; with radiology as nodules, masses, or consolidations; and with tumor lesions on FOB. Even if the bronchial lavage is ARB negative, we must follow the mycobacteria culture. Although EBTB can occur simultaneously with lung cancer, it can also be a very good cancer imitator.

As lung cancer screening is now covered by statutory health insurance and with the goal of early cancer detection, the number of diagnostic and interventional bronchoscopic procedures is expected to increase substantially - in order to facilitate timely treatment and improve patient survival. This trend underscores the growing importance of evidence-based anaesthesiological management in interventional bronchoscopy.This review summarises current anaesthetic strategies, oxygenation and ventilation techniques, and the monitoring modalities used in interventional bronchoscopy. The review critically appraises the available evidence regarding safety, risk profiles, and procedural outcomes.While diagnostic bronchoscopy is commonly performed under local anaesthesia, with or without moderate sedation to improve patient comfort, modern interventional bronchoscopy imposes significantly higher demands on anaesthetic care. Increasingly complex and invasive procedures, such as transbronchial cryobiopsy, airway stent implantation, and endobronchial tumour ablation, require tailored approaches to analgesia, anaesthesia, airway management, and respiratory support, in order to ensure procedural success and patient safety. The shared airway necessitates close interdisciplinary collaboration and the continuous maintenance of adequate oxygenation and ventilation throughout the intervention.Anaesthetic strategies range from various levels of procedural sedation to general anaesthesia with neuromuscular blockade. Airway management options include augmented spontaneous breathing, supraglottic airway devices, infraglottic techniques such as rigid bronchoscopy, endotracheal tubes, and specialised catheters for jet ventilation. In addition to conventional oxygen supplementation, established respiratory support modalities include high-flow nasal oxygen therapy, controlled mechanical ventilation, and jet ventilation, which may be selected or combined - depending on procedural and patient-specific requirements.Individually adapted anaesthetic concepts are essential for minimising procedural complications and optimising outcomes. This requires structured pre-interventional interdisciplinary evaluation and the implementation of standardised peri-interventional strategies. The choice of anaesthetic technique should be individualised, considering patient-related risk factors, comorbidities, underlying pulmonary pathology, and the type and invasiveness of the bronchoscopic procedure.

Aim: Haemoptysis is a clinical condition characterised by blood in the airways and is difficult to manage even for experienced clinicians. Bronchoscopy is a crucial tool in the treatment and evaluation of haemoptysis. However, we see that it is not used sufficiently in diagnosis and treatment. Within the scope of our research, we aimed to investigate the place and importance of bronchoscopy in haemoptysis through our bronchoscopy applications in patients we follow with the diagnosis of haemoptysis. Material and Method: The files and data of patients who were admitted to the Pulmonary Diseases Department and Intensive Care Unit with the diagnosis of haemoptysis or who were followed up as outpatients and underwent bronchoscopy were retrospectively reviewed. Results: Bronchoscopy findings were normal in 18% of patients, endobronchial lesions (EBL) in 18%, external compression in 1%, mucosal-submucosal infiltration, increased raying in 4%, narrowing of orifices in 2%, mucosal petechiae-vascularity increased in 2%, fragile mucosal hyperaemia-oedema in 12%, active haemorrhage in 5%, haemoptysis residues-coagulum in 37%, and purulent secretion in 1%. While no findings were observed in 19% of the patients during bronchoscopy and no procedure was performed, 55% received topical applications, 7% received only thermal applications, and 19% received both thermal and endobronchial treatments (EBT). Conclusion: We believe that our study will support the existing literature by revealing that bronchoscopy plays an important role in the diagnosis and treatment processes of patients with haemoptysis and that this method has the potential to increase its clinical contributions in the future.

Efficacy of therapeutic bronchoscopic interventions in patients with unilateral total lung atelectasis secondary to lung cancer.

An 86-year-old woman with dyspnea was referred to the Interventional Pulmonology Department due to airway stenosis just below the vocal cords. Bronchoscopic intervention was performed. During the procedure, the right femoral artery and vein were accessed, with a cardiologist and otolaryngologist on standby for emergency tracheotomy. Severe (> 90%) stenosis posed a high risk of respiratory depression and suffocation; therefore, muscle relaxants were not used, and only intravenous anaesthesia was administered. Initially, a laryngeal mask was used, and 2% lidocaine was applied to the airway. A rigid bronchoscope was positioned before the stenosis for airway control. The stenosis, located in the membranous portion, was debulked using a cryoprobe starting from the central area, followed by core-out with a rigid bronchoscope and further dilation with the cryoprobe. Haemostasis was achieved with argon plasma coagulation. The procedure was successful, and symptoms improved. The pathological examination of the cryobiopsy confirmed a diagnosis of mucosa-associated lymphoid tissue lymphoma.

Bronchial stenosis after lung transplant: Risk factors and clinical outcomes.

This study evaluated the clinical implementation of bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) for patients with advanced emphysema and COPD at a university hospital in Sweden. Between 2022 and 2025, a total of 116 patients were evaluated, of whom 32 were treated. BLVR with EBV significantly improved lung function (FEV1), exercise capacity (6-MWT), and symptom burden (CAT score), with mean improvements exceeding the minimal clinically important difference. 3 patients (11 %) experienced complications (2 with pneumothorax, 7 %; 1 with COPD exacerbation, 4%). A dedicated multidisciplinary team with expertise in COPD, bronchoscopic interventions, and thoracic radiology is essential for treatment success. This study highlights BLVR as a promising treatment option in Sweden, with a potential for broader implementation.

Primary Ewing sarcoma of the trachea is an exceptionally uncommon malignancy that often presents with non-specific airway symptoms, leading to diagnostic delays. We report a woman in her early 30s with progressive cough, dyspnoea, hoarseness and stridor who was initially mismanaged as having common airway disease. Imaging revealed a near-obstructing tracheal mass, which was successfully excised bronchoscopically. Histopathology examination, immunohistochemistry and fluorescent in situ hybridisation confirmed the diagnosis of Ewing sarcoma with EWSR1 gene rearrangement. The patient was subsequently initiated on chemotherapy and is doing well on follow-up. This case underscores the importance of considering rare tracheal tumours in patients with persistent unexplained airway symptoms, the pivotal role of immunohistochemistry and molecular testing in diagnosis, and the value of bronchoscopic intervention for both airway relief and tissue diagnosis. Early recognition and a multidisciplinary approach are essential for optimal outcomes in such rare presentations.

Rigid bronchoscopic intervention for airway stenosis in post-pneumonectomy patients.

This study investigated the efficacy and prognosis of bronchoscopic interventional therapy in elderly patients with tracheobronchial tuberculosis (TBTB). We prospectively included 142 elderly patients with TBTB for interventional treatments such as bronchoscopic balloon dilation, mechanical evacuation, and stent implantation, and long-term follow-up (median 28.4 months). The results showed that the technical success rate of interventional therapy was 90.8, 92.3% of patients had improved symptoms, and FEV1 was significantly improved from 43.2% at baseline to 65.8% after surgery (p < 0.001). Fibrostenosis TBTB (OR 3.42), Freitag grade 5 stenosis (OR 2.76), stenosis length > 2 cm (OR 2.18), and Charlson comorbidity index ≥3 (OR 1.98) were independent predictors of poor prognosis. Restenosis occurred in 27.1% of patients after surgery, and the survival rate of older patients (≥75 years) was significantly lower than that of younger patients (81.6% vs. 94.2%, p = 0.003). In this study, we propose a prognostic risk scoring model and confirm that bronchoscopic intervention is safe and effective in elderly patients with TBTB, but patient selection is crucial.

ABSTRACTImmune checkpoint inhibitors (ICIs), such as sintilimab, have revolutionized non‐small cell lung cancer (NSCLC) treatment but can trigger immune‐related adverse events (irAEs). While pneumonitis is well documented, central airway obstruction (CAO) due to immune‐mediated necrosis is an extremely rare and life‐threatening phenotype that poses significant diagnostic challenges. A patient with recurrent squamous cell carcinoma of the lung achieved partial remission after two cycles of sintilimab combined with chemotherapy. However, 48 h after the third cycle, the patient developed acute, severe dyspnea and hypoxemia. Emergency bronchoscopy revealed extensive necrotic material occluding the right main bronchus and carina. Pathological analysis indicated lymphocytic infiltration with necrosis, while microbiological tests were negative for pathogens. Given the temporal relationship, exclusion of alternative etiologies, and response to corticosteroids, the event was considered probable sintilimab‐related acute necrotizing CAO. Immediate interventional bronchoscopy with cryoablation was performed to restore airway patency. This was followed by a short course of systemic corticosteroids (methylprednisolone, then a prednisone taper). The patient's symptoms resolved completely, and follow‐up bronchoscopies confirmed mucosal healing without recurrence of stenosis or necrosis. This case highlights a distinct, underrecognized pulmonary irAE manifesting as acute central airway necrosis. Although a definitive causal relationship cannot be established from a single case, the clinical course strongly suggests a probable association with sintilimab.

Long-term statistical data on lung cancer (LC) show an overall 34% reduction in mortality compared to 1991. The primary reasons for this decline include a reduced smoking rate, earlier diagnosis, advancements in invasive diagnostic methods, and the introduction of low-dose computed tomography (LDCT) screening. These factors have contributed to detecting LC at earlier stages of the disease and improving timely treatment. The diagnostic sensitivity of conventional bronchoscopy for peripheral pulmonary lesions (PPL), representing early-stage LC, has historically been relatively low, ranging from 30% to 60%. Over the past two decades, diagnostic sensitivity for PPL has improved with the development of advanced navigational techniques, such as virtual bronchoscopic navigation, electromagnetic navigation bronchoscopy, radial endobronchial ultrasound, cone-beam computed tomography, and ultrathin bronchoscopy. In the past two to three years, robotic-assisted bronchoscopy has further enhanced diagnostic navigation capabilities to their current maximum potential.

Airway stenting is a complex bronchoscopic intervention that is infrequently performed in children due to limited training opportunities and a lack of appropriate paediatric equipment. We present our institutional data on children (<18 years) who underwent airway stent placement for various tracheobronchial pathologies. We conducted a retrospective study of children with notable airway anomalies who underwent stent placement at our institute over a 3.5-year period (January 1, 2020, to June 30, 2023). Data collected included patient age, type and severity of airway obstruction, clinical condition at presentation, type of stent used, complications, outcomes, and follow-up findings. During the study period, 13 stents were deployed in 12 children with tracheobronchial obstruction. Indications for stenting included severe airway stenosis, airway malacia, stenosis with malacia, and tracheoesophageal fistula (TEF). Stent selection depended on age, lesion location, and device availability. No procedure-related mortalities were noted. The most common complication was granulation tissue formation. After an average 10-month follow-up, 85.7% were clinically stable following stent removal. Although limited by sample size, our findings support the safety and efficacy of airway stenting in children with tracheobronchial obstruction. Stenting serves as a suitable therapeutic choice when conventional approaches have been unsuccessful or are not suitable. Therefore, it is crucial to establish a robust follow-up system to promptly address any potential complications.

Chordoma, Post obstructive pneumonia is a known consequence of proximal airway obstruction, but the underlying causes may range from infection and mucus plugging to occult malignancy or foreign body aspiration.

This article reported a 46-year-old male patient with pulmonary mucormycosis and a history of poorly controlled diabetes. Chest imaging revealed rapidly progressive patchy opacities and multiple cavities in both lungs. Bronchoscopy showed mucor plug obstructing multiple segmental and subsegmental bronchi. The patient underwent sequential treatment, including local nebulization, oral/intravenous antifungals, and bronchoscopic removal of mucor plugs combined with intrabronchial instillation of amphotericin B deoxycholate. However, this yielded no significant improvement. During the procedure, massive airway hemorrhage occurred and was successfully controlled with balloon tamponade. Subsequent exploration with a thin bronchoscope enabled the removal of mucor plugs from subsegmental and distal bronchi. The infusion protocol was adjusted based on chest CT findings by increasing the dosage, volume, and frequency of antimucormycosis drug administration. Following this individualized approach, the patient's condition improved, and he was eventually discharged. This case exemplified the successful combination of pharmacologic and individualized bronchoscopic interventions for pulmonary mucormycosis. It introduced innovations that went beyond current guideline recommendations, highlighting the importance of personalized treatment strategies.

ABSTRACTTracheobronchial aspergillosis (TBA) is an uncommon form of invasive Aspergillus infection that can closely mimic endobronchial malignancy, particularly when presenting as an obstructive pseudotumoral lesion. We report the case of a 78‐year‐old immunocompetent male who presented with hemoptysis, progressive dyspnea, and an endobronchial mass initially suspected to represent bronchogenic carcinoma. Bronchoscopy revealed a tumor‐like obstructive lesion, and both bronchoalveolar lavage (BAL) culture and bronchial biopsy culture grew Aspergillus spp. based on characteristic microscopic morphology. Histopathologic examination demonstrated septate hyaline hyphae with clear evidence of tissue invasion, confirming invasive fungal disease. The patient experienced marked clinical and endoscopic improvement following systemic voriconazole therapy and bronchoscopic intervention, with near‐complete resolution of the lesion. This case highlights the need to consider fungal etiologies in the differential diagnosis of endobronchial masses and emphasizes the essential role of early bronchoscopy, microbiological cultures, and histopathologic evaluation in establishing a timely and accurate diagnosis.

The subspecialty of interventional bronchoscopy has grown exponentially in recent times, and airway stenting is a frequently performed procedure. It is a therapeutic bronchoscopic intervention for both benign and malignant conditions, being mostly performed with a palliative intent, especially in cases of malignant central airway obstruction (CAO).We report a previously undocumented complication of airway stenting-disintegration of a self-expanding metallic stent (SEMS) and its spontaneous expectoration. A man in his late 40s with newly diagnosed squamous cell carcinoma of the lung presented with CAO and respiratory failure. Rigid bronchoscopy with tumour debulking and Y-SEMS placement was performed, resulting in clinical stabilisation. Four-and-a-half months post-stenting, the patient presented with expectoration of metallic fragments. Bronchoscopy revealed extensive disintegration of the posterior wall of the tracheal limb of the stent, with the bronchial limbs intact. The disintegrated stent was carefully removed under rigid bronchoscopy without any complications. Given adequate airway patency, no replacement stent was inserted. The patient continued systemic chemotherapy and remained stable, with no recurrence of airway compromise. This case highlights an unusual delayed complication of airway stenting.

Tuberculous tracheitis is an uncommon yet serious complication of tuberculosis (TB) infection. The underlying granulomatous inflammation typically results in tracheal stenosis within six months of diagnosis.This report details a case of a woman from Southeast Asia in her mid-40s who presented with chronic weight loss and cough. Imaging demonstrated pulmonary nodules as well as tracheal and oesophageal thickening. Bronchoscopy showed friable, ulcerated tracheal mucosa. Mycobacterium TB was confirmed on microbiological testing. Despite initiating anti-tuberculosis therapy with a standard 4-drug regimen, the patient presented with progressive dyspnoea and inspiratory stridor attributable to severe mid-tracheal stenosis. Multiple bronchoscopic interventions were needed to restore airway patency and prevent recurrent stenosis. This case highlights the importance of prompt recognition, timely intervention and regular follow-up to prevent fibrotic stenosis in tuberculous tracheitis.

Bronchoscopic intervention for endobronchial metastasis from clear cell renal cell carcinoma : A case report