Telescoping Stents to Maintain a 3-Way Patency of the Airway.

Background: Central airway obstruction near the right upper lobe (RUL) airway orifice poses a dilemma for the clinician. Maintaining ventilation to the right middle and right lower lobes is of utmost importance. However, preserving ventilation to the RUL is desirable as well especially in patients with significant dyspnea. Case presentation: In this case report, we describe telescoping 2 covered self-expanding hybrid stents to relieve airway obstruction while maintaining RUL ventilation. Conclusions: Review of current literature revealed several additional documented approaches to overcome this challenge. The choice of intervention needs to be deliberated based on the available stents, delineation of the airway obstruction, and the patient's anatomy.

Novel Coronavirus-Induced Right Ventricular Failure and Point of Care Echocardiography: A Case Report.

Various cardiovascular complications have been reported in patients with coronavirus disease 2019. Common complications include acute myocardial injury, myocarditis, arrhythmia, pericarditis, heart failure, and shock. We present a case of cor pulmonale diagnosed with serial point of care ultrasound. Given the current shortage of personal protective equipment (PPE) and high infectivity of this virus, we acknowledge the utility of this tool in obtaining important clinical information while minimizing exposure and PPE consumption.

A rare case of bronchial elastosis: An unusual presentation of an unexpandable lung.

Endobronchial obstruction is a known cause of an unexpandable lung. Endobronchial lesions are usually malignant, however benign cause like hemartoma, lipoma, amyloidosis and neuroendocrine tumors are known. We, hereby present the rare cause of bronchial elastosis presenting as right lower lobe lung collapse.

Incidental carcinoid tumor next to vascular malformation.

Dedicated linear endobronchial ultrasound (EBUS) is an established modality in sampling central pulmonary lesions, mediastinal and hilar lymph nodes to diagnose and stage lung malignancies as well as evaluate a number of inflammatory conditions. In addition, power Doppler modality of EBUS allows for vascular evaluation. We describe a case where EBUS visualized a submucosal lesion within a vascular malformation, which was eventually proven to be a carcinoid tumor. Computed tomographic scan of the chest failed to differentiate the 2 structures and bronchoscopy showed no endobronchial component. This case underscores the added diagnostic capabilities of endobronchial Doppler ultrasonography. We suggest considering EBUS in investigating central opacities associated with vascular features within the lung parenchyma when technically feasible.

Dynamic Y stent fractures in crescentic tracheobronchomalacia.

Endobronchial stents have been used occasionally to treat benign conditions such as tracheobronchomalacia (TBM). This report describes a unique case of a patient with crescentic TBM in whom Dynamic Y stent was placed on 2 separate occasions to control symptoms and resulted in identical posterior wall stent fractures within a year of stent placement, both times. A silicone Y stent was substituted for the dynamic stent, and it has been effective in controlling symptoms for 9 months without complications. A literature review of cases of fractured Dynamic Y stents is made and factors affecting the choice of stent type for crescentic TBM are explored.

Tracheobronchopathia osteochondroplastica.

A 71-year-old patient presented for cough, generalized body aches, and fever. Pulmonary work-up included computed tomography scan of the chest, which showed an irregular anterior tracheal wall. Flexible bronchoscopy showed the presence of multiple sessile nodules in the anterior and lateral walls of the trachea and mainstem bronchi, sparing the posterior membranous wall and the airways distal to the mainstem bronchi. Bronchoalveolar lavage grew Mycobacterium avium-intracellulare and the patient was started on appropriate treatment. Biopsy of the lesions showed no malignancy or inflammation. An 18-month follow-up confirmed stability of these lesions pathognomonic of tracheobronchopathia osteochondroplastica, a rare benign condition of the large airways. Fewer than 400 patients with this disorder have been described to date.