Tuberculosis (TB) remains a major global health challenge, particularly in low- and middle-income countries where socioeconomic disparities, comorbidities, and limited health infrastructure hinder control efforts. Sputum smear conversion is a critical early marker of treatment response and infectiousness. Delayed conversion is associated with poor outcomes, prolonged transmission, and increased risk of drug resistance. To identify determinants of sputum smear conversion and treatment outcomes among pulmonary tuberculosis patients in Eastern Baghdad, focusing on therapeutic, socioeconomic, and programmatic factors. A retrospective observational study was conducted at the Consultation Clinic for Chest and Respiratory Disease, Al Rasafa, Baghdad, from 1st of January 2018, to 31 of December 2023. Of 6,208 registered TB patients, 3,039 smear-positive pulmonary TB cases met the inclusion criteria. Data were extracted from the national TB registry and medical records. The primary outcome was sputum smear conversion at two months; secondary outcomes were treatment success or failure, defined by WHO standards. Associations were analyzed using chi-square and multivariable logistic regression. At two months, 95.0
The Bedside Lung Ultrasound in Emergency (BLUE) protocol is a diagnostic algorithm proposed to guide the diagnosis of the main causes of acute respiratory failure. Despite growing evidence supporting its use, questions remain regarding the overall diagnostic accuracy of the BLUE protocol in emergencies among critically ill patients. This study aimed to assess the diagnostic accuracy of the BLUE protocol in critically ill patients. This cross-sectional diagnostic accuracy study included 110 critically ill adult patients consecutively admitted to the chest intensive care unit (ICU). Chest CT was performed during assessment in the emergency department, followed by bedside chest X-ray (CXR) and lung ultrasound (LUS) after ICU admission. The LUS examination was performed by an operator blinded to the patients’ clinical history and other imaging findings. The final diagnosis established by the ICU team, based on clinical findings, laboratory investigations, clinical course, and imaging results, including CT/CTPA, was used as the composite reference standard. LUS demonstrated high diagnostic performance for several causes of acute respiratory failure. For obstructive airway disease, LUS showed a sensitivity of 90.5
Abstract Background Agitation occurs in 20–50% of ICU patients and can lead to failure of noninvasive ventilation (NIV). The use of benzodiazepines poses a risk of respiratory depression, which makes dexmedetomidine use in COPD patients a suitable alternative despite its haemodynamic profile. Yet, the available literature provides inconsistent data regarding its efficacy and safety. Aim of work The study aimed to compare ability of dexmedetomidine to control agitation in COPD patients receiving NIV, and to avoid invasive mechanical ventilation (IMV) compared to conservative approaches without using sedation. Methods Agitated COPD patients admitted for NIV (Richmond’s Agitation-Sedation Scale (RASS) ≥ + 2) were randomized to receive either conservative management alone or adding IV dexmedetomidine infusion (0.2–0.7 mcg/kg/wt). Sedation was assessed using RASS at baseline, 1, 2, 12, 24, and 48 h thereafter. Vital signs, Glasgow Coma Scale (GCS), ABGs, and Visual Analogue Scale (VAS) were also documented. The primary outcomes were agitation control (RASS 0 to -2– at 48 h), and NIV success. Secondary outcomes included haemodynamic effects, pain control, ICU mortality, NIV duration and length of stay (LOS) in ICU. Results Ninety-three patients were enrolled into this randomised-controlled trial. Data of 80 patients (39 and 41 in Dexmedetomidine and No-sedation group) were analyzed. The two groups were comparable regarding demographic and baseline clinical characteristics. HR and SBP were comparable throughout the study, while DBP was significantly lower at 12 and 24 h in dexmedetomidine group. Agitation control was more frequent (81.2% vs. 34.1% P < 0.001) and delirium was less frequent (one vs. eight patients, P = 0.029) among Dexmedetomidine recipients. However, no significant differences were observed regarding NIV success ( P = 0.328), ICU mortality ( P = 0.999), NIV duration ( P = 0.086), or LOS in ICU ( P = 0.817). Conclusion For agitated COPD patients receiving NIV, dexmedetomidine could achieve agitation control in a significantly larger number of patients compared to not using a sedative. However, it had no significant effect on NIV success, NIV duration, ICU mortality or LOS. Transient decrease in DBP was observed with dexmedetomidine.
Excessive dynamic airway collapse (EDAC) is a form of expiratory central airway collapse (ECAC) characterized by excessive inward movement of the posterior tracheal wall during expiration. Although awareness of EDAC has increased, the biological mechanisms underlying posterior wall dysfunction remain poorly understood. This narrative review synthesises current evidence on the anatomy, biomechanics, and clinical relevance of the posterior membranous wall in relation to EDAC. A literature search covering 2014–2024 was conducted using Google Scholar, Scopus, and PubMed. Studies examining the anatomy, biomechanics, imaging, pathology, and management of EDAC were reviewed. Due to limited direct evidence in EDAC, manual searches were also performed for relevant studies from related airway conditions with similar biomechanical or pathological features and outside the specified time frame to provide supporting context. The posterior membranous wall is a complex dynamic structure that contributes to normal airway function and mucus clearance. Current evidence does not support trachealis muscle (TM) atrophy alone as the basis of EDAC. Instead, biological factors, including chronic airway inflammation and GERD, and mechanical factors, including prolonged intubation, local compression, obesity, and OSA, may interact to alter posterior wall structure and compliance. Repeated expiratory collapse may further increase mechanical stress, creating a possible vicious cycle of posterior wall dysfunction. Posterior wall dysfunction in EDAC may represent a complex functional disorder involving interactions between tissue properties and mechanical forces rather than a single structural defect. This framework highlights the need for direct histological, morphometric, and biomechanical studies to clarify the mechanisms of EDAC and support the development of more targeted approaches. As this conceptual framework has not been directly investigated in EDAC, its proposed mechanisms should be interpreted with caution. 1. EDAC likely involves more than trachealis muscle atrophy alone. 2. Chronic airway inflammation and mechanical stress may drive posterior wall collapse. 3. Future studies should combine anatomy, histology, and biomechanics in EDAC.
Interstitial lung diseases (ILDs) are a heterogeneous group of conditions that frequently require histopathology for a confident diagnosis. Transbronchial lung cryobiopsy (TBLC) is a minimally invasive alternative to surgical lung biopsy, but evidence comparing small-diameter and standard-diameter cryoprobes remains fragmented, with most studies being single-centre and underpowered. To evaluate the diagnostic performance and safety of small-diameter (1.1–1.7 mm) versus standard-diameter (1.9 mm) cryoprobes for TBLC in patients with suspected ILD. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched from inception to March, 2026. Eligible studies assessed small-diameter cryoprobes for TBLC. The primary endpoint was diagnostic yield; secondary endpoints were bleeding, pneumothorax, number of biopsies, and specimen size. Random-effects meta-analyses were performed in R; single-arm proportions were pooled with a generalised linear mixed model, comparative dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD), with heterogeneity assessed by the I² statistic and certainty rated with GRADE. Five studies (two RCTs, three retrospective cohorts; 232 small-probe patients) were included. In the two RCTs (142 per arm), diagnostic yield did not differ between probe sizes (RR 0.95; 95
Ultrasound interrogation of the thorax for detection of pneumonia has been explored most in critical care and emergency department settings. However, recently, the application has spread to general practice and even prehospital settings. This work aimed to evaluate the role of chest ultrasound as a diagnostic tool for pneumonia in adults compared to chest x-ray. This prospective observational cross-sectional study was carried out on 30 adult patients admitted to the General Chest Departments of Desouk and Damanhour Hospitals with a preliminary diagnosis of community-acquired pneumonia. The studied patient were divided into two groups: Group I: 21 patients (70
Despite the availability of diagnostic methods of tuberculosis, differentiating active tuberculosis (TB disease) from latent tuberculous infection remains challenging. FCGR1A reflects immune activation during active disease, while prealbumin decreases in inflammatory and malnourished states, making both potential indicators of disease activity. To evaluate the role of FCGR1A gene expression and plasma prealbumin levels, either alone or in combination, in distinguishing TB disease from latent tuberculous infection. This cross sectional analytic study included 90 participants divided into three equal groups: patients with active tuberculosis (Group I), individuals with latent tuberculosis infection (Group II), and healthy controls (Group III). All participants underwent clinical evaluation, radiological assessment, and routine laboratory investigations. Plasma prealbumin was measured using ELISA, while FCGR1A gene expression was assessed using quantitative real-time PCR. Statistical analysis was performed to compare the groups and determine the diagnostic value of the studied markers. Patients with active tuberculosis (Group I) had significantly higher values of FCGR1A gene expression (median fold change 8.76) compared to Groups II and III. Plasma prealbumin was lower in Group I (median 100.7 µg/ml). Both prealbumin (≤ 111.48 µg/ml, AUC = 0.737) and FCGR1A (> 2.23 fold change, AUC = 0.797) effectively distinguished TB disease from latent infection, with sensitivities of 73–80
Pulmonary granular cell tumour is a seldom-seen Schwann cell-derived lesion, particularly in children, and most frequently endobronchial in the case of the respiratory tract. A 12-year-old boy presented with cough, rhinorrhoea and mild breathlessness and imaging performed at another site revealed atelectasis of the right middle lobe. Bronchoscopy showed the right middle lobe bronchus narrowing, and an incidental whitish lobulated polypoid lesion at the genesis of the right upper lobe bronchus. Endobronchial biopsy was done and histopathology revealed bronchial mucosa was stretched by cells with great cytoplasmic granules and smooth nuclei. Positiveness of S100 and CD68 with negativity of cytokeratin, INSM1, p40 and smooth muscle actin on immunohistochemistry confirmed granular cell tumour. Although the lesion appeared relatively benign bronchoscopically, PET-CT was performed to further characterize the lesion and assess its metabolic activity and extent before management. Biopsy and bronchoalveolar lavage microbiological tests were negative to tuberculosis, fungal elements and bacterial growth. As indicated in this case, endobronchial granular cell tumour can be incidentally discovered during bronchoscopy and diagnosis requires histopathology with immunohistochemistry. The management should be personalised based on the symptoms, size of tumour, airway obstruction and follow-up results.
Ventilator-associated pneumonia (VAP) is a frequent complication among critically ill patients in intensive care units. Its clinical diagnosis remains challenging because clinical criteria are subjective and diagnostic tests have limited ability to distinguish cases accurately. This study was conducted to validate the diagnostic ability of single and combined BAL biomarkers for identifying bacterial VAP in mechanically ventilated patients. This study was conducted in the respiratory, surgical, emergency, and internal medicine ICUs of the Faculty of Medicine, Zagazig University Hospitals from May to December 2025. It included 64 mechanically ventilated adult patients who underwent (BAL) for suspected (VAP). Baseline demographic, clinical, laboratory, radiological, and comorbidity data were recorded at the time of BAL. Lung ultrasound was performed within 6 h of detecting a new infiltrate on chest X-ray to assess sonographic signs suggestive of VAP .Microbiological confirmation was based on quantitative BAL cultures, with VAP diagnosed when bacterial growth reached ≥ 10⁴ CFU/mL.Patients were classified into definite VAP, indeterminate VAP, or definite absence of VAP according to clinical, imaging, microbiological, and treatment findings. Laboratory evaluation included inflammatory biomarkers such as suPAR, sTREM-1, MIF, IL-1β, and IL-8. The study enrolled 64 patients who were classified into three groups: Definite VAP (n = 24), Indeterminate (n = 15), and No VAP (n = 25). Analysis of (BAL) fluid showed that IL-1β and suPAR were the most significant biomarkers for distinguishing Definite VAP from the other groups (p < 0.001). IL-1β concentrations were substantially higher in Definite VAP arm, with a median of 702 pg/mL, compared with 25 pg/mL in the No VAP arm. Likewise, suPAR levels were significantly increased in Definite VAP cases (6.9 ng/mL) compared with the Indeterminate (3.3 ng/mL) and No VAP (4.6 ng/mL) groups. In contrast, sTREM-1, MIF, and IL-8 did not demonstrate significant differences among the three groups in univariate analysis. BAL-based biomarkers, particularly IL-1β and suPAR, offer significant incremental value and may help reduce diagnostic uncertainty, inappropriate antibiotic use, and delays in targeted therapy.
Abstract Background Interstitial lung disease (ILD) and cardiac pulmonary congestion often present with overlapping clinical and radiological features, leading to frequent diagnostic challenges. Accurate differentiation during the acute worsening of the ILD worsening is essential to guide appropriate management. Objective To determine the frequency of pulmonary congestion misinterpretation as ILD based initially on HRCT interpretation alone and to identify particular HRCT findings that are more frequently related with correct diagnosis of ILD. Methods A prospective cross sectional study was conducted on 66 patients initially diagnosed with ILD based on HRCT radiological reports. All patients had their HRCT scans re-evaluated by multidisciplinary team comprising one radiologist and two pulmonologist furthermore during an exacerbation of the ILDTrans thorthac echocardiography was performed for all patients. The final diagnosis was established through multidisciplinary discussion (MDD), integrating the clinical presentation, HRCT findings, cardiac/echocardiographic assessment, and clinical course. The diagnostic agreement between the first and the final diagnoses was evaluated using kappa analysis. Logistic regression was utilized to find predictors for pulmonary congestion diagnosis. Results A significant proportion of patients initially diagnosed with ILD were later reclassified after radiological reassessment and incorporation of echocardiographic data. Only 59.1% confirmed as ILD, 34.8% as cardiac congestion, and 6.1% mixed ILD and cardiac congestion. Regarding the HRCT findings associated with diagnostic accuracy, our results suggest that specific radiological patterns and their distribution were more informative than individual parenchymal abnormalities. In particular, the presence of honeycombing, traction bronchiectasis/bronchiolectasis, and a basal and subpleural distribution of reticular abnormalities were important features associated with correct recognition of ILD. Kappa analysis showed weak agreement between initial and final diagnoses (kappa = 0.3), indicating a notable rate of misdiagnosis. Conclusion Misdiagnosis between ILD and cardiac congestion is common due to overlapping imaging features. Multidisciplinary discussion including echocardiographic assessment with specific radiological feature can increase diagnostic accuracy and prevent improper treatment. Trial registration NCT06198608
Abstract Background E-cigarette or vaping product use–associated lung injury may show variable clinical, radiologic, and histopathologic patterns. Although it usually presents as acute or subacute lung injury, chronic or atypical forms may mimic interstitial lung disease and lead to diagnostic delay. This case highlights an uncommon interstitial lung disease–like presentation of vaping-associated lung injury in a young adult. Case presentation A 32-year-old man presented with progressive exertional dyspnea and worsening radiologic abnormalities despite previous treatment for presumed interstitial lung disease. The patient remained under a presumed chronic ILD diagnosis for almost two years before detailed reassessment of the exposure history and re-evaluation of the lung biopsy prompted diagnostic reconsideration. Serial thoracic computed tomography showed progressive bilateral ground-glass opacities and interstitial changes. Reassessment of exposure history revealed daily e-cigarette use, particularly during periods of symptom worsening. Re-evaluation of the prior surgical lung biopsy demonstrated a macrophage-predominant smoking-related injury pattern with desquamative interstitial pneumonia–like features and no typical findings of usual interstitial pneumonia or nonspecific interstitial pneumonia. Based on an integrated assessment of the clinical, radiologic, pathologic, and exposure findings, e-cigarette or vaping product use-associated lung injury was considered the most likely diagnosis. After cessation of e-cigarette use and high-dose corticosteroid therapy, the patient showed marked clinical and radiologic improvement. Conclusions Vaping-associated lung injury should be considered in young patients with progressive dyspnea and interstitial lung disease–like imaging, especially when the clinical course is atypical or treatment response is poor. Careful exposure history and multidisciplinary radiologic–pathologic reassessment may facilitate recognition and appropriate diagnostic reconsideration.
Post-COVID syndrome (PCS) involves multisystemic effects, occurring even after a relatively mild acute illness. “To determine the frequency and nature of ongoing symptoms in Upper Egypt at 3 and 6 months post-acute COVID-19, characterize patient groups at risk for PCS, and evaluate changes in clinical parameters. This prospective observational descriptive cohort study of 120 patients with COVID-19 infection. Patients were consecutively enrolled based on eligibility criteria, including positive PCR or combined clinical criteria, imaging, including CT chest and chest US, and laboratory investigation, such as CRP for confirmation of COVID-19 diagnosis. Follow-up of patients was done at 3 and 6 months. The most common symptoms at the acute stage were cough (100
Pulmonary Tuberculosis (TB) and human immunodeficiency virus (HIV) are closely linked since the emergence of the acquired immunodeficiency syndrome (AIDS). The syndemic relationship between tuberculosis (TB) and HIV remains a critical global health challenge, particularly in resource-limited settings where co-infection complicates diagnosis, treatment, and outcomes. This study aimed to estimate the prevalence of HIV infection among adults diagnosed with pulmonary and extrapulmonary tuberculosis at Cairo University Hospitals. A cross-sectional study was conducted over one year (October 2022 to October 2023) and included 100 adult TB patients who met the inclusion criteria, recruited from both inpatient and outpatient settings. Data collection involved comprehensive history-taking, laboratory investigations for TB diagnosis and performance status assessment. HIV screening was performed using a rapid blood test, with positive cases confirmed by polymerase chain reaction (PCR) and CD4 count measurement. Prevalence was calculated with 95
Non-resolving pneumonia (NRP) remains a significant diagnostic challenge because of its diverse etiologies, particularly in tuberculosis-endemic regions. Although a structured non-bronchoscopic evaluation establishes the diagnosis in a substantial proportion of patients, many remain without a definitive etiological diagnosis. Bronchoscopy is frequently employed in such patients; however, its incremental diagnostic contribution following an inconclusive non-bronchoscopic evaluation has not been adequately defined. This study aimed to evaluate the incremental diagnostic yield of bronchoscopy following a structured non-bronchoscopic diagnostic evaluation in patients with NRP. This prospective observational study included 130 adult patients with NRP evaluated at a tertiary care centre in Eastern India between June 2024 and December 2025. All patients initially underwent a structured non-bronchoscopic diagnostic evaluation. Patients who remained undiagnosed after the initial evaluation (n = 78) subsequently underwent flexible bronchoscopy. Bronchoscopic evaluation was performed using a standardized protocol comprising bronchoalveolar lavage (BAL), bronchial brush cytology, and transbronchial lung biopsy (TBLB) during the same bronchoscopy session in all patients. The primary outcome was the incremental diagnostic yield of bronchoscopy, defined as the additional definitive diagnoses established following an inconclusive non-bronchoscopic evaluation. The initial non-bronchoscopic evaluation established a definitive diagnosis in 52 of 130 patients (40.0
Abstract Background Pleural effusion is a common clinical condition with diverse etiologies. Differentiating exudative from transudative pleural effusions is essential for appropriate diagnosis and management. High-sensitivity C-reactive protein (hs-CRP) has been investigated as a potential biomarker in the evaluation of pleural effusion. This study aimed to assess the discriminative performance of pleural fluid hs-CRP, serum hs-CRP, the serum–pleural fluid hs-CRP gradient, and the pleural fluid/serum hs-CRP ratio in differentiating exudative from transudative pleural effusions classified according to Light’s criteria. Methods This cross-sectional study included 62 patients with pleural effusion. Levels of hs-CRP, total protein, and lactate dehydrogenase were measured in pleural fluid and serum. Differences between groups were analyzed using the Mann–Whitney U test. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, and multivariable logistic regression was performed to assess the independent association of hs-CRP parameters with exudative pleural effusion after adjustment for potential confounding variables. Results The mean age of participants was 52.3 ± 16.0 years, and 53.2% were male. Exudative effusion accounted for 58.1% of cases, with parapneumonic effusion representing the most common etiology (33.9%). Pleural fluid hs-CRP, serum hs-CRP, and the serum–pleural fluid hs-CRP gradient were significantly higher in exudative effusions (all P < 0.001). The area under the curve values for pleural fluid hs-CRP, serum hs-CRP, and the hs-CRP gradient were 0.866 (95% CI: 0.775–0.958), 0.845 (95% CI: 0.746–0.943), and 0.762 (95% CI: 0.641–0.883), respectively. Pleural fluid hs-CRP showed the best discriminative performance and, at a cutoff value of 2.20 mg/dL, achieved a sensitivity of 63.9% and a specificity of 100%. Multivariable logistic regression showed that pleural fluid hs-CRP, serum hs-CRP, and the serum–pleural fluid hs-CRP gradient remained significantly associated with exudative pleural effusion after adjustment for potential confounding variables. Conclusions Pleural fluid hs-CRP, serum hs-CRP, and the serum–pleural fluid hs-CRP gradient demonstrated good discriminative performance for differentiating exudative from transudative pleural effusions according to Light’s criteria. Among these parameters, pleural fluid hs-CRP demonstrated the highest discriminative performance with the highest specificity and diagnostic accuracy. The pleural fluid/serum hs-CRP ratio did not provide additional discriminatory value.
Abstract Urachal carcinoma is a rare and aggressive malignancy arising from the urachal remnant and accounts for less than 1% of all bladder cancers. It is characterized by late presentation and an unpredictable metastatic pattern, most commonly involving the lungs and liver. Tracheo-oesophageal fistula (TEF) is usually associated with primary oesophageal or bronchogenic malignancies, and occurrence secondary to metastatic urachal carcinoma has not been previously reported. We describe a 33-year-old male with metastatic urachal adenocarcinoma who presented with cough and blood-tinged sputum triggered by swallowing liquids. Contrast-enhanced CT of the thorax suggested peri-tracheal pathology, and bronchoscopy confirmed a large fistulous communication in the posterior tracheal wall. The patient was managed with bronchoscopic placement of a self-expandable metallic stent, which resulted in symptomatic improvement. This case illustrates an exceptionally rare presentation of metastatic urachal carcinoma causing malignant TEF and emphasizes early and timely airway intervention to reduce aspiration-related complications and improve quality of life in advanced malignancy.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) accelerate disease progression and mortality, yet accessible biomarkers for risk stratification remain limited. The triglyceride-glucose (TyG) index may reflect the metabolic-inflammatory axis implicated in exacerbation susceptibility. In this analytical cross-sectional study, 91 patients with COPD (48 stable, 43 AECOPD per GOLD 2025/Rome criteria) were consecutively recruited. The TyG index calculation was performed as TyG index = Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]. Multivariable logistic regression adjusted for age, diabetes mellitus, hypertension, smoking index, BMI and C-reactive protein (CRP); diagnostic performance was assessed by ROC analysis. The TyG index was significantly elevated in AECOPD versus stable disease (4.7 ± 0.2 vs. 4.6 ± 0.2; p < 0.001) and associated with AECOPD (OR = 29.06, 95
Abstract Persistent or enlarging lymphadenopathy during treatment for tuberculous lymphadenitis is common but is frequently misinterpreted as microbiological treatment failure. Residual fibrosis, paradoxical inflammatory reactions, inadequate dosing or adherence, drug resistance, altered drug exposure, and alternative diagnoses may produce similar clinical presentations, while validated response criteria for lymph-node tuberculosis remain lacking. This structured narrative review synthesizes available guidance, observational studies, diagnostic evidence, pharmacokinetic literature, and expert clinical judgement to propose a practical framework for reassessment. The framework emphasizes confirmation of the original diagnosis, correct weight-based dosing, adherence and treatment continuity, recognition of paradoxical reactions, selective use of imaging, individualized repeat tissue sampling, molecular and drug-resistance testing, and consideration of alternative diagnoses. Imaging may define disease extent and complications but cannot reliably distinguish viable bacilli from paradoxical inflammation, sterile necrosis, or residual fibrosis. Repeat sampling may be considered when progressive or discordant disease is present and when the result is likely to alter management. Therapeutic drug monitoring is not routine standard care for drug-susceptible tuberculous lymphadenitis. Evidence supporting its use is very limited, predominantly indirect, and derived mainly from pulmonary or heterogeneous tuberculosis populations. It may be considered only as an optional specialist investigation in exceptional patients after more common causes of apparent non-response have been evaluated. The proposed framework is a practice-oriented and hypothesis-generating synthesis rather than a validated clinical algorithm or evidence-graded guideline. Its components should be individualized according to the clinical context and available resources, and prospective studies are required to validate their diagnostic and therapeutic utility.
Abstract Background Papillary thyroid carcinoma has a favorable prognosis; however, recurrent or locally invasive disease may rarely involve the trachea and cause critical airway obstruction. Therapeutic bronchoscopy with tumor debulking and airway stenting can provide rapid airway restoration in selected patients with malignant central airway obstruction. Case presentation A 55-year-old man with a history of papillary thyroid carcinoma treated with thyroidectomy and adjuvant radioactive iodine-131 ablation therapy presented with progressive shortness of breath, stridor, orthopnea, reduced exercise tolerance and intermittent hemoptysis. Oxygen saturation was 88% on room air and examination revealed audible inspiratory stridor. CT imaging demonstrated a heterogeneously enhancing solid mass arising from the left side of the trachea with tracheal wall invasion and severe airway narrowing. Flexible bronchoscopy showed a friable lesion occluding the tracheal lumen. Urgent rigid bronchoscopy was performed under general anesthesia. Argon plasma coagulation was applied to reduce tumor vascularity, followed by cryodebulking and deployment of a fully-covered self-expanding metallic (SEMS) nitinol tracheal stent. Histopathology and immunohistochemistry confirmed recurrent papillary thyroid carcinoma. Four-week follow-up confirmed satisfactory stent position and airway patency. Conclusion This case demonstrates the feasibility of urgent therapeutic bronchoscopy for immediate airway stabilization and short-term symptomatic improvement and its potential as a bridge to further oncological treatment in selected patients with recurrent papillary thyroid carcinoma causing malignant tracheal obstruction.
To investigate the effect of a speleotherapy environment on spirometric parameters in smokers and to compare the outcomes with those of the same yoga-based breathing exercise program performed in a standard clinical setting. This randomized controlled clinical trial included 60 adult smokers aged 18–65 years who were allocated to a speleotherapy group (n = 30) or a control group (n = 30). Both groups received the same physiotherapist-supervised yoga-based breathing exercise program for 6 weeks, twice weekly, in 50-minute sessions; the only difference was the intervention setting. Forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow, and forced expiratory volume in 1 s/forced vital capacity were assessed at baseline, week 3, and week 6. Physical activity, functional exercise capacity, and quality of life were also evaluated. Data were analyzed using linear mixed-effects models with group, time, and group × time interaction as fixed effects and participant as a random effect. Both groups showed improvements over time in spirometric and secondary outcomes. In the linear mixed-effects model analysis, the primary spirometric outcome, forced expiratory volume in 1 s, showed a significant group × time interaction in favor of the speleotherapy group. Significant group × time effects were also observed for 6-minute walk distance and selected quality-of-life domains, whereas broader spirometric superiority across forced vital capacity, peak expiratory flow, and forced expiratory volume in 1 s/forced vital capacity was limited. The findings suggest that the treatment environment may influence selected respiratory and functional outcomes in smokers. Yoga-based breathing exercises were associated with improvements in spirometric outcomes in both settings. The additional effect of the salt-cave environment on respiratory outcomes was limited, with a significant between-group difference observed only for forced expiratory volume in 1 s. The salt-cave setting may also be associated with greater improvements in functional capacity and selected quality-of-life outcomes, but broader pulmonary benefits or an independent speleotherapy effect cannot be concluded from the present findings. ClinicalTrials.gov, NCT07737587. Retrospectively registered on 30 July 2026.
