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Primary adenoid cystic carcinoma (ACC) of the trachea is a rare entity, with a 5-year survival between 50% and 80% for resectable cases and 30% in case of unresectable disease. We report a case of a primary ACC on a woman in her 70s that presented with a drawn-out history of dyspnoea. She was diagnosed with an unresectable obstructive tumour of the trachea, which required the placement of a Y-shaped stent. The patient underwent concomitant chemoradiotherapy, with partial response, and is still in follow-up, without evidence of disease progression., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

A 64-year-old manpresented with non-productive cough and dyspnoea and was evaluated and diagnosed to have a left lung mass on CT of the chest. A transthoracic needle biopsy under CT guidance revealed necrotic tissue on histopathology and was inconclusive. Positron emission tomography scan revealed a fluoro-deoxyglucose-avid left lung mass with a left upper lobe luminal cut-off. A flexible video bronchoscopy was performed and revealed left upper lobe complete obstruction with an endoluminal plug which was removed in piecemeal fashion, and deeper biopsies were taken from the lingula. Histopathology revealed underlying adenocarcinoma colonised by aspergillosis. This case serves to remind us of the possibility of missing underlying malignancy when taking superficial biopsies of clearly visualised endobronchial necrotic tissue and the need for debulking it to a reasonable extent and to take deeper biopsies in order to not miss a possible underlying malignancy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

A 38-year-old woman developed a spontaneous right-sided tension pneumothorax during light aircraft travel. The aircraft was diverted to a regional centre, where emergent needle thoracostomy and chest tube insertion were performed. History suggested that this was the second episode of pneumothorax, with an untreated event with similar symptomatology during air travel 1 year ago. She was taken for surgical intervention. Intraoperative findings were of a large right middle lobe cyst of uncertain origin; the procedure was subsequently aborted. A CT chest demonstrated a large multiseptated air-filled pulmonary cystic lesion. Inpatient stay was notable for persistent right pneumothorax with interval cyst rupture. A right middle lobectomy was subsequently performed with histopathology showing a benign epithelioid bronchogenic cyst. Recovery was unremarkable with no residual pneumothorax or further episodes at 2 months postoperatively. Preventative excision of air-filled pulmonary abnormalities should be considered prior to air travel., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

A 66-year-old woman presented with dry cough and subsequent intermittent breathlessness and wheeze. During this time she was treated by her general practitioner for chronic obstructive pulmonary disease. When her symptoms worsened and her lung function had deteriorated, a high resolution CT scan was undertaken. This showed bilateral fine nodules. Investigations did not support a diagnosis of vasculitis and sarcoidosis was suspected. A lung biopsy was performed that showed diffuse idiopathic neuroendocrine cell hyperplasia. At follow-up, to date, the patient remains symptomatic but has not progressed or developed a carcinoid tumour.