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Background Bronchial resection and reimplantation in surgical management of lung cancer is intended to spare lung parenchyma, with curative intent. We studied the incidence and management of anastomotic complications after such procedures. Methods We retrospectively reviewed charts of patients referred to our center for lung tumors who underwent bronchial resection and reimplantation from 1992 to 2011. Results A total of 108 patients were included. Sixty-eight percent were male, and mean age was 58 years. Sleeve lobectomies were performed in 100 patients, bronchial resections without lung parenchymal resection in 8 patients. Squamous cell carcinoma represented 46.3% of cases, carcinoid tumors 22.2%, and adenocarcinoma 18.5%. Mean time between surgery and first bronchoscopic examination was 4.47 days. During the follow-up, anastomotic abnormalities were detected in 23 patients (21.3%): malacic or fibrotic bronchial stenoses in 9 cases (39.1%), dehiscences in 7 (30.4%), obstructive granulomas in 4 (17.4%), and bronchopleural fistulas in 3 (13.0%). Endoscopic treatment was indicated in 14 patients (13%) and consisted of stent placement in 6 cases (26%), mechanical dilations in 3 (13%), laser treatment for 1 case of bronchomalacia (4.3%), and resection of granulomas in 4 (17.4%). No risk factors were identified as predisposing for bronchial complications. There was a trend toward lower 1-year survival in patients with bronchial complications compared with those without (71.9% versus 83.4%; p = 0.114). Conclusions Bronchial resection and reimplantation is a surgical procedure associated with an anastomotic complication rate of 21.3%, but only 13% required endoscopic management. Regular endoscopic surveillance is advised to detect and treat early complications.

Complex airway diseases represent a therapeutic challenge and require multidisciplinary input. Surgery remains the definitive modality. Minimally invasive endobronchial techniques have resulted in symptom control and long-term improvements. The rigid bronchoscope remains the method of choice for the treatment of both benign and malignant central airway obstruction. However, it has limited use if lesions are located in the upper lobes or lung periphery, but significant technological advances allow for effective treatments using the flexible bronchoscope. Rigid and flexible bronchoscopes should be seen as complementary procedures and most cases require the use of both modalities.

Malignant mesothelioma (MM) is an uncommon neoplasm with a poor prognosis usually associated with asbestos exposure. 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) has become an invaluable tool for the diagnosis, staging, and prognosis of this severe disease as it combines both anatomic and functional information in a single imaging procedure, allowing for improved management of this disease. For many authors, 18F-FDG-PET/CT is the cornerstone of the pre-therapeutic evaluation of mesothelioma patients, particularly when multimodal therapy (including extra-pleural pneumonectomy or omentectomy) is considered. However, while characteristic patterns have been reported as predictive of macroscopic pleural or peritoneal involvement, false negative findings are possible, both for pleural and peritoneal mesothelioma, during the initial diagnosis or during the patient's surveillance as illustrated by this report of three cases of suspected MM with negative PET/CT. This report highlights the limitations of PET/CT in the diagnostic evaluation of MM and the importance of histopathological confirmation by thoracoscopy and/or laparoscopy, which remain the most important diagnostic procedures in MM.

Tracheostomy is often performed in patients requiring prolonged mechanical ventilation. Complications include tracheal stenosis, more often below the stoma than suprastomal. We report 3 cases of suprastomal complete obliteration of the trachea, all of which were successfully managed endoscopically using diode laser, mechanical dilation with the rigid bronchoscope, and stent placement.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as an interesting tool in the investigation of sarcoidosis and lymphoma. Aims: To describe the performance of EBUS-TBNA in the assessment of sarcoidosis and lymphoma, with attention given to alternative infectious diagnoses. Methods: We retrospectively reviewed the data of 69 patients evaluated for sarcoidosis or lymphoma, who had EBUS-TBNA between January 2013 and December 2014 in our center. Efficacy of EBUS-TBNA was evaluated in terms of providing a specific diagnosis with pathological or microbiological analyses. Results: Mean age of patients was 55 years old (range 21-87), with 41(59.4%) males and 57(82.6%) Caucasians. Culture on lymph node was obtained in 47(68.1%). EBUS procedure yielded diagnosis in 42/69(60.9%): 25 sarcoidosis, 6 lymphomas, 5 cancers, 3 tuberculosis (TB), 1 Mycobacterium avium complex (MAC) and 2 other benign diseases. The 3 patients diagnosed with lymph node TB were from Bangladesh, Haiti and Togo. All 3 underwent EBUS-TBNA for suspicion of sarcoidosis (2 of them having radiologic features compatible with stage 1 and the other, with stage 2). Culture on lymph nodes showed TB in 3, while granulomas were detected in only 1 case. Bronchoalveolar lavage was non diagnostic for all. MAC was found in an immunocompromised Caucasian with mediastino-hilar lymphadenopathy and suspected lymphoma. Diagnosis was obtained from EBUS-TBNA material which showed non-caseating granulomas and culture positive for MAC. Conclusion: In suspected cases of sarcoidosis or lymphoma, culture on lymph nodes should be obtained with EBUS-TBNA, especially in patients from countries with high prevalence of TB.