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Technique Awake tracheostomy for devastating airway obstruction have applied this simple, safe, efficient and low-cost procedure as a management strategy for malignant or benign tracheal obstruction that would frequently require Extracorporeal Membrane Oxygenation (ECMO) for circulatory support in other centers. Results We present a 52-year-old male with a rapidly growing neck mass, complicated by worsening orthopnea over the span of one week. A computed tomography (CT) scan revealed a huge, irregular neck mass extending from the upper mediastinum, causing severe airway compression. The patient initially had gone through an awake tracheostomy to secure tracheal obstruction, followed by a T-tube insertion under general anesthesia for both stabilization of the airway and voice preservation. Patent lumen after T-tube insertion allowed for a smooth procedure including a Magnetic Resonance Imaging (MRI) of the thorax and a Positron Emission Tomography with Computed Tomography (PET-CT) scan. An upper G-I endoscopy with a biopsy confirmed an esophageal tumor over 27–30 cm from the incisor. Following the diagnosis of squamous cell carcinoma of the esophagus with critical tracheal invasion, chemoradiotherapy was then given for definite treatment. We implemented this simple method in order to secure the devastated airway, sparing the need for a demanding rigid bronchoscopy, or use of a costly ECMO expedient. Conclusions We implemented this simple method in order to secure the devastated airway, sparing the need for a demanding rigid bronchoscopy, or use of a costly ECMO expedient.

Summary Technique Uncovered metallic stents have the potential to cause granulation tissue ingrowth, leading to re-occlusion and difficult or impossible retrievability. This can cause severe dyspnea or even life threatening respiratory distress. Critical tracheal stenosis which manifests itself into stridor and wheezing, while also exhibiting aggravated symptoms of orthopnea, will indicate that there is near total airway obstruction. Here, we present an awaked tracheostomy aid to initially treat the patient while under spontaneous ventilation to secure the airway readily. Results A 45-year-old female with tracheal stenosis due to tracheal trauma, underwent a tracheostomy followed by T-tube treatment. A recurrence of tracheal stenosis was noted two years later after decannulation, so the patient was employed an uncovered ultraflex stent for cosmetic reasons. Severe stenosis with orthopnea, due to fulminating granulomatosis with a variously cobble-stone shaped adherence over the proximal stent, was detected six months later. An awaked tracheostomy performed under local anesthesia following a laser ablation and removal of the stent while under general anesthesia, before an adequated T-tube stent was alternatively inserted. Conclusions The patient had maintained a hallmark of breathing ability and sound sleep after the operation, which was observed during a one-year follow-up examination.

A 62‐year‐old man was referred to our medical centre with productive cough and high fever over the span of one week, as well as the affiliated symptoms of chronic cough and dizziness for more than six months. Computed tomography (CT) of the thorax was performed and analysed revealing lobulated empyema with thick pleura and two foreign body (FB) retentions in the right lower lobe bronchus. The patient proceeded to thoracoscopic decortications and finalized through retrieval of two dark black stained bonelets with ignored aspiration. After surgery, the patient recovered uneventfully and was discharged in stable condition., We describe the successful treatment of an adult patient who presented to our hospital with the serious condition of empyema complicated by anaemia due to occult bonelet aspiration.

A 40‐year‐old man had considered himself to be robust, with the exception of an earlier diagnosis of hepatitis C. He underwent a wedge resection of the lung, at the left upper lobe (LUL), mimicking an anterior mediastinal tumor. A pathology report showed a 5 × 5 × 2.5 cm grey‐brown and yellowish lesion in a resected 9 × 6 × 3 cm of the lung, with a subsequent diagnosis of organizing pneumonia. The patient recovered uneventfully and was discharged while in a stable condition. One month later, he was admitted and given empiric antibiotic treatment for a lung abscess due to a compound symptom for three weeks after discharge. Although his symptom improved readily, a computed tomography (CT) of the chest disclosed a steady consolidation over the LUL. The fluctuation with haemoptysis and a productive cough spanned 11 months, until a bout of aggravated symptoms including foul and blood‐tinged sputum which mingled with an intermittent high fever became evident. The patient then underwent a bronchoscopy, which surprisingly revealed a metal material impacted over the orifice of the LUL bronchus, requiring biopsy forceps removal. The patient readily recovered with his symptoms thoroughly subsiding thereafter.

Background Neoadjuvant chemoradiotherapy is currently the gold standard treatment for esophageal cancer prior to surgery. This radiation therapy will sometimes lead to liver damage parallel to esophageal lesions, which mimics liver metastasis visualized by 18F-fluorodeoxyglucose positron emission tomography with computed tomography. In this report, we publish virtual radiation-induced liver damage images obtained during surgery, along with the coherent pathology, in order to confirm the false-positive result through an optimally decisive radiological examination. Case presentation We report a case of a Asian male patient with distal esophageal cancer who had undergone neoadjuvant chemoradiotherapy (5000 cGy). Subsequently, a new lesion was discovered during a positron emission tomography with computed tomography scan 6 weeks later, near the left caudate lobe of the liver during tumor restaging. To exclude the possibility of liver metastasis, serial imaging was conducted, which included liver sonography, computed tomography, and magnetic resonance imaging for a more intimate probe. The patient’s condition was verified as being liver inflammation change, as seen by the liver magnetic resonance imaging presentation. Thoracoscopic esophagectomy was performed with cervical esophagogastrostomy via the retrosternal route, along with a feeding jejunostomy. The procedure was performed smoothly, with an intraoperative liver biopsy also being conducted 2 weeks later, after positron emission tomography with computed tomography restaging. The pathology report revealed esophageal cancer in the form of poorly differentiated squamous cell carcinoma, pT3N1M0. The liver biopsy revealed obvious inflammation change after radiation therapy, which elucidated sinusoidal congestion with the attenuated hepatic cords and filled with erythrocytes. There was no evidence of liver metastasis. The patient recovered uneventfully and was discharged with his oral intake performing smoothly, and a stable condition was observed during 12 months of outpatient department follow-up. Conclusions New foci of increased 18F-fluorodeoxyglucose avidity are commonly seen in the caudate and left hepatic lobes of the liver during neoadjuvant chemoradiation for distal esophageal cancer, and these findings generally reflect radiation-induced liver disease rather than metastatic disease. Awareness of the pitfalls of a high 18F-fluorodeoxyglucose uptake in radiation-induced liver injury is crucial in order to avoid misinterpretation and overstaging. Except for the location of 18F-fluorodeoxyglucose uptake, the shape of the lesion, and an maximum standardized uptake value (> 10/h), a convincing liver magnetic resonance imaging scan or even a liver biopsy can provide accurate information for distinguishing radiotherapy-induced liver injury from liver metastasis.

Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. Conservative treatment is full‐fledged for uncomplicated cases. We presented here an 18‐year‐old young adult with chest trauma caused by a fall. Chest computed tomography disclosed a cavitary lesion 10.5 × 8.5 × 6.4 cm3 over right upper lobe (RUL) with bilateral lower lung contusion and a mild haemopneumothorax but without rib fractures. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X‐ray were recorded for the analysis of natural healing processes., Traumatic pneumatocele (TP) is a very rare condition that occurs mostly in children and young adults. To the best of our knowledge, we present here a case of the largest TP without rib fracture. Under conservative treatment, the condition lasted for ~8 months before complete resolution. Detailed temporal changes in chest X‐ray were recorded for the analysis of natural healing processes.