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Pulmonary extra-intestinal manifestations of inflammatory bowel disease are rare, comprising 0.21% to 0.4% of the inflammatory bowel disease population. Common symptoms include cough, chest pain, and dyspnea. Abnormal pulmonary function tests are common in these patients, with restrictive, obstructive, and diffusion capacity defects. CT scanning remains the most sensitive imaging technique to detect abnormalities. Pulmonary manifestations are diverse and include airway, parenchymal, and pleural disease. Large airway disease predominates, particularly bronchiectasis. Upper airway disease is rare but concerning for the development of acute airway compromise. To our knowledge, there are no reports of concurrent mediastinitis with tracheitis in the setting of inflammatory bowel disease. We present a case of a patient with ulcerative proctitis who experienced the development of inflammatory tracheitis and mediastinitis. Her disease responded to systemic steroids and biologic therapy. In addition to our case, we reviewed the literature and provide an approach to pulmonary complications as extra-intestinal manifestation of inflammatory bowel disease., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Competing Interests: None

Pathologies acquired after the establishment of an artificial airway include stenosis, granulomas and the formation of pseudomembranes, to name a few. The most common form of presentation in adults is circumferential stenosis, which often requires therapeutic endoscopic measures to achieve resolution. This Case Report describes the case of an obstructive inflammatory tracheal pseudomembrane in the shape of a tracheal septum secondary to repeated intubations that was resolved with conservative treatment. The clinical presentation of this entity generally includes the appearance of respiratory infection and/or atelectasis after the withdrawal of the orotracheal tube as a consequence of the accumulation of secretions between the tracheal wall and the pseudomembrane. Inflammatory pseudomembranes can resolve spontaneously with the help of glucocorticoids, although on occasion they require an invasive endotracheal procedure depending on the evolution., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Pulmonary aspergillosis encompasses a heterogeneous group of mycoses that result from either colonisation or pathogenic damage of lung tissue by Aspergillus fungi. These clinical entities range from relatively benign saprophytic hypersensitivity associated with fungal inhabitation to life threatening invasive disease. The diagnosis of pulmonary disorders related to Aspergillus is on the increase and it is more important than ever those both general and respiratory physicians have a good understanding of these disorders. This paper reviews the contemporary understanding of the clinical, radiographic and histopathological aspects of pulmonary aspergillosis., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

First clinical experiences with the organ care system (OCS) in lung transplantation showed that this device allows perfusion and ventilation of the lungs under practically physiological conditions. Some pulmonary pathologies necessitate ex situ operations, e.g. to avoid pneumonectomy. The objective of this work was to investigate the feasibility of ex situ pulmonary surgery within the OCS.In the first procedure a large tracheobronchial leakage was covered with a pericardial patch. The procedure was authorized by the local committee of animal welfare. In the second surgery a replacement of the distal trachea using an aortic graft was performed after removal of the heart-lung segment from a pig from the slaughterhouse. The postoperative ventilation of both lungs was free of problems. The mean pressure of the pulmonary artery remained steady during the whole experiment. The setup to prevent lung edema was basically successful.Performing thoracic surgery with the OCS is feasible; however, this approach is reserved for very special indications. Further investigations to optimize technical details of the OCS setup for this purpose are necessary.

Pediatric disorders that involve actual or potential airway compromise are among the most challenging cases that emergency department providers face. This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction.

Tracheomalacia is a frequent disease in the older population involving excessive airway collapse and it may present symptoms similar to pulmonary emboli. This is a case study depicting a patient's inadvertent breathing during a CT scan, performed to rule out pulmonary emboli. This examination revealed significant tracheomalacia, a condition usually diagnosed by bronchoscopy or specially tailored CT.

Invasive fungal infections of the respiratory tract are a major cause of serious morbidity and mortality especially in immunocompromised patients due to neutropenia, corticosteroids, or hematologic malignancy. The role of imaging is very important in the management of patients with fungal infections and chest x-ray is still the most used exploration. Nevertheless, new approaches recommend the systematic use of computed tomography scan for early documentation of invasive fungal infection. Combination of clinical setting with recognition of radiological pattern is the best approach to pulmonary fungal diseases. The following is a review of the imaging features of different invasive fungal infections we can face in our daily practice.

The spectrum of radiographic findings in pulmonary infections due to M. tuberculosis (TB) and non-tuberculous mycobacteria (NTM) are being increasingly discussed, primarily as a result of the increasing prevalence of these infections. The NTM organisms are often overlooked as potential infecting organisms, diagnosis is often delayed and radiologists tend not to include NTM in their differential diagnosis. The literature on the imaging appearances of NTM pulmonary infections is now sufficiently large as to identify some features that would help to distinguish an NTM infection from conventional pulmonary tuberculosis, allowing the radiologist at least to raise the possibility of NTM infection. This review article is intended to describe the radiological features, in the immunocompetent host, that accompany TB and NTM pulmonary infections and highlight the imaging features that would favour an NTM as the causative organism.

Objective: To examine the potential of the two tumour necrosis factor (TNF) inhibitors infliximab and etanercept as remission-inducing agents in chronic therapy-resistant inflammatory disorders of immune or non-immune pathogenesis., Methods: 14 patients with adult Still's disease/macrophage activation syndrome (4), Wegener's disease (3), Behçet's disease (3), keratoscleritis (1), lymphomatous tracheo-bronchitis (1) Cogan's syndrome (1), and rapidly destructive crystal arthropathy (1) were treated with infliximab (n = 10) and etanercept (n = 4). All patients showed organ-threatening progression of their diseases with resistance to conventional immunosuppressive medication. Therapeutic benefit was assessed clinically and by documenting organ-specific functional and morphological alterations. Side effects were compared with the data of our clinic's rheumatoid arthritis (RA) patients treated by TNF inhibitors., Results: A rapid and dramatic beneficial effect was documented in 9 patients and a moderate one in 5. Best responses (clinical and laboratory parameters) were seen in patients with macrophage activation syndrome/adult Still's disease and Behçet's disease, while the results were less impressive in those with Wegener's disease, Cogan's syndrome, idiopathic cerato-scleritis and lymphomatous tracheobronchitis. In all cases immunosuppressive agents and systemic glucocorticoids could be reduced or discontinued., Conclusions: TNF inhibition may be highly effective in patients with severe, therapy-resistant chronic inflammatory disorders.

Computed tomographic (CT) findings are described in three diabetic patients with central airways mucormycosis. The CT findings of the tracheobronchial mucormycosis include enhancing areas of mural thickening (n = 3), luminal narrowing (n = 3), intramural air (n = 3), low-attenuation nonenhancing bronchial wall thickening (n = 2), and bronchonodal fistula formation (n = 1). These CT features in a diabetic patient should raise a high index of suspicion for tracheobronchial mucormycosis, particularly when typical radiographic features of pulmonary tuberculosis are absent.

The evaluation of children with airway obstruction always involves a history and physical examination. The definitive diagnosis is most often made with microlaryngoscopy and bronchoscopy (MLB), and in cases of extrinsic compression, information is gained from magnetic resonance imaging. Although plain radiographs of the airway are often used as a primary diagnostic modality in children with airway obstruction, the accuracy of plain radiographs in predicting specific airway abnormalities has not previously been evaluated. This study was designed to correlate the findings of plain airway radiographs with the diagnosis made at the time of MLB. Medical records from 1991 to 1996 were reviewed to identify patients that had MLB and airway radiographs within 2 days of one another. One hundred forty-four cases were identified and divided into diagnostic categories. Statistical analysis showed a high sensitivity (>86%) for the accuracy of the radiologic diagnoses of exudative tracheitis, airway foreign body, and innominate artery compression. Laryngomalacia and tracheomalacia had a much lower sensitivity (5% and 62%, respectively). We believe that plain radiographic evaluation of the airway provides important information to the diagnostician. However, plain radiographs can be inaccurate and must be considered along with a history, physical examination, and clinical suspicion. Microlaryngoscopy and bronchoscopy remains the ultimate diagnostic test for airway disorders.

Bacterial tracheitis is characterized by acute upper-airway obstruction and purulent secretions within the trachea. Historically, affected children were young, stridorous, and toxic-appearing and required tracheal intubation, and morbidity and mortality were significant. Staphylococcus aureus was the most common organism involved. During the 14 months of this retrospective study, 46 children were admitted to the pediatric intensive care unit because of this diagnosis, and their medical records were reviewed. Compared with those in previous reports, children in this study were older (mean +/- standard error of the mean [SEM], 69.3 +/- 6.8 months) and less toxic. Only 26 (57%) of 46 patients required tracheal intubation. Intubated patients were significantly younger than nonintubated patients (mean +/- SEM, 46.9 +/- 6.5 vs. 98.9 +/- 9.9 months). Moraxella catarrhalis was identified in 12 (27%) of 45 bacterial respiratory cultures, while influenza A virus was recovered from 18 (72%) of 25 viral respiratory cultures. There were no major complications. This series represents the largest reported cohort of patients with this condition and suggests an epidemiological change toward a less morbid condition.

Bacterial tracheitis is a rare, life-threatening form of upper airway obstruction usually seen in children. It is often confused with other forms of upper airway obstruction and must be distinguished from viral croup and epiglottitis. The mainstay of treatment is establishing and maintaining an artificial airway, thus clearing the trachea of the mucopurulent exudate which has accumulated. It is wise for the physician to maintain a high index of suspicion for bacterial tracheitis especially in those children with fever and an upper airway obstruction who fail to exhibit the typical clinical features of croup or epiglottits.

The clinical entity of necrotizing tracheobronchitis (NTB) is well described in the pediatric literature. The incidence of NTB in neonatal autopsies varies from 4% to 44%. More than 3 hr of assisted ventilation may be necessary for the development of NTB in neonates. A similar clinical problem was described as "hemorrhagic tracheitis" in two adults during high frequency jet ventilation and as a complication of conventional mechanical ventilation in an adult. We present here a rather unusual case of NTB in an adult on mechanical ventilation, in whom tracheobronchitis was diagnosed incidentally with an 111In white blood cell scan obtained for other purposes.

Chronic tracheobronchial syndrome was diagnosed in eight dogs which had had a chronic mild cough for two to 13 months but were otherwise clinically normal. In five of them there was evidence of contact with other coughing dogs before the appearance of clinical signs and the majority at first responded favourably to antibacterial therapy. The coughing occurred mainly when the dogs pulled on their leads or became excited. Three cases had bronchoscopic evidence of active airway inflammation, and five had varying numbers of inflammatory cells (neutrophils) in bronchial aspirates. There was no evidence of excessive production of mucus in the airways of any of the dogs. Seven had an increased bronchial pattern on radiographs but only one of the dogs has developed chronic bronchitis.

Bacterial tracheitis is an uncommon cause of acute respiratory distress in children. The authors present a case of bacterial tracheitis in a 6-year-old girl caused by an unusual pathogen, Streptococcus pneumoniae. Her clinical presentation and radiographic findings are typical for an older child. Management of this case involved endotracheal intubation, although a review of the literature suggests that airway management can vary with age and size of the tracheal lumen. The microbiology of bacterial tracheitis shows a predominance of Staphylococcus and Streptococcus reported previously, with only three prior reported cases of Pneumococcus.

Cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) can present as either disseminated disease, pneumonitis, retinitis, gastroenteritis, neuropathy, or a subclinical infection. We report a patient whose initial manifestation of CMV infection was severe central airways obstruction due to necrotizing tracheitis. At bronchoscopy, the lesion appeared deeply ulcerated, distinctly different from previously described airway lesions in patients with AIDS. Mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only CMV. The patient responded partially to ganciclovir, steroids, and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma. CMV infection of the upper airway should be considered in the patient with AIDS presenting with atypical cough or stridor and ulcerated endobronchial lesions.

Ligneous conjunctivitis is a rare disease of unknown cause characterized by pseudomembranous, fibrous, woody, plaquelike deposits on the conjunctiva. The disease appears to be hereditary and/or familial. Deposits similar to those found in the eye occur in the larynx, tracheobronchial tree, nose and nasopharynx, and vagina. When these lesions occur in the larynx and tracheobronchial tree, voice change and potentially life-threatening obstruction and pulmonary disease may occur. This paper reports the findings in a child with ligneous conjunctivitis who was followed for 1 1/2 years and who had laryngeal and tracheobronchial involvement with voice change and airway obstruction. The literature is reviewed and the histopathologic findings and endoscopic findings and management of the patient are documented. Because the patient had multiple papillomata of both hands, a possible association with human papillomavirus was suspected but never confirmed.

To evaluate the usefulness of lateral neck roentgenograms when laryngotracheobronchitis (LTB) is the suggested diagnosis, three pediatric radiologists were asked to examine a series of lateral neck roentgenograms of subjects with LTB and controls. In six of the group with LTB, the roentgenograms were unreadable. Given adequate roentgenograms, the radiologists diagnosed or excluded LTB with a high degree of accuracy (sensitivity, 93%; specificity, 92%). However, their predictions of severity based on the roentgenograms showed a poor correlation with measures of clinical severity. The clinical severity of those with unreadable roentgenograms was significantly greater.

Membranous laryngotracheobronchitis (membranous croup), not previously described as a distinct entity, is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea (conus elasticus) and in the upper trachea distal to the conus elasticus. We reviewed 28 cases of membranous croup diagnosed by endoscopy and/or radiographic examination. The importance of the recognition of membranous croup as a distinct entity is discussed. The characteristic radiologic findings consist of subglottic tracheal narrowing, irregularity of contour of the proximal tracheal mucosa, and sometimes detached or partially detached proximal tracheal membranes, which can be mistaken for tracheal foreign bodies.

Important aspects for the diagnosis and therapy of diseases of the trachea and bronchi are the surgical anatomy, physiology and histopathology. For the evaluation of these diseases x-ray studies can make a major contribution.