Figure A shows nodules anteriorly on the tracheal rings which may be mistaken for tracheobronchopathia osteochondroplastica (TPO) as it spares the posterior membrane.

Image courtesy of See Wei Low

39 year-old-male, smoker who comes in with worsening dyspnea and mass noted on CT chest occluding the distal tracheal. Bronchoscopy with biopsy diagnosed papillomatosis.

Image courtesy of MOUNIR FERTIKH

54 year old male patient presented with left main bronchus mass. Narrow-band bronchoscopy image. Biopsy revealed carcinoid tumor

Image courtesy of Zias Nikolaos

a 60-year old male patient with chronic cough, bronchoscopic image, biopsy revealed metastatic adamantinoma

Image courtesy of Apostolos Frimas

two endotracheal stents placed in a sleeve-like manner , required to provide adequate endotracheal pressure to open a left bronchus of a patient closed over 90% by mediastenum mass

Image courtesy of Apostolos Frimas

a case of a 35-year old male who presented with pain in the throat, inability to talk and wheezing while eating fish. The bronchoscopy revealed a fishbone placed perfectly between the vocal cords. The bone was snapped with forceps, then removed completely

Image courtesy of Apostolos Frimas

Pulmonary Carrtilaginous Hamartoma
Middle age gentleman presented with solitary pulmonary nodule in medial segment of right middle lobe during a routine chest radiograph. R-EBUS demonstrated an eccentric lesion with multiple hyperdense shadow within the target lesion. Transbronchial lung biopsy was consistent with cartilaginous pulmonary hamartoma.

Image courtesy of Kho Sze Shyang

Endobronchial Melioidosis
Middle age gentleman from melioidosis endemic region presented with acute onset of fever with cough. CT thorax noted infiltrating mass at left hilar peri-aortic region. Bronchoscopy noted abnormal scaly mucosa at left main bronchus circumstantially on white light and narrow band imaging. Blood culture grew burkholderia pseudomallei and endobronchial biopsy consistent with inflammatory changes. Patient responded to prolonged antimicrobial and lesion resolved on surveillance imaging.

Image courtesy of Kho Sze Shyang

Tumour infiltration over the right primary bronchus with friable mucosa and contact bleeding
HPE: small cell lung carcinoma

Image courtesy of Lee Kai Quan

unhealthy mucosa at secondary carina left lung, contact bleeding
HPE: squamous cell lung carcinoma

Image courtesy of Lee Kai Quan

Endobronchial lipoma as a cause of chronic cough - A non smoker male patient presented with dry cough off and on, with no diurnal or seasonal variation , over 10 years. The cough had increased in intensity and frequency since 1 year and there was no associated dyspnea or other symptoms. Chest xray PA, spirometry and HRCT thorax was normal. A fibreoptic bronchoscopy revealed a smooth, lobulated, non-friable endobronchial mass on the opening of the right middle lobe bronchus without any features of atelectasis of the distal lobes. Biopsy confirmed it as lipoma. Endobronchial lipomas account for 0.1%–0.5% of lung tumors. Diagnosis is often delayed due to the indolent nature of this tumor. Common symptoms include a persistent cough (81% of cases), chest pain and dyspnea, recurrent fever, pneumonia, and wheezing (if it obstructs the lumen significantly).

Image courtesy of Saurabh Karmakar

Subglottic Tracheal stenosis in a patient of Granulomatosis with polyangiitis (GPA), earlier known as Wegener's granulomatosis A non smoker patient aged 28 years old presented with cough off and on, dyspnea on exertion , hoarseness of voice and off and on hemoptysis since 3 months . Chest xray PA view and CT thorax showed multiple infiltrates in the bilateral upper lobes. Serum PR3 ANCA was elevated. A fibreoptic bronchoscopy revealed a tracheal stenosis in the subglottic area . Approximately 15% to 25% of all GPA patients experience subglottic stenosis.

Image courtesy of Saurabh Karmakar

A severe distal left mainstem bronchial stenosis several months following a motor vehicle accident is shown in A1 where a pediatric bronchoscope could not be passed. After serial balloon dilation, the left upper and left lower lobes with cartilage fracture are shown (A2).

Image courtesy of See Wei Low

77-year-old female, non smoker, no known exposure who comes in with dyspnea, weight loss, left sided pleural effusion and pleural disease on chest CT. She underwent rigid pleuroscopy, fluid drainage, pleural biopsy and tunneled pleural catheter placement - Pathology: Stage IV Adenocarcinoma

Image courtesy of MOUNIR FERTIKH

Malignant Trapped Lung - Metastatic Adenocarcinoma

Image courtesy of Kho Sze Shyang

Multiple large nodules and superficial dilated vessels over parietal pleura HPE: metastatic adenocarcinoma

Image courtesy of Lee Kai Quan

Pleural lipomatosis as a cause of pleural effusion -- Lipomas are benign tumors most commonly found in the subcutaneous tissue; however rarely, they may involve parietal pleura. Pleural lipomas are slow-growing tumors with no malignant potential but can diagnostic dilemmas to the clinicians. Pleural lipomas are benign soft-tissue neoplasms that originate from the submesothelial layers of parietal pleura and extend into the subpleural, pleural, or extrapleural space. They are soft, encapsulated fatty tumors with slow growth. The patient presented with pleural effusion of unknown etiology and semi rigid thoracoscopy revealed smooth, lobulated, multiple smooth yellowish nodules studded on the parietal pleura at multiple sites .Histopathology of biopsy sample was reported as adipose tissue comprising adipocytes and no evidence of atypia or malignancy, a finding which is characteristic of pleural lipomas.

Image courtesy of Saurabh Karmakar

Right-sided diaphragmatic pores in a patient with catamenial pneumothorax.

Image courtesy of Liu Estradioto and Rodrigo Bettega de Araújo

Thoracoscopic vision of central venous catheter wrongly positioned intrapleuraly.

Image courtesy of Cesar Ribeiro Zuccoli and Rodrigo Bettega de Araújo

Thoracoscopic image of parietal pleura showing potato like nodules- metastatic adenocarcinoma

Image courtesy of Dr. Sharad Joshi

Case Metastatic Malignant Melanoma. Male Patient 45 years old , with history of malignant Melanoma of the skin , removed surgically and received chemotherapy. 2 years later , he had right sided pleural effusion , exaudate , on thoracoscopic examination we found multiple parietal pleural based dark black nodules of different sizes , biopsy revealed Malignant Metastatic Melanoma

Image courtesy of Ayman A Hamid Farghaly, MD

Multiple large whitish nodules over visceral and parietal pleura HPE: metastatic adenocarcinoma

Image courtesy of Lee Kai Quan, MD

Hemorrhagic pleural effusion Multiple whitish nodues over the parietal pleura HPE: metastatic adenocarcinoma

Image courtesy of Lee Kai Quan, MD

Thoracoscopy images of left pleural cavity with parietal pleura studded with large irregular nodules with yellowish tip - histopathology shown clear cell renal cell carcinoma - Fuhrman grade III.

Case description:
A 66 years old male patient with history of left nephrectomy 2 years back due to renal cell carcinoma, presented with left sided pleural effusion - and was found to have isolated left pleural metastasis of clear cell renal cell carcinoma.

Image courtesy of Dr. Jaykumar Mehta

Pleuroscopic images demonstrate bloody pleural effusion and multiple small round red nodules on the diaphragm (A) and parietal pleura (B). Multiple small holes (*) are also discovered on the diaphragm (C). The histopathology of the nodules shows proliferative endometrial-typed glands surrounding by endometrial stroma which is covered with mesothelial cells (D). Thus, the diagnosis of pleural endometriosis is made by flex-rigid pleuroscopy.

Image courtesy of Viboon Boonsarngsuk, MD & Tharintorn Chansoon, MD

65yrs male patient with left sided encysted pleural effusion under gone thoracoscopy biopsy showing multiple grape like vascular nodules on parietal pleura. Biopsy revealed Squamous Cell carcinoma.

Image courtesy of DR SOMNATH BHATTACHARYA

Genitourinary (renal cell carcinoma)

Image courtesy of Fabien Maldonado, MD