We report a 55-year old lady with the presentation of stridor and type II respiratory failure requiringtracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiographrevealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis.However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe trachealcompression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascularsurgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopyfor airway stenting is unknown due to limited evidence available. Indeed, this form of central airwayobstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned.It may facilitate early weaning and allows less complicated airway control.

Madam S, who diagnosed to have stage IV lung adenocarcinoma with exon 21 L858R point mutation (T3N2M1a) was admitted for massive pericardial effusion in April 2016. She was ECOG 4 on admission. Her ECOG improved to 1 after pericardial tapping and initiation of free sample erlotinib 100 mg daily. Repeated CT thorax post treatment showed the disease was partial responded. Due to financial constraints, she had never bought any EGFR-TKI. She was given a free sample of erlotinib intermittently for total of 12 months followed by intermittent afatinib supply for 2 years. Due to this limited supply, she took half doses of afatinib by cutting a 40 mg tablet once every few days to sustain the continuation of cancer treatment. No major side effects were observed and she remained ECOG 0 with good weight gain. Up to her last clinic visit in September 2021, her PFS was more than 5 years. Intermittent doses of EGFR-TKI may prolong PFS in patients with advanced EGFRm+ NSCLC who has limited treatment options.

Foreign body aspiration is uncommon in adults who have no known risk factors such as mental retardation, poor dentition, or advanced age. Adults with foreign body aspiration are commonly misdiagnosed with bronchial asthma, however, does not respond to standard bronchodilator treatment. A thorough history-taking, focused physical examination and a high index of suspicion is crucial in making the correct diagnosis. This paper reports an interesting case of a 41- year-old woman with an undetected 10-year long foreign body aspiration which was misdiagnosed as bronchial asthma.