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case_images: A CT Chest that was obtained before intubation. This demonstrated left sided consolidation, infiltrate, mucus plugging and impaction of the left mainstem bronchus (red arrow), which was suspicious for a post-obstructive process secondary to possible neoplasm. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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case_images: He underwent computed tomography (CT) imaging of his chest showing a background of emphysematous changes along with mediastinal lymphadenopathy and left-sided tree-in-bud and ground glass opacities, consolidation, infiltrate, mucus plugging and impaction of the left mainstem bronchus (red arrow, Fig. 1). In the ICU, he underwent an urgent bedside fiberoptic flexible bronchoscopy revealing a white, fleshy, nodular mass with mucus impaction (Fig. 1).
case_images: Initial fiberoptic flexible bronchoscopy via GlideScope shortly after urgent endotracheal intubation. This was performed by overnight critical care revealing a white, fleshy, and nodular mass with mucus impaction. Biopsy not done due to concern for malignancy and to avoid additional bleeding.
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case_images: Diagnostic flexible bronchoscopy with endobronchial forceps biopsies were performed on the left mainstem mass a few days after ICU admission, and rapid-on-site-evaluation (ROSE) touch preps did not reveal any obvious neoplasm (Fig. 2).
case_images: Follow-up fiberoptic flexible bronchoscopy was performed a few days after initial endotracheal intubation and flexible bronchoscopy. This image shows a white, nodular tumor suspicious for malignancy after multiple forceps biopsies and before APC debulking.
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case_images: APC to pre-specified pulmonary settings (40 W, 0.8 L/min) in concert with large forceps for further debridement. At the end of the case, there was substantial improvement of the left mainstem lumen patency and was estimated to be 80 % (Fig. 3).