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Long-term sequelae of scapholunate instability predictably result in progressive arthritic changes. In early stages of arthritis, joint space narrowing, subchondral sclerosis, and osteophytic formation can be difficult to appreciate on posterior-anterior (PA) X-ray views of the wrist. In patients with scapholunate advanced collapse (SLAC) wrist, the pencil grip X-ray may more accurately define the joint space narrowing in the radioscaphoid and radiolunate articulations compared with standard PA radiographs. We conducted a retrospective chart review of all patients with pencil grip X-ray views and documented wrist arthritis at a single institution. A total of 29 patients met criteria. Two authors independently reviewed wrist X-rays and classified the X-rays based on radiographic stages of arthritis for both PA and pencil grip X-rays. Radioscaphoid and radiolunate joint spaces were measured, and mean comparisons were performed using student's t -test, and boxplot comparisons were calculated for each arthritis grade. In direct comparison of joint space narrowing, the radioscaphoid distance observed on the pencil grip radiographs was significantly lower than the PA wrist view in all arthritis grades ( p &#x2009;<&#x2009;0.05). The pencil grip view demonstrated more accurate joint space narrowing in patients with grade 2 osteoarthritis, but, not in other grades. There were no differences in radiolunate distance between pencil grip and PA wrist X-rays in all arthritis grades. The pencil grip X-ray view demonstrated significantly lower radioscaphoid distances across all arthritis grades compared with PA views, suggesting it may be more sensitive in detecting joint space narrowing. In particular, the pencil grip view more accurately demonstrated radioscaphoid joint space narrowing with grade 2 osteoarthritis. No significant differences were found in radiolunate distances between the two imaging methods. This study highlights the potential of the pencil grip X-ray view as a valuable tool for more accurately assessing early radioscaphoid wrist arthritis.

Major advances in tuberculosis diagnostics and biomarker research from 2020 to 2025 have informed updated WHO policy guidance, consolidating recommendations for the detection of tuberculosis disease and drug resistance within a single framework. These recommendations align screening, diagnosis, and drug-resistance testing across populations and specimen types. Digital chest radiography, increasingly supported by computer-aided detection, is now a core WHO-recommended screening and triage tool, improving case detection and referral for confirmatory testing at scale. Decentralised molecular diagnosis has expanded through diversified deployment of WHO-recommended rapid diagnostic test classes, particularly low-complexity automated nucleic acid amplification tests (NAATs), including the Xpert MTB/RIF Ultra and Truenat platforms. These tests are complemented by low-complexity manual NAATs such as tuberculosis loop-mediated isothermal amplification and by emerging near point-of-care molecular platforms under evaluation. Latest WHO policy updates have also introduced a new class of near point-of-care NAATs designed for decentralised use, alongside novel specimen types such as tongue swabs for individuals unable to produce sputum, and programmatic innovations, including sputum pooling, to improve efficiency. Expanded use of molecular diagnostics across non-sputum specimens, including stool, gastric aspirate, and nasopharyngeal samples, together with simplified workflows, has improved bacteriological confirmation in children and other sputum-scarce populations. Rapid molecular drug-resistance testing has advanced with Xpert MTB/XDR, and targeted next-generation sequencing is now recognised as a WHO-endorsed approach for comprehensive drug-susceptibility testing at reference laboratory level. Urine lipoarabinomannan-based assays improve diagnostic yield in people with HIV, particularly those with advanced disease, although performance limitations constrain broader use. Substantial performance, implementation, and equity gaps remain. In parallel, host blood transcriptomic signatures show strong short-term prognostic and triage performance, and additional proteomic, metabolomic, cellular, imaging, and pathogen-derived biomarkers are advancing through clinical evaluation. However, no biomarker has yet met the WHO target product profile criteria for a point-of-care test that reliably distinguishes M tuberculosis infection from tuberculosis disease, including asymptomatic or minimally symptomatic tuberculosis disease, often described in the research literature as subclinical tuberculosis.

Postoperative respiratory complications, particularly in patients with poor oral hygiene, contribute significantly to morbidity and healthcare burden. The oral cavity serves as a reservoir of pathogenic micro-organisms that, when aspirated during or after surgery, can lead to respiratory infections. While chlorhexidine mouthwash has shown promise in high-risk surgeries, its role in short-duration elective abdominal surgeries remains unexplored, especially in low-resource settings. This double-blind, randomised controlledrial included 228 patients (American Society of Anaesthesiologists I/II, aged 18-65 years, Oral Hygiene Index (OHI) >6) undergoing elective abdominal surgery under general anaesthesia lasting <4 hours. Patients were randomised to receive either 0.2% chlorhexidine (group A) or normal saline (group B) mouthwash two times before surgery. Outcomes measured included postoperative sore throat, fever, pneumonia, surgical site infections (SSI) and length of hospital stay. Microbiological cultures, complete blood count, C-reactive protein (CRP) and chest X-rays were evaluated on postoperative days 1, 3 and 7. Chlorhexidine significantly reduced sore throat (18.42% vs 47.37%, p<0.001), positive bacterial cultures (21.05% vs 62.28%, p<0.001), CRP elevation and SSI (4.39% vs 21.93%, p<0.001). Length of hospital stay was also shorter in the chlorhexidine group (p<0.001). Pneumonia rates were low and comparable. This double-blind randomised controlled trial demonstrates that preoperative use of chlorhexidine mouthwash significantly reduces postoperative sore throat, bacterial colonisation, SSI and length of hospital stay in patients with poor oral hygiene undergoing short-duration elective abdominal surgeries. These findings highlight the utility of a simple, low-cost oral hygiene intervention in improving surgical outcomes, particularly in low-resource settings and support its incorporation into standard perioperative protocols, even for lower risk procedures. CTRI/2024/06/069511).

Achieving the goal of tuberculosis (TB) elimination in India requires innovative approaches. The TB-Free Haryana Mission is a decade-long public-private partnership (PPP) between the government of Haryana state and Medanta - The Medicity, a tertiary corporate hospital designed to strengthen TB case detection and care, particularly among underserved populations. Launched in 2014 as a pilot in Rewari district, the initiative scaled statewide by 2019 using a mobile diagnostic model that integrated digital chest X-ray screening, sputum microscopy and rapid molecular testing. Over time, point-of-care molecular diagnostics and AI-assisted chest X-ray interpretation were incorporated to enable same-day diagnosis and treatment initiation. Over 10 years, the Mission performed >62 000 chest X-rays, achieving an overall high diagnostic yield (5.3%) and extending access to quality diagnostics in remote rural settings. The approach improved detection of smear-negative TB, reduced delays between diagnosis and treatment and remained operationally effective even during the COVID-19 pandemic. Long-term sustainability was supported through shared funding, continuous technological upgrades, strong monitoring systems, community engagement and alignment with national TB policies. This experience demonstrates that a technology-enabled, domestically funded PPP model can effectively bridge diagnostic gaps and is scalable for replication to accelerate TB elimination efforts in India.

This study aimed to evaluate the validity of the test bolus tracking (TBT) method for head computed tomography (CT) angiography (CTA) using four-dimensional (4D) CT data in patients with subarachnoid hemorrhage (SAH). We analyzed 39 patients who developed SAH and underwent 4D CT. Based on the imaging protocol, patients were classified into a test-injection (TI) group and a TBT group. Time-enhancement curves (TECs) of the M1 segment of the middle cerebral artery were measured. Validation was performed by assessing the concordance between the TEC peak time and the peak scan timing set on 4D CT (peak concordance rate). The median TEC peak time for all patients was 10.7&#x2009;s (range: 9.2-17.1&#x2009;s). The peak concordance rate was 100% in the TI group and 76% in the TBT group. In TBT cases where the peaks did not match, the scan start was determined prematurely using bolus tracking during the test injection. Univariate analysis comparing the TBT group with the TI group showed that the TBT group had a lower concordance rate and shorter examination time (P<0.05). The results of this study suggest that, if the TBT method can accurately determine the peak time of the test injection, it is a valid technique for head CTA.

Biliary disease is the leading identifiable cause of acute pancreatitis, yet many attacks remain "idiopathic" after routine tests. Wider use of endoscopic ultrasonography (EUS) has revealed biliary sludge and microlithiasis as frequent, previously occult causes of pancreatitis. To summarise current evidence on the pathophysiology, diagnosis and management of biliary sludge-associated acute pancreatitis (BSAP) and propose a simple clinical framework. Narrative review of experimental and clinical studies, practice guidelines and consensus statements identified through targeted searches of PubMed, Embase and the Cochrane Library, complemented by citation tracking of key articles. Available data support a microcrystal-driven model in which lithogenic bile, impaired gallbladder emptying and mucin-rich aggregates promote sludge formation, while transient obstruction and bile acid-mediated epithelial injury in the distal bile duct-papillary outflow segment trigger pancreatitis. First-line ultrasonography and computed tomography have low sensitivity for sludge, whereas EUS is more sensitive than magnetic resonance cholangiopancreatography for detecting microlithiasis in suspected idiopathic acute pancreatitis. Grading diagnostic confidence (definite, probable or presumptive BSAP) and integrating disease severity can rationalise use of MRCP/EUS, selective ERCP, cholecystectomy and adjunctive medical or metabolic strategies. BSAP is a clinically relevant entity within the biliary pancreatitis spectrum. Applying a structured, confidence- and severity-based approach may help standardise investigations, optimise timing of ERCP and cholecystectomy and reduce preventable recurrences.

Intermaxillary fixation (IMF) is commonly performed following orthognathic surgery, including Le Fort I osteotomy and sagittal split ramus osteotomy, to maintain the planned occlusion. Although perioperative pulmonary complications are rare in healthy young adults, we encountered a case of lung abscess that developed from aspiration pneumonia during the period of IMF. Here, we report the case with a review of the literature. The patient was a 22-year-old man with bilateral cleft lip and palate, presenting with class III malocclusion due to maxillary hypoplasia. Orthognathic surgery (Le Fort I osteotomy and sagittal split ramus osteotomy) was performed to improve facial appearance and occlusion. Postoperatively, he developed a fever, and his oxygen saturation decreased. On postoperative day (POD) 8, chest radiography and CT revealed pneumonia in the left lower lobe, and antibiotic therapy was initiated. Despite treatment, his condition persisted, and a repeat CT on POD 15 showed progression to a lung abscess. A string test-positive Klebsiella pneumoniae (Kp) was identified as the causative organism. Upon switching to broad-spectrum antibiotics, the inflammatory response subsided, and antibiotic treatment was completed on POD 43. Severe aspiration pneumonia is rare in young patients without underlying disease. In this case, IMF and infection with a string test-positive Kp led to abscess formation, complicating treatment. This highlights the importance of early detection and treatment of pneumonia during the period of IMF.

Adenoid cystic carcinoma (ACC) is an uncommon malignancy arising from secretory glands. While most commonly involving the parotid and submandibular glands, it can arise from any of the minor salivary gland tissue in the upper aerodigestive tract. This report features a more uncommon presentation of ACC in a 69 y.o. gentleman with a mass in his upper lip. Initial CT scan with contrast was concerning for an invasive lesion which subsequently led to a guideline-driven workup including fine-needle aspiration that was concerning for suspected salivary gland malignancy, most likely ACC. Pre-treatment chest CT was negative for metastatic disease. The patient underwent surgical excision followed by radiation therapy for definitive treatment. Surgical pathology confirmed a diagnosis of ACC with perineural invasion. The patient was treated with radiation therapy to minimize risk of tumor recurrence. Due to high prevalence for late recurrence and lung metastasis in patients with adenoid cystic carcinoma, the patient will be seen for ongoing surveillance including imaging. This case report looks to describe a more uncommon presentation of ACC and reviews the literature for management of ACC involving the minor salivary glands.

The purpose of this study was to investigate distribution and pattern of tracer uptake on single-photon emission computed tomography/computed tomography (SPECT/CT) images around the scapula after reverse total shoulder arthroplasty (rTSA) and to determine the correlation between tracer uptake values and clinical parameters. Thirty-five patients treated with primary rTSA (21 lateralized type vs. 14 medialized type) were retrospectively reviewed. All patients were taken SPECT/CT preoperatively and postoperatively at 6 months. Maximum standardized uptake value (SUVmax) was measured at the 4 regions of interest (ROIs): anterior acromion, posterior acromion (PA), scapular spine (SS), and coracoid process (CP). Demographic data and clinical parameters were prospectively evaluated before surgery and at postoperative 6 months. During the postoperative 6-month follow-up evaluation, 2 cases with nondisplaced scapular stress fracture (5.7%) and 1 case with scapular stress reaction (2.8%) were diagnosed. Mean postoperative SUVmax for 3 ROIs including PA, SS, and CP were significantly increased compared to preoperative values (PA: 9.6 &#xb1; 9.0 vs. 5.3 &#xb1; 2.2, SS: 7.0 &#xb1; 2.8 vs. 5.9 &#xb1; 2.0, and CP: 7.3 &#xb1; 2.1 vs. 6.3 &#xb1; 2.0). PA had the highest mean postoperative SUVmax among 4 ROIs and the largest SUVmax difference between before and after rTSA. Bone mineral density, activity of daily living score, American Shoulder and Elbow Surgeons score, forward flexion, and abduction at postoperative 6 months were negatively correlated with postoperative SUVmax for PA. Visual analog scale pain score at postoperative 6 months was positively correlated with postoperative SUVmax for PA. However, after correction for multiple testing using the Benjamini-Hochberg false discovery rate method, none of the associations remained statistically significant. This SPECT/CT study demonstrated increased tracer uptake in PA, SS, and CP after rTSA to indicate stress concentration. In particular, PA was the most vulnerable area for stress concentration following rTSA. These findings may support the potential role of SPECT/CT in early detection of stress-related changes in symptomatic patients.

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Stapled bullectomy is a safe procedure for primary spontaneous pneumothorax (PSP). Early infection-driven staple-line failure with metalloptysis after bullectomy for PSP is rare. A 21-year-old man underwent video-assisted thoracoscopic bullectomy for persistent right PSP. The staple lines were reinforced with polyglycolic acid sheets. The early postoperative course was uneventful, but the patient developed fever, cough, and purulent sputum on postoperative day 21. Computed tomography demonstrated fluid-filled cavitary lesions along the staple lines in the right upper and lower lobes, with partial staple-line disruption. Sputum cultures yielded oral commensals, and an acute lung abscess associated with staple-line failure was diagnosed. Antibiotic therapy was initiated, and he expectorated several surgical staples. The abscess resolved with conservative treatment. This case suggests that acute infection along pulmonary staple lines can lead to staple-line failure and metalloptysis even after routine bullectomy. Persistent postoperative fever or purulent sputum should prompt careful evaluation for staple-line-associated infection.

Most recently, a novel color-encoding light-field detector based on perovskite material has been demonstrated for x-ray differential phase contrast (DPC) imaging. However, it lacks performance evaluation and comparison between such a novel light-field detector and a widely used grating interferometer before applying it into medical imaging field. This study aims at evaluating and comparing the DPC imaging performance of the light-field detector and the grating&#xa0;interferometer. In this work, a mathematical signal model was developed for the color-encoding perovskite light-field detector designed for x-ray DPC imaging. Specifically, the beam refraction angle was modeled based on the changes in the emitted color within the standard CIE1931 color space. Upon it, noise responses were derived. Numerical simulations were conducted to compare the sensitivity and signal variance of the perovskite light-field detector with those of a generic grating interferometer system. Additionally, impacts of the polychromatic x-ray beam and the Compton scattering were also&#xa0;investigated. It was found that the sensitivity of the perovskite light-field detector may surpass that of the grating interferometer if its color depth exceeds 30-bit (three 10-bit color channels). For perovskite light-field detectors, the signal noise increases as the detected refraction signal increases. In addition, polychromatic x-ray beam adds bias to the retrieved DPC signal, but has slight impact on the signal noise. Compton scattered x-ray photons could dramatically change the retrieved DPC&#xa0;signal. This study demonstrates that the novel perovskite light-field detector may not be suitable for medical grade DPC imaging due to the inevitable Compton scatters. However, it might be a promising alternative to the grating interferometer in developing state-of-the-art scientific DPC imaging instruments for small sample ( &#x2264; 2 mm ), in which the impact of Compton scatters could be&#xa0;ignored.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis characterized by asthma, eosinophilia, and multi-organ involvement. Adolescent-onset disease is uncommon, and evidence guiding biologic therapy in this population remains limited. We report the case of an 18-year-old female with a history of chronic rhinosinusitis and eosinophilic asthma who presented with worsening asthma control, arthralgia, and peripheral eosinophilia (4, 600 cells/&#x3bc;L), with palpable purpura developing during hospitalization. Chest radiography was initially unremarkable, but chest computed tomography revealed peripheral ground-glass opacities and consolidations. Further workup demonstrated eosinophil-rich perivascular infiltrates with karyorrhectic debris without necrotizing vasculitis on skin biopsy, and high-titer anti-myeloperoxidase (anti-MPO) antibodies >200 RU/mL on immunologic testing. The diagnosis of EGPA was established according to the 2022 ACR/EULAR classification criteria with a total score of 10. Initial treatment with high-dose corticosteroids resulted in partial improvement, but the disease relapsed during tapering, indicating corticosteroid dependence. Benralizumab was subsequently introduced, leading to rapid eosinophil depletion, improved pulmonary function, successful corticosteroid reduction, and prompt clinical remission. At 12-month follow-up, the patient remained in complete remission, with normalized pulmonary function, no evidence of new organ involvement, and a marked decline in anti-MPO antibody titers. This case highlights the importance of considering EGPA in adolescents presenting with difficult-to-control eosinophilic asthma and systemic manifestations, and demonstrates that benralizumab can achieve stable, long-term remission with successful corticosteroid reduction even in ANCA-positive disease.

Generative artificial intelligence (GenAI) is increasingly explored for medical image synthesis, medical education, and dataset augmentation; however, the detectability and reader-perceived visual authenticity of synthetic chest radiographs generated by accessible multimodal models remain insufficiently understood. This study evaluated synthetic disease-specific chest radiographs generated by gpt-image-2 and gemini-3-pro-image-preview, hereafter referred to as the GPT-image model and the Gemini-image model, respectively, using two generation strategies: text-only generation and image-conditioned generation based on age- and sex-matched normal conditioning radiographs. We included 320 real disease-positive frontal chest radiographs covering cardiomegaly, pneumothorax, pleural effusion, and pneumonia, together with 320 matched normal conditioning radiographs. Synthetic and real disease-positive radiographs were randomized and independently assessed by four radiologists in a blinded single-image reader study, followed by paired evaluation of previously undetected image-conditioned synthetic radiographs. Image-level similarity was assessed using the structural similarity index measure (SSIM), learned perceptual image patch similarity (LPIPS), and Fr&#xe9;chet Inception Distance (FID). Image-conditioned generation had significantly lower AI detection rates than text-only generation (34.0% vs. 56.1%) and consistently lower FID values. Synthetic radiographs generated by the GPT-image model were less frequently detected than those generated by the Gemini-image model and showed higher image-level structural and perceptual similarity to the conditioning radiographs. Paired comparison improved detection of previously undetected image-conditioned synthetic radiographs. These findings indicate that image-conditioned GenAI can produce synthetic chest radiographs that may appear visually authentic to radiologists, highlighting the need for transparent labeling, provenance tracking, expert review, and controlled integration of synthetic medical images into healthcare, education, and research workflows.

State-level dense breast legislation aims to increase awareness of breast density and promote supplemental imaging, yet the association of specific legislation type with imaging use remains unclear. To evaluate the differential association of dense breast notification and insurance coverage laws with supplemental imaging use and to assess how specific legislative features are associated with imaging use. This retrospective, quasi-experimental cohort study used data from the MarketScan database, one of the largest national administrative claims databases in the US, from January 1, 2008, through December 31, 2019. A total of 12.6 million women aged 40 to 64 years undergoing screening mammography with continuous insurance enrollment for at least 6 months after the index screening mammography were followed up for up to 6 months after the screening mammography. Data were analyzed from January to July 2025. Dense breast legislation, including notification and insurance coverage laws. Receipt of supplemental ultrasonography or magnetic resonance imaging (MRI) within 6 months of screening mammography. Multivariable logistic regression with an extended difference-in-differences design was used to assess within-state changes over time, leveraging variation in the timing of policy adoption across states. Of 12&#x202f;555&#x202f;082 women (mean [SD] age, 51.3 [6.9] years) undergoing mammography, 9.0% received supplemental ultrasonography and 0.6% received supplemental MRI. Notification mandates were associated with higher use of ultrasonography (odds ratio [OR], 1.09; 95% CI, 1.08-1.10) and MRI (OR, 1.09; 95% CI, 1.06-1.12). Insurance coverage was associated with higher odds of supplemental ultrasonography use (OR, 1.88; 95% CI, 1.86-1.90). Among states with notification mandates, including information on supplemental screening (OR, 2.84; 95% CI, 2.81-2.86) and targeting notification only to women with dense breasts (OR, 1.32; 95% CI, 1.31-1.33) were both associated with higher odds of ultrasonography use. In this cohort study of women undergoing mammography, both dense breast notification and insurance coverage laws were associated with increased use of supplemental ultrasonography, with greater odds observed for insurance mandates. Specific legislative features, particularly targeted notification and inclusion of supplemental screening information, were also associated with increased use of supplemental ultrasonography. Further studies covering wider populations and integrating claims data with clinical registries, imaging reports, or electronic health records are needed to better delineate the association between dense breast legislation and supplemental screening behavior.

Childhood tuberculosis (TB) remains a significant global health challenge, with a substantial number of cases going undiagnosed, particularly among children under five. Early diagnosis and intervention are crucial to reduce TB-associated morbidity and mortality. Point-of-Care Ultrasound (POCUS) represents a promising technology that could enhance TB diagnosis, especially in resource-constrained settings. This qualitative study assessed the acceptability and feasibility of POCUS implementation in the TB diagnostic evaluation in children under 5&#x2009;years of age in Uganda, by exploring the perspectives and experiences of local healthcare professionals. Semi-structured interviews were conducted with clinicians at two different sites and stakeholders involved in paediatric TB policy and programmes in Uganda. Interviews focused on exploring participants' perspectives on the acceptability and feasibility of POCUS implementation for diagnosing paediatric TB. Thematic analysis was used to analyse interview data, aiming to identify key themes related to POCUS implementation in the local healthcare context. Participants highlighted POCUS as a potentially valuable tool for improving paediatric TB diagnosis, as it enables immediate imaging and interpretation, bypassing the delays and accessibility barriers associated with X-rays. Potential barriers identified for large-scale implementation include limited diagnostic accuracy, usability, lack of equitable access, need for capacity building and durability of POCUS devices. This study underscores the potential role of POCUS in the management of children with presumed TB in resource-constrained settings like Uganda. Addressing identified barriers through targeted interventions and further research will be essential for the successful implementation of POCUS in local healthcare practices.

Radiologists classify breast density using the Breast Imaging Reporting and Data System (BI-RADS) as required by the 2024 Mammography Quality Standards Act (MQSA), which mandates disclosure of breast density in all mammography reports. FDA-approved AI software now provides objective, reproducible breast density assessments to improve workflow and guide supplemental screening. This study examines concordance between AI-based systems (Volumetric density measurement by Volpara/Lunit) and radiologist assessments and explores potential clinical and economic implications. A retrospective cohort study with IRB approval was conducted at Avera Health using 54,819 mammograms between February 2024 and June 2025. Radiologists assessed breast density with the option to override AI-generated assessments. Density classifications were compared and categorized as "agreement" or "substantial change." Effects on Tyrer-Cuzick (TC) lifetime risk scores, patient referrals, and prospective healthcare costs were analyzed. Overall, AI and radiologist assessments had agreement rates of 92-97% for BI-RADS B and C and 85-90% for A and D. Most discrepancies involved BI-RADS B and C categories, leading to misclassification of breast density and potential repercussions for patient care. Overestimation resulted in unnecessary procedures, radiation, costs, and anxiety, while underestimation risked delayed detection of aggressive cancers. Current AI software demonstrates concordance with radiologist assessments, though notable variability persists at critical diagnostic thresholds. Utilizing standardized protocols, periodic AI model updates, and radiologist oversight are crucial to minimizing misclassification, enhancing workflow efficiency, optimizing patient outcomes, and fostering trust in AI-assisted breast imaging.

Amyloidosis comprises a group of disorders characterized by extracellular deposition of misfolded amyloid proteins within tissues and organs. Tracheobronchial amyloidosis is a rare form of localized amyloidosis involving deposition within the tracheobronchial tree and often presents with nonspecific respiratory symptoms that can mimic more common pulmonary diseases. Because of its rarity and variable presentation, diagnosis may be delayed. Increased awareness of this condition is important to facilitate timely recognition and management. A 49-year-old male presented to a pulmonology clinic with a nine-month history of intermittent cough and hemoptysis. Episodes were characterized by sore throat followed by nonproductive cough, wheezing, dyspnea during coughing spells, and blood-tinged sputum. Symptomatic episodes lasted several weeks and recurred three times over nine months. Prior treatment with antibiotics, corticosteroids, and bronchodilators provided partial relief. Chest radiography demonstrated mild hyperinflation without acute findings, and physical examination revealed rhonchi. Computed tomography of the chest demonstrated irregular thickening of the anterior tracheal wall with calcifications near the level of the aortic arch. Subsequent bronchoscopy revealed a friable papillomatous lesion nearly obstructing the mid-trachea. Biopsy was negative for acid-fast and fungal organisms. Histopathology demonstrated amyloid deposition with apple-green birefringence on Congo red staining. The patient underwent rigid bronchoscopy with successful soft tissue debulking. Follow-up bronchoscopy two months later showed a normal airway without recurrence, and evaluation revealed no evidence of systemic amyloidosis. Tracheobronchial amyloidosis is an uncommon cause of chronic cough and hemoptysis that may mimic other airway diseases. Recognition of characteristic imaging and bronchoscopic findings, along with confirmatory Congo red staining, is essential for diagnosis. Early bronchoscopic intervention can restore airway patency and improve symptoms.