Diffuse cystic lung diseases (DCLDs) comprise a heterogeneous group of disorders characterized by multiple pulmonary cysts with overlapping clinical and radiologic manifestations. Accurate diagnosis relies on recognizing characteristic imaging patterns in conjunction with clinical and extrapulmonary findings. High-resolution computed tomography (HRCT) plays a central role in distinguishing true pulmonary cysts from common cyst mimickers, including emphysema, bullae, cavities, pneumatoceles, cystic bronchiectasis, and honeycombing, thereby narrowing the differential diagnosis. This review summarizes the imaging features of the major DCLDs encountered in adults, including lymphocytic interstitial pneumonia, pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis, and folliculin deficiency-associated disease (formerly Birt-Hogg-Dubé syndrome). Emphasis is placed on cyst morphology, craniocaudal distribution, associated parenchymal abnormalities, and characteristic extrapulmonary manifestations that facilitate diagnosis. The underlying pathophysiologic mechanisms responsible for cyst formation and their relationship to imaging appearances are also discussed. In addition, the review highlights important clinical features, including smoking history, autoimmune disease, genetic predisposition, and systemic involvement, which help refine the differential diagnosis. An integrated pattern-recognition approach combining HRCT findings with clinical context allows confident differentiation of the major DCLDs in most patients while reducing the need for invasive diagnostic procedures. Awareness of ancillary imaging findings and less common cystic lung disorders is essential when the imaging pattern is atypical or overlaps with other diffuse pulmonary diseases. A systematic understanding of characteristic imaging appearances and associated extrapulmonary manifestations enables radiologists and clinicians to establish an accurate diagnosis, guide appropriate genetic and clinical evaluation, and optimize patient management.

Lemierre-like syndrome, an atypical variant of Lemierre's syndrome, is characterised by septic thrombophlebitis without classical features and may be complicated by descending necrotising mediastinitis (DNM). Contrast-enhanced computed tomography revealed extensive thrombosis of the right internal jugular, external jugular, and subclavian veins, along with multiple cervical and mediastinal abscesses, consistent with DNM. A cystic lesion in the right upper lobe suggested a lung abscess. Emergency cervical drainage was performed, followed by thoracoscopic mediastinal drainage. Communication between the mediastinal and pulmonary abscess cavities was identified intraoperatively. As no air leak was detected during a 20 cmH2O leak test, pulmonary resection was avoided. Methicillin-susceptible Staphylococcus aureus was isolated, and the patient recovered with antibiotics and anticoagulants. The patient remained recurrence-free for 7 months. Careful intraoperative assessment may allow successful management without resection in selected cases of mediastinal-pulmonary communication.

Pneumoconiosis complicated with pulmonary tuberculosis is characterized by high prevalence and disability rates, as well as difficulty in early diagnosis, constituting a serious public health problem. The Chinese Society of Tuberculosis (Chinese Medical Association) and the Society of Labor Hygiene and Occupational Diseases (Chinese Preventive Medicine Association) organized multidisciplinary experts in respiratory diseases, occupational diseases, tuberculosis and other related fields to formulate the Chinese expert consensus on the diagnosis and treatment of pneumoconiosis complicated with tuberculosis. This consensus aims to enhance professional practitioners' understanding of the disease, improve the capacity for early clinical diagnosis, and further advance the prevention and treatment of pneumoconiosis complicated with pulmonary tuberculosis in China. It summarizes 12 key clinical issues and proposes 13 targeted recommendations to address difficulties and misconceptions in clinical practice. This consensus was registered on the International Practice Guidelines Registry Platform (PREPARE-2024CN271). It aims to enhance the standardized diagnosis and treatment of pneumoconiosis complicated by pulmonary tuberculosis, improve patient outcomes, and provide practical guidance for the prevention and control of occupational and infectious diseases in China. The main recommendations are as follows.Recommendation 1: Clinicians and pathologists are advised to pay attention to the mixed pathological features of pneumoconiosis complicated with pulmonary tuberculosis. For patients with pneumoconiosis presenting atypical imaging manifestations or poor response to conventional treatment, pathological specimens should be actively obtained to confirm the diagnosis. Combined use of acid-fast staining, Mycobacterium tuberculosis culture or molecular pathological detection is recommended to increase the detection rate (2C).Recommendation 2: When performing chest CT examinations and dynamic follow-up for pneumoconiosis patients, clinicians and radiologists should focus on multifocal and polymorphic lesions, as well as short-term imaging changes suggestive of active tuberculosis (2C).Recommendation 3: For patients with suspected pulmonary tuberculosis complicated with pneumoconiosis: (1) Be aware that sputum bacteriological tests may yield false-negative results due to dust interference. Repeated sampling or combined detection methods are recommended, including bacteriological and molecular tests on bronchoalveolar lavage fluid (BALF) obtained via bronchoscopy. Results of immunological assays such as the interferon-γ release assay (IGRA) and tuberculin skin test (TST)shall also be combined for comprehensive judgment. (2) In cases with atypical imaging findings and clinical symptoms, bronchoscopy-guided pathological sampling (e.g., EBUS-GS [endobronchial ultrasound with guide sheath], ENB [electromagnetic navigation bronchoscopy]) is prioritized. When microbiological evidence is insufficient, percutaneous lung biopsy or pleural biopsy (for patients with pleural effusion) is suggested to clarify the diagnosis (2B).Recommendation 4: The diagnosis of pneumoconiosis complicated with pulmonary tuberculosis shall follow the integrated diagnostic principle. Provided that patients meet the national diagnostic criteria for pneumoconiosis and pulmonary tuberculosis respectively, a comprehensive assessment shall be conducted combining occupational exposure history, dynamic imaging changes and laboratory results. Patients shall be stratified for managementaccording to the activity of tuberculosis (2C).Recommendation 5: For differential diagnosis between pneumoconiosis complicated with pulmonary tuberculosis and non-tuberculous mycobacterial (NTM) lung disease: (1) NTM lung disease commonly involves the apical and anterior segments of the upper lobes, the right middle lobe and the lingular segment of the left upper lobe. Typical imaging manifestations include a combination of centrilobular nodules and bronchiectasis. (2) Multiple thin-walled cavities are frequently seen in silicosis complicated with NTM lung disease. (3) Pathologically, NTM lesions are dominated by epithelioid granulomas with inconspicuous caseous necrosis. (4) Definitive diagnosis relies on mycobacterial culture and species identification, complying with combined clinical, imaging and microbiological criteria (2C).Recommendation 6: For patients with pneumoconiosis complicated with pulmonary tuberculosis who present progressively enlarged cavities or newly developed cavities accompanied by aggravated symptoms after anti-tuberculosis treatment, radiologists shall evaluate imaging signs of pulmonary aspergillosis, such as the early halo sign and the late air crescent sign within cavities (2C).Recommendation 7: For patients with suspected pneumoconiosis complicated with pulmonary aspergillosis: (1) Bronchoscopy is performed to collect BALF or tissue specimens for fungal culture and pathological examination (gold standard). (2) Conduct BALF galactomannan (GM) test, metagenomic next-generation sequencing (mNGS) or other DNA detection assays. (3) Detect serum specific antibodies against Aspergillus fumigatus (e.g., IgE-m3, IgM) (1A).Recommendation 8: For patients with pneumoconiosis complicated with drug-susceptible pulmonary tuberculosis: (1) Adopt the standard first-line four-drug anti-tuberculosis regimen. (2) Ensure a sufficient treatment course (generally ≥6-8 months). (3) Extend the treatment course to≥9-12 months for patients with severe lesions or concomitant tracheal, pleural or extrapulmonary tuberculosis, so as to improve clinical outcomes and reduce recurrence (2A).Recommendation 9: For patients receiving concurrent treatment for pneumoconiosis (including tetrandrine, nintedanib, pirfenidone, glucocorticoids, bronchodilators, etc.) and rifampicin-containing anti-tuberculosis regimens: (1) Be aware that rifampicin, a potent hepatic enzyme inducer, may accelerate the metabolism of concomitant drugs such as glucocorticoids and nintedanib and reduce their efficacy. (2) Adjust the dose of affected drugs accordingly when rifampicin is initiated or discontinued (1B).Recommendation 10: Extracorporeal membrane oxygenation (ECMO) may be used as a bridge to lung transplantation only for end-stage pneumoconiosis patients complicated with pulmonary tuberculosis awaiting transplantation (2D).Recommendation 11: For end-stage patients with pneumoconiosis complicated with pulmonary tuberculosis who have received adequate and standard anti-tuberculosis therapy, the feasibility of lung transplantation shall be evaluated. Pre-transplant precautions: (1) Ensure complete control of active tuberculosis. (2) Optimize the anti-tuberculosis regimen (e.g., replace rifampicin with rifabutin) to maintain the effective concentration of immunosuppressants (2D).Recommendation 12: For patients with severe, end-stage pneumoconiosis complicated with pulmonary tuberculosis who no longer benefit from active treatment, palliative care and hospice care shall be initiated. Clinicians and medical teams shall communicate fully with patients and their families about the condition, prognosis, treatment options and medical burden. The core goals are to relieve symptoms, alleviate suffering and improve quality of life (2D).Recommendation 13: For patients with pneumoconiosis complicated with tuberculosis who meet the indications for surgical or interventional therapy, a multidisciplinary team shall conduct joint decision-making and implement treatment in a timely manner after full assessment of pulmonary function, nutritional status and surgical risks. Surgical treatment is mainly indicated for patients with drug-resistant tuberculosis with localized lesions, persistent cavitary lesions with ongoing mycobacterial excretion, destroyed lung, massive hemoptysis unresponsive to medical treatment, tuberculous empyema and other critical conditions. Interventional therapy can be applied for emergency treatment of massive hemoptysis, as well as palliative treatment for pulmonary artery stenosis secondary to tuberculosis or pneumoconiosis (2C).

Necrotizing pneumonia (NP) represents an uncommon but severe complication of community-acquired pneumonia (CAP) in children, characterized by the destruction of lung parenchyma and formation of multiple thin-walled cavities. Despite its rarity, the incidence of pediatric NP has increased substantially over the past two decades, creating major diagnostic and treatment challenges. The COVID-19 pandemic has further altered the epidemiological landscape, with unique patterns of respiratory pathogen circulation. This narrative review synthesizes current evidence on pediatric necrotizing pneumonia through a comprehensive literature search of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library for articles published between January 1994 and January 2025. Search terms included "necrotizing pneumonia," "necrotising pneumonia," and "cavitary pneumonia" paired with "child," "pediatric," or "paediatric," along with specific terms for etiology, diagnosis, treatment, and outcomes. We included English-language original research articles, systematic reviews, and case series with at least 10 patients. Streptococcus pneumoniae continues to dominate as the primary pathogen, accounting for 30-60% of cases, though the emergence of Mycoplasma pneumoniae as a major cause in Asia, with macrolide resistance exceeding 85%, presents new therapeutic challenges. Diagnostic approaches have evolved significantly, with lung ultrasound demonstrating comparable accuracy to CT (κ=0.85) while avoiding radiation exposure. Novel biomarkers including presepsin, copeptin, and fetuin-A show promise for early detection and prognostication. Treatment outcomes remain encouraging, with most cases (80%) successfully managed conservatively using prolonged antibiotics for a median duration of 28 days. Surgery is reserved for specific complications, and long-term outcomes are favorable with normal pulmonary function in 80-90% of children at one-year follow-up. While pediatric necrotizing pneumonia remains a serious condition, recent advances in non-invasive diagnostics, biomarker development, and understanding of post-pandemic epidemiology offer opportunities for improved outcomes. Future research should focus on validating AI-powered diagnostic tools, optimizing antimicrobial therapy in the era of resistance, and establishing evidence-based surgical intervention criteria. The integration of lung ultrasound as a radiation-free diagnostic modality represents a paradigm shift in pediatric pneumonia management.

Postmortem microbial communities may provide useful information for forensic microbiology, but species-level and functional profiles across multiple cadaveric anatomical sites remain poorly characterized. Here, shotgun metagenomic sequencing was performed on 144 samples from six anatomical sites, including the oral cavity, nasal cavity, trachea, lung, colon, and anus, collected from 24 human cadavers. A total of 15,301,799,968 raw reads were obtained, and 6565 species were identified, and KEGG pathways were annotated at the L1, L2, and L3 levels. Species-level microbial composition differed significantly among anatomical sites. PERMANOVA with permutations blocked by individual identity showed that anatomical site was the dominant factor explaining microbial community variation (R2 = 0.3778, p = 0.001, q = 0.001), whereas postmortem interval did not show a significant independent effect within the 1-38-day interval. KEGG functional profiles also differed significantly among anatomical sites at the L2 and L3 levels, and 182 of 214 L3 pathways showed significant site-associated differences after false-discovery-rate correction. Pathway-level mixed-effect models further indicated that anatomical site remained significantly associated with most L3 pathways after accounting for postmortem interval, age, sex, cause of death, and repeated sampling from the same individual. Species-pathway correlation analysis identified significant taxon-function associations, but these were interpreted as correlative rather than direct evidence of species-specific functional contribution. Low-biomass sensitivity analyses indicated that respiratory-site results, especially lung and tracheal findings, should be interpreted cautiously because of high host DNA proportions and low non-host read counts. Inter-site shared occurrence and intra-site co-occurrence analyses further described distributional associations across anatomical sites. This study establishes a multi-site postmortem metagenomic reference framework for characterizing anatomical-site-specific microbial and functional patterns, offering insights into forensic microbiology and postmortem microbial ecology.

Right-sided infective endocarditis (RSIE) commonly causes septic pulmonary embolism, whereas systemic manifestations typically suggest concomitant left-sided infective endocarditis or an intracardiac right-to-left shunt such as patent foramen ovale (PFO).

CF is associated with multiple risk factors for caries and gingivitis, which in turn are potential risk factors for poor lung health, mediated through aspiration of dysbiotic oral microbiota. Nonetheless, the association between dental diseases and respiratory outcomes in CF has not previously been evaluated. Here, we report the baseline cross-sectional associations between dental diseases (caries and gingivitis) and respiratory outcomes (FEV1 and the respiratory domain of the CFQ-R) modeled using linear regression with adjustment for appropriate covariates from an ongoing multicenter, prospective cohort study enrolling people with CF ages 12 to 30. Among 203 participants (mean (SD) age at enrollment of 18.7 (5.0) years, 86% on elexacftor-tezacaftor-ivacaftor or ivacaftor)), we found that ≥3 surfaces with untreated caries was associated with a mean decrement of -0.88 (95% CI -1.61, -0.16, p = 0.02) in FEV1 z score compared to no untreated caries, and a mean decrement of -11.7 (95% CI -20.7, -2.7, p = 0.01) in the CFQ-R respiratory domain. We did not observe an association between gingivitis and respiratory outcomes. Our results suggest that poor oral health could be a modifiable risk factor for worse lung health in CF, and that prevention and treatment of dental caries could potentially improve respiratory health in adolescents and young adults with CF, even in the post-modulator era.