Secondary spontaneous pneumothorax in elderly patients is often challenging to treat surgically; hence, conservative management strategies, such as chemical pleurodesis, are frequently utilized. Viscum album extract is an established sclerosing agent used for pleurodesis, though some studies have reported associated complications, including acute pneumonitis. Here, we report the case of a 93-year-old male with secondary spontaneous pneumothorax who developed acute chemical pneumonitis following pleurodesis with V. album extract. Despite the initial radiologic severity, the patient was successfully managed and exhibited a benign clinical course.

Background: Tube thoracostomy is performed by several specialties in several hospital settings, but institution-wide data comparing who performs the procedure, where, how, and with what complications are limited. Methods: In this retrospective observational cohort study, all tube thoracostomies performed over a three-year period at a tertiary university hospital were identified through the hospital information system. Procedures were grouped by performing team (emergency medicine, thoracic surgery, and intensive care) and by setting (emergency department [ED], operating room/ward, and intensive care unit [ICU]) and compared with respect to demographics, indications, operator seniority, anesthesia practice, chest tube size, and complications. Effect sizes are reported with 95% confidence intervals (CIs), and predictors of complications were examined in a multivariable binomial logistic regression model. Results: In total, 487 procedures were analyzed (76.0% male; median age 56 years). The emergency medicine team performed 47.2% of procedures (all in the ED), the thoracic surgery team 46.8% (the only team active in all three settings), and the intensive care team 6.0%. Indication profiles diverged (p < 0.001): traumatic (34.8%) and spontaneous pneumothorax (31.7%) dominated the emergency medicine caseload, pleural effusion (40.4%) the thoracic surgery caseload, and iatrogenic pneumothorax (72.4%) the intensive care caseload. Overall, 95.9% of tubes were 28 F or 32 F; the thoracic surgery team favored 32 F (75.9%; p < 0.001). First-year residents performed 39.8% of procedures, two-thirds of them on the thoracic surgery team. Complications occurred in 70 procedures (14.4%), 90.0% of which were tube malpositions. Crude complication rates were 10.0% for emergency medicine, 16.2% for thoracic surgery, and 34.5% for intensive care (p = 0.001), but rates rose with the acuity of the setting (ED 10.9%, ICU 26.8%) and within-setting differences between teams were not significant (ED p = 0.363; ICU p = 0.301). In a multivariable model adjusting for team, setting, age, indication group and operator seniority, neither team (p = 0.164) nor setting (p = 0.223) was independently associated with complications. Complication rates did not differ by postgraduate year (16.5%, 9.8%, 14.3% and 20.8% for years 0-1 to 3-4; p = 0.157, test for trend p = 0.738), by tube size (≤28 F 12.0% versus ≥32 F 15.8%; p = 0.287) or by age (p = 0.276). Conclusions: This hospital-wide map of procedural labor shows that the three teams served largely distinct patient populations. Team, setting and indication are so tightly linked in this hospital that no independent effect of specialty could be demonstrated in either direction. Operator seniority and tube size were not associated with complications. Malposition accounted for nine of every ten complications, which supports routine verification of tube position after insertion. Which team drains which pathology, where, and at what level of training is determined locally rather than by specialty training standards, and that map is the principal contribution of this series.

Background: Superficial cervical lymphadenopathy frequently requires tissue sampling because infectious, inflammatory, and malignant diseases often share overlapping clinical and radiological features. Although ultrasound-guided sampling of superficial cervical lymph nodes is well established, the available literature predominantly focuses on fine-needle aspiration cytology (FNAC) or core needle biopsy (CNB). Comparatively less data specifically describe aspiration-based tissue acquisition providing material for combined histopathological, microbiological, and molecular analyses, particularly in very small cervical lymph nodes. We describe our single-center experience with ultrasound needle aspiration biopsy (US-NAB), focusing on technical feasibility, sample adequacy, diagnostic contribution, and procedural safety. Methods: We retrospectively analyzed 20 consecutive patients referred to a tertiary respiratory infectious diseases center between April 2023 and June 2024 for suspected cervical tuberculous lymphadenopathy. All patients underwent real-time US-NAB using an 18-gauge modified Menghini aspiration needle. Biopsy specimens were processed, as applicable, for histopathology, acid-fast bacilli smear microscopy, molecular testing (real-time PCR), and mycobacterial culture. Diagnostic yield, final diagnoses, lymph node size, and procedural safety were evaluated. Results: A final diagnosis of tuberculosis was established in 13 patients (65%), while seven patients (35%) received alternative diagnoses, including metastatic malignancies (20%), sarcoidosis (10%), and bacterial lymphadenitis (5%). Adequate material contributing to a definitive diagnosis was obtained in all 20 procedures (20/20). Notably, 60% of sampled lymph nodes measured <15 mm in short-axis diameter, including two nodes measuring only 5-6 mm. Histopathology was diagnostic of tuberculosis in eight patients, whereas five additional cases with nonspecific necrosis were confirmed by positive TB-PCR. No major procedure-related complications, including bleeding, pneumothorax, or pneumomediastinum, were observed. Conclusions: In this small single-center cohort, US-NAB was feasible and safe and provided adequate material for histopathological, microbiological, and molecular analyses, including when very small superficial lymph nodes were sampled. Beyond confirming tuberculosis, the procedure contributed to the identification of alternative benign and malignant diagnoses. These findings support further evaluation of US-NAB as a complementary sampling option in the diagnostic work-up of superficial cervical lymphadenopathy.

Thoracic surgery in patients with severely limited pulmonary reserve may be unsafe or infeasible with conventional one-lung ventilation. In patients with previous pneumonectomy, surgical exclusion of the only functioning lung abolishes native ventilation, making conventional lung isolation impossible. Venovenous extracorporeal membrane oxygenation (VV-ECMO) may provide temporary respiratory support in carefully selected patients by maintaining oxygenation and carbon dioxide removal while allowing optimal surgical exposure. We report the case of a 79-year-old man with single-lung physiology following left pneumonectomy who presented with recurrent right pneumothorax and underwent uniportal video-assisted thoracoscopic surgery (VATS) bullectomy supported by perioperative VV-ECMO. Peripheral VV-ECMO was established using bilateral femoral venous cannulation, permitting alternating periods of controlled apnea and protective mechanical ventilation while maintaining adequate gas exchange. Following surgery, ECMO support was electively continued during the early postoperative period because of the patient's severely limited respiratory reserve and was successfully weaned 36 hours after surgery. The postoperative course was complicated by bilateral femoral deep venous thrombosis after decannulation, requiring therapeutic anticoagulation. This case illustrates that perioperative VV-ECMO may represent a feasible strategy for carefully selected high-risk thoracic surgical patients in whom conventional lung isolation is not possible. It also highlights the importance of meticulous multidisciplinary planning, individualized anticoagulation strategies, and routine surveillance for cannula-related thrombotic complications.

Boerhaave syndrome, the spontaneous barogenic rupture of the oesophagus, is lethal when unrecognised and its cardiorespiratory mimicry frequently delays diagnosis. Optimal management remains debated. We retrospectively reviewed four consecutive patients with spontaneous oesophageal perforation managed over two years at a tertiary surgical-gastroenterology unit. Diagnosis was confirmed by water-soluble oral-contrast computed tomography; presentation, operative findings, complications and outcomes were analysed and compared with the contemporary literature. The four patients were initially assessed by non-surgical services, with an intercostal drain placed for a presumed effusion or pneumothorax before food or purulent fluid in the drain revealed the diagnosis. The perforation was left-sided in three and right-sided in one. Management was individualised: laparoscopy converted to laparotomy with transhiatal primary repair and omental buttress; laparotomy with transhiatal repair and thoracoscopic lavage; a thoraco-abdominal approach; and a right posterolateral thoracotomy. A postoperative leak occurred in two patients and was managed by endoscopic vacuum therapy and by transhiatal oesophagectomy with gastric conduit, respectively. All four patients survived. Food-stained or purulent output from a chest drain placed for a presumed effusion should prompt immediate contrast computed tomography. An individualised, multidisciplinary strategy combining timely source control, thoracoscopic pleural lavage and modern endoscopic rescue achieved survival in every patient, including a rare right-sided rupture.

Background: Thoracic air complications after autologous breast reconstruction (ABR) are uncommon and incompletely characterised. A personalised perioperative approach requires integration of patient anatomy, reconstructive technique, anaesthetic exposures and the postoperative clinical trajectory rather than reliance on population-level estimates alone. Methods: We report a 41-year-old woman in whom pneumomediastinum was identified after bilateral DIEP flap reconstruction and performed a focused literature review restricted to primary studies of pneumothorax or pneumomediastinum following autologous flap breast reconstruction. Searches across MEDLINE-Ovid, PubMed and Wiley Online Library using predefined MeSH terms were conducted. Data extraction focused on study characteristics, incidence, mechanism of injury, perioperative factors, and management. Results: The patient developed postoperative hypotension and persistent tachycardia, followed by pleuritic chest pain. CT excluded pulmonary embolism and oesophageal perforation but demonstrated Moderate volume pneumomediastinum without pneumothorax. She was managed conservatively and discharged on postoperative day 7. Five primary studies met the eligibility criteria. Study-specific pneumothorax frequencies were 1/463 (0.22%) after rib-sparing free-flap reconstruction, 3/749 (0.4%) after extended latissimus dorsi reconstruction, and 4/180 patients (2.2%; 1.4 per 100 internal mammary vessel dissections). Reported mechanisms included pleural injury during internal mammary vessel dissection, inadvertent puncture during regional anaesthesia, barotrauma under positive-pressure ventilation, and drain-related barotrauma. No previous primary report of pneumomediastinum after autologous flap breast reconstruction was identified. Conclusions: Pneumothorax and pneumomediastinum are uncommon but potentially serious complications of ABR. They are rarely documented postoperatively; however, surgeons and anaesthetists must remain vigilant, particularly during exposure of the internal mammary vessels and airway management. Patient-specific assessment, symptom-directed imaging and multidisciplinary management may support early recognition to prevent morbidity and preserve the outcomes of reconstructive procedures.

Thoracic endometriosis is an uncommon but likely underrecognized manifestation of extragenital endometriosis that can present with catamenial pneumothorax, chest pain, and respiratory symptoms. This case series reviews imaging findings from three patients (aged 27 to 38) with histologically confirmed thoracic endometriosis. Imaging modalities included chest radiographs and contrast-enhanced magnetic resonance imaging. Key findings included pleural nodules, recurrent right-sided pleural effusions, pneumothoraces, and diaphragmatic involvement, often correlating with menstrual cycles. Recognizing these imaging features is essential for accurate diagnosis, as thoracic endometriosis can mimic other pulmonary conditions. Radiologists and clinicians should maintain a high index of suspicion in reproductive-age women with cyclic thoracic symptoms.

The costochondral graft (CCG) is a well-established reconstruction modality for the temporomandibular joint (TMJ), particularly for the growing patient. Donor site complications such as pneumothorax have been reported, but only in isolated reports or small case series or single-center studies, precluding understanding of the true risks. This retrospective cross-sectional study used the National Inpatient Sample database, a large-scale database of hospitalizations in the United States, for the years 2020 to 2022, to calculate the estimated nationally representative frequency of thoracic complications in the United States. Between 2020 and 2022, there were 235 weighted hospitalizations related to CCG (57.4% female; mean age: 16.9 y). The mean hospital length of stay and hospital charges were 11.5 days and $177,235 (2022 US dollars), respectively. There were 15 weighted hospitalizations with thoracic complications, with a weighted frequency of 6.4%. Within the limitations of the analysis of a 3-year nationally representative sample, the estimated frequency of thoracic complications in the United States was nontrivial, at 6.4%. Knowledge of the risk can guide the clinician during clinical decision-making, from consideration of viable alternatives to implementing risk mitigation strategies.