Tuberculosis with simultaneous pulmonary, vertebral, and cerebral involvement is observed episodically in HIV-negative patients, thus requiring evaluation of the entire cerebrospinal axis and a multidisciplinary approach. We report the case of a 54-year-old man who presented with a three-month history of productive cough, constitutional symptoms, dyspnea, and lower back pain. Bilateral pulmonary cavitary lesions, pleural thickening, dorsal spondylitis (T10-T11) with fracture, compression, and edema of these vertebral bodies, paravertebral fluid collections partially compressing the spinal cord, and multiple focal cerebral and cerebellar lesions were identified. Sputum was positive for acid-fast bacilli (AFB), and molecular testing confirmed tuberculosis susceptible to isoniazid and rifampicin. First-line antituberculosis treatment and spinal stabilization surgery were performed, including T10 corpectomy and titanium mesh placement. The patient's recovery was favorable. We emphasize the importance of suspecting disseminated tuberculosis in non-HIV patients and highlight the value of the clinical-surgical approach and multidisciplinary follow-up.

Background: Resistant hypertension poses a significant therapeutic challenge, often leading to severe polypharmacy. Renal denervation (RDN) has re-emerged as a valuable adjunctive intervention for blood pressure control. Case Presentation: We report the case of a 64-year-old man (body mass index [BMI] 34 kg/m2) with long-standing resistant hypertension (RH), after previous percutaneous coronary intervention (PCI) to the left anterior descending artery, heart failure with preserved ejection fraction (HFpEF), and prior nephron-sparing surgery for clear cell renal carcinoma. Despite treatment with an extensive antihypertensive regimen encompassing nine pharmacological classes including diuretic therapy (angiotensin-converting enzyme inhibitor; calcium channel blocker, thiazide diuretic, β-blocker, α1-blocker, central α2-agonist, mineralocorticoid receptor antagonist, loop diuretic, long-acting nitrates), blood pressure remained severely uncontrolled on both home and office measurements. Persistent hypertension was accompanied by exertional dyspnoea and episodes of exertional chest discomfort. Following comprehensive evaluation and exclusion of secondary causes of hypertension, the patient underwent catheter-based renal denervation using the SymplicitySpyral™ (Medtronic) multi-electrode radiofrequency system. The procedure was associated with substantial and sustained improvement in blood pressure control, with mean 24 h ambulatory blood pressure measurements decreasing to 130/80 mmHg at six-month follow-up. Importantly, successful blood pressure reduction enabled major simplification of pharmacotherapy, including complete discontinuation of clonidine, loop diuretic therapy, and long-acting nitrates, together with marked dose reduction in doxazosin. Conclusions: This case illustrates the potential clinical utility of renal denervation in carefully selected patients with true resistant hypertension and pronounced sympathetic overactivity. Beyond achieving satisfactory blood pressure control, RDN may facilitate meaningful reduction in medication burden, potentially improving treatment adherence, quality of life, and long-term cardiovascular risk. Written informed consent was obtained from the patient for both the procedure and the publication of this case report.

Acute coronary syndrome (ACS) is a life-threatening condition that typically presents with chest pain, dyspnea, or chest discomfort. However, atypical manifestations occur in a considerable proportion of patients and may lead to delayed diagnosis and treatment. Gastrointestinal symptoms such as nausea and vomiting are relatively common in inferior wall myocardial infarction, whereas diarrhea is an extremely rare presenting symptom. We report the case of a 38-year-old man with no known past medical history who presented to the emergency department with multiple episodes of acute diarrhea without abdominal pain or chest discomfort. Initial clinical evaluation suggested acute gastroenteritis; however, electrocardiography revealed ST-segment elevation in the inferior leads. The patient was diagnosed with ST-elevation myocardial infarction (STEMI) and received immediate treatment including dual antiplatelet therapy and thrombolysis, followed by coronary angiography and stent placement in the right coronary artery. This case highlights the importance of considering atypical presentations of ACS in emergency settings and emphasizes the role of early electrocardiographic evaluation even in patients presenting with non-cardiac symptoms.

Small cell lung carcinoma (SCLC) is a high-grade pulmonary neuroendocrine carcinoma strongly associated with smoking and commonly presents with advanced intrathoracic disease. Atrial fibrillation (AF) is common in acutely ill patients and in patients with cancer; however, causal attribution in an individual patient is often difficult because multiple arrhythmogenic stressors coexist. A 72-year-old man with hypertension, morbid obesity, peripheral arterial disease, heavy prior tobacco exposure, and no known prior cardiac arrhythmia or structural heart disease presented with progressive dyspnea, cough, fatigue, weight loss, and hypoxemic respiratory failure. Thoracic imaging revealed bulky mediastinal and hilar lymphadenopathy, right bronchial obstruction with collapse and consolidation of much of the right lung, a large recurrent right pleural effusion, and an additional contralateral pulmonary lesion suspicious for malignancy. Integrated pleural cytology and tissue biopsy results supported the diagnosis of extensive-stage SCLC with malignant pleural involvement in this patient. The patient was treated empirically for post-obstructive pneumonia and required repeated pleural drainage procedures. During hospitalization, he developed recurrent AF with a rapid ventricular response and asymptomatic post-conversion pauses of up to six seconds, despite preserved left ventricular systolic function and no major structural heart disease on echocardiography. Rate control with beta-blockade was limited by bradycardia and hypotension; flecainide incompletely suppressed recurrent episodes; amiodarone was later initiated because rhythm instability persisted, and alternatives were limited. Transesophageal echocardiography showed no intracardiac thrombus before the planned cardioversion, but the patient spontaneously converted to sinus rhythm before shock delivery and later reverted to AF after a coughing spell. This case highlights the complexity of managing AF in advanced thoracic malignancy complicated by hypoxemia, pleural disease, and suspected post-obstructive pneumonia.

Radiation-induced cardiovascular disease may appear decades after cancer therapy and can involve multiple vascular, valvular, myocardial, and conduction structures of the heart. Management is particularly challenging when prior irradiation results in a hostile chest environment and impaired wound healing.

In this case series and review, we highlight 2 adult congenital cases, diagnosed with anomalous origin of the right coronary artery (RCA) from the pulmonary artery (PA). Patient 1 is a 57-year-old woman who presented to the cardiology clinic for episodes of palpitations and dizziness associated with dyspnea on minimal exertion. Ambulatory electrocardiograph monitoring revealed brief runs of nonsustained ventricular tachycardia and supraventricular tachycardia up to 3 minutes. Cardiac computed tomography angiography revealed anomalous origin of the RCA from the main PA. Nuclear Regadenoson stress test demonstrated anterior wall/anterolateral wall peri-infarctional ischemia. She underwent successful surgical repair with coronary reimplantation. Patient 2 is a 61-year-old man who presented to the emergency department for shortness of breath and alcohol intoxication. Computed tomography angiography of the chest/abdomen/pelvis was performed in the emergency department that was suspicious for anomalous RCA. Left heart catheterization revealed large RCA, with anomalous origin from the PA.

Well-differentiated papillary mesothelial tumor (WDPMT) is a rare neoplasm characterized by a distinct papillary architecture, bland cytological features, and a propensity for superficial spread without stromal invasion. We herein report the diagnosis and management of a patient with pleural WDPMT presenting predominantly with recurrent spontaneous pneumothorax and pleural effusion, along with a review of the current literature on this entity. The patient was a 58-year-old female who presented with a two-week history of chest tightness and dyspnea on a background of recurrent spontaneous pneumothorax and pleural effusion over the preceding seven years. She had experienced four episodes of recurrence during that period and denied any history of asbestos exposure. Thoracoscopic exploration revealed pulmonary bullae, pleural effusion and pneumothorax, pleural thickening, and scattered grayish-white nodules on both the visceral and parietal pleura. Histopathological examination of the pleural nodule biopsy confirmed the diagnosis of WDPMT. Based on the features of this case and a review of the literature, clinicians should be aware that WDPMT may present with the atypical manifestation of recurrent spontaneous pneumothorax accompanied by pleural effusion. .

Background/Objectives: Cardiopulmonary exercise testing (CPET) provides an integrated assessment of cardiovascular, respiratory, and metabolic responses during exercise. Although CPET is increasingly used in older adults for preoperative physiological evaluation and assessment of exercise limitation, evidence regarding its safety and clinical feasibility in elderly patients with mixed cardiopulmonary comorbidities remains limited. Methods: In this retrospective observational study, we evaluated 235 consecutive patients who underwent CPET at a tertiary referral center. Patients were categorized into two groups according to age: ≥65 years and <65 years. Clinical characteristics, pulmonary function parameters, CPET findings, feasibility outcomes, and adverse events during testing were analyzed. Results: A total of 235 patients were included, with a mean age of 62.3 ± 12.8 years. Among them, 112 (47.6%) patients were aged ≥65 years and 35 (14.8%) were aged ≥75 years. Comorbidities were present in 170 patients, with hypertension being the most common. The leading indication for CPET was preoperative evaluation prior to thoracic surgery. Most elderly patients successfully completed CPET and provided clinically interpretable physiological data. In the ≥65 years group, CPET was terminated prematurely in 10 patients due to syncope, severe dyspnea, bronchospasm, chest pain, or arrhythmia. In the ≥65 years group, exercise-induced desaturation occurred in 24 patients; the lowest recorded oxygen saturation was 84%, and no desaturation episode required premature termination of the test. No major complications, deaths, myocardial infarctions, or cardiac arrests were observed during CPET or within the subsequent three days. No statistically significant differences in adverse event rates were observed between the age groups. Univariate logistic regression analysis demonstrated that lower FEV1 % predicted and lower FEV1/FVC % predicted ratio were associated with clinically significant adverse events in elderly patients [OR (95% CI): 0.96 (0.94-0.99), p = 0.02, OR (95% CI): 0.90 (0.84-0.96), p = 0.001, respectively]. Conclusions: CPET was feasible in the majority of elderly patients with cardiopulmonary comorbidities, with most individuals successfully completing testing and providing clinically interpretable physiological data. No major complications were observed in this cohort. These findings suggest that, when performed under appropriate supervision and careful patient selection, CPET may represent a practical tool for functional assessment and preoperative physiological evaluation in older adults. Larger prospective multicenter studies are warranted to further define its safety and feasibility in this population.