Nontuberculous mycobacteria (NTM) are well-established pulmonary pathogens across all demographics; conversely, pulmonary artery aneurysms (PAAs) represent rare and potentially life-threatening vascular complications. The pathophysiological association between chronic NTM infection and the development of PAAs remains largely underexplored. A 69-year-old man with a history of untreated NTM infection presented to our facility with a chief complaint of hemoptysis. Initial diagnostic imaging suggested the presence of a PAA in a branch of the pulmonary artery. Consequently, a multidisciplinary consultation ensued to determine the true structural classification of the lesion, weighing a PAA against an acquired, infection-mediated pseudoaneurysm. Subsequent bronchoscopy and culture analysis of the bronchial lavage fluid grew Mycobacterium abscessus complex. The patient was managed with intravenous antibiotics and supportive respiratory therapies. Following multidisciplinary consultations, the cardiology service concluded that the PAA was an incidental finding likely secondary to an infectious etiology. The patient was deemed a nonsurgical candidate and was discharged with plans for close outpatient follow-up with cardiology, pulmonology, and infectious disease specialties. This case details a rare clinical intersection: an incidental PAA discovered during the workup of an active, untreated M. abscessus complex infection. While the patient was managed conservatively without surgical intervention, the concurrence of these pathologies underscores a critical diagnostic consideration. Due to the scarcity of documented literature on NTM-associated vascular complications, this presentation highlights the importance of recognizing chronic atypical mycobacterial infections as potential drivers of adjacent vascular wall degradation. Further research is warranted to elucidate the mechanisms by which NTM-mediated inflammation induces vascular wall injury, potentially predisposing patients to aneurysm formation.

Splenic abscess secondary to Actinomyces species is an exceedingly rare condition that presents with a constellation of nonspecific symptoms often leading to delayed presentation, diagnostic uncertainty, and misidentification. While Actinomyces is typically an indolent infection, splenic abscess has a high mortality when untreated due to the risk of splenic rupture. This case report highlights a rare instance of isolated Actinomyces splenic abscess in a 52-year-old man with a history of intravenous drug use, hepatitis C, and recent incarceration who presented with several weeks of hemoptysis, fevers, night sweats, pleuritic chest pain, and left upper quadrant abdominal pain. The history and clinical presentation were most concerning for malignancy, tuberculosis, or other pulmonary infectious etiologies. Computed tomography imaging revealed a 14.9 x 7.7 x 12.1 cm splenic abscess with associated pleural effusion. A percutaneous drain was placed by interventional radiology, and the resulting fluid culture grew Actinomyces meyeri. In consultation with infectious disease specialists, prolonged antibiotic therapy was started with four weeks of intravenous piperacillin-tazobactam followed by six months of oral amoxicillin. This case highlights both the diagnostic challenge of splenic actinomycosis and the importance of maintaining a broad differential diagnosis to avoid anchoring bias or early diagnostic closure in high-risk patients with nonspecific symptoms.

Life-threatening hemoptysis is a serious complication of cavitary pulmonary tuberculosis and can result from multiple coexisting mechanisms, including vascular lesions and chronic pulmonary aspergillosis (CPA), which is frequently missed in post-tuberculosis lung disease. Therefore, we present the case of a 23-year-old immunocompetent man with cavitary pulmonary tuberculosis who developed massive hemoptysis with hemorrhagic shock and acute respiratory failure requiring mechanical ventilation. Emergency angiography identified a arteriovenous fistula and a Rasmussen aneurysm of the right pulmonary artery, which was successfully treated with endovascular embolization using ethylene-vinyl alcohol copolymer, achieving immediate hemostasis. Further evaluation revealed concomitant pulmonary aspergillosis, supported by radiological findings and a positive galactomannan result on bronchoalveolar lavage. The antituberculosis treatment was modified to avoid rifampicin, and antifungal treatment with voriconazole was initiated, resulting in a favorable clinical course. This case underscores the multifactorial nature of life-threatening hemoptysis in tuberculosis-endemic settings and highlights the need for integrated vascular and infectious disease management to reduce recurrence and improve outcomes.

Catamenial pneumothorax is a rare form of recurrent spontaneous pneumothorax occurring in women in temporal association with the menstrual cycle, most commonly within 72 h before or after the onset of menstruation, and is frequently encountered as part of thoracic endometriosis syndrome. Thoracic endometriosis represents an extrapelvic manifestation of endometriosis in which ectopic endometrial tissue may involve the pleura, diaphragm, lung parenchyma, or airways, leading to cyclic pleuropulmonary symptoms. The clinical spectrum includes catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis, and pulmonary endometriotic nodules. This narrative review critically analyzes the diagnostic challenges and limitations of imaging modalities in thoracic endometriosis, with particular emphasis on diagnostic delay, radiological pitfalls, and the discrepancy between morphological detection and etiological confirmation. Chest radiography and computed tomography are useful for documenting acute thoracic events, whereas magnetic resonance imaging may provide additional tissue characterization in selected cases, particularly when hemorrhagic or diaphragmatic lesions are suspected. However, imaging findings are often nonspecific, temporally variable, and insufficient to establish the diagnosis when interpreted in isolation. Recognition of thoracic endometriosis therefore requires correlation of imaging findings with menstrual cyclicity, gynecological history, clinical phenotype, and, when indicated, surgical and histopathological assessment. The available evidence remains limited by retrospective designs, small case series, inconsistent diagnostic criteria, and lack of validated thoracic-specific imaging pathways. Accordingly, an integrated clinical-radiological-surgical approach should be regarded as a pragmatic diagnostic framework rather than a validated algorithm. Such an approach may improve clinical suspicion, reduce diagnostic delay, and support more appropriate multidisciplinary management of this underrecognized condition.

Objective:TNFSF13B, which encodes B-cell-activating factor (BAFF) and peptidylarginine deiminase 4 (PADI4), plays crucial roles in the pathogenesis of ANCA-associated vasculitis (AAV). This study investigated the associations of single-nucleotide polymorphisms (SNPs) in TNFSF13B/BAFF and PADI4 genes with AAV susceptibility, clinical phenotypes, and disease activity in a Guangxi Chinese population. Methods: A case-control study included 324 AAV patients and 324 healthy controls. After propensity score matching (201 pairs), genomic DNA was genotyped for TNFSF13B/BAFF rs3759467 (formerly rs386492354) and rs1041569, and PADI4 rs11203366 and rs874881 using multiplex PCR and high-throughput sequencing. Genetic associations were analyzed via logistic regression, subgroup, haplotype, and clinical correlation analyses. For each of the four SNPs separately, machine learning models (logistic regression, SVM, Random Forest, XGBoost) were built and evaluated via 5-fold cross-validation. No formal adjustment for multiple comparisons was applied due to the exploratory nature of this study. Results: For TNFSF13B/BAFF, the rs3759467 C allele was protective (dominant model OR = 0.60, p = 0.011; log-additive OR = 0.71, p = 0.020; CA haplotype OR = 0.71, p = 0.019), while the rs1041569 T allele was a risk factor (dominant model OR = 1.70, p = 0.016). Subgroup analysis revealed stronger protective effects of rs3759467 in females, Han ethnicity, and MPA patients, and stronger risk effects of rs1041569 in Han ethnicity and MPA patients. Haplotype CA was protective (OR = 0.71, p = 0.019), and TT was risk-associated (OR = 1.55, p = 0.017). Both TNFSF13B/BAFF SNPs were associated with rash and hemoptysis incidence (p < 0.05). rs1041569 was also associated with RBC (red blood cell) count and HB (hemoglobin) levels (p < 0.05). For PADI4, rs11203366 and rs874881 showed no association with AAV susceptibility (all p > 0.05). However, their genotypes were associated with disease activity (BVAS, Birmingham Vasculitis Activity Score), RBC count, and HB levels (p < 0.05). Although machine learning was applied to explore predictive patterns, its performance was suboptimal (AUC < 0.6), indicating limited clinical applicability. Accordingly, the primary findings rely on the genetic model analysis, and the machine learning results should not be overinterpreted as clinically actionable. SHAP analysis indicated that risk-associated genotypes contributed most to model predictions. Conclusions:TNFSF13B/BAFF gene polymorphisms rs3759467 and rs1041569 were associated with AAV susceptibility in this Guangxi cohort, influencing clinical manifestations like rash, hemoptysis, and anemia severity. PADI4 polymorphisms rs11203366 and rs874881 are not associated with susceptibility but may correlate with disease activity and hematological parameters. These findings highlight the ethnic and clinical subtype specificity of genetic influences in AAV. Due to the lack of external validation, these findings are exploratory and require replication.

Surgical resection constitutes the cornerstone of treatment for lung cancer, a disease with high global incidence. Among postoperative complications, delayed fatal hemorrhage occurring beyond 30 days postoperatively has garnered scant attention in clinical and research settings. Notably, there are no documented cases of vascular rupture and bleeding induced by chronic mechanical friction between the bronchial stump and pulmonary artery trunk to date. Following pulmonary lobectomy, the anatomical proximity between the bronchial stump and pulmonary artery trunk creates a potential risk of delayed pulmonary artery hemorrhage secondary to bronchial stump-related pathology. Herein, we report a case of a 53-year-old male patient who presented with sudden massive hemoptysis on the 40th day after right upper lobectomy. Bronchial artery embolization was initially performed but failed to control the bleeding. Emergency thoracotomy revealed a 3-mm rupture with active bleeding in the right pulmonary artery trunk, accompanied by a 2-mm fistula at the right upper lobe bronchial stump. Intraoperatively, the vascular rupture was repaired using a pericardial patch, and both the repaired vessel and the bronchial stump were wrapped with an intercostal muscle flap, achieving successful hemostasis. The patient experienced an uneventful postoperative recovery and remained alive and well at the 3-month follow-up. Written informed consent was obtained from the patient for the publication of this case report and the accompanying clinical images.

Coronary-bronchial artery fistulas (CBAFs) represent a rare subset of coronary artery fistulas characterised by an abnormal communication between an epicardial coronary artery and the bronchial arterial circulation. Although historically considered incidental findings, the widespread use of multimodality cardiovascular imaging-particularly coronary computed tomography angiography-has led to increasing recognition of these anomalies in contemporary clinical practice. The clinical significance of CBAFs varies widely and depends primarily on fistula size, shunt magnitude, and associated cardiopulmonary conditions. While many small fistulas remain asymptomatic, larger or haemodynamically significant lesions may result in myocardial ischaemia due to coronary steal, ventricular remodelling, pulmonary manifestations such as haemoptysis, and aneurysmal degeneration of the fistulous tract. A comprehensive evaluation typically requires an integrated multimodality approach combining anatomical imaging, functional ischaemia testing, and, in selected cases, invasive haemodynamic assessment. Management strategies range from conservative surveillance in small asymptomatic fistulas to percutaneous or surgical closure in symptomatic or haemodynamically significant lesions. This review provides an updated overview of the epidemiology, pathophysiology, diagnostic evaluation, and management of CBAFs. Particular emphasis is placed on size-based clinical stratification, multimodality imaging strategies, and contemporary therapeutic approaches, with the aim of offering a practical framework for the diagnosis and longitudinal management of patients with this uncommon but clinically relevant coronary anomaly.

This report describes a 59-year-old woman with a history of malignancy and post-tuberculosis lung disease complicated by chronic cavitary pulmonary aspergillosis. She was admitted with worsening hemoptysis and underwent bronchial artery embolization. However, she subsequently developed massive post-procedural hemoptysis, requiring mechanical ventilation. Sputum metagenomic next-generation sequencing detected SARS-CoV-2 and bacterial pathogens, prompting Paxlovid treatment for COVID-19 pneumonia. While her respiratory symptoms improved, epigastric pain developed. Based on elevated serum amylase/lipase and CT-confirmed peripancreatic inflammation, she was diagnosed with acute pancreatitis. One year later, pulmonary tuberculosis and liver metastasis recurred. This case highlights acute pancreatitis temporally associated with COVID-19 pneumonia in a patient with multiple competing risk factors. Further, this case underscores the diagnostic complexity of structural lung disease with overlapping infections such as COVID-19 and stresses on the need for long-term surveillance.