Actinomycosis is a rare, slow-progressing infection mimicking malignancies by penetrating mucosal barriers and spreading across anatomical planes. While typically affecting the cervicofacial area, it can also involve the thorax and abdomen, with simultaneous hepatic and pulmonary involvement being particularly rare.

One-lung ventilation (OLV) is performed during lung surgeries by ventilating a single lung, while collapsing the operative lung to provide surgical exposure within the thoracic cavity. While a lung-protective ventilation strategy is recommended during OLV, increasing the fraction of inspired oxygen (FiO2) or tidal volume (VT) may be required to prevent hypoxemia during surgery. Unfortunately, these increases are associated with postoperative lung injury. Using a porcine model of OLV, our project aims to determine if high FiO2 or VT during OLV contributes to elevation of pro-inflammatory lipid mediators postoperatively. Fifteen three-month-old farm-bred pigs underwent left upper lobectomy requiring OLV. Pigs were exposed to one of three ventilation parameters: normoxic low VT lung-protective ventilation LPV-NO, n = 5, FiO2 < 50%, VT = 6 mL/kg), hyperoxic lung-protective ventilation (LPV-HO, n = 5, FiO2 >100%, VT = 6 mL/kg), or normoxic high VT (injurious mechanical ventilation) (IMV, n = 5, FiO2 < 50%, VT = 10-12 mL/kg). Arterial plasma was collected before and after OLV, and lipids were detected via LC-MS-MS. Lipidomic analysis demonstrated a statistically significant increase (FC = 2, p ≤ 0.05) in lysophosphatidylethanolamines (LPE 18:3, LPE 20:4, LPE 18:2, LPE 22:6), free fatty acids (FFA 20:4), phosphatidylserine (PS 38:5), lysophosphatidylcholine (LPC 18:1, LPC 18:3, LPC 22:6), triglyceride (TG 18:2-18:2-20:4), free fatty acids (FFA 20:5), linoleyl-carnitine molecules (C18-2 Linoleoyl Carnitine), and phosphatidylethanolamines (PE 36:5) in LPV-HO. IMV resulted in a significant increase (FC = 2, p ≤ 0.05) in triglyceride (TG 18:2-18:2-20:4), diglyceride (DG 18:1-20:4, DG 16:0-20:4), linoleyl-carnitine molecules (C18-2 Linoleoyl Carnitine), and free fatty acids (FFA 20:5). There was no significant change in lipid biomarker levels following LPV-NO post-surgery. Our lipidomic analysis supports that both high FiO2 and VT contribute to systemic lipid metabolic derangements. Lipids that were elevated in LPV-HO and IMV are associated with multiple inflammatory pathways implicated in lung injury. This suggests that intra-operative anti-inflammatory therapies targeted to these lipid pathways may reduce or prevent postoperative pulmonary complications after lung surgery.

Pulmonary tuberculosis typically exhibits characteristic imaging findings; however, radiological manifestations can be atypical in certain cases, leading to potential misdiagnosis based solely on CT imaging. We describe a 59-year-old man who developed a 4-month history of cough and a 2-week fever during postoperative radiotherapy following esophagectomy for esophageal cancer. CT scans revealed multiple, scattered cystic cavities in both lungs, characterized by regular shape and well-defined borders. Following anti-tuberculosis therapy, the pre-existing cystic cavities collapsed and evolved into nodular opacities, a change highly suggestive of cystic metastases given the patient's history of esophageal cancer. A biopsy confirmed granulomatous inflammation, and follow-up at eight months after the initiation of anti-tuberculosis therapy showed near-complete resolution of the lesions. Although cystic pulmonary tuberculosis is rarely reported, this case is notable for its distinct cystic characteristics. To our knowledge, this is the first case to systematically document the transformation of cystic lesions into nodules during anti-tuberculosis therapy-a finding that may raise suspicion for cystic metastases and highlights the diverse and atypical radiological manifestations of tuberculosis in immunocompromised hosts.

Carcinosarcoma is a rare and aggressive malignancy characterized by both epithelial and mesenchymal components. It most commonly arises in the uterus, lung, or gastrointestinal tract, whereas occurrence in the oral cavity is exceptionally rare. Here, we report a rare case of an aggressive neoplasm with mixed epithelial and sarcoma-like features that initially presented as a benign-appearing upper lip lesion. A 47-year-old male first presented in March 2025 with a painless upper lip mass that had persisted for two months. The lesion appeared clinically benign, and an excisional biopsy was performed. However, during surgery, intraoperative frozen section analysis revealed features highly suspicious for malignancy. Following surgery, systemic imaging demonstrated multiple hypermetabolic lesions in the lung, colon, liver, pancreas, adrenal glands, and lymph nodes. Biopsies from the lip, colon, and lung revealed a high-grade malignant tumor with variable epithelioid and sarcomatoid features across sampled sites. Immunohistochemistry showed co-expression of cytokeratin and vimentin, supporting mixed epithelial and sarcoma-like features. As no primary tumor was identified despite extensive work-up, the available findings favored an aggressive malignant neoplasm of uncertain primary origin with mixed epithelial and sarcoma-like features, although the final histologic sub-classification remained uncertain due to incomplete original pathology information. The patient subsequently received palliative systemic chemotherapy with an alectinib-based targeted regimen starting in April 2025, but showed progressive disease on follow-up, even with additional second-line gemcitabine/cisplatin and third-line pembrolizumab therapy. The patient ultimately succumbed in September 2025. This case highlights that even relatively subtle-appearing lesions require a high index of suspicion for malignancy, emphasizing the importance of early biopsy and comprehensive systemic evaluation. Carcinosarcoma, though rare, should be considered in the differential diagnosis of aggressive tumors arising in atypical locations.

Gastropleural fistula is a rare but serious complication characterised by an abnormal communication between the stomach and the pleural cavity. It poses substantial diagnostic and therapeutic challenges and often requires coordinated multidisciplinary intervention. We report the case of a 52-year-old woman with a complex surgical history, including multiple bariatric procedures, who developed a persistent gastropleural fistula complicated by necrosis of the left lower lung lobe. Multiple endoscopic interventions, including Ovesco clip placement and fibrin glue injection, were unsuccessful in achieving fistula closure. Clinically, she presented with a chronic productive cough yielding greenish sputum, along with coarse crepitations localised to the left lower lung zone. Imaging demonstrated a left-sided pleural effusion, prompting further evaluation. Contrast-enhanced CT of the chest and abdomen revealed a patent fistulous tract communicating with the proximal gastric body and extensive left lower lobe necrosis. Surgical management included left lower lobectomy, circumferential dissection, and identification of the gastropleural fistula, transposition of the fistulous tract into the abdominal cavity, and primary diaphragmatic repair to prevent continued leakage into the thoracic cavity. Following surgery, the patient was transferred to a specialised upper gastrointestinal centre for ongoing care and definitive fistula management. This case highlights the profound impact gastropleural fistulas can have on pulmonary structures and underscores the complexity of their management. It emphasises the necessity of a multidisciplinary approach integrating thoracic and upper gastrointestinal surgical expertise to optimise outcomes.

Indium lung disease remains an ultra-rare interstitial lung disease with no initiative effective in changing the trial. It is related to excessive protein deposition, the development of interstitial inflammation, and subsequent pulmonary fibrosis. This is a "destructive" pulmonary disease. The pathogenesis of indium lung disease remains unclear because the disease progresses continuously, making early diagnosis difficult. This study aimed to identify the histopathological features of pulmonary injury during and after Nano-ITO intratracheal instillation. Male Sprague-Dawley rats were intratracheally instilled (single and multiple) with dispersed Nano-ITO at low (0.6 mg/kg) and high (6 mg/kg) doses and were sacrificed at 1, 4, 8 and 12 weeks after exposure to test inflammation, pulmonary alveolar proteinosis (PAP), and interstitial fibrosis in the lungs. The results demonstrated that even low-dose Nano-ITO exposure made the lungs susceptible to various types of lung injuries that may lead to PAP and disorders of lipid metabolism. The pro-inflammatory action of Nano-ITO-induced progressive interstitial fibrosis may promote this process by aggravating PAP, including the acute aggravation of foamed alveolar macrophages (AM) and lipid metabolism disorders. When inspecting the effects of these inflammatory responses, the current study uncovered the significance of prospective relationships between PAP, lipid metabolism disorders, and pulmonary fibrosis. Nano-ITO induces a large amount of reactive oxygen species production and mitochondrial damage to trigger redox imbalance, ultimately leading to indium lung disease. Nano-ITO causes pulmonary parenchymal lesions, and its pathological features mainly include: foam macrophage accumulation in respiratory bronchioles and alveolar cavities, fibrosis in alveolar septa (collagen deposition in alveolar septa), epithelial-mesenchymal transition (decreased expression of E-cadherin, increases expression of alpha smooth muscle actin and vimentin), intracytoplasmic lipid droplets (Oil Red-O-positive AM), and cholesterol clefts forming small nodules and granuloma. These findings suggest that intratracheal instillation of rats for 12 weeks is sufficient to observe progressive lung lesions caused by Nano-ITO and is an appropriate experimental scheme to evaluate the early stages of indium lung disease.

Photodynamic therapy (PDT) is a promising treatment for pleural malignancies, yet accurate dosimetry remains challenging due to complex cavity geometries and the need to protect surrounding critical structures. The reactive oxygen species ([ROS]rx) generated during treatment serve as a direct predictor of therapeutic efficacy. We developed a finite element model using COMSOL Multiphysics to simulate macroscopic photophysical kinetics, using clinical data inputs, including light fluence derived from a navigation system and patient-specific photosensitizer concentrations. Crucially, we integrated a deformable image registration framework to align intra-operative navigation data with pre-treatment CT scans, enabling the calculation of [ROS]rx dose accumulation in critical Organs at Risk (OARs), such as the lung, heart, and esophagus. The model successfully reconstructed 3D [ROS]rx distributions for multiple clinical cases. Point-to-point comparison at 32 detector locations across ten patients showed strong agreement between COMSOL-simulated and clinically calculated [ROS]rx (mean percentage difference 0.6 ± 5.8%), while volume-averaged values differed by -6.0%, reflecting the enhanced spatial coverage of the 3D model relative to discrete sampling. The two-stage deformable registration improved CT-to-navigation surface alignment from HD95 = 4.08 mm to 1.78 mm (56.4% reduction) and MSD = 1.77 mm to 0.68 mm (61.5% reduction), enabling the first patient-specific mapping of [ROS]rx onto OAR structures. This study demonstrates the feasibility of a comprehensive 3D dosimetry system for pleural PDT. By integrating kinetic modeling with deformable registration, we provide a robust platform for evaluating treatment efficacy and ensuring OAR safety, paving the way for eventual integration into treatment planning and real-time feedback.

Pulmonary brucellosis is a rare focal manifestation of human brucellosis with non-specific clinical features. Predominant imaging findings include pneumonia, pleural effusion, pulmonary nodules, abscesses, and interstitial changes. Multiple cavitary lesions are exceptionally rare. Herein, we report a case of bilateral multiple pulmonary cavities in a 76-year-old man with a 2-year history of intermittent cough, sputum production, and progressive dyspnea that acutely worsened 10 days prior to admission with intermittent fever, anorexia, and fatigue. Chest computed tomography (CT) revealed bilateral upper lobe irregular mass-like opacities and multiple nodules with heterogeneous density, punctate calcifications, and cavitation; multiple microcavitations in the right middle and lower lobes and the left lower lobe; and enlarged, calcified hilar and mediastinal lymph nodes. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid identified Brucella species, which was confirmed by positive serology. After 3 days of doxycycline (0.1 g bid po) and rifampicin (0.6 g qd po), followed by 140 days of doxycycline (0.1 g bid po), rifapentine (0.6 g biw po), and levofloxacin (0.5 g qd po), along with silibinin meglumine tablets 0.1 g tid po for hepatoprotective therapy, the patient became afebrile with significant symptomatic improvement. Repeat chest CT demonstrated reduction in the right upper lobe consolidation/cavity and left upper lobe consolidation, resolution of the right lower lobe cavity, and complete resolution of the microcavitations. This case underscores that pulmonary brucellosis should be considered in the differential diagnosis of cavitary lung lesions in patients with livestock exposure and that prolonged combination antibiotic therapy can achieve favorable clinical and radiological outcomes.

Hereditary hemorrhagic telangiectasia (HHT) is a multiple-organ disease. Herein, we report a case of rupture of an undiagnosed pulmonary arteriovenous malformation (PAVM) during pregnancy in which good outcomes for both mother and children were achieved with transcatheter embolization. The patient was a pregnant 32-year-old Pashtun woman, G4P3, with a history of cesarean section. She had undergone pregnancy checkups at our hospital for a dichorionic diamniotic twin pregnancy. In gestational week 20, the patient experienced loss of consciousness at home and was transported by ambulance to our hospital. Her Glasgow Coma Scale score was 9 (E2V2M5) and her blood pressure was 57/27 mmHg. Blood test results showed severe anemia; right atelectasis and mediastinal shift were shown on chest radiography. Contrast-enhanced chest computed tomography revealed right hemothorax and a single pulmonary arteriovenous malformation measuring 35 mm in the middle lobe of the right lung. The patient was diagnosed with hemothorax due to rupture of the right PAVM. Emergency transcatheter embolization was performed, disappearance of the arteriovenous malformation was confirmed, and hemostasis was achieved. Recurrent epistaxis and telangiectasias on the tongue, buccal mucosa, and nasal cavity were noted, and the patient was diagnosed with HHT. An abdominal cesarean section was performed due to the low-lying placenta and right hydronephrosis. Two male neonates were delivered: one weighed 1988 g and the other 2166 g. Both mother and infants progressed well. This case illustrates how unrecognized HHT can lead to catastrophic PAVM rupture during pregnancy and emphasizes the lifesaving value of early diagnosis and prompt endovascular intervention. In addition, it highlights the critical importance of pre‑pregnancy screening for HHT to prevent life‑threatening complications.

The spotted seal (Phoca largha) is a flagship species and natural monument inhabiting Korean coastal waters. Due to its conservation importance and the rarity of carcass discoveries, determining the cause of death of each individual is critical. A juvenile female spotted seal carcass was discovered on the eastern coast of Korea in May 2025. External examination revealed multiple parallel lacerations consistent with propeller strike injuries. Post-mortem computed tomography (PMCT) was performed prior to necropsy to provide a comprehensive forensic analysis. CT imaging revealed the longest wound measured 10.49 cm in length and 1.58 cm in depth, suggesting a minimum propeller diameter of approximately 19 cm. Skeletal injuries included a coccygeal vertebral fracture and subluxation of the left astragalus and calcaneus. CT images of the respiratory tract showed frothy fluid in the nasal cavity and trachea, as well as ground-glass opacity and consolidation in the lung parenchyma. Necropsy findings confirmed severe pulmonary edema, congestion, and abundant frothy foam throughout the respiratory tract. Histological analysis revealed pulmonary edema with eosinophilic fluid and erythrocytes in alveolar spaces, markedly distended blood vessels, and intra-alveolar hemorrhage. This comprehensive approach demonstrated that the cause of death was drowning, secondary to propeller strike by a small vessel (<4.5 m). To the authors' knowledge, this is the first case report providing a detailed forensic analysis of a juvenile spotted seal found on the eastern coast of Korea. This case highlights the importance of integrating PMCT with conventional necropsy to improve cause-of-death determination in marine mammal conservation.