Bronchopleural fistula (BPF) is a rare but severe complication following pneumonectomy, associated with high morbidity and mortality, particularly when pleural contamination occurs. Several predisposing factors have been described, including preoperative corticosteroid use, right-sided pneumonectomy, neoadjuvant therapy, diabetes mellitus, and the presence of a long bronchial stump. Preventive strategies such as bronchial stump reinforcement have been widely employed, though the optimal technique and material remain controversial. Therapeutic options range from minimally invasive approaches, including endobronchial closure with cauterization or biological glue, to complex surgical procedures such as intrathoracic muscle transposition, thoracostomy, and thoracoplasty. In cases where conventional reclosure of the stump is hindered by infection or adhesions, the transsternal transpericardial approach described by Abruzzini in 1961 offers an alternative that avoids direct manipulation of the infected pleural cavity. This technique enables safe exposure of the mediastinal structures through a full median sternotomy, allowing direct closure of the bronchial stump. The present study provides a descriptive account and educational video of the Abruzzini technique, based on a real clinical case. The patient, a 72-year-old male with silicosis and endobronchial aspergilloma, underwent left pneumonectomy with radical mediastinal lymphadenectomy. Postoperative evolution was complicated by stump dehiscence and recurrent BPF, despite previous surgical attempts with manual suturing and thymic flap reinforcement. Definitive management was achieved through the transsternal transpericardial approach, involving careful mediastinal dissection, protection of major vascular structures, and closure of the bronchial stump with stapling under bronchoscopic guidance. This report emphasizes the technical nuances of the procedure, including the impact of mediastinal shift in left pneumonectomy, the risks of vascular injury, and the necessity of meticulous preoperative imaging. Differences between left- and right-sided fistulas are also highlighted, underscoring the importance of individualized surgical planning. BPF remains one of the most challenging post-pneumonectomy complications, with mortality exceeding 50% in uncontrolled cases. Although rarely performed, the Abruzzini technique remains a valuable tool in selected scenarios, with reported success rates above 80%. By documenting this surgical approach through video demonstration, the present work aims to enhance thoracic surgery training, preserve classical techniques, and promote safer management of complex BPF.

The aim of this study was to investigate hydatid cysts observed in unusual localizations of the body without liver and lung involvement. A single-center retrospective study was conducted between 2000 and 2024, evaluating a total of 173 cases of hydatid cysts located in uncommon regions of the body, excluding liver and lung involvement. Unusual hydatid cysts accounted for 4.8% (173/3623) of all hydatid cysts. Among the cases, 89 (51.4%) were female and 84 (48.6%) were male. The cohort included 49 children (≤ 18 years, 28.3%) and 124 adults (> 18 years, 71.7%), with a mean age of 33.7 ± 20.2 years (range: 5-85 years). The distribution of hydatid cysts included the spleen in 34 cases (19.7%), kidney in 27 (15.6%), intracranial in 24 (13.9%), muscle in 23 (13.3%), bone in 15 (8.7%), mediastinum in 10 (5.8%), pelvic space in 9 (5.2%), cardiac in 8 (4.6%), subcutaneous and soft tissue in 6 (3.5%), omentum in 6 (3.5%), ovarian fossa in 3 (1.7%), diaphragm in 3 (1.7%), pancreas in 3 (1.7%), uterine wall in 1 (0.6%), retroperitoneal space in 1 (0.6%), nasal cavity in 1 (0.6%), and thyroid in 1 (0.6%). Primary surgical treatment was applied to 144 cases (83.2%). Primary hydatid cysts are less common in other parts of the body without involvement of the liver and lungs. Surgical resection remains the preferred treatment method for these cases, where diagnosis can be challenging.

Necrotizing pneumonia (NP) is a severe and life-threatening complication of lung infection in children. While rare, it can lead to catastrophic complications such as hemothorax, where blood fills the pleural cavity. We present the case of a previously healthy 5-year-old girl who initially appeared to have a gastrointestinal illness. Her condition rapidly evolved into a complex medical emergency involving influenza-associated NP, which was then complicated by a sudden, massive hemothorax. Her hospital course was further challenged by drug-induced acute kidney injury (AKI) requiring temporary hemodialysis and the persistent mystery of negative bacterial cultures. This case highlights the aggressive potential of NP, the critical need for vigilance when clinical signs worsen abruptly, and the essential role of timely surgical intervention. Following an urgent thoracotomy and lung resection, the child made a full recovery, underscoring how a multidisciplinary approach can be life-saving in these extreme scenarios.

Polyamines are organic cations that are present at sub-millimolar concentrations in the cytoplasm and extracellular fluids and serve as versatile modulators of TRP channels, fine-tuning their functions in physiological and pathological contexts, including pain, inflammation and cancer. Despite extensive functional studies, the structural basis by which polyamines regulate TRP channels remains unclear. Here, we combine calcium imaging, electrophysiology, cryo-electron microscopy, mutagenesis and molecular dynamics simulations to study regulation of human TRPV6 by polyamine spermine. Our functional experiments demonstrate voltage-dependent block of TRPV6-mediated currents by spermine. Cryo-electron microscopy reveals that spermine binds in the open pore of TRPV6, extending along the pore axis through the selectivity filter and central cavity. Mutagenesis and molecular dynamics simulations confirm the main binding site of spermine in the selectivity filter and suggest a stepwise molecular mechanism of channel block that includes two more binding sites in the pore transiently occupied by spermine. Our findings enrich the knowledge about TRPV6 regulation by endogenous factors and provide details of the ion channel blocking mechanism that can be explored for inhibition of this channel in disease conditions.

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.

Respiratory morphology in chelonians exhibits unique adaptations compared to mammals, with multicameral lungs and large terminal chambers. This study combined computed tomography (CT) imaging and Rodopas-casting to assess structural and volumetric changes in the lungs of adult male European pond turtles (Emys orbicularis) between extended and flexed postural states of the head, neck, and limbs. Five turtles (550 ± 10.22 g) were evaluated under anaesthesia. CT scans quantified lung dimensions, volume, parenchymal thickness, and percentage coelomic occupancy, while Rodopas casts provided detailed bronchial architecture. CT imaging revealed bilateral wedge-shaped lungs positioned dorsally in the coelomic cavity, with the trachea entering from the right side and bifurcating into a longer left and shorter right bronchus. Each lung contained three lateral and four medial secondary bronchi, terminating in sac-like chambers, plus a large caudal terminal chamber. Lateral chambers were larger than medial ones; tertiary bronchi were denser in cranial lung regions. Casting confirmed bronchial branching but showed smaller terminal sac volume than CT, likely due to post-mortem differences. Morphometric analysis showed no significant differences in lung length or height between sides or postures. Cranial lung width decreased significantly in the flexed state (p < 0.05), while overall lung volume dropped markedly from 29.93 ± 0.33 cm3 (left) and 29.77 ± 0.33 cm3 (right) in extension to 23.41 ± 0.33 cm3 and 23.31 ± 0.32 cm3 in flexion (p < 0.001). Caudal parenchymal thickness was significantly reduced in flexed posture (p < 0.05). Coelomic cavity occupancy decreased from 43.06% ± 0.44% to 34.10% ± 0.47% (p < 0.001). These findings demonstrate that E. orbicularis lungs maintain overall shape during postural changes but undergo substantial cranial width and volume reduction with caudal parenchymal thinning. Differences between CT and casting highlight the complementary value of both techniques, with CT capturing functional, in vivo configurations and casting revealing intricate bronchial anatomy. The data provide new insights into respiratory adaptation and volumetric modulation in semi-aquatic chelonians, with relevance for comparative anatomy, evolutionary biology, and clinical imaging applications.

Bronchopleural fistula (BPF) refers to an abnormal passage connecting the bronchial tree to the pleural cavity, which may arise from infection, trauma, or post-surgical complications. When associated with tuberculosis (TB), its insidious and slowly progressive nature often delays recognition, complicating timely management. This case highlights a rare presentation of large tuberculous peripheral bronchopleural fistula in a young adult, complicated by massive pyopneumothorax and ultimately requiring pneumonectomy, a rare intervention in this age group. The patient, on his fifth month of anti-tuberculosis therapy, showed symptoms of fever, productive cough, weight loss, and respiratory distress. Imaging revealed left-lung consolidation with "tree-in bud" nodule, and ground-glass opacity, together with extensive right-sided pyopneumothorax. Chest computed tomography and virtual bronchoscopy confirmed a 19-mm fistulous tract arising from the right secondary bronchus. In TB-related BPF, structural lung damage may occur through ruptured cavities or erosion of caseating lymph nodes, forming sinus tracts that permit persistent air and purulent drainage into the pleural space. When conventional bronchoscopy is limited computed tomography and virtual bronchoscopy provide reliable noninvasive visualization of the fistula and airways, enabling accurate diagnosis and management planning.

Approximately 4% of metastatic lung tumors exhibit cavitation. Cavitary pulmonary metastases arising from urothelial carcinoma are rare. Renal pelvic cancer accounts for only 3%-5% of all urothelial carcinomas; cavitary pulmonary metastasis from renal pelvic cancer is rare. This report describes pulmonary metastasis from renal pelvic cancer with cavitation. A man in his 50s underwent laparoscopic left nephroureterectomy with hilar lymph node dissection for left renal pelvic cancer 2 years earlier. During follow-up, chest computed tomography (CT) revealed a gradually enlarging lesion with internal cavitation in the right lower lobe. Chest CT demonstrated a 17-mm cavitary nodule in segment 7 of the right lung, enlarged from 4 mm over 1 year. Cavitation was evident even when the lesion was small; tumor diameter and cavity size also increased. The cavity wall remained thin, measuring 1.5 mm in most areas, up to 4 mm, without progressive thickening. Given the rarity of cavitary metastasis from renal pelvic cancer, a surgical biopsy was performed. Thoracoscopic wedge resection revealed a nodular lesion with a grayish-white cavity. Immunohistochemical staining demonstrated GATA3 positivity, confirming pulmonary metastasis. Microscopically, the tumor proliferated while destroying the lung architecture, with small tumor cell clusters within the alveolar spaces. Tumor extension into a bronchiole lacking cartilage resulted in partial luminal obstruction. Here, radiological progression and pathological findings supported cavity formation via a check-valve mechanism. This case provides radiological and pathological evidence supporting a check-valve mechanism of cavitation in pulmonary metastasis and contributes to the differential diagnosis of thin-walled cavitary pulmonary nodules.

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.

This case report discusses a middle-aged patient with metastatic pleuro-pulmonary Ewing sarcoma, with the rare initial presentation of spontaneous haemothorax. The patient had a prior history of Ewing sarcoma of the pelvis in young age, which had been treated with chemoradiotherapy with remission. There was a 2-week history of right sided chest pain and shortness of breath, and a chest x-ray showed complete opacification of the right hemithorax, with subsequent CT arising suspicion of a heterogeneous soft tissue pleural lesion with fluid in the pleural cavity. While awaiting further treatment including biopsy, the patient deteriorated rapidly and was eventually started on end-of-life care. Postmortem examination showed large right pleural haemorrhage with lung collapse, and histological examination of pleural lesions confirmed a diagnosis of recurrent Ewing's sarcoma. Extraskeletal presentations of Ewing's sarcoma, particularly with spontaneous haemothorax as the initial presentation have been rarely reported in the literature in adult patients. Diagnosing pleural Ewing's sarcoma requires a multimodal approach, utilising investigations such as contrast-enhanced CT imaging, pleural fluid analysis, thoracoscopy, and PET-CT to evaluate for disease spread. Treating pleural Ewing's sarcoma can be challenging; early diagnosis and management of complications such as haemothorax is essential with thoracocentesis or thoracotomy. Ongoing treatment can include multimodal therapies including chemotherapy and radiotherapy with or without surgery, depending on disease extent.