Chlamydia pneumoniae is a significant cause of community-acquired pneumonia, yet its diagnosis remains challenging due to non-specific symptoms and the limitations of traditional methods like serology, which can cause delays. We present the case of a 14-year-old female admitted with cough and right-sided chest pain. Initial laboratory tests were unremarkable, except for a positive C. pneumoniae IgM result. A chest CT scan revealed right upper lobe infiltrates. Despite empirical azithromycin, her improvement was limited. Bronchoscopy was performed, and bronchoalveolar lavage fluid was analyzed by targeted next-generation sequencing (tNGS), which identified C. pneumoniae as the dominant pathogen with a high sequence count (9886), providing strong evidence for the etiology. Targeted macrolide therapy was continued (transitioned to oral doxycycline), leading to marked clinical improvement within 72 h. Longitudinal lab monitoring revealed a self-resolving transaminitis and a rise in Serum Amyloid A post-treatment. This case suggests that tNGS can serve as a valuable adjunctive tool in providing a rapid, culture-independent etiological diagnosis for atypical pneumonias, helping to guide effective therapy in selected patients with complex respiratory infections.

BACKGROUND Extracorporeal membrane oxygenation (ECMO) serves as a life-sustaining intervention for pediatric patients with severe, reversible respiratory or circulatory failure refractory to conventional therapies, providing temporary cardiopulmonary support to maintain oxygenation, perfusion, and hemodynamic stability. CASE REPORT Following a family argument, a 9-year-old boy fell from the seventh floor, with partial obstruction by a canopy. He presented with immediate loss of consciousness, absent voluntary motor activity, Kussmaul respirations, otorrhagia, and epistaxis. Initial computed tomography (CT) revealed high-attenuation nodules in the right main bronchus, right lower lobe bronchus. Despite endotracheal intubation and supportive measures, oxygenation remained refractory to correction, prompting interhospital transfer. On admission to our unit, imaging revealed high-attenuation opacities in the right middle bronchus and left lower lung. Multidisciplinary consultation was conducted. Under ECMO support, flexible bronchoscopy enabled retrieval of tooth fragments from the right upper lobe and an entire left maxillary first permanent molar from the left lower lobe. Postoperatively, ECMO was successfully discontinued, with the patient exhibiting stable vital signs, and subsequent management was continued. CONCLUSIONS The successful retrieval of dental fragments and an entire tooth via flexible bronchoscopy, facilitated by ECMO support, underscores the critical role of ECMO as a stabilizing platform enabling otherwise high-risk airway interventions in hemodynamically compromised pediatric trauma patients. This case illustrates the strategic implementation of venoarterial ECMO as a salvage therapy in the context of refractory hypoxemia and cardiopulmonary instability, rather than as a routine adjunct to flexible bronchoscopy procedures.

Double sleeve lobectomy, involving both bronchial and vascular reconstruction, is a complex but lung-sparing alternative to pneumonectomy for centrally located tumors. While traditionally performed via thoracotomy, its application through video-assisted thoracoscopic surgery (VATS) remains limited. We report the first known case of a double sleeve lobectomy in Türkiye performed via a VATS approach in a 58-year-old female with a centrally located left upper lobe pleomorphic carcinoma involving both the pulmonary artery and bronchus. This case demonstrates the technical feasibility of VATS double-sleeve lobectomy when performed by experienced surgeons and shows that a mistake made during pulmonary artery division does not necessarily result in pneumonectomy.

Invasive pulmonary aspergillosis (IPA) is a severe fungal infection caused by Aspergillus mold, primarily affecting immunocompromised individuals, but increasingly seen in those with critical illness (e.g., viral infections) or in a subacute form in those with severe lung disease. We report the case of a 38-year-old woman with a history of pulmonary tuberculosis (TB) and a suspicion of post-TB chronic pulmonary aspergillosis who presented with dyspnoea and a productive cough unresponsive to antibiotics. Her condition rapidly evolved to respiratory insufficiency requiring intubation. Imaging revealed an extensive abscess in the left upper lobe with surrounding consolidation. Bronchoscopy showed a large amount of mucus requiring clearance. Cytopathology and cultures confirmed Aspergillus fumigatus (A. fumigatus). Laboratory testing showed marked eosinophilia, elevated total immunoglobulin-E, and positive A. fumigatus precipitins. The combination of a predisposing factor (post-tuberculosis cavities), cultures, and radiological findings was compatible with the diagnosis of subacute invasive pulmonary aspergillosis or chronic cavitating aspergillosis, as strictu sensu diagnosis of probable invasive aspergillosis could not be made (as typical immunocompromising host factors were not met). However, the disease was rapidly progressive, and the patient exhibited a good clinical, biochemical, and radiological evolution under voriconazole therapy. Long-term antifungal therapy will be required. This case highlights the importance of considering IPA, even in patients without classic profound immunosuppression, and recognizing post-tuberculosis cavities as a significant predisposing factor.

Pulmonary disease caused by nontuberculous mycobacteria represents an important diagnostic challenge, particularly in immunocompromised patients, in whom clinical and radiologic findings may mimic malignancy. We report the case of a 70-year-old woman with myelofibrosis treated with ruxolitinib who developed a tumor-like lesion in the left upper lobe on computed tomography, highly suggestive of lung cancer. Despite broad-spectrum antibiotic therapy, the lesion persisted; bronchoscopy did not yield diagnostic findings, and CT-guided transthoracic biopsy demonstrated necrotizing granulomatous inflammation without evidence of malignancy. Microbiological analysis subsequently identified Mycobacterium avium, and targeted antimycobacterial therapy led to clinical and radiologic improvement. This case highlights that pulmonary nontuberculous mycobacterial infection may present as a pseudotumoral lesion and should be considered in the differential diagnosis of mass-like pulmonary opacities, particularly in patients receiving Janus kinase inhibitor therapy.

Cryptococcosis is an opportunistic and conditional disease. The lungs and central nervous system are common organs invaded by Cryptococcus. Most patients with pulmonary cryptococcosis are immunocompromised, such as acquired immune deficiency síndrome, subjects with immunosupressive drugs and hematological malignancies. We present an immunocompetent 46-year-old man with diabetes mellitus, who had cough, chest pain and weight loss. Computed tomography of thorax demonstrated a pulmonary nodule in the right upper lobe, measuring 8.5 cm. To confirm the diagnosis, the patient underwent CT-guided biopsy of the nodule. Pathology revealed round structures with asymmetric budding on Periodic acid-Schiff-diastase, Grocott methenamine silver and mucicarmine stains, morphologically compatible with Cryptococcus sp. Serum cryptococcal antigen was positive. Once the diagnosis of isolated pulmonary cryptococcosis was confirmed, the patient was treated with oral fluconazole 400 mg daily for 6 months. The treatment response was categorized as partial resolution, and the patient underwent a right upper lobectomy. Pulmonary cryptococcosis in non-HIV patients is a relatively common, and in some of them is difficult to differentiate from lung cancer.

Percutaneous lung biopsy and cryoablation (CRA) under imaging guidance are safe and effective options in the diagnosis and treatment of pulmonary ground-glass nodules (GGNs) with favourable outcomes. However, percutaneous puncture procedures conventionally require multiple freehand needle manipulations until a satisfactory needle position is achieved, which leads to unnecessary radiation exposure, complications and failure. Despite increasing utilisation of robotic-assisted systems in recent years, literature describing their use in CT-guided percutaneous lung biopsy and CRA for pulmonary GGNs remains limited. Herein, we report our initial experience with robotic-assisted CT-guided synchronous percutaneous lung biopsy and CRA of a mixed GGN that was accidentally discovered during a physical health examination in a 77-year-old female. The 14-mm-sized mixed GGN involving the anterior segment and apical segment of the right upper lobe was successfully biopsied and cryoablated without recurrence at the 7-month follow-up. This case highlights the feasibility, safety and greater accuracy of employing a novel robotic-assisted system in lung biopsy and CRA for pulmonary sub-solid nodules.

Pneumocystis jirovecii, an atypical fungus, is a recognized cause of severe pneumonia in individuals with HIV. However, P jirovecii pneumonia (PJP) is now increasingly encountered among immunocompromised patients without HIV, including those receiving treatment for hematologic or solid organ malignancies, solid organ or bone marrow transplant recipients, patients with autoimmune diseases treated with immunosuppressive therapy, and patients requiring prolonged corticosteroid therapy; many of whom may not receive prophylaxis. This article summarizes characteristic and atypical chest CT findings of PJP in immunocompromised patients to support early recognition. Diffuse pulmonary ground-glass opacity (GGO) is the most common chest CT manifestation and should strongly suggest PJP in immunocompromised patients, although variant patterns, particularly peripheral and upper lobe predominant distributions, are frequently observed; midlung and basilar distributions are rare. Consolidation is also common, especially in more severely ill patients, but neither GGO nor consolidation distribution reliably differs across underlying causes of immunocompromise. Interlobular septal thickening and mosaic attenuation are additional CT findings, and, although lymphadenopathy and pleural effusion may occur, these often reflect the underlying condition causing immunocompromise or comorbid disease rather than PJP itself. Cyst formation may be observed and can predispose to pneumothorax. CT abnormalities often improve quickly after initiation of PJP-directed therapy, but not in all patients. Atypical CT manifestations, including nodules (with solid nodules potentially representing "granulomatous" PJP), masses, and cavitation, should raise suspicion for coinfection or other superimposed processes. Complex or mixed CT patterns in patients with PJP may result from the disease predisposing to immunocompromise or from its treatment, underscoring the importance of clinical context in interpreting chest CT findings. Keywords: CT, Pulmonary, Thorax, Lung, Infection, Transplantation, Pneumocystis jirovecii Pneumonia, Immunosuppression, Ground-Glass Opacity Supplemental material is available for this article. © RSNA, 2026.