Pulmonary fungal infections are typically opportunistic but can also develop in immunocompetent hosts. These infections frequently present with diverse imaging appearances, often mimicking more common pulmonary or mediastinal conditions. We report the case of a 64 year old male with cough, shortness of breath and chest heaviness whose imaging features (neural formainal extension; destruction of adjacent ribs and vertebral bodies and chest wall invasion) initially suggested a malignant peripheral nerve sheath tumor. However, biopsy performed twice confirmed the lesion to be a cryptococcal infection. This case highlights that fungal infections in immunocompetent individuals may present as invasive mass-like lesions. Consequently, infections-particularly fungal etiologies-should remain an important consideration in the differential diagnosis of thoracic masses, even in patients without overt immunosuppression.

Immune checkpoint inhibitors (ICIs) have emerged as a promising therapeutic strategy for lung cancer. This case report describes a patient with situs inversus totalis (SIT) and initially unresectable, advanced lung squamous cell carcinoma (LSCC) who successfully underwent surgical resection following neoadjuvant therapy with pembrolizumab and chemotherapy. The patient was incidentally found to have SIT and a 6.5 × 5.0 cm mass in the right upper lobe (RUL) with hilar and mediastinal lymphadenopathy on a local chest CT scan. PET-CT scan revealed the RUL lesion (approximately 6.6 cm, SUVmax 13.7) and multiple hypermetabolic lymph nodes in the right hilum and station 4R (largest 1.8×1.8 cm, SUVmax 2.5-5.2). EBUS/TBNA was not performed due to limited availability at the initial treating institution. The tumor was deemed unresectable due to its large size (6.6 cm), central location involving the apical segment bronchus, and bulky N2 disease (station 4R, >2 cm), which increased the risk of incomplete resection and recurrence. A CT-guided biopsy confirmed squamous cell carcinoma. The patient was staged as cT3N2M0 (stage IIIB) and received three cycles of neoadjuvant pembrolizumab (200 mg), cisplatin (60 mg), and paclitaxel (270 mg). A repeat PET-CT at our institution showed significant reduction of the tumor (approximately 1.9×1.7 cm, SUVmax 8.9) and mediastinal (stations 3A, 4) and hilar lymph nodes with decreased metabolic activity (SUVmax 2.5). The restaging was ycT1cN1M0 (stage IIA). Following a multidisciplinary team (MDT) discussion, the patient underwent video-assisted thoracoscopic surgery (VATS) right upper lobectomy with mediastinal lymph node dissection. The final pathology confirmed a pathological complete response in the lymph nodes and minimal residual disease in the primary lesion, yielding a postoperative pathological stage of ypT1cN0M0 (stage IA3). Postoperative management included supportive care, infection control, and airway clearance. The patient was discharged on postoperative day 4 and subsequently received adjuvant pembrolizumab monotherapy. This case demonstrates that neoadjuvant chemoimmunotherapy can effectively downstage initially unresectable advanced LSCC, even in a patient with SIT, creating an opportunity for successful surgical intervention and potentially improving outcomes, thereby informing future clinical practice.

Hydatid disease (Echinococcus infection) is a parasitic condition primarily affecting the liver and lungs. Cervical involvement is extremely rare and can mimic other benign cystic neck lesions, making diagnosis challenging. We report a 35-year-old woman with a gradually enlarging left cervical mass extending toward the superior mediastinum, causing dysphagia and mild shortness of breath. Imaging revealed a large cystic lesion with daughter cysts abutting cervical vessels and the subclavian artery, with no abdominal or pulmonary involvement. The patient underwent transcervical excision with careful preservation of surrounding structures, followed by postoperative albendazole therapy. She recovered uneventfully and remains recurrence-free. This case highlights that hydatid disease should be considered in the differential diagnosis of cystic neck masses, particularly in rural or endemic regions. Accurate preoperative imaging is essential to delineate lesion extent, especially with mediastinal extension, and meticulous surgical excision without rupture is critical to prevent complications and recurrence.

Ganglioneuromas are benign neoplasms of the neuroblastic tumor family, primarily arising from neural crest cells within the sympathetic nervous system. They are often asymptomatic and detected incidentally upon imaging for different conditions, commonly found in the mediastinum, retroperitoneum, and adrenal glands. This case report described the diagnosis and management of a 40-year-old female with a retroperitoneal ganglioneuroma featuring mesenteric involvement. The nonspecific imaging features and clinical presentation necessitated histological examination, which ultimately confirmed the diagnosis of a ganglioneuroma of mesenteric origin. The patient underwent complete surgical resection with an uneventful recovery and remains free of recurrence 15 years post-treatment. This case underscores the importance of integrating clinical, radiological, and histological findings to differentiate GNs from other soft tissue abdominal masses.

A 10-year-old castrated male Chihuahua weighing 3.06 kg was presented with a chronic, progressively worsening cough of five months' duration. Diagnostic imaging, including thoracic radiography and computed tomography, identified a well-defined cranial mediastinal mass consistent with a thymic tumor. Surgical excision was performed via median sternotomy with complete thymectomy. Following tumor removal, sternal closure was achieved using a non-absorbable ultra-high-molecular-weight polyethylene (UHMWPE) suture material (FiberWire[®], Arthrex, Naples, FL, USA). Histopathological examination confirmed the diagnosis of an epithelial-predominant thymoma with narrow but complete surgical margins. Postoperative recovery was uneventful, and the dog was discharged three days after surgery. Clinical signs, including coughing, progressively improved during follow-up. Radiographic evaluation performed up to postoperative day 57 demonstrated stable sternal alignment without evidence of dehiscence, implant-related complications, or disease recurrence. This report describes the first clinical case of FiberWire use for median sternotomy closure following thymectomy in a dog. The favorable clinical and radiographic outcomes observed during postoperative follow-up suggest that FiberWire may represent a viable alternative to traditional stainless-steel wire for sternal fixation in canine thoracic surgery.

Primary mediastinal liposarcomas are exceedingly rare mesenchymal tumors that can grow to a massive size before becoming symptomatic, often leading to diagnostic and therapeutic challenges. We present the case of a 45-year-old male with a giant, well-differentiated liposarcoma occupying the entire left hemithorax, anterior mediastinum and extending into the contralateral hemithorax, causing complete collapse of the left lung. The patient underwent a successful complete surgical resection via a single posterolateral thoracotomy, leading to an excellent postoperative outcome. This case highlights the importance of considering this rare entity in the differential diagnosis of large thoracic masses and underscores the feasibility and efficacy of complete surgical excision even for tumors of exceptional size.

This paper presents a reproducible, data-driven approach for prioritisation of AI-detected chest X-ray (CXR) findings to support faster lung cancer diagnosis in the NHS. The Annalise Enterprise CXR system was deployed in shadow mode across seven acute trusts in Greater Manchester. Two cohorts were used: a retrospective cancer cohort (n = 1,282) with confirmed lung cancer and visible CXR abnormalities, and a prospective cohort (n = 13,802) comprising consecutively acquired GP-referred CXRs. Prevalence ratios were calculated for 124 AI-detected abnormalities across both cohorts, and three prioritisation strategies were developed. Strategy 3, which combined prevalence analysis with expert clinical review, achieved optimal performance with a sensitivity of 95.87% and estimated specificity of 79.11%, while maintaining a negative predictive value of 99.95%, for identification of lung cancer. Findings most associated with cancer included solitary lung mass, mediastinal mass, and hilar lymphadenopathy. An Excel-based tool was developed to support rapid configuration and evaluation of categorisation. Application of this approach enabled safe deployment of AI using shadow mode to inform configuration prior to live use. This work provides a scalable model for AI implementation in radiology workflows that aligns with the National Optimal Lung Cancer Pathway and addresses real-world challenges of diagnostic capacity, safety, and reproducibility.

We report a case of a patient presenting with melena and dysphagia. His gastroscopy revealed an oesophageal mass and active duodenal papillary haemorrhage. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) confirmed the presence of a haemorrhagic mediastinal pancreatic pseudocyst (MPP). Due to severe alcohol withdrawal syndrome, the patient declined surgical intervention. Conservative management and pancreatic tube placement under ERCP were performed, resulting in clinical stabilization. Follow-up imaging 2 months later demonstrated partial remission of the MPP. We further review the clinical characteristics and contemporary management strategies for MPP.

Bronchogenic cysts are rare congenital anomalies arising from abnormal budding of the ventral foregut during early embryogenesis. They are typically located in the mediastinum or pulmonary parenchyma and are mostly asymptomatic. However, complications such as infection, compression, hemorrhage, or rupture may cause significant morbidity. Surgical resection is recommended in symptomatic or complicated cysts and may also be justified in asymptomatic patients to prevent future complications. We report the case of a 40-year-old male who presented with chest pain and dysphagia. A presumptive diagnosis of a mediastinal bronchogenic cyst complicated by acute pericarditis and probable secondary infection was made based on the clinical presentation and imaging findings. The patient underwent robot-assisted thoracoscopic surgery, and histopathological analysis confirmed the diagnosis of a bronchogenic cyst. This case highlights a rare but clinically significant complication of a bronchogenic cyst.

Giant mediastinal teratomas in the pediatric population are uncommon entities that may grow insidiously and cause significant compression of intrathoracic structures. We report the case of a 10-year-old girl with a two-year history of progressive exertional dyspnea, chest pain, orthopnea, and increasing thoracic enlargement. Chest radiography demonstrated marked mediastinal widening, and contrast-enhanced chest CT revealed a predominantly cystic mediastinal mass measuring approximately 15 × 14 cm, with mediastinal shift and ipsilateral lung collapse. Routine laboratory tests were within normal limits, and surgical resection confirmed a mature mediastinal teratoma. The patient had an uneventful postoperative course, and follow-up CT showed complete pulmonary re-expansion with no residual lesion. This case highlights the clinical and imaging features that should raise suspicion for a giant mediastinal teratoma in children and underscores the importance of reporting these cases given the limited pediatric literature available.

Ectopic cervical thymus (ECT) is a rare congenital anomaly caused by the incomplete descent of thymic tissue during fetal development. Imaging modalities such as ultrasonography and magnetic resonance imaging (MRI) are useful tools for diagnosing this condition. However, ECT is often difficult to diagnose based solely on imaging findings because of its rarity. Surgical excision is frequently performed for differentiation from malignant neck tumors. We encountered a four-week-old male infant with left-sided neck swelling noted at three weeks of age. Ultrasonography revealed a well-defined hypoechoic lesion showing a fine mosaic-like internal pattern identical to that of the normal mediastinal thymus. MRI demonstrated a mass with signal intensity similar to the thymus, without airway or vascular compression. Based on these findings, ECT was diagnosed noninvasively, and the patient was managed conservatively, showing gradual regression over time. This case emphasizes that direct comparison of imaging characteristics between the cervical lesion and normal thymic tissue can make the diagnosis of ECT more definitive, thus allowing avoidance of invasive procedures and enabling safe conservative management.