Pleural tuberculosis (TB) is the most common presentation of extrapulmonary TB and the most common cause of pleural effusion worldwide. Effusion due to TB is rare in children younger than 5 years and more common in adolescent boys. Pleural disease can range from small effusions associated with parenchymal disease in young children to large effusions seen mostly in older children and adolescents. The effusion can progress from a simple effusion to complicated pleural disease with the development of TB empyema or involvement of the chest wall. There is a paucity of information on the management of complicated TB pleural disease. Although most children will be treated conservatively, surgical intervention may be required to prevent post-TB lung disease and functional loss. Bronchopleural fistula (BPF) is a rare complication in children but can be very difficult to manage, especially in children with severe chronic or cystic lung disease, leading to prolonged hospitalization. Interventional bronchoscopy may have a role in the management of persistent BPF with the placement of either blood clots or valves, but there is limited evidence for these procedures in paediatrics.

An 18-year-old male receiving haemodialysis through a central venous catheter presented with fever, productive cough, night sweats and progressive dyspnoea. Point-of-care ultrasound demonstrated bilateral complex pleural effusions, lung consolidation and a complex pericardial effusion. Initial management targeted severe bacterial sepsis, but computed tomography performed after clinical stabilization revealed bilateral consolidations, cavitary lung lesions and cavitating pulmonary nodules, raising concern for disseminated tuberculosis. GeneXpert testing of sputum, pleural fluid and pericardial fluid was negative, while blood, pleural fluid and catheter tip cultures grew methicillin-resistant Staphylococcus aureus. Despite pleural and pericardial drainage and intravenous vancomycin therapy, the patient deteriorated and died from sepsis. This case highlights how disseminated thoracic MRSA infection may mimic tuberculosis and underscores the value of bedside ultrasound in identifying multi-compartment thoracic suppuration when advanced imaging is delayed.

Adenoid cystic carcinoma (ACC) is a slow-growing malignancy characterised by late recurrence, making long-term follow-up essential. We report a case of 55-year-old woman who presented with exudative right pleural effusion and subcarinal lymphadenopathy after haematopoietic stem cell transplantation for myelofibrosis. She had undergone surgery and radiotherapy for primary tracheal ACC 24 years prior. Although haematologic disease-related conditions were initially suspected, endobronchial ultrasound-guided transbronchial needle aspiration of the subcarinal lymph node revealed isolated recurrence of ACC, with no evidence of pleural malignancy on pleural biopsy results. Because ACC progresses more slowly than many other malignancies, the growth rate alone does not reliably distinguish benign from malignant lesions. Therefore, a history of ACC should always be considered, and a tissue diagnosis should be pursued when clinically indicated.

Tubercular pleural effusion is a common cause of exudative pleural effusion, particularly in endemic regions, and adenosine deaminase (ADA) is widely used as a supportive diagnostic marker. However, lower-than-expected ADA levels can lead to diagnostic uncertainty. We report a 21-year-old male who presented with prolonged fever, weight loss, and dry cough. He was initially managed as a case of parapneumonic effusion due to lymphocytic exudative pleural fluid with low ADA levels. Persistent symptoms and imaging findings of multiple loculated pleural collections with associated lung collapse prompted further evaluation. Medical thoracoscopy revealed septations and nodular pleural lesions, and targeted biopsy demonstrated chronic granulomatous inflammation consistent with tuberculosis. This case underscores the limitations of interpreting ADA in isolation and highlights the importance of integrating clinical, radiological, and histopathological findings. Early use of a thoracoscopic pleural biopsy plays a key role in establishing diagnosis in complex or inconclusive pleural effusions.

Primary pulmonary artery sarcoma (PPAS) is a mesenchymal tumor originating from the pulmonary artery, accounting for approximately 0.001-0.003% of all sarcomas. The early clinical symptoms are atypical, and diagnosis is often delayed, making the management of this disease challenging. The widespread availability of multidetector computed tomography (MDCT), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), and high-resolution echocardiography has significantly improved the diagnostic capability for PPAS. We herein report a 74-year-old female patient who presented with a 3-week history of exertional dyspnea without an apparent trigger. She had received anti-inflammatory therapy at another hospital for one week. Five days before admission, she experienced right-sided chest pain without apparent cause, which was respiratory-related. On the day of admission, laboratory tests revealed a slight elevation in D-dimer levels. Echocardiography showed an irregular, moderately echogenic mass at the origin of the right pulmonary artery. Enhanced computed tomography (CT) of the chest revealed a filling defect in the right pulmonary artery accompanied by bilateral pleural effusion. The patient was given heparin anticoagulation therapy. To confirm the nature of these lesions, a PET/CT scan was conducted five days after admission, which indicated hypermetabolism in the right pulmonary artery, suggesting primary pulmonary artery sarcoma. Due to the poor efficacy of anticoagulation therapy, the patient continued to experience breath-holding after physical activity. Subsequently, catheter-guided interventional angiography was carried out for pulmonary artery thrombectomy and biopsy, and histopathological examination revealed pulmonary artery sarcoma. Given the patient's respiratory failure and heart failure, as well as the uncertain efficacy of radiotherapy and chemotherapy, interventional pulmonary artery thrombectomy alleviated the chest pain. Currently, the patient's overall condition is stable.

Background and Clinical Significance: Pleural effusion results from an imbalance between fluid production and lymphatic drainage within the pleural space and may arise from a wide range of conditions. Chylothorax, characterized by the accumulation of chyle in the pleural cavity, is an uncommon cause of pleural effusion in the pediatric population. Although octreotide has been widely used in neonatal postoperative chylothorax, evidence supporting its role in acquired chylothorax beyond infancy remains limited, and dosing strategies are not standardized. This report describes the management of massive chylothorax in an adolescent patient. Case Presentation: A 13-year-old girl presented with fatigue, decreased exercise tolerance, vertigo, and diaphoresis and was diagnosed with massive right-sided chylothorax based on imaging and pleural fluid analysis. Treatment consisted of pleural drainage, dietary measures, and continuous intravenous octreotide administered within a multidisciplinary care framework. Chylous drainage declined progressively, with complete resolution of the effusion achieved without surgical intervention. Conclusions: Chylothorax in older children and adolescents may present with nonspecific symptoms and requires a high index of clinical suspicion. Early diagnosis, appropriate drainage, and individualized therapy are essential for favorable outcomes. Continuous octreotide infusion may represent an effective adjunctive treatment in selected pediatric cases, but further studies are needed to define optimal dosing and treatment duration.

Background: Pneumocystis jirovecii pneumonia (PJP) increasingly affects non-HIV immunocompromised patients; however, the spectrum of computed tomography (CT) findings in this population remains poorly defined. Objectives: To describe and compare chest CT findings of PJP in patients with and without HIV infection and to evaluate the impact of respiratory coinfections on imaging patterns. Methods: This retrospective single-centre cohort study included 72 adult patients with confirmed PJP diagnosed between 2011 and 2024, 27 HIV-positive and 45 non-HIV immunocompromised patients. Chest radiography was available in 71 patients and chest CT in 62. Imaging studies were independently reviewed for predefined patterns, including ground-glass opacities, alveolo-interstitial pattern, mosaic attenuation, crazy paving, pulmonary cysts, consolidation, and pleural effusion. CT findings were compared between HIV-positive and non-HIV patients, and a subgroup analysis was performed in non-HIV patients according to the underlying type of immunosuppression. Respiratory coinfections were recorded and classified based on microbiological results. Results: Chest radiography was normal in 32.4% of patients. An interstitial pattern tended to be more frequent in HIV-positive patients, whereas consolidations were more commonly observed in non-HIV patients (p = 0.051). On CT, ground-glass opacities were the predominant finding in both groups. HIV-positive patients more frequently demostrated an alveolo-interstitial pattern, mosaic attenuation, and pulmonary cysts, while consolidations and pleural effusions were more common in non-HIV patients, particularly among solid organ transplant recipients. Respiratory coinfections were identified in 63.9% of patients; however, no statistically significant differences in CT patterns were observed between patients with and without coinfections. Conclusions: PJP demonstrates different CT presentations according to immune status. HIV-positive patients more frequently demonstrated alveolo-interstitial patterns, mosaic attenuation, and pulmonary cysts, whereas consolidations were more commonly observed in non-HIV immunocompromised patients. Respiratory coinfections do not appear to significantly influence CT patterns.

Backgrounds/Objectives: Malignant pleural effusion (MPE) is a frequent complication of advanced cancer, and talc pleurodesis via video-assisted thoracoscopic surgery (VATS) represents a standard palliative treatment with high efficacy. However, evidence regarding synchronous bilateral pleurodesis in patients with bilateral MPE is limited. This study evaluates the feasibility, safety, and outcomes of a single-stage bilateral VATS talc pleurodesis approach. Materials and Methods: We retrospectively analyzed patients undergoing synchronous bilateral VATS talc poudrage between 2000 and 2025 at a single tertiary cancer center. Inclusion criteria included adult patients with bilateral MPE, expandable lungs, and suitability for surgery. Preoperative assessment involved imaging and multidisciplinary evaluation. Perioperative data, complications, mortality, and recurrence rates at 30 days and 3 months were collected. Survival and pleural effusion-free survival were estimated using the Kaplan-Meier method. Results: Thirty patients were included (median age 63.2 years). The most common primary tumors were breast (43%), lung (30%), and ovarian cancer (17%). Mean operative time was 78.6 min, with no intraoperative complications. Mean hospital stay was 6 days. Postoperative morbidity included atrial fibrillation (13%) and respiratory failure (6.6%), both managed conservatively. Thirty-day mortality was 3%. Pleural effusion recurrence occurred in 6.6% at 3 months and 10% at 7 months. Mean follow-up was 9.7 months. Conclusions: Synchronous bilateral VATS talc pleurodesis is a feasible and safe procedure in selected patients with bilateral MPE with acceptable morbidity. Further prospective studies are needed to confirm these findings and refine patient selection.

Acute hypoxemic respiratory failure (AHRF) represents one of the most common and clinically challenging indications for invasive mechanical ventilation in the intensive care unit, characterized by profound etiological heterogeneity that demands accurate diagnosis to guide treatment. While clinical history, physical examination, and laboratory data remain essential, they are often insufficient to reliably discriminate among conditions such as acute respiratory distress syndrome (ARDS), cardiogenic pulmonary edema, and pneumonia-particularly in mechanically ventilated patients. Lung imaging has therefore emerged as an indispensable complement to clinical assessment. In this narrative review, we systematically describe the physical principles, clinical applications, and limitations of the imaging modalities currently available in critical care: chest X-ray (CXR), computed tomography (CT), lung ultrasound (LUS), electrical impedance tomography (EIT), and positron emission tomography (PET). CXR remains the most widely used bedside tool but is constrained by low sensitivity and significant interobserver variability. CT is the gold standard for morphological and quantitative lung phenotyping, enabling the assessment of recruitability, baby lung characterization, and the identification of complications, but requires patient transport and exposes patients to ionizing radiation. LUS offers real-time, bedside evaluation of aeration with high diagnostic accuracy for pneumothorax and pleural effusion, and is increasingly integrated into revised ARDS diagnostic criteria. EIT enables continuous, radiation-free monitoring of regional ventilation distribution and positive end-expiratory pressure (PEEP)-guided titration directly at the bedside. While PET provides unparalleled quantification of regional inflammation and ventilation-perfusion mismatch, it currently remains a purely investigative research tool. Finally, we discuss emerging technological and AI-driven advances-including dual-energy CT, next-generation EIT, and deep learning algorithms-that are poised to transform lung imaging from a passive diagnostic tool into an active, personalized guide to respiratory management.

Background: Blunt thoracic aortic injury (BTAI) is an uncommon but life-threatening consequence of blunt thoracic trauma. Left-sided hemothorax is frequently identified during initial evaluation and typically prompts early chest drainage. However, when an unrecognized BTAI is present, pleural decompression may precipitate hemodynamic instability. This study aimed to identify early predictors of BTAI requiring thoracic endovascular aortic repair (TEVAR) in patients presenting with left-sided hemothorax. Methods: We conducted a single-center retrospective cohort study including consecutive trauma patients aged ≥ 16 years with radiologically confirmed left-sided hemothorax between 2015 and 2025. Patients were stratified according to the need for TEVAR. Clinical, laboratory, and radiological variables available at emergency department admission were analyzed. Independent predictors of BTAI requiring TEVAR were identified using multivariable logistic regression. Results: Among 146 included patients, 27 (18%) underwent TEVAR for confirmed BTAI. Patients requiring TEVAR were generally younger and more frequently involved in high-energy trauma. Independent predictors of TEVAR included high-energy mechanism (p = 0.048), lower admission hemoglobin (p = 0.007), presence of extra-thoracic fractures (p < 0.001), and a higher number of right-sided rib fractures (p = 0.018). The volume of left-sided hemothorax was not independently associated with BTAI. The model demonstrated strong discriminative ability (AUC = 0.926). Conclusions: In trauma patients with left-sided hemothorax, BTAI requiring TEVAR may occur even in the presence of minimal pleural effusion. Readily available admission parameters may help identify patients who could benefit from a CT angiography-first approach rather than routine early chest drainage, except in cases of immediate life-threatening pleural compromise.