Impaired contractility of the diaphragm can occur secondary to diaphragm paralysis. Signs and symptoms of diaphragm paralysis vary among patients. Some may be asymptomatic and present incidentally, while others experience dyspnea secondary to impaired ventilation. Patients who are symptomatic from diaphragm paralysis may benefit from surgical intervention with diaphragm plication. Many surgical approaches are available for diaphragm plication, including open, thoracoscopic, laparoscopic, and robotic-assisted procedures. In this paper, we discuss our step-by-step approach to a robotic, transabdominal diaphragm plication. This was performed in a 60-year-old female presenting with dyspnea secondary to left hemidiaphragm paralysis. The technique includes inducing an iatrogenic pneumothorax to create a pressure equilibrium between the thoracic and peritoneal spaces. Subsequently, a diaphragm plication is performed in a 2-layer approach, using an initial running suture and subsequent reinforcing interrupted sutures in two separate axes, namely the posterior and anterior axes. Lastly, the plication repair is verified through the use of a thoracic port, which is subsequently used for tube thoracostomy placement.

Objective.Chest x-ray (CXR) imaging is widely used for screening thoracic diseases. However, accurate multi-disease detection remains challenging because lesion sizes vary substantially, multiple abnormalities often coexist, and small or low-contrast lesions can be obscured by anatomical structures. This study aims to improve multi-disease detection in CXR images by enhancing multi-scale lesion representation and cross-level feature consistency.Approach.We propose a CXR multi-disease detection framework based on multi-scale parallel perception and adaptive feature fusion. The Multi-scale Parallel Feature Sensing module captures complementary lesion features under different receptive fields. The Smooth Residual Fusion Block refines lesion-related spatial responses and suppresses irrelevant background interference. The adaptive pyramid feature fusion module dynamically integrates multi-level features to reduce semantic discrepancies and preserve fine-grained lesion details.Main results.On the VinDr-CXR dataset, the proposed method achieved mean Average Precision scores of 0.389 forand 0.186 for, corresponding to absolute improvements of 5.3% and 1.9% points over the baseline, respectively. The gains were particularly evident for small and subtle abnormalities, such as nodules/masses and pneumothorax. Additional validation on the bounding-box annotated subset of ChestX-ray8 further confirmed robustness, with,, and Recall values of 0.186, 0.093, and 0.240, respectively.Significance.The proposed framework provides an effective solution for structurally consistent multi-disease detection in CXR images. Results on two public datasets suggest that multi-scale parallel perception and adaptive feature fusion improve lesion localization robustness, showing potential as a supportive tool for computer-aided screening workflows.

Spontaneous bilateral pneumothorax is an uncommon but serious complication seen in patients with osteosarcoma that has metastasised to the lungs. This article describes the case of a 20-year-old man with a history of osteosarcoma who presented to hospital with increasing dyspnoea (shortness of breath) and was found to have mild bilateral spontaneous pneumothorax secondary to pulmonary metastases. This case report highlights the features of this rare but serious condition and the importance of close patient monitoring following treatment for osteosarcoma.

Cardiac tamponade is a medical/traumatic emergency characterized by the increased intrapericardial pressure from the accumulation of excessive fluid (either exudate, transudate, or blood) in the pericardium. Emergency sonography is a vital part of the rapid assessment of cases with traffic accidents and chest traumas, as pericardial injuries are among the hidden affected organs. Here, we present a case of successful resuscitation of cardiac tamponade.

In light of recent clinical trials, we are witnessing a paradigm shift towards lung parenchyma-preserving, sublobar resection for early-stage lung cancers. When performing sublobar resection via thoracoscopy, sometimes locating the lesion can be challenging. Thoracoscopy does not provide the same exposure and tactile feedback as open thoracotomy; as a result, detecting subsolid, small, and deep lesions can be difficult for the thoracic surgeon. This problem can be obviated by preprocedural marking of lesions. Various CT-guided transthoracic and bronchoscopic techniques have been reported. Transthoracic techniques include injecting dye into the lesions and placing fiducials and hook wires. Although these procedures are widely performed, complications, such as pneumothorax, air embolism, dye dissipation and extravasation, and hook-wire dislodgement have been reported. Conventional bronchoscopy can be used in conjunction with real-time 3-dimensional imaging for transbronchial marking of pulmonary lesions. However, given the limitations of conventional bronchoscopy, navigating to peripheral lesions can be tough. Robotic bronchoscopy, with or without real-time 3-dimensional imaging, is a safe and accurate modality for marking pulmonary lesions. Robotic bronchoscopy can be used to perform dye injection into the lesion, potentially in the same setting as the resection. Robotic bronchoscopy can also be used to bronchoscopically deploy dye-soaked coils. Robotic bronchoscopy may not be widely available and may have a learning curve. Ultimately, the choice of lung marking modality depends on available resources, institutional expertise, and the specific advantages and disadvantages of each modality.

BackgroundEndobronchial hamartoma and leiomyoma are rare benign airway tumors that may cause significant airway obstruction and require bronchoscopic intervention. However, comparative data on their clinical characteristics and interventional outcomes, particularly according to anatomic location, remain limited.ObjectivesThe objective of this study was to compare the clinical characteristics and bronchoscopic resection outcomes of endobronchial hamartoma and leiomyoma, with a focus on the impact of airway location.DesignThis study was a retrospective observational cohort study conducted over a 21-year period at a single tertiary referral center.MethodsIn this retrospective cohort study, we analyzed 107 patients with benign airway tumors, specifically comparing 56 hamartomas and 51 leiomyomas. Data on clinical presentation, radiologic findings, and bronchoscopic intervention outcomes were collected. A stratified analysis by airway level (trachea to segmental bronchi) was performed.ResultsEndobronchial leiomyomas were predominantly located in the central airways (trachea, 29.4%), while endobronchial hamartomas were more frequent in peripheral bronchi (segmental, 35.7%; P for trend = 0.011). Peripheral tumors showed significantly higher degrees of stenosis (P for trend < 0.001) and more frequent secondary CT findings, such as obstructive pneumonia. The complete resection rate was significantly higher for leiomyomas than for hamartomas (94.1% vs. 80.4%; P = 0.035). However, this difference was driven by anatomic location rather than histology; complete resection rates declined from 100% in the trachea to 64.5% in the segmental bronchi (P for trend < 0.001). Major complications included three pneumothoraxes and one massive hemorrhage during distal airway dissection. No recurrences occurred during a median follow-up of 10 months.ConclusionBronchoscopic resection is highly effective for benign airway tumors. Anatomic location, rather than histological subtype, is the primary determinant of procedural success and technical difficulty. Meticulous preoperative anatomical mapping is essential to identify danger zones near major vessels and optimize therapeutic strategies.

COPD remains a leading cause of global morbidity and mortality, and a substantial minority of patients remain disabled by hyperinflation, chronic bronchitis, and exacerbations despite optimized inhaled pharmacotherapy and pulmonary rehabilitation. Over the past two decades, bronchoscopic interventions have matured from clinical trial investigation into guideline-endorsed treatments for patients with refractory symptoms despite optimal medical treatment. This state-of-the-art review synthesizes the mechanistic rationale, evidence-based clinical trial data, patient-selection criteria, key controversies, and future research needs for bronchoscopic lung volume reduction (BLVR) and airway-directed therapies. In rigorously selected patients with severe emphysema, hyperinflation, and absence of interlobar collateral ventilation, endobronchial valves deliver clinically meaningful, durable improvements in FEV1, 6-min walk distance, dyspnea, and quality of life with moderate-to-high certainty and carry the highest guideline rating (GOLD Evidence A). Pneumothorax, occurring in roughly 18-34% of valve recipients, is the principal early complication, necessitating several days of in-patient monitoring that add complexity and cost to care. Endobronchial coils and thermal vapor ablation offer fissure-independent but more modest benefit; airway scaffolds are an emerging, tissue-sparing option that may extend candidacy to patients ineligible for existing bronchoscopic approaches; targeted lung denervation may stabilize lung function and symptoms but did not reduce exacerbations in its pivotal trial; and bronchial rheoplasty and metered cryospray are emerging options for the chronic bronchitis phenotype. The field is now advancing toward expanding candidacy for endobronchial valve therapy through collateral ventilation conversion, individualized complication prediction, and phenotype-matched airway therapies. Multidisciplinary, imaging-driven patient selection that addresses the key features of a patient's symptoms while avoiding significant comorbidity remains the cornerstone of successful outcomes.

Chronic cough, defined as a cough lasting 8 weeks or longer in adults, presents a significant diagnostic challenge due to the complexity of underlying causes. Unexplained chronic cough accompanied by shortness of breath that does not improve with chest tube placement administration may be suspected of esophago-pleural fistula. A 54-year-old woman experienced a 2-month chronic cough, shortness of breath, and chest and abdominal pain. Initially treated symptomatically, she was later diagnosed with right-sided pneumothorax. The patient underwent chest tube placement, fluid therapy, antibiotics, gastroprotective agents, and breathing exercises. A chest CT scan suggested an esophago-pleural fistula, although this diagnosis was suspected radiologically and not definitively confirmed by esophagography or endoscopy, and she was referred for thoracic surgical intervention. This case highlights the importance of a comprehensive diagnostic approach in chronic cough with systemic symptoms. Pneumothorax with esophago-pleural fistula is a rare but serious condition requiring early stabilization, empirical antibiotic therapy, and further imaging evaluation. Esophago-pleural fistula should be considered in cases of atypical pneumothorax with gastrointestinal symptoms. Early diagnosis, appropriate intervention, and multidisciplinary collaboration are key to successful treatment.