Background: Lung cancer is the second most common cause of cancer with high mortality, thereby emphasizing the importance of early detection. However, the rate of new lung cancer diagnosis has remained relatively unchanged. Despite the advancements in navigational bronchoscopy, the diagnostic yield of pulmonary nodules, particularly posterior nodules, is often limited by CT-to-body divergence. Our study aims to evaluate the feasibility and safety of prone positioning during navigational bronchoscopy and its impact on the diagnostic yield of posterior pulmonary nodules. Methods: Retrospective cohort study of nine patients who underwent Ion robotic navigational bronchoscopy in prone position and 237 patients in supine position. The study period was July 2024 to December 2024 for the prone cohort and July 2020 to September 2024 for the supine cohort. Results: In the supine cohort, the diagnostic yield was 93.3%, including a malignant yield of 62.3%, and the post-operative complication rates were 1.5% for pneumothorax, 3.5% for bronchopulmonary hemorrhage, and 1.9% for respiratory failure. In the prone cohort, the diagnostic yield was 77.8% and a malignant yield of 85.7%, and the postoperative complication rates were 0% for pneumothorax, bronchopulmonary hemorrhage, and respiratory failure. Conclusions: CT-to-body divergence is a major obstacle in the diagnostic work-up of pulmonary nodules, of which a major contributor is atelectasis. Our study demonstrates that prone positioning combined with a strict anesthesia protocol is both a feasible and safe approach in the diagnostic work-up of pulmonary nodules.

Medical thoracoscopy (MT) is a minimally invasive procedure with a well-established role in the diagnosis and management of malignant pleural disease; however, its therapeutic applications in benign pleural conditions remain variably adopted and inconsistently defined. In response to increasing clinical utilisation and emerging evidence, the World Association for Bronchology and Interventional Pulmonology (WABIP) and the American Association for Bronchology and Interventional Pulmonology (AABIP) convened a multidisciplinary, international expert panel to develop a consensus statement examining the therapeutic role of MT in benign pleural disease. Six clinically relevant PICO (patient, intervention, comparison and outcome) questions were formulated to guide a systematic literature review of PubMed, Scopus and Cochrane databases from 1980 through 2025. Evidence was appraised using standardised risk-of-bias tools and consensus was achieved using a modified Delphi methodology. This consensus statement summarises the available evidence regarding MT across a spectrum of benign pleural conditions, including recurrent benign pleural effusions, primary and secondary spontaneous pneumothorax, empyema, and tuberculous pleural disease. Emphasis is placed on procedural outcomes, complication profiles and comparative effectiveness relative to alternative medical and surgical approaches. The document also highlights key considerations related to patient selection, procedural complexity and the influence of operator expertise and local resources on clinical outcomes. Given the heterogeneity of underlying disease processes and the predominance of observational data, this work is presented as a consensus statement rather than a formal clinical practice guideline. Overall, it aims to consolidate current knowledge, identify gaps in evidence and provide a practical framework to inform multidisciplinary decision-making and future research on the therapeutic use of MT in benign pleural disease.

Purpose To investigate whether deep learning models trained on chest radiographs (CXRs) rely on radiographic exposure parameters as shortcut features and to quantify the resulting biases under controlled confounding and natural exposure regimes. Materials and Methods In this retrospective study, CXRs from MIMIC-CXR (January 2011-December 2016), the Medical Imaging and Data Resource Center (MIDRC; August 2020-May 2022), and EmoryCXR (September 2008-February 2023) were analyzed for pneumothorax detection, coronavirus disease 2019 (COVID-19) diagnosis, and race classification. Dataset-provided labels served as the reference standard. Three exposure parameters (ExposureTime, XRayTubeCurrent, ExposureInuAs) were extracted from Digital Imaging and Communications in Medicine (DICOM) metadata. Models were trained under biased and balanced exposure-label alignments and evaluated on matched and reversed distributions. A priori screening additionally identified high-risk exposure regimes. Area under the receiver operating characteristic curve (AUC) was compared using the DeLong test. Results A total of 727,604 CXRs from 240,681 patients (mean age, 60 years ± 17 [SD]; 126,432 men, 114,128 women) were analyzed. For pneumothorax detection, AUC decreased from 0.94 (95% CI: 0.94, 0.95) to 0.56 (95% CI: 0.55, 0.58) on mismatched exposure distributions (ΔAUC = -0.38; P < .001). Similar declines were observed for COVID-19 (ΔAUC = -0.33; P < .001) and race classification (ΔAUC = -0.09; P < .001). The priori exposure-regimen screening revealed high-risk regimes within the natural distribution that were associated with reduced model performance compared with typical exposures. Conclusion Deep learning models trained on CXRs may exploit exposure parameters as shortcut features; exposure-regimen audits may flag high-risk conditions before clinical deployment. ©RSNA, 2026.

Paragonimiasis is a foodborne zoonosis transmitted mostly by the consumption of inadequately cooked crabs and crayfish harboring Paragonimus metacercariae. We present the case of a 38-year-old male with a history of crab ingestion who developed severe eosinophilia, transaminitis, and serositis. Initial presentation included fever, epigastric pain, weight loss, and pleural effusion. He was managed empirically with albendazole and corticosteroids along with other supportive measures. Two months later, he re-presented with hemoptysis and hypoxemia. HRCT showed multiple cavitary pulmonary lesions, pleural nodules, and left-sided pneumothorax. Sputum wet mount demonstrated Paragonimus species ova, confirming pulmonary paragonimiasis. The patient was managed with intercostal tube drainage, tranexamic acid nebulization, and praziquantel with clinical improvement. This case highlights the importance of considering paragonimiasis in patients, even with pneumothorax, when the patient has hemoptysis and eosinophilia in the background of ingestion of raw or undercooked crustaceans in endemic regions.

Congenital pulmonary airway malformation (CPAM), previously termed congenital cystic adenomatoid malformation (CCAM), is a rare developmental anomaly of the lower respiratory tract that is most commonly diagnosed prenatally or during early infancy. Presentation in adolescence is uncommon, particularly when associated with bilateral lesions and pneumothorax. We report the case of a 14-year-old female with no relevant past medical history who presented with sudden-onset progressive dyspnea and was found to have an approximately 50% right-sided pneumothorax. Contrast-enhanced chest computed tomography demonstrated bilateral apical cystic lesions initially interpreted as pneumatoceles, measuring 25 × 10 mm in the right lung apex and 10 × 18 mm in the left lung apex. After initial pleural drainage, the patient underwent right apical wedge resection, followed one week later by left-sided wedge resection. Histopathological examination of both specimens revealed pulmonary tissue with congested vessels, focal alveolar collapse, and multiple cystic spaces of variable size with thin fibrous walls and focal simple cuboidal epithelial lining. CD31 immunostaining was negative in the cyst lining, and Ziehl-Neelsen staining was negative. The overall findings were consistent with Stocker type 2 CPAM. This case highlights an unusual adolescent presentation of bilateral apical CPAM complicated by pneumothorax and underscores the importance of histopathologic confirmation when imaging findings are atypical or inconclusive.

Spontaneous pneumothorax in pregnancy is a very uncommon condition, with fewer than 100 cases described in the English literature. This case report describes a pregnant woman who experienced two episodes of primary spontaneous pneumothorax during pregnancy. A 31-year-old, Caucasian pregnant woman (P2 G3 A1, gestational age 17+0 weeks), conceived naturally, body mass index 28, a former smoker, arrived at the hospital with dyspnea and chest pain. Pneumothorax was detected and managed with a chest tube. However, three days after discharge, pneumothorax reoccurred. Due to a persistent air leak, video-assisted thoracoscopic surgery was performed. Histological examination revealed enlarged airspaces without any signs of specific lung pathology. Postoperative recovery was uneventful, and the patient delivered a healthy newborn without complications. This case highlights the importance of multidisciplinary, individualized diagnostic and treatment options in pregnant patients with primary spontaneous pneumothorax to prevent misdiagnosis and ensure optimal outcomes for both mother and fetus.