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To assess the budget impact of incidental pulmonary nodule (IPN) detection using an artificial intelligence-software for chest X-ray (CXR) interpretation - qXR - for early lung cancer (LC) detection in Vietnam, Colombia, Thailand, Costa Rica, and Mexico. Country-specific hybrid decision-tree and budget impact models were developed from the public payer perspective over a 5-year time horizon. Each compared current symptomatic LC detection with a scenario adding AI-enabled Chest X-Ray for IPN detection and referral to low-dose computed tomography. Costs included diagnostics, set-up, treatment, healthcare resource use, and end-of-life care, expressed in 2024 USD. One-way sensitivity and scenario analyses tested parameter and structural uncertainty. Over the 5-year time horizon, the implementation of AI-enabled CXR for IPN detection is estimated to avert 24,763 premature deaths across the five countries, improving survival and lowering long-term expenditures. Following the introduction of qXR, more costs were incurred due to additional patients being diagnosed and treated. This resulted in fewer late-stage patients and cost savings. The breakeven point was reached in year 3 for Vietnam, Thailand, Colombia, and Mexico and in year 4 for Costa Rica. Cost savings were primarily driven by the stage shift towards earlier detection, where treatment costs are lower and survival outcomes are better. Integrating AI-enabled CXR for IPN detection into national hospital workflows may enable earlier LC detection and achieve cost neutrality within 5 years in low- and middle-income countries. These findings support the economic feasibility and scalability of AI-assisted imaging as part of national lung cancer control strategies.

Anti-granulocyte macrophage colony stimulating factor (anti-GM-CSF) antibodies, classically associated with pulmonary alveolar proteinosis (PAP), are increasingly recognised as a cause of adult-onset immunodeficiency predisposing to opportunistic infections. Coinfections with multiple opportunistic pathogens in this context are uncommon. We describe a rare case of disseminated Nocardia paucivorans, pulmonary Cryptococcus gattii, pulmonary Mycobacterium chelonae, and subsequent PAP in a patient with high-level anti-GM-CSF antibodies. A 64-year-old man presented with subacute bilateral shoulder pain and was diagnosed with acromioclavicular septic arthritis. N. paucivorans was isolated, and subsequent evaluation demonstrated disseminated infection with numerous brain abscesses, left eye endophthalmitis and pulmonary involvement. Interval computed tomography of the chest revealed new right lower lobe consolidation, a biopsy of which identified C. gattii and M. chelonae. Immunological testing confirmed high-level anti-GM-CSF antibodies. The patient received prolonged combination antimicrobial therapy, including meropenem, ceftriaxone, linezolid, trimethoprim-sulfamethoxazole, moxifloxacin, fluconazole, tigecycline and clofazimine, with clinical and radiological improvement of infectious lesions. Despite microbiological clearance, progressive bilateral ground-glass opacities developed on serial chest imaging consistent with PAP, with no pathogens identified on bronchoscopic sampling. Given minimal respiratory symptoms, PAP-directed therapy was deferred. The patient remains clinically stable on trimethoprim-sulfamethoxazole prophylaxis with ongoing clinical and radiological surveillance. This case illustrates the expanding clinical spectrum of anti-GM-CSF antibody-associated disease and underscores the importance of considering this diagnosis in patients presenting with opportunistic infections, in particular, disseminated nocardiosis or C. gattii infection. It also highlights the need for vigilance in evaluating for coinfections, recognition of PAP as a noninfectious codiagnosis, and the importance of long-term follow-up in affected patients.

Accurate lung field segmentation in chest radiographs is essential for reliable computer-aided diagnosis of pulmonary diseases. This study aimed to systematically benchmark baseline, lightweight, and attention-based U-Net architectures while integrating explainable artificial intelligence (AI) to evaluate both segmentation performance and anatomical focus. We conducted a comparative evaluation of three U-Net variants-baseline U-Net, attention U-Net, and shallow U-Net-using the chest X-ray Masks and Labels dataset. All models were trained under identical conditions with five-fold cross-validation and evaluated using accuracy, Intersection over Union (IoU), and Dice coefficient. Gradient-weighted Class Activation Mapping (Grad-CAM) was applied to visualize model attention and assess whether network activations were anatomically localized within lung regions. All architectures were implemented in TensorFlow. U-Net and attention U-Net achieved the highest segmentation performance (Dice ≈ 0.97, IoU ≈ 0.94), with Grad-CAM activations consistently localized to lung fields, indicating reliable anatomical focus. The shallow U-Net showed slightly lower accuracy (Dice= 0.96, IoU= 0.92) but demonstrated faster inference and broader sensitivity to internal parenchymal structures, which may facilitate future disease-focused pulmonary analysis. This study highlights the trade-offs between segmentation accuracy, computational efficiency, and model interpretability across U-Net variants. By combining quantitative benchmarking with explainable AI-based analysis, our results provide performance insights, supporting the development of trustworthy AI tools for chest radiograph analysis.

Radiologic findings associated with SARS-CoV-2 infection have been well described since its emergence. However, long-term clinical and radiologic complications of pediatric SARS-CoV-2 infection are less defined, including radiologic findings in children following recovery. This study compares chest radiographic (CXR) and low-dose chest computed tomography (CT) findings in pediatric participants; a longitudinal cohort of children who have recovered from SARS-CoV-2 infection and uninfected controls. Eight hundred forty-six children (700 laboratory confirmed SARS-CoV-2-infected children and 146 uninfected controls) completed a radiologic exam at the baseline visit, which occurred 9.8 months (mean) post-infection. CXR (n=485) and CT (n=362) images were evaluated by three radiologists for known radiologic manifestations of COVID-19 including various patterns of opacities (ground glass, reticular, consolidation), nodules, perihilar thickening, effusions, and/or cystic changes. Comparisons were made using generalized estimating equations with cohort (infected vs. uninfected) as the predictor. Overall, the incidence of radiologic abnormalities detected at baseline was 32.1% in the infected cohort and 24.0% in the uninfected cohorts. Infected participants were more likely to have CXR abnormalities than uninfected (21.2% vs. 12.4%; OR 2.44; 95% CI 1.19-5.02; P=0.016). This was primarily due to an increased incidence of perihilar peribronchial thickening (17.4% in infected vs. 10.1% in noninfected). There were no statistically significant differences between cohorts for CT abnormalities (46.2% vs. 42.1%; OR 1.24; 95% CI 0.71-2.16; P=0.46). Radiologic abnormalities were not statistically significantly associated with presence of pulmonary symptoms after recovery. At the baseline visit, infected participants were more likely than uninfected controls to have chest radiographic abnormalities, limited to perihilar peribronchial thickening. There was no significant difference in CT abnormalities between the two cohorts. There was no increased frequency of radiographic findings in children with underlying asthma, nor in children who experienced pulmonary symptoms following recovery at the baseline visit.

Chronic obstructive pulmonary disease (COPD) is frequently accompanied by systemic manifestations, including muscle wasting, osteoporosis, and cardiovascular disease. However, the associations between extrapulmonary CT features and acute exacerbation (AE) risk remain incompletely understood. We investigated whether chest CT-derived measures of body composition, bone mineral density (BMD), and coronary artery calcification (CAC) are associated with AE risk and frequency in COPD. In this prospective observational cohort study, 306 patients with COPD and 83 healthy controls were enrolled. Quantitative chest CT was used to assess pectoralis muscle area (PMA), subcutaneous adipose tissue (SAT), thoracic vertebral BMD, and CAC. COPD patients were categorized according to the occurrence and frequency of AEs within one and two years. Group comparisons were performed using nonparametric and categorical statistical tests. Compared with controls, patients with COPD had significantly lower PMA, SAT, and BMD (all p<0.001), while CAC did not differ. Within one year, patients with AEs showed lower BMD than those without AEs (p=0.032). Frequent exacerbators had reduced PMA and altered left circumflex artery calcification indices (p<0.05). Over two years, patients with AEs exhibited greater left circumflex and total coronary calcification (p<0.05). CT-derived muscle mass, BMD, and coronary calcification are associated with AE risk and frequency in COPD, supporting the clinical relevance of extrapulmonary CT markers for exacerbation risk stratification.

Primary pulmonary inflammatory myofibroblastic tumor (IMT) associated with paraneoplastic pemphigus (PNP) is extremely rare. IMT is an intermediate (rarely metastasizing) mesenchymal neoplasm rather than a conventional sarcoma. We report a case of a 68-year-old female patient who initially presented with generalized skin rash, oral mucosal ulceration, and fever. Chest CT revealed a thoracic mass (initially difficult to determine whether mediastinal or pulmonary in origin). Subsequent thoracotomy and surgical resection with pathological examination confirmed an ALK-rearranged inflammatory myofibroblastic tumor (SQSTM1: ALK fusion) of pulmonary origin. Oral mucosal pathology, combined with clinical findings, supported a diagnosis of PNP. This case aims to provide reference for the diagnosis and treatment of patients with primary pulmonary IMT complicated by PNP. However, the follow-up period was short and systemic immunosuppressive therapy was not administered; this should be regarded as a cautionary note rather than a therapeutic recommendation.

Systemic inflammation is closely associated with acute exacerbations of chronic obstructive pulmonary disease and may reflect the risk of future exacerbations. Blood-based inflammatory biomarkers represent simple and practical tools for identifying patients at increased risk. The aim of this study was to evaluate the association between systemic inflammatory biomarkers measured during stable chronic obstructive pulmonary disease and overall exacerbation burden across Global Initiative for Chronic Obstructive Lung Disease stages. This retrospective cohort study included 132 patients with chronic obstructive pulmonary disease followed for at least 2 years. Clinical, functional, and laboratory data obtained during clinically stable periods were analyzed. Systemic inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, aggregate index of systemic inflammation, and modified Glasgow prognostic score) were calculated. Exacerbation frequency was defined as the annualized number of moderate-to-severe exacerbations. Patients were classified according to Global Initiative for Chronic Obstructive Lung Disease groups A, B, and E, and associations between inflammatory biomarkers and clinical outcomes were evaluated using appropriate statistical methods, including receiver operating characteristic curve analyses. Elevated levels of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, aggregate index of systemic inflammation, modified Glasgow prognostic score, and C-reactive protein were significantly associated with increased exacerbation frequency and hospitalization rates in the overall cohort (all p<0.05), whereas systemic inflammation response index showed no significant association. Receiver operating characteristic analyses demonstrated moderate discriminative ability of C-reactive protein and inflammatory indices for predicting frequent exacerbations. Systemic inflammatory biomarkers were associated with adverse clinical outcomes in patients with chronic obstructive pulmonary disease and were significantly related to exacerbation frequency and severity. These findings suggest that systemic inflammatory markers may be useful for overall clinical assessment and identifying patients at increased risk of exacerbations, rather than for stage-specific risk stratification.

The diagnostic evaluation of pulmonary embolism (PE) in pregnancy is challenging, as the physiologic changes of pregnancy can mimic several PE symptoms. Acute respiratory infections introduce additional diagnostic complexity by producing systemic inflammation, altering vital signs, and, in some cases, elevating D-dimer levels. As a case in point, we examined how SARS-CoV-2 infection affected presentation, pretest probability, and diagnostic testing in pregnant patients with possible PE. We performed a retrospective cohort study across 21 community medical centers from October 1, 2021, to March 30, 2023. We included pregnant outpatients &#x2265; 18 years evaluated for suspected PE with D-dimer testing, compression ultrasonography, computed tomography pulmonary angiography (CTPA), or lung scintigraphy. We compared patients with and without COVID-19 using bivariate analysis. Among 860 patients, the median age was 30.0 years; 39.1% were in the third trimester. COVID-19 was present in 147 (17.1%). Compared with non-COVID-19 patients, those with COVID-19 more often had fever (36.1% vs. 4.2%), tachycardia &#x2265; 110&#x2009;bpm (66.0% vs. 34.2%), and oxygen saturation&#x2009;<&#x2009;95% (12.2% vs. 4.8%), but less often reported chest pain (49.7% vs. 65.5%; all p &#x2009;<&#x2009;0.001). Nearly all patients had low-to-intermediate pretest probability, but intermediate classification was more common with COVID-19 patients (63.3% vs. 39.0%; p &#x2009;<&#x2009;0.001). COVID-19 patients more often had elevated D-dimer&#x2009;>&#x2009;1.0&#x2009;mg/L (49.1% vs. 36.4%; p &#x2009;<&#x2009;0.001) and more commonly underwent chest radiography (61.9% vs. 50.1%; p &#x2009;=&#x2009;0.009). Among patients who underwent advanced imaging ( n &#x2009;=&#x2009;393), CTPA predominated in both cohorts. Overall, PE was rare ( n &#x2009;=&#x2009;6; 0.7%), and mortality was low ( n &#x2009;=&#x2009;3; 0.3%). COVID-19 in pregnancy was associated with worse vital signs, higher pretest probability, higher D-dimer values, and increased diagnostic testing. These findings illustrate how acute respiratory infections may recalibrate PE risk assessment in pregnancy and highlight the need to refine diagnostic strategies when infection-related physiologic changes are present.

Visceral Kaposi's sarcoma (KS), like pulmonary KS (PKS), is more common in HIV associated/epidemic KS (EpKS). Its presentation often mimics other opportunistic pulmonary infections and is associated with poor outcomes. This study investigated the prevalence of PKS, and factors associated with overall survival at a tertiary hospital in Tanzania. This retrospective study reviewed records of 269 histologically confirmed cutaneous KS patients treated at the Ocean Road Cancer Institute between January 2019 and December 2022. Sociodemographic, clinical, and survival data were extracted from patients' files. Specialist radiologists reviewed chest radiographs taken at the time of diagnosis, categorizing them as normal, infectious infiltrates, or PKS. Data were analyzed using descriptive statistics, and Cox Proportional Hazard model identified factors linked to overall survival. Statistical significance was defined as p&#x2009;<&#x2009;0.05. Among 269 patients with cutaneous KS, 195 had EpKS, 66 had Endemic KS (EnKS), and 8 had unknown HIV status and were excluded from further analysis. The male-to-female ratio was 2:1. While all patients had cutaneous KS lesions, 23 (8.8%) had PKS which was significantly more common in the EpKS than EnKS group (p&#x2009;=&#x2009;0.024). Additionally, 24 patients (9.2%) had Chest X-ray findings (CXR) indicative of infection. At one year, overall survival was 53% for patients with PKS, compared with 87% for those without PKS. In the adjusted analysis, patients without PKS had an 86% lower risk of mortality than those with PKS (aHR&#x2009;=&#x2009;0.14; 95% CI: 0.07-0.32; P&#x2009;<&#x2009;0.001). There is high prevalence of advanced KS presentation and poor overall survival especially among PKS in SSA, despite widespread ART use. Although CXR remains the diagnostic mainstay in this setting, it is subject to notable limitations. Simple, low-cost diagnostic algorithms are needed to optimize CXR utility alongside the ongoing expansion of advanced imaging and bronchoscopic services in the region.

Purpose: Acute ischemic stroke (AIS) is the most prevalent stroke subtype. Given the brain-heart interaction, this study investigated the association between cardiac parameters on admission routine preoperative chest CT and recanalization following thrombectomy in AIS patients. Method: We retrospectively analyzed 215 AIS patients (August 2018-June 2022) who underwent admission of none contrast chest computed tomography (NCCT) and thrombectomy within 24 h. Successful recanalization was defined as modified Treatment in Cerebral Ischemia (mTICI) score 2b-3. Multivariable logistic regression identified independent predictors. A nomogram was developed and validated using ROC, calibration, and decision curve analyses. Result: The cohort had a median age of 72 years; 63.7% were male. Hypertension (65.1%), atrial fibrillation (25.1%), and pleural effusion (56.3%) were prevalent. Successful recanalization occurred in 172 patients (80%). Independent predictors included mean arterial pressure (OR: 1.022, CI: 1.003-1.041, p = 0.025), left pulmonary artery diameter (OR: 0.838, CI: 0.733-0.958, p = 0.010), RV/A ratio (standardized) (OR:1.908, CI: 1.293-2.817, p = 0.001), septal angle (OR: 1.055, CI: 1.018-1.094, p = 0.004), and intraventricular septal angle (OR: 0.973, CI: 0.952-0.995, p = 0.015). The model achieved an AUC of 0.774 (p < 0.001) with strong calibration and net benefit. Conclusions: Cardiac parameters on routine preoperative chest CT correlate with recanalization following thrombectomy in AIS patients. The developed nomogram offers a reliable tool for clinical risk stratification.

Sarcopenia, assessed via computed tomography (CT), is an emerging prognostic tool in critically ill, pulmonary, and geriatric patients. Laboratory inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and neutrophil-to-lymphocyte ratio (NLR) are routinely obtained in these populations. Whether CT-assessed sarcopenia combined with laboratory markers offers superior prognostic accuracy over either measure alone remains unclear. To systematically evaluate the prognostic value of CT-assessed sarcopenia, alone or combined with laboratory inflammatory/nutritional markers, for predicting mortality, mechanical ventilation duration, and ICU length of stay in critically ill, pulmonary, and geriatric patients. MEDLINE/PubMed, Scopus, Embase, and Cochrane Library were searched from inception to December 2024. Observational studies (prospective or retrospective cohorts, case-control) that reported CT-based sarcopenia assessment alongside at least one laboratory inflammatory marker and at least one clinical outcome were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale (NOS). Random-effects meta-analysis was performed; heterogeneity was assessed using the I&#xb2; statistic. Twenty-five studies encompassing 12,347 patients were identified. The pooled odds ratio for mortality in sarcopenic versus non-sarcopenic patients was 2.28 (95% CI: 1.83-2.83; I&#xb2; = 22.1%) across critically ill ICU cohorts. In COVID-19 pulmonary populations, pooled OR for in-hospital mortality with low skeletal muscle mass was 5.84 (95% CI: 1.07-31.83). CT-derived muscle measurements correlated inversely with CRP (r = -0.315), fibrinogen (r = -0.392), D-dimers (r = -0.363), and WBC count (r = -0.287). Combined CT-sarcopenia and inflammatory marker models outperformed conventional scoring systems (APACHE II, SOFA, CURB-65, PSI). CT-assessed sarcopenia, when integrated with laboratory inflammatory markers, provides a robust, mechanistically grounded, and clinically accessible multimodal prognostic framework across critically ill, pulmonary, and geriatric populations.

Silicosis is a well-recognised occupational lung disease caused by inhalation of crystalline silica dust; however, extrapulmonary involvement, particularly splenic silicosis, remains rare and underreported in the literature. A 46-year-old female sand sifting machine operator presented with six years of occupational silica exposure at a sand classification and packing factory. In 2005, she developed respiratory symptoms, and chest radiography revealed diffuse nodular opacities, although silicosis was not diagnosed at that time. In October 2024, approximately 19 years after initial presentation, computed tomography demonstrated multiple calcified pulmonary nodules, progressive massive fibrosis, eggshell calcification of mediastinal lymph nodes, and multiple calcified micronodules throughout the splenic parenchyma. Based on these characteristic radiological findings and her occupational exposure history, a diagnosis of complicated silicosis with extrapulmonary splenic involvement was established. Despite a latency period shorter than the traditionally reported 10-30 years for chronic silicosis, the clinical course was indolent across the interval between the two assessments (2005 and 2024), which may lie near the boundary between chronic and accelerated forms. Splenic silicosis should be considered in patients with occupational silica exposure who present with splenic calcifications. Although sand sifting operations have received limited attention as a potential source of silica exposure, the occurrence of multiple cases at the same facility suggests potentially high exposure intensity. These findings emphasise the importance of comprehensive prevention strategies and raise the question of whether earlier initiation of health surveillance may benefit workers in sand processing industries.

In patients with congenital lung malformations (CLM), prenatal imaging is used to risk stratify patients and delineate algorithms for delivery planning and neonatal care. Most algorithms include a chest x-ray immediately after birth in all patients. This study sought to evaluate whether chest x-ray impacts clinical decision-making, ability to predict symptoms, and the decision to manage patients in the Neonatal Intensive Care Unit (NICU). A single center, retrospective cohort study was performed of patients diagnosed prenatally with a CLM (2015 - 2025). Maternal demographics, pre- and postnatal imaging, surgical details and outcomes were collected. Patients with symptoms at birth were compared to the asymptomatic cohort. 124 patients were included, with a median peak Congenital Pulmonary Airway Malformation Volume Ratio (CVR) of 0.79 (IQR 0.38-1.17). Only 15.3% received supplemental oxygen after birth (4% required mechanical ventilation). 72.3% were admitted to the NICU. 47.2% (50/106) had an abnormal x-ray, including 62% with a potential CLM and 38% with a clearly visible CLM. Of those with a clear CLM on x-ray, 84.2% (16/19) didn't have symptoms. The abnormal x-ray did not trigger further imaging or management changes. 13/19 patients with a clear CLM on x-ray were monitored in the NICU. X-ray sensitivity to detect symptomatic patients was 56.3% and specificity was 54.4%. Comparing the symptomatic and asymptomatic cohorts revealed no significant differences in the probability of an abnormal x-ray. Chest x-rays have poor sensitivity and specificity in the initial evaluation of asymptomatic CLM patients and did not change clinical decision-making including whether the patient required NICU-level care.

Acute pulmonary embolism (PE) has a heterogeneous clinical presentation, varying from mild chest symptoms to shock or cardiac arrest. Optimal management of severe acute PE requires assessment of multiple parameters to confirm the diagnosis and assess the patients prognosis, preferably by EXPERT-PE care/Pulmonary Embolism Response Teams (PERTs), integrating multidisciplinary expertise to optimize PE management. While management of severe acute PE already can be challenging, this particularly applies to certain patient subgroups, in particular pregnant women. As a result of ruling out pregnant women in randomized trials, specific guideline recommendations on severe PE are unavailable. This case-based narrative review aims to provide an overall overview of the approach to treating patients with severe PE, based on the comprehensive case description of a pregnant patient with high-risk PE.

Kounis syndrome is an allergic acute coronary syndrome triggered by hypersensitivity reactions. Its association with allergic bronchopulmonary aspergillosis (ABPA) is rarely reported. We describe a 77-year-old woman with asthma, chronic obstructive pulmonary disease, and established ABPA who developed acute chest tightness and dyspnea during an ABPA relapse. Laboratory testing showed marked eosinophilia, elevated total IgE, and evidence of myocardial injury, with increased cardiac troponin I and B-type natriuretic peptide. Electrocardiography revealed ischemic changes, and coronary angiography demonstrated nonobstructive coronary arteries. Based on the clinical and immunologic findings, Kounis syndrome, possibly triggered by ABPA, was diagnosed. The patient improved with antifungal therapy, systemic corticosteroids, coronary vasodilators, and supportive care. This case highlights ABPA relapse as a potential trigger of Kounis syndrome and emphasizes the need for cardiovascular vigilance in patients with severe allergic airway disease.

Amiodarone is a widely used antiarrhythmic agent. Pulmonary toxicity is its most feared non-cardiac complication and is classically associated with high doses and prolonged duration of therapy. We report a case of early-onset amiodarone pulmonary toxicity (APT) developing after approximately one month of standard-dose amiodarone therapy (400 mg/day) in the setting of concurrent decompensated heart failure with preserved ejection fraction (HFpEF), which substantially complicated the diagnostic evaluation. A 71-year-old male with paroxysmal atrial fibrillation, nonischemic cardiomyopathy, and multiple comorbidities was initiated on amiodarone 400 mg/day in April. Within one month, he developed progressive dyspnea on exertion and productive cough. He presented to the emergency department in September with acute hypoxic respiratory failure (SpO&#x2082; 86% on room air), weight gain, and bilateral lower extremity edema approximately five months after symptom onset. CT of the chest demonstrated bilateral ground-glass and consolidative opacities with upper lobe predominance and interlobular septal thickening. The initial working diagnosis of decompensated HFpEF was supported by elevated BNP and peripheral edema; intravenous furosemide led to the resolution of edema but no improvement in oxygenation. APT was subsequently suspected, and intravenous methylprednisolone was initiated, resulting in marked clinical improvement. The patient was discharged on room air on a prolonged prednisone taper. At the three-month follow-up, he demonstrated complete symptomatic resolution, marked radiological improvement, and normalization of BNP. This case adds to the existing evidence that clinically significant APT may occur at standard maintenance doses and within a shorter timeframe than traditionally recognized. Coexistent HFpEF poses a major diagnostic challenge given the substantial overlap in clinical and radiological features. The possibility of concurrent rather than competing pathology should always be considered. Clinicians should maintain a high index of suspicion for APT in any patient on amiodarone with progressive respiratory symptoms, irrespective of dose or duration of exposure.

Pulmonary hypertension (PH) refers to a disease condition with elevated mean pulmonary arterial pressure of more than 20&#x2009;mm Hg. This may arise secondary to an underlying pathology involving the lungs, heart, or major vessels of the chest. Patients with PH can present with nonspecific cardiac or respiratory complaints. Although right heart catheterization is the gold standard for diagnosing PH, it is not always done or required and often, PH is diagnosed based on clinical suspicion and noninvasive tests such as echocardiography. Computed tomography (CT) scans play a vital role in diagnosing PH, detecting the severity of the disease, and discerning the etiological factors. A stepwise approach to review CT imaging of the thorax to aid in the diagnosis of PH and to look for the etiology and prognostic factors is described in this article.

Unilateral upper-lung field pulmonary fibrosis (upper-PF) can occur on the operative side after lung cancer surgery. It is reportedly associated with pleural effusion at 6&#xa0;months post-surgery (PE-6mo), but the perioperative risk factors for PE-6mo and the cumulative incidence of upper-PF remain unclear. We retrospectively reviewed all patients with lung cancer who underwent radical surgical resection between 2008 and 2016. Perioperative characteristics were compared based on the presence of PE-6mo. The cumulative incidence of upper-PF in patients with PE-6mo was estimated using a competing risk analysis. Of the 587 patients, 160 (27.2%) had PE-6mo. Multivariate analysis identified age&#x2009;>&#x2009;70&#xa0;years, body mass index&#x2009;<&#x2009;22, thoracotomy, lobectomy, pulmonary apical cap, and adjuvant chemotherapy as independent risk factors for PE-6mo. Among 115 patients evaluable by chest CT for 2&#xa0;years, 25 (21.7%) subsequently developed upper-PF (upper-PF group), while 90 did not (non-upper-PF group). The 3-, 5-, and 10-year cumulative incidences of upper-PF were 11.5%, 16.4%, and 24.6%. The upper-PF group more commonly had prolonged pleural effusion at 2&#xa0;years than the non-upper-PF group (21/25 vs. 51/90, p&#x2009;=&#x2009;0.018). Furthermore, pleural thickening was already evident at 6&#xa0;months in the upper-PF group (15/25 vs. 18/90, P&#x2009;<&#x2009;0.001) and thereafter. For patients with pleural thickening at 6&#xa0;months, the 3-, 5-, and 10-year cumulative incidences of upper-PF were 24.2%, 35.0%, and 51.8%. Prolonged pleural effusion with pleural thickening was a common phenomenon in patients who later developed upper-PF after surgery and may therefore be a strong postoperative indicator of upper-PF development.

Sarcoidosis is a multifactorial granulomatous disease that affects adults of all ages, primarily targeting the lungs. Symptoms can range from none at all to severe respiratory failure requiring lung transplantation. Diagnosis is made using three main criteria: compatible clinical or radiological findings, histological proof of non-necrotizing granulomatous inflammation in tissue, and ruling out other causes of granulomatous disease. Pulmonary fibrosis, advanced findings on high-resolution chest CT, decreased pulmonary function, and pulmonary hypertension are widely recognized as significant predictors of adverse clinical outcomes. A narrative, non-systematic review of important recent literature was carried out using computerized database searches, manual searches, and authoritative sources. This review examines the various patterns observed in high-resolution computerized tomography of the chest and their association with the severity and the pathophysiology of sarcoidosis. The patterns addressed include nodules, ground-glass opacities, consolidations, honeycombing, traction bronchiectasis, and cysts. Both historical and current methods of categorizing high-resolution CT interstitial findings will be reviewed. &#xb7; Chest HRCT in sarcoidosis demonstrates a broad spectrum of interstitial lung disease patterns, including micronodules, ground-glass opacities, traction bronchiectasis, honeycombing, and cystic change, with important implications for differential diagnosis.. &#xb7; The diagnosis of pulmonary sarcoidosis requires concordant clinical and radiologic findings, histologic evidence of non-necrotizing granulomatous inflammation, and exclusion of alternative granulomatous disorders.. &#xb7; Fibrotic HRCT manifestations of sarcoidosis are associated with adverse clinical outcomes, including impaired pulmonary function, pulmonary hypertension, and chronic respiratory failure, and should be distinguished from UIP/IPF despite overlapping imaging features.. &#xb7; Al-Qaqaa R, Lazarus MS, Franco A. Spectrum of Interstitial Lung Disease in Sarcoidosis. Rofo 2026; DOI 10.1055/a-2871-9924. Die Sarkoidose ist eine multifaktorielle granulomat&#xf6;se Erkrankung, die Erwachsene jeden Alters betrifft und haupts&#xe4;chlich die Lunge bef&#xe4;llt. Die Symptome reichen von v&#xf6;llig symptomfrei bis hin zu schwerem Lungenversagen, das eine Lungentransplantation erforderlich macht. Die Diagnose wird anhand von drei Hauptkriterien gestellt: entsprechende klinische oder radiologische Befunde, histologischer Nachweis einer nicht-nekrotisierenden granulomat&#xf6;sen Entz&#xfc;ndung im Gewebe sowie der Ausschluss anderer Ursachen f&#xfc;r eine granulomat&#xf6;se Erkrankung. Lungenfibrose, eindeutige Befunde in der hochaufl&#xf6;senden Thorax-Computertomografie (CT), verminderte Lungenfunktion und pulmonale Hypertonie gelten allgemein als signifikante Pr&#xe4;diktoren f&#xfc;r einen ung&#xfc;nstigen klinischen Verlauf. Eine narrative, nicht-systematische &#xdc;bersichtsarbeit &#xfc;ber wichtige aktuelle Literatur wurde mithilfe computergest&#xfc;tzter Datenbankrecherchen, manueller Suchen und fundierter Quellen erstellt. Diese &#xdc;bersicht untersucht die verschiedenen Muster, die in der hochaufl&#xf6;senden Thorax-CT beobachtet werden, sowie deren Zusammenhang mit dem Schweregrad und der Pathophysiologie der Sarkoidose. Zu den untersuchten Mustern geh&#xf6;ren Kn&#xf6;tchen, milchglasartige Tr&#xfc;bungen, Konsolidierungen, Wabenbildung, Traktionsbronchiektasien und Zysten. Sowohl historische als auch aktuelle Methoden zur Kategorisierung interstitieller Befunde in der hochaufl&#xf6;senden CT werden untersucht. &#xb7; Die hochaufl&#xf6;sende Thorax-CT bei Sarkoidose zeigt ein breites Spektrum an interstitiellen Lungenerkrankungsmustern, darunter Mikroknoten, milchglasartige Tr&#xfc;bungen, Traktionsbronchiektasien, Wabenbildung und zystische Ver&#xe4;nderungen, mit wichtigen Implikationen f&#xfc;r die Differentialdiagnose.. &#xb7; Die Diagnose einer pulmonalen Sarkoidose erfordert &#xfc;bereinstimmende klinische und radiologische Befunde, den histologischen Nachweis einer nicht-nekrotisierenden granulomat&#xf6;sen Entz&#xfc;ndung sowie den Ausschluss von anderen granulomat&#xf6;sen Erkrankungen.. &#xb7; Fibrotische Manifestationen in der hochaufl&#xf6;senden Thorax-CT bei Sarkoidose sind mit einem ung&#xfc;nstigen klinischen Outcome verbunden, darunter eingeschr&#xe4;nkte Lungenfunktion, pulmonale Hypertonie und chronisches Lungenversagen, und sollten trotz sich &#xfc;berlappender bildgebender Merkmale von einer gew&#xf6;hnlichen interstitiellen Pneumonie/idiopathischen Lungenfibrose abgegrenzt werden..