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Pulmonary metastasectomy has become a well-established procedure for patients with certain types of solid tumors. Patients are usually scheduled for staged lung metastasectomy in case of primary tumor control, the absence of distant non-lung metastases, and when complete resection is achievable. Nodules are removed with precision resection in order to ensure radical resection with minimal margins; this technique permits good oncological results, preserving the surrounding pulmonary parenchyma and causing minimal distortion compared to staplers. When possible, anatomical resections should be avoided since they are not justified by real oncological advantages and, in the majority of cases, sacrifice too much healthy tissue, possibly leading to inoperability in the case of metachronous relapses. Thus, preserving the maximum amount of pulmonary parenchyma is crucial because repeated metastasectomies are possible and frequent, with no theoretical limits to the number of reinterventions. In our multidisciplinary board team, we support the role of pulmonary metastasectomy as a useful curative therapy, with acceptable morbidity and mortality, with indications to be discussed case-by-case.

Spontaneous hemothorax is a rare but potentially life‐threatening manifestation of granulomatosis with polyangiitis (GPA). This case highlights the importance of considering vasculitis in unexplained hemothorax and underscores the role of early surgical intervention in preventing deterioration in immunosuppressed patients. Multidisciplinary management is crucial for timely diagnosis, treatment, and optimizing outcomes. Histologic lung section illustrating chronic vasculitis characteristic of GPA.

Lung cancer remains a leading cause of cancer-related mortality, with diagnostic delays significantly impacting patient outcomes. Despite advancements in diagnostic strategies, inefficiencies persist, particularly in geographically complex regions with limited healthcare resources. The Fast-Track Program was developed to address these challenges in lung cancer diagnostics within the geographically complex and resource-limited Valtellina region. This prospective observational study compared patients managed under the Fast-Track pathway (May–August 2024) with those following standard diagnostic procedures (January–April 2024). The program integrated structured, pre-scheduled diagnostic slots, a rotating Case Manager role, and weekly multidisciplinary team (MDT) discussions to enhance coordination and reduce diagnostic timelines. Results showed a significant reduction in the mean time to definitive diagnosis from 42.9 days (95% CI: 35.6–50.3) in the control group to 25.0 days (95% CI: 20.8–29.3) in the Fast-Track cohort (p < 0.001). Patient adherence to diagnostic pathways improved from 71% to 92% (p < 0.05), while satisfaction scores increased from 64% to 89%, with patients rating their experience as “very good” or “excellent” (p < 0.05). Although the predefined clinical significance criteria were not fully met, the program demonstrated a favorable trend toward improved efficiency and patient-centered care. These findings support the feasibility and scalability of structured diagnostic workflows in streamlining lung cancer diagnostics, with potential implications for broader oncological and chronic disease management in resource-constrained healthcare settings.

Thoracic endometriosis-related non-catamenial pneumothorax is a rare entity whose pathogenesis is still less unclear than catamenial pneumothorax one. Hormonal therapy and/or talc pleurodesis are not sufficient for successful management. Surgical videothoracoscopic resection has a central role in the treatment. We displace a case of thoracic endometriosis-related non-catamenial pneumothorax presenting with recurrent right pneumothorax, surgically treated three times and misdiagnosed at first two interventions. At third operation, unusual histological findings on diaphragmatic and pulmonary specimens were disclosed. These results could partially clarify the presentation of some complicated misdiagnosed cases. More has to be investigated about pathogenesis of the disease and influence of the hormonal balance on it.

Chest drain insertion is a simple procedure with very low morbidity and mortality. The correct procedure provides for a good fixation of the drainage to the skin. An alternative “Roman Sandal technique” for securing the chest drain to the skin is proposed compared to the classical methods. The main feature of the method is the fact that a single suture acts as “tube fixing” and “wound closure” by creating an alpha-cross-wires into and around the wound. The new method is presented as more elegant, effective, quicker application and removal of the drainage and excellent cosmetic results.

Valproic acid (VPA) is one of the most frequently used antiepileptic drugs for the treatment of focal and generalized epilepsies, absence seizures, and Lennox-Gastaut syndrome (LGS). VPA has been demonstrated to have a negative effect on both the intrinsic and extrinsic coagulation systems and controversy exists about the clinical relevance of such hematological abnormalities. We describe a case of reversible lung hemorrage due to VPA. In English-language literature only two other similar cases (one of which fatal) have been described so far.

Screening for lung cancer with modern imaging technology may decrease lung cancer mortality, but encouraging results have only been obtained in uncontrolled studies. To explore the effect of screening with low-dose spiral computed tomography (LDCT) on lung cancer mortality. Secondary endpoints are incidence, stage at diagnosis, and resectability. Male subjects, aged 60 to 75 years, smokers of 20 or more pack-years, were randomized to screening with LDCT or control groups. All participants underwent a baseline, once-only chest X-ray and sputum cytology examination. Screening-arm subjects had LDCT upon accrual to be repeated every year for 4 years, whereas controls had a yearly medical examination only. A total of 2,811 subjects were randomized and 2,472 were enrolled (LDCT, 1,276; control, 1,196). After a median follow-up of 33 months, lung cancer was detected in 60 (4.7%) patients receiving LDCT and 34 (2.8%) control subjects (P = 0.016). Resectability rates were similar in both groups. More patients with stage I disease were detected by LDCT (54 vs. 34%; P = 0.06) and fewer cases were detected in the screening arm due to intercurrent symptoms. However, the number of advanced lung cancer cases was the same as in the control arm. Twenty patients in the LDCT group (1.6%) and 20 controls (1.7%) died of lung cancer, whereas 26 and 25 died of other causes, respectively. The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.

[...]while the bacteria that infect a weak body have the fate of a lit match falling on a pile of straw, the bacilli entering a robust body have the fate of a lit match falling on a marble table: [...]in our daily activities we can confirm that the \"new explosion\" of TB, is due mainly to the migratory flows from highly endemic countries in our hospital (mainly countries from Eastern Europe and South Asia).

Background: Central airway obstruction (CAO) remains a major challenge in thoracic oncology, particularly in patients with advanced lung cancer. Despite advances in systemic therapies, interventional bronchoscopy, especially rigid bronchoscopy (RB), plays a critical role in managing CAO. Methods: Between June 2005 and December 2023, 416 patients with central airway obstructions were treated. The cohort included 213 males (51%) and 203 females (49%), with a mean age of 64.8 years. A retrospective review of patient data was conducted, and descriptive statistics were used to summarize demographics and procedural outcomes. Survival rates and complication data were analyzed using Kaplan–Meier survival curves. Multivariate analysis was performed to identify significant predictors of survival and complications, considering factors such as tumor stage, prior treatments, and comorbidities. The study also analyzed the impact of adjuvant therapies and stenting on patient outcomes. Results: Of the 416 patients, 86 (20.7%) had benign lesions, including 61 cases of post-tracheostomy stenosis or prolonged intubation, while the remaining 330 (79.3%) had malignant CAO. Patients receiving adjuvant therapies showed a significant survival advantage, with a median survival of 24 months compared to 15 months for those not receiving adjuvant therapies (p = 0.015). Stenting was performed in 141 cases, but no significant survival difference was found between patients with and without stents (p = 0.52). Complications were rare, with airway rupture observed in 1.9% and perioperative mortality in 0.25%. Symptom relief was achieved in the majority of patients, with significant improvements in quality of life, particularly in those with malignant obstructions. Conclusions: RB remains a cornerstone in the management of CAO, providing effective and durable symptom relief. It is particularly beneficial for advanced malignancies, offering a palliative approach that improves both survival and quality of life. Our study supports the guidelines endorsing RB for CAO management and highlights its role in providing significant symptom relief and stabilization in patients with severe airway obstruction.