Search Results (1,267)

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency characterized by important sex-related differences in presentation, management, and outcomes. Although women account for a smaller proportion of cases, they typically present at older ages and more frequently exhibit atypical symptoms, hemodynamic instability, and complications such as pericardial effusion or tamponade, contributing to diagnostic delays and higher pre-hospital mortality. Beyond clinical factors, biological differences may influence disease expression in women. Menopause-associated vascular aging, hormonal modulation of extracellular matrix remodeling, and pregnancy-related hemodynamic and connective tissue changes may alter aortic wall integrity and susceptibility to dissection. Notably, women often experience dissection at smaller absolute aortic diameters, highlighting the potential importance of body-size indexing in risk stratification and surgical thresholds. In type A AAD, women are less likely to undergo extensive surgical repair in some cohorts, and although contemporary in-hospital mortality differences are narrowing, long-term survival disparities may persist. In type B AAD, women are more frequently managed conservatively, while outcomes following thoracic endovascular aortic repair appear broadly comparable between sexes. Pregnancy and the postpartum period represent particularly vulnerable windows, especially among patients with underlying heritable aortopathies. Greater awareness of sex-specific biological and clinical characteristics, incorporation of indexed aortic dimensions, and improved multidisciplinary management strategies are essential to optimize outcomes for women with acute aortic dissection. Full article

Background: Neonatal septic arthritis is a rare but potentially devastating infection that can present with subtle clinical signs and rapidly progress to joint destruction, osteomyelitis, and permanent sequelae. We aimed to describe the clinical and microbiological characteristics, imaging findings, management, and follow-up outcomes of neonatal septic arthritis patients and to report ultrasonography (US) and magnetic resonance imaging (MRI) findings within the same cohort. Methods: This retrospective observational study was conducted in a tertiary neonatal intensive care unit and included neonates who were diagnosed with septic arthritis between January 2016 and December 2025. Demographic, clinical, laboratory, microbiological, imaging, treatment, and outcome data were systematically obtained from medical records. The diagnosis was based on compatible clinical findings supported by laboratory and/or microbiological evidence, with imaging used to support diagnosis and guide management. Results: Twelve neonates were included. The median gestational age was 36.5 weeks (26–40), and the median birth weight was 2435 g. The median symptom onset was 22 days of life. The hip (n = 4) and knee (n = 4) were most commonly affected. Pseudoparalysis and swelling were the most frequent findings. Synovial cultures were positive in 10/12 (Staphylococcus aureus, n = 7; methicillin-resistant Staphylococcus aureus (MRSA), n = 3), and blood cultures were positive in 6/12. US detected joint effusion in 33% of the patients, whereas MRI revealed inflammatory changes in all the patients. Concomitant osteomyelitis occurred in 5/12 patients. Orthopedic sequelae developed in 6/12; no mortality was observed. Conclusions: Neonatal septic arthritis is associated with a substantial risk of osteomyelitis and early sequelae. Delayed recognition may worsen outcomes. Normal ultrasonographic findings should not exclude the diagnosis when clinical suspicion persists, and MRI may provide complementary information for timely management. Full article

Background: Necrotizing pneumonia is a severe complication of Mycoplasma pneumoniae pneumonia (MPP) in children. Early recognition remains challenging because initial clinical manifestations are often non-specific, highlighting the need for a practical tool for early risk stratification. Methods: We conducted a single-center retrospective study of hospitalized children with MPP. Data from 2015–2023 were used for model development, and patients enrolled in 2024 were reserved for temporal validation. We compared candidate machine-learning algorithms and selected a parsimonious random forest model using routinely available variables obtained during the early hospitalization period. Model performance was evaluated using discrimination, calibration, and decision curve analysis, and model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results: The random forest model showed good discriminatory performance in internal validation and retained acceptable performance in the 2024 temporal cohort. Calibration indicated reasonable agreement between predicted and observed risks. Decision curve analysis suggested potential clinical value as a supportive tool for early risk stratification. SHAP analysis highlighted fever duration, C-reactive protein, pleural effusion, alanine aminotransferase, and gamma-glutamyl transferase as the main contributors to model prediction. Conclusions: We developed and temporally validated a clinical prediction model for necrotizing pneumonia in children hospitalized with MPP. The model may support early risk stratification using routinely available clinical data, but it is intended to complement rather than replace clinical judgment. External prospective validation is required before routine clinical implementation. Full article

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article

Background/Objectives: AI-based tools for chest radiograph interpretation are increasingly used as decision-support systems, yet their performance must be validated in local clinical environments before deployment. This study evaluated the diagnostic performance of qXR (Qure.ai, v3.2) for detecting pulmonary nodules, cardiomegaly, and pleural effusion in adult patients at Hospital Clínica Bíblica, San José, Costa Rica. Methods: Three radiologists independently interpreted 225 chest radiographs, providing the reference standard. qXR outputs were compared against radiologist assessments for each finding. The sensitivity, specificity, Cohen’s kappa, and area under the ROC curve (AUC) were calculated. Due to the convenience-stratified sampling design, predictive values were not used for clinical interpretation. Results: For pulmonary nodules, qXR achieved a sensitivity of 0.71, specificity of 0.90, Cohen’s kappa of 0.51, and AUC of 0.80. For pleural effusion, sensitivity and specificity were both 0.86, with a kappa of 0.63 and AUC of 0.86. Cardiomegaly showed the lowest agreement, with a sensitivity of 0.64, specificity of 0.91, kappa of 0.57, and AUC of 0.77. Conclusions: qXR demonstrated moderate diagnostic agreement with radiologist assessments for pulmonary nodules and pleural effusion, and lower agreement for cardiomegaly under local imaging conditions. These results reflect technical concordance between the AI system and individual radiologists and do not constitute evidence of clinical utility or real-world impact. Context-specific validation is essential prior to integrating AI tools into routine radiological workflows. Full article

Background: Pediatric adenotonsillectomy is commonly performed for infectious and obstructive indications, but postoperative hemorrhage remains a concern. This study describes outcomes from a high-volume territorial network in southern Modena province, Italy. Methods: Retrospective observational study of 10,753 pediatric patients (aged 3–18 years) undergoing adenotonsillectomy at Sassuolo Hospital and affiliates (Vignola, Pavullo) from 2005 to 2024. Indications included recurrent tonsillitis (Paradise criteria), obstructive sleep apnea (OSA) (polysomnography-confirmed or clinical), and recurrent otitis media or otitis media with effusion (OME). Surgical techniques included curettage adenoidectomy and Colorado microdissection needle tonsillectomy. Our institutional postoperative care protocol included analgesics, oral hydration, soft diet, antibiotics (amoxicillin) and scheduled follow-up; however, no analysis regarding this protocol was intended to demonstrate correlations with study outcomes. Primary outcomes were postoperative hemorrhage (overall and requiring revision), stratified by indication, age, and technique, and contextualized against ranges reported in large published cohorts (qualitative, exploratory comparison). Secondary outcomes included pain (VAS scores), infection rates, and tissue regrowth. Data completeness was verified via electronic records (95.6%). Statistical analyses used descriptive statistics with 95% confidence intervals (95% CI) and inferential tests for within-cohort comparisons (χ² tests, Fisher’s exact test, and t-tests where appropriate). Results: A total of 10,753 procedures were analyzed (4325 tonsillectomies, 3942 adenotonsillectomies, 2486 adenoidectomies). Postoperative hemorrhage occurred in 202 patients (1.88%; 95% CI 1.64–2.15%); surgical revision was required in 75 (0.70%; 95% CI 0.56–0.87%), with multifactorial stratification showing higher risk for infectious indications (OR 1.41 vs. OSA), younger age < 5 years (OR 2.1), and tonsillectomy origin (OR 8.25 vs. adenoidectomy); all rates are at the lower end of literature ranges (2–5% and 0.9–2.5%, respectively), in line with large published cohorts, although these comparisons are qualitative and exploratory. Mean VAS pain scores decreased from 3.2 (day 1) to 1.1 (day 7). No significant infections occurred; tissue regrowth rates aligned with the literature (adenoidal 6–26%, tonsillar 5–10%). Conclusions: Sassuolo Hospital’s experience highlights favorable postoperative outcomes and low complication rates in adenotonsillar surgery. Limitations include the retrospective design, potential selection bias and long period evaluation. Prospective studies are needed to confirm these findings. Full article

Oral minoxidil, including low-dose regimens, is increasingly used off-label for alopecia, but cardiovascular safety remains a clinical concern. We compared cardiovascular adverse event reporting patterns for oral versus topical minoxidil using a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS). FAERS data (2004Q1–2025Q3) were imported and deduplicated; minoxidil reports were restricted to primary/secondary suspect (PS/SS) drugs and eligible reports from 2012 to 2025. Exposure was classified as ORAL, TOPICAL, BOTH, or UNKNOWN using a standardized route/dose-form dictionary. Signals for Core and Expanded cardiovascular MedDRA Preferred Terms (PTs) were assessed using reporting odds ratios (RORs) with 95% confidence intervals; sensitivity analyses included alopecia-restricted cohorts excluding hypertension indications. In the primary ORAL-versus-TOPICAL cohort (559 oral; 56,947 topical), 23 Core-list PTs and 31 Expanded-list PTs met the signal definition. Strongest primary signals included pericardial effusion (ROR 307; 95% CI 158–597), hypertensive crisis (ROR 1037; 95% CI 133–8117), pulmonary hypertension (ROR 932; 95% CI 118–7368), and pulmonary edema (ROR 1965; 95% CI 114–33,813). In an alopecia-restricted sensitivity cohort excluding hypertension/blood-pressure indications (146 oral; 24,367 topical), hemodynamic and effusion-related PTs (e.g., tachycardia, palpitations, orthostatic hypotension, syncope, and pericardial effusion) remained disproportionately reported, although event counts were smaller and confidence intervals were wider. Oral minoxidil PS/SS reports in FAERS showed disproportionate reporting of several cardiovascular PTs relative to topical minoxidil reports. However, because FAERS is a spontaneous reporting system without exposed-patient denominators and with important limitations including under-reporting, stimulated reporting, incomplete clinical information, and residual confounding, these findings should be interpreted strictly as hypothesis-generating reporting signals rather than evidence of incidence, relative risk, or definitive comparative clinical safety. Full article

Background: There is limited information about treatment success and outcomes in retrovirus-positive cats diagnosed with feline infectious peritonitis (FIP). Methods: A survey was distributed to caretakers of cats with feline leukemia virus (FeLV) and/or feline immunodeficiency virus (FIV) that were treated with GS-441524 for presumptive effusive FIP based on survey responses. Results: Cats with FIV developed FIP at an older age and longer after retrovirus infection than cats with FeLV. The average starting dosage (7 mg/kg/d) was increased in 65% of cats, and treatment was extended in 35%. Three cats relapsed (18%). There was a 94% (16/17) twelve-week survival rate and 82% (14/17) one-year survival rate. Seven cats were alive at follow-up, a median of 1306 days (range 983–2069) after FIP diagnosis, but many cats succumbed to neoplasia. Conclusions: Treatment success for retrovirus-positive cats with presumptive FIP was similar to previously reported outcomes for FIP alone. This could support current evidence of successful antiviral therapy for similar populations, if noncurrent, unstandardized protocols and unlicensed product use are considered. Additional studies are needed to determine ideal protocols for rapid resolution of FIP, good long-term survival, and limited relapse in retrovirus-positive cats, and the impact of the FeLV proviral load. Full article

A 2-year-old female Labrador Retriever, with a body condition score of 6/9, underwent ovariohysterectomy 24 h prior at another center and was urgently referred for a possible exploratory laparotomy. The dog presented with lethargy, abdominal pain, and a haematoma with active bleeding in the surgical wound, indicating a possible haemoabdomen. An abdominal-Focused Assessment with Sonography for Trauma (A-FAST) revealed fluid in all four quadrants (abdominal fluid score-AFS 4/4) without abdominal distension, corresponding to an effusion with a packed cell volume of 15% and 4 g/dL of protein. Haematological analysis showed a slight decrease in haematocrit (HCT) and red blood cells, with neutrophilia, while the rest of the blood tests were within normal limits. Physical examination parameters were mostly normal, except for cardiac auscultation where tachycardia, irregular rhythm, and pulse deficit were noted, with normal blood pressure. The electrocardiogram (ECG) indicated both monomorphic and polymorphic ventricular tachycardia with isolated episodes of sinus tachycardia. Treatment included the administration of metamizole, methadone, and maintenance fluid therapy, along with compressive abdominal bandaging. Lidocaine and continuous infusion of fentanyl therapy were initiated. The dog’s HCT, platelets, temperature, and blood pressure remained in the normal range. During the first 8 h, both the ECG and A-FAST showed no relevant changes. From the 9th hour onward, there was a predominance of sinus rhythm, the free fluid decreased to AFS 1/4, allowing for the gradual suspension of lidocaine. Tests for Leishmania, Ehrlichia, Anaplasma, Babesia, and Dirofilaria were negative. The evolution remained favorable, and the dog was discharged after 72 h, showing a good outcome in the cardiology follow-up 5 days later. Full article

Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient surveillance. Methods: This review summarizes the current evidence on the use of CEUS in major pleuropulmonary disorders, including pneumonia, pleural effusion, pulmonary embolism, neoplasms, and COVID-19-related lung injury. The most relevant clinical studies and meta-analyses were analyzed, focusing on CEUS parameters, diagnostic performance, and integration with other imaging techniques. Results: CEUS enables the differentiation between inflammatory, ischemic, and malignant lesions through qualitative and quantitative analyses of enhancement patterns. Early and homogeneous enhancement is typical of inflammatory or infectious processes, whereas heterogeneous or delayed enhancement with early washout strongly suggests malignancy or ischemia. In pneumonia and pleural infections, CEUS identifies non-perfused or necrotic areas, guiding drainage and evaluating therapeutic responses. In pulmonary embolism, it reveals avascular consolidations corresponding to infarction, even when CT angiography is inconclusive. For peripheral lung tumors, CEUS assesses angiogenesis and vascular supply, correlating perfusion parameters with histopathology, and improving biopsy targeting. Furthermore, in COVID-19 pneumonia, CEUS can detect microvascular alterations related to thrombosis and fibrosis. Conclusions: CEUS is a safe, noninvasive, and radiation-free technique that provides unique real-time information on pulmonary perfusion. Its integration with conventional ultrasound enhances diagnostic precision, optimizes interventional guidance, and allows for dynamic monitoring of treatment response. Future developments in quantitative analysis, artificial intelligence, and targeted contrast agents are expected to further expand CEUS clinical applications in pleuropulmonary imaging. Full article

Myocarditis and inflammatory cardiomyopathy are inflammatory diseases of the heart muscle that can have both infectious and non-infectious causes. They can be caused by an unresolved viral infection or other infection, or they can be autoimmune, toxic, or allergic in nature. The specific identification of the pathogen and/or confirmation of inflammation can only be achieved through direct tissue analysis using endomyocardial biopsy (EMB), as neither detection of the virus nor assessment of the quality and intensity of the inflammation is possible using non-invasive methods. Accordingly, the removal and analysis of an EMB is considered the diagnostic gold standard in international guidelines and statements. The sudden onset of atypical angina pectoris and initially exertion-dependent dyspnea, as well as arrhythmias, pericardial effusion, and progressive symptoms of heart failure, indicate an acute inflammatory process of the myocardium. In addition, nonspecific symptoms such as fatigue and reduced physical performance may also occur. Diagnostic evaluation includes an electrocardiogram (ECG), cardiac imaging, and laboratory tests. The analysis of the EMB is crucial for a definitive diagnosis and thus for the initiation of an etiology-based, specific and personalized therapy. This includes histological and immunohistochemical inflammation diagnostics as well as molecular virological diagnostics. These enable both the detection of viruses and the assessment of transcriptional virus activity. New analyses using metagenomic next generation sequencing (NGS) techniques provide insights of enormous diagnostic and therapeutic relevance. This applies both to the spectrum of detectable pathogens and to the possibility of confirming transcriptional viral activity. In addition, gene expression profiling enables the differentiation of specific forms of myocardial inflammation (e.g., giant cell myocarditis, cardiac sarcoidosis, and eosinophilic myocarditis) and reduces the influence of “sampling errors” in focal inflammatory processes. The treatment of heart failure or ventricular arrhythmias is always symptomatic according to general evidence-based guidelines. In severe cases, mechanical circulatory support or even a heart transplant may be necessary. Patients with histologically confirmed myocardial inflammation or intramyocardial viral infection can be offered specific, causal, and personalized therapy. These patients can be successfully treated with immunosuppressive or antiviral therapy, which significantly improves the prognosis of the disease. Full article

Objective: This study aims to investigate the correlation between blood leukocyte, CRP, LDH, and cytokine levels and the severity of illness in children with adenovirus pneumonia. Methods: A total of 100 children with adenovirus pneumonia (55 mild cases and 45 severe cases) who were treated at Guangzhou Women and Children’s Medical Center from January 2022 to January 2024, and 40 healthy children as a control group, were selected. Clinical data, some laboratory test data, and serum cytokine levels detected by flow cytometry were collected, and statistical methods were used to analyze the correlation between relevant indicators and the severity of the illness. Results: The research showed that among general clinical manifestations, the proportions of children with fever, dyspnea, pleural effusion, and moist rales in the severe group were all higher than those in the mild group (p < 0.05). Among the collected laboratory test data, indicators such as WBC, neutrophils, and LDH were significantly higher than in the mild group and the control group (p < 0.05) and were positively correlated with the severity of the disease. Regarding the tested cytokines, most children with adenovirus pneumonia showed elevated levels, and cytokines such as IL-6, IL-2, and IL-8 were significantly positively correlated with the disease. In the ROC curve analysis, NEU 6.03 × 10⁹/L (sensitivity 82.2%, specificity 72.7%, AUC 0.830) and IL-6 41.823 pg/mL (sensitivity 75.6%, specificity 81.8%, AUC 0.833) demonstrated certain value in the early identification of children with severe disease. Conclusion: In this study, laboratory indicators (C-reactive protein, lactate dehydrogenase, neutrophils, etc.) and changes in the levels of specific cytokines (TNF-β, IL-2, IL-6, IL-8, etc.) in children with adenovirus pneumonia were closely related to the severity of the disease. Notably, neutrophil count and interleukin-6 were significantly positively correlated with disease severity and had high AUC values, suggesting they may be important parameters for early prediction of the progression of mild adenovirus infection to severe disease. Full article

Background: Malignant pleural effusion (MPE) represents a frequent and clinically challenging manifestation of advanced malignancy, particularly in metastatic non-small cell lung cancer (NSCLC). Its management requires integration of diagnostic imaging, symptom-directed therapeutic strategies, and, increasingly, molecular profiling technologies. Recent advancements in this field based on liquid medium (so-called liquid biopsy) have achieved a significant increase in sensitivity, enhancing our ability to investigate biofluids and suggesting their potential integration into standard diagnostic practices, far beyond the canonical plasma biopsies. Fluid obtained from MPE after cytological sample centrifugation is rich in cell-free DNA and less susceptible to nucleic acid degradation during processing, improving overall diagnostic accuracy. Methods: This narrative review summarizes current evidence on the clinical management of malignant pleural effusions in patients with metastatic NSCLC, integrating imaging, procedural management, and molecular profiling from a multidisciplinary tumor board perspective. The primary objective was to synthesize contemporary knowledge with particular attention to the feasibility, reliability, and reproducibility of pleural fluid-based molecular testing. Results: MPE poses diagnostic and therapeutic challenges for all members of the multidisciplinary tumor board, traditionally associated with an adverse prognosis. However, recent advances in cytopathology, histopathology, and liquid-based techniques demonstrate that MPE could be an important source of prognostic or predictive information. At the same time, optimal patient management requires careful integration of imaging findings and procedural strategies (such as pleurodesis or indwelling pleural catheters) with individualized systemic therapy selection. Cell-free DNA in pleural effusions is a promising field of exploration and study, potentially suitable for future guideline implementation, after validation in adequately powered studies, contributing to improving patient management, particularly useful in fragile subsets. Conclusions: The management of MPE in advanced NSCLC is evolving toward a multidisciplinary, precision-oriented model that integrates clinical evaluation, imaging, procedural interventions, and molecular testing. Liquid biopsy technology has gained enough analytical robustness and clinical feasibility to be a useful tool in routine analysis. Biofluid-based molecular testing may have outstanding potential, contributing to improving patient management, avoiding repetitive procedures, and optimizing the overall efficiency and cost-effectiveness of diagnostic practices. Moreover, collaborative projects among different specialties help in consolidating trust in the tumor board decision-making process. Full article

Background: This study aimed to evaluate the etiology, clinic and laboratory features of acute pancreatitis (AP) in children retrospectively. We also aimed to determine the effects of clinical, laboratory and radiological markers on length of hospital stay (LOS). Materials and methods: This study was conducted of 133 patients diagnosed with AP. Patients were divided into two groups based on LOS: ≤7 days and >7 days. Demographic, clinical, laboratory and radiological parameters, as well as time to initiation of feeding, were analyzed. Results: The mean age of patients was 11.2 ± 4.8 years, and 54.1% were male. The most common etiologies were obstructive (30.8%) and idiopathic (29.3%). Drug-induced and traumatic causes were significantly more prevalent in patients with a hospital stay of more than seven days (p = 0.001). Radiological findings other than pancreatic edema (peripancreatic fluid, pleural effusion, or ascites) were significantly associated with prolonged LOS (p = 0.002). A positive correlation was observed between LDH and LOS (r = 0.253, p = 0.031). LOS was significantly shorter in patients who initiated oral feeding within 48 h (p < 0.001). Conclusions: LOS in pediatric AP is influenced by laboratory parameters, radiological findings, and the timing of feeding initiation. Identifying early prognostic indicators, particularly in the pediatric patient group, may guide individualized management and improve clinical outcomes. Full article

Background and Objectives: Chronic adenoiditis is a major contributor to persistent middle ear dysfunction (PMED) in children; however, clinical evolution varies considerably despite similar anatomical obstruction. This study aimed to identify inflammatory endotypes of chronic adenoiditis using unsupervised clustering and to evaluate their association with PMED through mechanistic and predictive modeling. Materials and Methods: A retrospective cohort of 236 children (3–12 years) with chronic adenoiditis and otitis media with effusion was analyzed. Clinical, endoscopic, audiological, and hematologic inflammatory parameters (eosinophils, NLR, ELR, CRP, IgE) were included. K-means clustering identified inflammatory endotypes. Associations with PMED at six months were evaluated using multivariate logistic regression and mediation analysis. Predictive performance was compared using logistic regression, random forest, and gradient boosting models, with SHAP-based interpretability and decision curve analysis. Results: Three distinct endotypes were identified: eosinophilic (28%), neutrophilic (41%), and fibrotic–obstructive (31%). PMED occurred in 44% of the fibrotic endotype compared with 22% in the eosinophilic group (p < 0.001). In multivariate analysis, the fibrotic endotype independently predicted PMED (OR = 3.48, 95% CI 1.92–6.31), alongside PTA > 30 dB (OR = 2.91) and NLR > 3.5 (OR = 2.36). Mediation analysis showed that hearing impairment accounted for 34% of the effect of anatomical obstruction on persistence. Gradient boosting achieved superior discrimination (AUC = 0.90) and demonstrated the highest net clinical benefit. Conclusions: Chronic adenoiditis comprises biologically distinct inflammatory endotypes with differential risk of persistent middle ear dysfunction. Integrating inflammatory profiling with machine learning enhances mechanistic understanding and risk stratification, supporting precision-based management in pediatric otorhinolaryngology. Full article