Search Results (197)

Background/Objectives: The frequency of image-guided biopsies has increased substantially in recent decades; however, high technical success rates are offset by potential complications. Methods: This retrospective study compared the safety profile of ultrasound- and CT-guided percutaneous biopsies in 250 patients involving the liver, thoracic organs, retroperitoneum, peripheral lymph nodes, and bone. The parameters analyzed included procedure duration, technical success, as well as type, frequency, severity, timing, and treatment of complications. Statistical comparisons comprised Mann–Whitney-U and Chi-square tests. Results: The overall technical success rate was 97.6%, with no significant difference between CT and ultrasound (p = 0.491). Ultrasound-guided biopsies were performed more often in women; CT-guided procedures were performed more often in men (p = 0.031). Ultrasound-guided interventions were significantly faster with a median duration of 19:00 min vs. 25:30 min in CT (p < 0.001). Median radiation dose for CT-guided procedures was 445 mGy·cm (interquartile range 307.8–634.0). Including minor events, complications occurred in 19.6% of cases. Complication rates were significantly higher for CT- (30.3%) compared to ultrasound-guided biopsies (7.6%; p < 0.001). Bleeding and pneumothorax were significantly more frequent in CT-guided interventions (p = 0.004). Most complications were mild (85.7%) with no life-threatening events. The majority of complications occurred within four hours post-biopsy (93.9%). The severity of complications did not differ significantly between modalities (p = 0.399). Conclusions: CT-guided biopsies were associated with higher complication rates, likely reflecting procedural complexity and better detection of minor complications. Post-interventional complications such as pneumothorax and bleeding were mostly mild, while severe complications occurrence was extremely rare. Full article

Background and Clinical Significance: Spina bifida in the cervical region is closely associated with Chiari malformation, which is an amalgamation of terminology for separate conditions with similar pathophysiological mechanisms and progression from one another. Chiari malformations are associated with varying degrees of dilation of the foramen magnum or lack of fusion of the occipital bone with syringomyelia, herniation of the cerebellum, occipitocele and occipitomyelocele; Case Presentation: A previously healthy 23-year-old primigravida presented to our institution due to fetal demise in the third lunar month, established on routine outpatient maternal consultation. Point-of-care ultrasound revealed an amniotic sac measuring 3 cm in diameter and containing a single fetus, without cardiac function. Due to these, the patient was scheduled for pregnancy termination, during which the cervix was noted to be spontaneously dilated and abrasion accomplished complete evacuation of the amniotic sac, without its rupture. Upon sectioning of the amniotic sac, a fetus, measuring 2.5 cm in length, was noted, with a significant cuffing of the occipital and cervical paraspinal region. Histology revealed fetal structures with an adequate maturation index for its gestational age, but it presented with a pronounced meningoencephalomyelocele in the cervical and thoracic regions, characterized by the complete absence of vertebral arches and spinous processes from the atlanto-occipital to the sacral region; Conclusions: In the present case, not only is a significant and complex form of Chiari type III reported, but the condition is also associated with spina bifida aperta in all spinal regions, leading to meningoencephalomyelocele, incompatible with life. Full article

Background: Sarcopenia and low muscle mass are prevalent and prognostically relevant in patients with lung cancer, yet their diagnosis remains challenging in routine clinical practice. Opportunistic assessment using computed tomography (CT) has emerged as a valuable tool for body composition evaluation. We aimed to assess the utility of thoracic CT at T12 and T4 levels in identifying sarcopenia and low muscle mass and explore their correlation with morphofunctional tools such as bioelectrical impedance vector analysis (BIVA), nutritional ultrasound (NU), and functional performance tests. Methods: In this prospective observational study, 80 patients with lung cancer were evaluated at diagnosis. Body composition was assessed using BIVA-, NU-, and CT-derived parameters at T12 and T4 levels. Functional status was measured using the Timed Up and Go (TUG) and 30-Second Chair Stand Test. Sarcopenia was defined according to EWGSOP2 criteria. Results: Sarcopenia was identified in 20% of patients. CT-derived indices at T12CT demonstrated better diagnostic performance than T4CT. For detecting low muscle mass, the optimal SMI cut-off values were SMI_T12CT < 31.98 cm²/m² and SMI_T4CT < 59.05 cm²/m² in men and SMI_T12CT < 28.23 cm²/m² and SMI_T4CT < 41.69 cm²/m² in women. For sarcopenia diagnosis, the values were SMI_T12CT < 24.78 cm²/m² and SMI_T4CT < 57.23 cm²/m² in men and SMI_T12CT < 21.24 cm²/m² and SMI_T4CT < 49.35 cm²/m² in women. A combined model including SMI_T12CT, RF_CSA, and the 30 s squat test showed high diagnostic accuracy (AUC = 0.826). In multivariable analysis, lower SMA_T12CT was independently associated with risk of sarcopenia (OR = 0.96, 95% CI: 0.92–0.99, p = 0.022), as were older age (OR = 1.23, 95% CI: 1.07–1.47, p = 0.010) and fewer repetitions in the 30 s squat test (OR = 0.78, 95% CI: 0.63–0.91, p = 0.007). Conclusions: CT-derived body composition assessment, particularly at the T12 level, shows good correlation with morphofunctional tools and may offer a reliable and timely alternative for identifying sarcopenia and low muscle mass in patients with lung cancer. Full article

Background: Uncontrolled asthma remains a significant clinical challenge, often linked to impaired lung function and increased diaphragmatic workload. Recent studies have shown promising results using a triple inhaled therapy comprising beclomethasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/G). This study assessed the real-world efficacy of BDP/FF/G on lung function and diaphragmatic workload in patients with uncontrolled asthma. Methods: A prospective observational study enrolled 21 adult patients diagnosed with uncontrolled asthma despite high-dose ICS/LABA therapy. Patients underwent lung function tests and right diaphragmatic ultrasound assessments at baseline and after three months of treatment with BDP/FF/G (172/5/9 mcg, administered as two inhalations every 12 h). Results: After three months, significant improvements were observed in FEV₁ (from 57.75 ± 12.30% to 75.10 ± 18.94%, p < 0.001) and FEF_25–75 (from 47.80 ± 19.23% to 75.10 ± 36.06%, p < 0.001). Additionally, during the same period, we recorded significant reductions in residual volume (from 130.10 ± 28.20% to 92.55 ± 21.18%, p < 0.001) and total airway resistance (R_tot) (from 164.60 ± 83.21% to 140.70 ± 83.25%, p < 0.05). The mean asthma control test (ACT) score increased by 5.6 points (p < 0.001), surpassing the established minimal clinically important difference (MCID) of 3 points and raising the cohort mean above the well-controlled threshold. The right diaphragmatic workload was significantly decreased, as shown by a reduction in thickening fraction (TF) (from 63.86 ± 17.67% to 40.29 ± 16.65%, p < 0.01). Correlation analysis indicated significant associations between diaphragmatic function and some lung function parameters (FEV₁, FEF_25–75, and R_tot). Conclusions: In this real-world pilot, triple BDP/FF/G was linked to improvements in airflow, hyperinflation, symptoms, and a reduction in diaphragmatic thickening fraction, indicating potential physiological benefit. Due to the small sample size, single-centre design, and 3-month follow-up, these results should be viewed as hypothesis-generating and need to be confirmed in larger, controlled, multicentre studies with longer follow-up. Full article

Background: Pulmonary lobectomy remains the gold standard for early-stage non-small cell lung cancer, with the primary goal of complete tumor removal. Postoperative imaging is critical for evaluating recovery and identifying complications, yet systematic descriptions of radiologic patterns after lobectomy are limited. Methods: We conducted a retrospective analysis of 125 patients who underwent pulmonary lobectomy between 2019 and 2024 at a tertiary thoracic surgery center. Preoperative and postoperative imaging findings were coded and compared using a standardized classification system. Modalities included chest radiography, thoracic CT, ultrasound, PET-CT and MRI. Results: Postoperative imaging demonstrated a clear reduction in pathological findings. Emphysema decreased from 29.6% to 21.6%, pleural effusion from 12.8% to 3.2%, atelectasis/pleural thickening from 15.2% to 8.8%, and ground-glass infiltrates from 12.0% to 8.0%. The proportion of patients without abnormalities increased from 18.5% to 24.8%. Chest radiography (92%) and CT (89.6%) were the most frequently employed modalities. Patients treated with VATS lobectomy showed slightly fewer postoperative abnormalities compared with those undergoing open surgery. Conclusions: Pulmonary lobectomy is associated with measurable radiologic improvement, reflecting favorable structural recovery. Routine imaging follow-up, particularly chest radiography, remains essential for early detection of complications and guiding postoperative care. However, the retrospective single-center design and limited generalizability represent important limitations that should be considered when interpreting these findings. Full article

Background: First rib stress fractures (FRSFs) are exceptionally rare in skeletally immature athletes and are frequently overlooked because their symptoms mimic more common scapular conditions such as scapular dyskinesis or thoracic outlet syndrome. Early and accurate identification is critical to avoid delayed union, prolonged disability, and misdirected management. Case Presentation: We report a 12-year-old elite baseball pitcher with progressive scapular winging and audible snapping during pitching. Unlike typical posterior-type fractures near the costotransverse joint, imaging revealed a cortical discontinuity precisely at the serratus anterior enthesis, consistent with repetitive traction enthesopathy. High-resolution musculoskeletal ultrasound (MSK-US) identified cortical disruption with periosteal edema, and dynamic ultrasound reproduced the patient’s snapping and pain in real time, establishing a direct clinical–imaging correlation. Conservative three-phase rehabilitation (scapular stabilization, serratus anterior activation, and structured return-to-throwing) led to complete union and pain-free return to sport within 12 weeks. Discussion: This case highlights the superior diagnostic efficacy of MSK-US for FRSFs in adolescents. The posterior scanning approach facilitated bilateral comparison and growth plate assessment. Dynamic examination provided a functional correlation beyond static imaging, identifying a novel snapping mechanism. This underscores the value of MSK-US in visualizing not just anatomy but also pathophysiology. Conclusions: This is among the youngest documented cases of first rib stress fracture diagnosed with dynamic ultrasound. Its novelty lies in the following: (1) occurrence at the serratus anterior enthesis, (2) reproduction of snapping during provocative maneuvers, and (3) expansion of the etiological spectrum of scapular dyskinesis to include rib pathology. Dynamic ultrasound should be considered a frontline modality for adolescent throwers with unexplained periscapular pain. Full article

Objectives: This study aimed to assess the diagnostic contribution of fetal MRI across different anatomical systems and evaluate its added value beyond prenatal ultrasonography. Methods: This retrospective cohort included 556 fetuses who underwent both prenatal ultrasound and fetal MRI in a single tertiary center. Cases were classified by anatomical system. The concordance between ultrasound and MRI findings, as well as additional or ruled-out findings identified by MRI, was analyzed. Statistical significance and clinical relevance were also evaluated. Results: Among the 556 cases, complete concordance between ultrasound and MRI findings was observed in 48.9%. MRI ruled out the initial diagnosis in 20.1% and revealed additional findings in 32% of cases. A total of 192 additional findings were identified, while 115 previously suspected anomalies were ruled out. The highest diagnostic contribution was observed in central nervous system (CNS) and gastrointestinal system (GIS) anomalies. Posterior fossa abnormalities and cystic or mass lesions were frequently detected as additional findings on MRI. In contrast, ultrasound alone was generally sufficient for evaluating genitourinary (GUS), thoracic, and vertebral anomalies. The overall diagnostic yield of MRI was higher in anatomically complex or sonographically ambiguous cases. Conclusions: Fetal MRI provides significant additional diagnostic value, particularly in CNS and GIS anomalies, by detecting additional findings, clarifying uncertain diagnoses, or excluding suspected anomalies. Its selective use may enhance both prenatal counseling and postnatal management. Full article

Introduction: Non-surgical biopsy is recommended for diagnosing solid pulmonary nodules measuring >8 mm when the probability of malignancy is low to moderate. However, currently available biopsy methods do not have a sufficient diagnostic yield for nodule size <20 mm. Previous work has shown that one-lung flooding (OLF) enables complete lung sonography and good demarcation of lung nodules. Therefore, here, we report the first experiences with ultrasound-guided transthoracic core needle biopsy (USgTTcNB) under OLF for the histological diagnosis of small pulmonary nodules. Methods: In two patients with small pulmonary nodules, a transbronchial/thoracic biopsy was not indicated due to the size and location of the nodules. Following nodule detection under OLF, the USgTTcNB was performed. The biopsy cylinder was immediately examined via the frozen section procedure. After liquid draining and re-ventilation, the patients were extubated in the operation room and monitored in the intermediate care unit. Results: In both patients, a histological diagnosis was achieved. In the case of malignancy, the patient underwent lobectomy during the same session. In the case of a benign diagnosis, a futile operation was avoided. In case two, a small apical pneumothorax occurred. The hemodynamic values during and after the intervention were in the normal range. Lung function on day 2 after the intervention increased compared with that before the intervention. Conclusions: USgTTcNB under OLF is feasible and enables a histological confirmation of small pulmonary nodules. Nevertheless, this new promising technique should be evaluated in a study with a larger cohort. Full article

Background: Computed Tomography (CT) is considered a highly accurate tool for assessing body composition. The aim of this study is to assess the usefulness of chest CT for malnutrition diagnosis in people with cystic fibrosis (PwCF), compared with other body composition techniques, as well as to assess possible associations with nutritional and respiratory status. Methods: A cross-sectional study was carried out in clinically stable adult PwCF. Subjects who had undergone a CT including the twelfth thoracic vertebra (T12) during the 6 months prior to or after our assessment were included and body composition was assessed using FocusedON-BC. The results were compared with anthropometry, bioelectrical impedance analysis (BIA), muscle ultrasonography, and handgrip strength (HGS). Respiratory parameters were collected, and nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Results: A total of 55 PwCF were included. Muscle area assessed by CT correlated significantly with fat-free mass determined by BIA (r = 0.725) and anthropometry (r = 0.645), muscle mass evaluated by ultrasonography (r = 0.657), HGS (r = 0.593), Bhalla score (r = 0.403), and FEV1 (r = 0.488). Differences were observed when comparing muscle area in CT based on the Bhalla score (94.6 ± 21.1 cm² in normal/mild involvement vs. 79.3 ± 20.9 cm² in moderate/severe involvement; p = 0.009) and on nutritional status (96.3 ± 17.9 cm² in normo-nourished vs. 75.9 ± 22.1 cm² in malnourished; p < 0.001). Conclusions: In adult PwCF, measurements obtained from CT image analysis correlate adequately with anthropometry, BIA, muscle ultrasound, and HGS. Muscle area in CT is related to nutritional and respiratory status. Full article

Objectives: To evaluate the diagnostic performance of CVPs in predicting fetal Hb Bart’s disease among pregnancies at risk and to study hemodynamic changes based on CVP components in response to fetal anemia. Methods: The database was assessed to retrieve the ultrasound records of fetuses at risk of Hb Bart’s disease at 17–22 weeks and the relevant files including complete video sets of fetal echocardiography. The five components of CVPs of each case were blindly assigned. The definitive diagnosis of fetal Hb Bart’s disease was based on cordocentesis or neonatal blood analysis. Results: Among 378 pregnancies at risk that were recruited into the study, there were 76 (20.1%) affected fetuses and 302 (79.9%) unaffected fetuses. Using a cut-off score of <9, CVPs had a sensitivity of 92.1% and specificity of 97.4% in predicting affected fetuses. However, the effectiveness was not much superior to cardio-thoracic area ratio (CTAR) alone (area under curve; AUC: 0.983 vs. 0.954). Of all parameters, CTAR provided the best diagnostic performance. The combination of CTAR and assessment of hydropic sign provided the best diagnostic values, comparable with full CVPs (AUC 0.982 vs. 0.983). The affected fetuses cope well with anemia by physically increasing in cardiac size and functionally increasing in Tei index with minimally reduced shortening fraction, without compromising arterial and venous Doppler indices. Conclusions: CVPs are highly effective in predicting affected fetuses among pregnancies at risk of fetal Hb Bart’s disease. Nevertheless, only two components (CTAR and hydropic sign) are adequate to yield the best diagnostic performance. Full article

Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. Color Doppler thoracic ultrasound (CDUS) has emerged as a non-invasive, real-time modality capable of identifying ICAs and their anatomical variants prior to pleural access. This narrative review synthesizes current evidence on CDUS-guided ICA screening, focusing on its technical principles, diagnostic performance, and clinical applicability. While feasibility and utility are supported by multiple observational studies, robust evidence demonstrating a reduction in bleeding complications is still lacking. Barriers to widespread implementation include heterogeneous scanning protocols, operator dependency, and the absence of standardized training. We discuss the anatomical rationale for pre-procedural vascular mapping and highlight emerging protocols aimed at standardizing ICA visualization. Although not yet incorporated into major clinical guidelines, CDUS represents a promising tool to enhance procedural safety. Emerging AI applications may further improve vessel detection by reducing operator dependency and enhancing reproducibility. High-quality prospective studies are essential to validate potential clinical benefits, optimize implementation strategies, and support integration into routine pleural practice. Full article

Background: The diagnostic work-up of small peripheral pulmonary nodules (PPNs) is becoming increasingly important, especially in light of the upcoming lung cancer screening programs and recommendations in practice. The systematic clinical introduction of the ION robotic-assisted navigational bronchoscopy (RNB) system represents a significant innovation in Germany, whereas clinical experience in the United States has already yielded promising results. The objective of this study is to present the outcomes of the first 50 patients examined with the ION system at our institutions. Materials and Methods: This is a retrospective, single-center analysis. We included the first 50 consecutive patients who underwent diagnostic evaluation of pulmonary nodules using the ION-RNB system, either in the Department of Thoracic Surgery or the Department of Pulmonology. Results: A total of 50 patients were evaluated, including 24 from the Department of Thoracic Surgery and 26 from the Department of Pulmonology. The pulmonary nodules were found in the peripheral third of the lung in 74% of cases, in the middle third in 18% of cases, and in the central third in 8% of cases. The mean lesion size was 1.64 cm (±0.91 cm). In all, 84% of the nodules were solid, 4% were subsolid, and 12% presented as ground-glass opacities (GGOs). Cone beam computed tomography (CBCT) was used to confirm tool-in-lesion position in 68% of cases compared to C-arm fluoroscopy in 32%. Additionally, radial endobronchial ultrasound (rEBUS) was applied in 30% of procedures. The overall diagnostic yield, independent of imaging modality or histological processing method, was 78%. When CBCT and formalin-fixed paraffin-embedded (FFPE) histological analysis were utilized, the diagnostic yield exceeded 90%. Conclusions: Initial clinical experience with the ION-RNB system in Germany shows encouraging results. The high diagnostic accuracy underlines the system’s potential for evaluating peripheral pulmonary lesions precisely. The use of advanced imaging techniques, particularly CBCT, and the choice of histopathological processing methods are critical variables in optimizing patient-centered diagnostic pathways. Further prospective studies are warranted to assess the long-term clinical utility of robotic-assisted bronchoscopy in diverse clinical settings. Full article

Artificial intelligence (AI) is increasingly investigated as a potential adjunct in the diagnosis and staging of lung cancer, particularly through integration with bronchoscopy and endobronchial ultrasound (EBUS). Deep learning models have been applied to modalities such as white-light imaging, autofluorescence bronchoscopy, and spectroscopy, with the aim of assisting lesion detection, standardizing interpretation, and reducing interobserver variability. AI has also been explored in EBUS for lymph node assessment and guidance of transbronchial needle aspiration (EBUS-TBNA), with preliminary studies suggesting possible improvements in diagnostic yield. However, current evidence remains largely confined to small, retrospective, single-center datasets, often reporting performance under idealized conditions. External validation is rare, reproducibility is undermined by a lack of data and code availability, and workflow integration into real-world bronchoscopy practice has not been demonstrated. As such, most systems should still be regarded as experimental. Translating AI into routine thoracic oncology will require large-scale, prospective, multicenter validation studies, greater data transparency, and careful evaluation of cost-effectiveness, regulatory approval, and clinical utility. Full article

Poorly differentiated thyroid malignancy, a rare histological type of aggressive thyroid malignancy with associated difficulties and gaps in its histological and molecular characterization, might lead to challenging clinical presentations that require a prompt multimodal approach. This case study involved a 56-year-old, non-smoking male with a rapidly developing goiter (within 2–3 months) in association with mild, non-specific neck compressive symptoms. His medical history was irrelevant. A voluminous goiter with substernal and posterior extension up to the vertebral bodies was detected using an ultrasound and computed tomography (CT) scan and required emergency thyroidectomy. He had normal thyroid function, as well as negative thyroid autoimmunity and serum calcitonin. The surgery was successful upon “Y” incision, which was used to give better access to the retrosternal component in order to avoid a sternotomy. Post-operatively, the subject developed hypoparathyroidism-related hypocalcemia and showed a very high serum thyroglobulin level (>550 ng/mL). The pathological report confirmed poorly differentiated, multifocal thyroid carcinoma (with an insular, solid, and trabecular pattern) against a background of papillary carcinoma (pT3b, pN0, and pM1; L1; V2; Pn0; R1; and stage IVB). The subject received 200 mCi of radioiodine therapy for 6 weeks following the thoracic surgery. Whole-body scintigraphy was performed before radioiodine therapy and showed increased radiotracer uptake at the thyroid remnants and pre-tracheal levels. Additionally, single-photon emission computed tomography combined with CT (SPECT/CT) was performed, and confirmed the areas of intense uptake, in addition to a moderate uptake in the right and left pulmonary parenchyma, suggesting lung metastasis. To conclude, an overall low level of statistical evidence exists regarding poorly differentiated malignancy in substernal goiters, and the data also remains scarce regarding the impact of genetic and molecular configurations, such as the BRAF-positive profile, in this specific instance. Furthermore, multimodal management includes additional diagnosis methods such as SPECT/CT, while long-term multilayered therapy includes tyrosine kinase inhibitors if the outcome shows an iodine-resistant profile with a poor prognosis. Awareness remains a key factor in cases of a poorly differentiated carcinoma presenting as a rapidly growing goiter with substernal extension in an apparently healthy adult. A surgical approach, while varying with the surgeon’s skills, represents a mandatory step to ensure a better prognosis. In addition to a meticulous histological characterization, genetic/molecular features provide valuable information regarding the outcome and can further help with the decision to use new anti-cancer drugs if tumor response upon radioiodine therapy is no longer achieved; such a development is expected in this disease stage in association with a BRAF-positive configuration. Full article

Background and Objectives: Implantation of cardiac implantable electronic devices (CIEDs) is increasingly performed in elderly and comorbid patients, for whom minimizing perioperative complications—including pain and systemic drug use—is critical. Traditional local infiltration often provides insufficient analgesia. The ultrasound-guided PECS II block, an interfascial regional technique, offers promising analgesic benefits in thoracic wall procedures but remains underutilized in cardiac electrophysiology. Materials and Methods: We conducted a prospective, controlled, non-randomized clinical study including 106 patients undergoing de novo CIED implantation. Patients were assigned to receive either a PECS II block (n = 53) or standard lidocaine-based local anesthesia (n = 53). Pain intensity was assessed using the numeric rating scale (NRS) intraoperatively and at 1, 6, and 12 h postoperatively. Secondary outcomes included the need for rescue analgesia, procedural duration, length of hospitalization, and patient satisfaction. Results: Patients in the PECS II group reported significantly lower NRS scores at all time points (mean intraoperative score: 2.1 ± 1.2 vs. 5.7 ± 1.6, p < 0.001; at 1 h: 2.5 ± 1.5 vs. 6.1 ± 1.7, p < 0.001). Rescue analgesia (metamizole sodium) was required in only four PECS II patients (7.5%) vs. 100% in the control group within 1 h. Hospital stay and procedural time were also modestly reduced in the PECS II group. Patient satisfaction scores were significantly higher in the intervention group. Conclusions: The ultrasound-guided PECS II block significantly reduces perioperative pain and the need for additional analgesia during CIED implantation, offering an effective, safe, and opioid-sparing alternative to conventional local infiltration. Its integration into clinical protocols for device implantation may enhance procedural comfort and recovery. Full article