Introduction Titanium is widely regarded as a highly biocompatible material and is extensively used in surgical implants. Nevertheless, delayed hypersensitivity reactions are increasingly recognized and may act as potential contributing factors to implant‐related complications. Thoracic manifestations remain exceptionally rare, and their impact on clinical decision‐making is poorly described. Case Description A 65‐year‐old man, with chronic obstructive pulmonary disease (COPD), a 60 pack‐year smoking history (former smoker since 2005) and severe gas transfer impairment, underwent video‐assisted thoracoscopic right lower lobectomy for lung adenocarcinoma. The postoperative course was complicated by a prolonged air leak requiring surgical staple reinforcement and talc pleurodesis. Approximately 2 months after surgery, the patient developed invasive pneumococcal disease with Streptococcus pneumoniae bacteremia, which resolved following appropriate antimicrobial therapy. Several months later, the patient developed a bronchopleural fistula (BPF) with endobronchial extrusion of titanium staples, confirmed by computed tomography and bronchoscopy. Given the unusual presentation, allergy evaluation was performed. Patch testing demonstrated epicutaneous sensitization with positive reactions to titanium (IV) oxalate hydrate, cobalt (II) chloride hexahydrate, and manganese chloride. The allergy work‐up had a direct therapeutic impact. Endoscopic closure with an Amplatzer device, a procedure documented for central BPFs, was initially considered but deliberately avoided because the considered device contains nitinol (a nickel–titanium alloy), which would expose the sensitized patient to additional titanium. Owing to the high surgical risk, conservative multidisciplinary management with close clinical and radiological surveillance was adopted. Discussion BPF is a recognized complication after lung resection and is inherently multifactorial. In this patient, established surgical, anatomical (right lower lobectomy), and patient‐related comorbidity risk factors coexisted with documented titanium sensitization, suggesting that hypersensitivity may have acted as a potential contributing or modulating factor to impaired tissue integration and staple extrusion. This case highlights the diagnostic challenges of titanium hypersensitivity and the distinction between cutaneous sensitization and operative tissue allergy. Importantly, it illustrates how allergy assessment may directly influence therapeutic decision‐making by avoiding further exposure to potentially allergenic metallic devices. Titanium hypersensitivity should therefore be considered as an incremental factor in selected patients with unexplained implant‐related complications, even when conventional risk factors are present.
Silicosis is an irreversible occupational lung disease caused by inhaled crystalline silica and is a known risk factor for tuberculosis. We report a 26-year-old male construction worker with more than 10 years of unprotected silica dust exposure who presented with worsening dyspnea, chronic productive cough, and weakness. He had been diagnosed with pulmonary tuberculosis by GeneXpert and was receiving continuation-phase antituberculosis treatment. Chest imaging showed bilateral fibroinfiltrative changes, fibroconsolidation, bronchial dilatation, pleural thickening, and calcified nodules in the right upper lobe, suggesting silicotuberculosis. Bronchoscopy was deferred due to high anesthetic risk, and open lung biopsy with wedge resection was performed. Histopathology showed chronic nonspecific inflammation, dust-laden macrophages, multinucleated giant cells, and fibrosis, without alveolar proteinosis or classic silicotic nodules. Given his more than 10 years of unprotected occupational exposure to silica-containing dust, confirmed pulmonary tuberculosis, and overlapping radiological and pathological abnormalities, the overall presentation was interpreted as silicotuberculosis with an accelerated clinical course. The patient received oxygen therapy, continued antituberculosis treatment, antibiotics, bronchodilator nebulization, mucolytic therapy, and chest physiotherapy. His symptoms improved, but he remained oxygen-dependent during mobilization at discharge. He was subsequently readmitted in May 2024 with worsening respiratory symptoms and died during hospitalization. This case emphasizes the importance of occupational history and further evaluation for silicosis in young tuberculosis patients with persistent respiratory abnormalities and silica exposure.
Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms with intermediate malignant potential. While most commonly arising in the lung, airway involvement is exceedingly uncommon. Endobronchial IMTs typically manifest with symptoms of airway obstruction, including dyspnea, wheezing, and stridor. Diagnosis involves radiological imaging, bronchoscopic evaluation, and histopathological analysis. Additionally, assessment of anaplastic lymphoma kinase (ALK) status is particularly important in young and pediatric patients, as ALK-targeted therapies constitute a viable treatment option for tumors harboring ALK rearrangements or other actionable kinase fusions. Complete surgical resection remains the gold standard for treatment; however, bronchoscopic resection may be an effective option in selected cases. Herein, we describe two cases of IMTs involving the airways-one in an adult and one in a child-both presenting with significant airway obstruction and managed with bronchoscopic resection.
Introduction:Lymphangioleiomyomatosis (LAM) is a rare, progressive, multisystem disease primarily affecting women of reproductive age. It is characterized by the abnormal proliferation of smooth muscle-like LAM cells that infiltrate the lungs, lymphatics, and kidneys. This case highlights that the clinical value lies not in isolated features, but in the convergence of early gestational presentation, severe bilateral disease, diagnostic limitations, and the need for coordinated multidisciplinary decision-making in a resource-constrained setting. Case Presentation:A 23-year-old pregnant woman (G3P2L1A1) at 17 weeks of gestation presented with severe shortness of breath and bilateral shoulder pain, escalating to respiratory distress (SpO2 80%) and functional class IV within hours. Imaging revealed bilateral pneumothorax, near-complete lung collapse, and multiple small cysts in the lung parenchyma, suggestive of LAM. Chest tube placement and pulmonary consultations were performed, followed by a control CT scan confirming LAM. Because of the risk of worsening LAM during pregnancy, termination of the pregnancy was carried out, and diagnostic confirmation was achieved through video-assisted thoracoscopic surgery (VATS) with lung biopsy, showing cystic and adhesive lesions. Treatment included decortication, lesion removal, and sirolimus therapy, an mTOR inhibitor. The patient was discharged in stable condition with ongoing medical follow-up. Conclusion:Management of LAM during pregnancy requires a multidisciplinary approach, emphasizing personalized care to balance maternal and fetal health. This case highlights the need for vigilance and adaptability in the care of pregnant women with rare pulmonary disorders like LAM. Early diagnosis is key to slowing the progressive decline of pulmonary function. Further research is needed to improve treatment options for LAM patients.
Solitary fibrous tumors of the pleura (SFTPs) are rare mesenchymal neoplasms that typically originate from the visceral pleura. We report two cases of giant pleural SFTs involving the left hemithorax. The first case involved a 59-year-old woman presenting with two synchronous tumors, whereas the second case concerned a 39-year-old man with a single large intrathoracic mass. The coexistence of two distinct SFTs within the same hemithorax, as observed in the first patient, is exceptionally rare and may suggest a multicentric pleural origin or intrapleural dissemination. Both patients presented with progressive respiratory symptoms and mediastinal shift on chest computed tomography. Histopathological diagnosis was confirmed by percutaneous biopsy and immunohistochemical positivity for CD34, CD99, and BCL2. Complete tumor resection was achieved through posterolateral thoracotomy in both cases. One patient developed early postoperative recurrence during follow-up. These cases highlight the clinical heterogeneity of pleural SFTs and emphasize the diagnostic and surgical challenges posed by giant intrathoracic tumors. Accurate histopathological confirmation and complete surgical resection remain essential for optimal management, whereas long-term surveillance is warranted due to the potential risk of recurrence.
