Sternal wire fragmentation is a common radiographic finding. However, sternal wire displacement is a rare and often serious complication. We report the case of a 68-year-old man who was incidentally found to have sternal wire migration into his right ventricle 3 years after lung transplantation. Retrieval was attempted through a left parasternal approach, but the wires were not visible intraoperatively to facilitate removal. Because the patient was asymptomatic with no adverse outcomes and surgery was considered high risk, a decision was made not to pursue major surgery to remove the wires. Instead, the case was managed conservatively with ongoing surveillance for any further migration of the wires or associated complications.

A 64 year-old man presented with episodic wheeze for 3 months. He had a background of asthma. He was an ex-smoker with a 20 pack year history and worked as an accountant. He had no new environmental exposures or precipitating factors. His medications included Budesonide/Formoterol and Umeclidinium. Physical examination revealed bilateral polyphonic wheeze. Blood tests showed eosinophils of 0.6 109/l and IGE of 173 k U/L. Chest radiograph demonstrated a new left upper lobe lung collapse and opacity against the superior mediastinum.Pulmonary function tests (PFTs) showed normal spirometry and DLCO with FeNO 38ppb. CT thorax demonstrated a mass causing obstruction of the left upper lobe bronchus with enlarged ipsilateral hilar and mediastinal nodes. Bronchoscopy demonstrated no endobronchial lesion but an inflamed left upper airway with possible extrinsic compression, washings were taken from here. These showed no malignant cells.Multidisciplinary team (MDT) discussion recommended CT guided biopsy of the mass. This demonstrated fibrous tissue with lymphocytic abundant plasma cells and eosinophils, 23 IgG4 positive plasma cells were seen. The serum IgG4 level was 0.534 k U/L. Repeat MDT discussion recommended wedge resection of the lesion due to uncertainty if the biopsy findings were secondary to peri-tumoural inflammation or IgG4-related disease. This demonstrated parenchyma containing abscesses, inflammatory infiltrate, associated fibrosis and organising pneumonia. There was no evidence of carcinoma and stains were negative for mycobacteria and fungal culture. Station 10 and 11 lymph nodes were benign. Immunohistochemical staining showed a ratio of IgG4/IgG of 10% which was insufficient for diagnosis of IgG4 related disease (IgG4- RD) however final MDT discussion concluded the overall radiological and histologic features of this mass were suggestive of a pulmonary manifestation of IgG4-RD. This case is a rare manifestation of IgG4- RD, itself a rare condition. IgG4 disease can affect any organ system with the lungs affected in approximately 10% of cases (1). Diagnosis of IgG4-RD can challenging as pulmonary manifestations can be difficult to distinguish from malignancy or inflammatory conditions based on imaging alone (2). Diagnosis should be based on MDT discussion of radiologic and histologic findings (2).10%-30% of patients with IgG4-RD may have normal serum IgG4 levels despite histopathological criteria suggesting IgG4-RD (4).Optimal therapy is unclear as no randomised control trials have been performed to date (2). It can be a progressive fibrotic process so systemic therapy should be considered (1). Corticosteroids are typically used (3) however there are steroid sparing options (3).

Case Presentation A 50-year-old man presented to an acute medical unit with a cough productive of purulent sputum, 1 episode of small volume hemoptysis, right-sided chest pain, and fever. He had been generally unwell for 2 months prior and had 4 lower respiratory tract infections over the preceding 8 months, all treated with oral antibiotics.

A man in his 40s was incidentally found to have a large right sided apical pleural based mass on imaging. This was further investigated with a CT-guided biopsy. Histological and immunohistochemical analysis of the tissue revealed a diagnosis of a Schwannoma: a rare, slow-growing benign nerve sheath tumour. Only a handful of pleural based Schwannomas have been documented in the literature. They account for about 0.2% of lung tumours. The patient was referred to cardiothoracic surgery who advised surgical resection of the mass, which he is awaiting. Here, we report a rare case of a pleural based Schwannoma which was diagnosed incidentally on chest x-ray.

Background Pulmonary resection is commonly performed as curative treatment for congenital thoracic malformations. There is a plethora of high-quality evidence showing improved outcomes with digital chest drainage systems compared to traditional water-seal systems in adults. By contrast, there is a relative paucity of research with children and therefore much uncertainty in post-operative chest drain management in paediatrics. Methods A systematic review and meta-analysis was conducted to assess the effect of digital chest drainage systems in paediatric patients after pulmonary resection. Data sources included PubMed, Cochrane Central Register of Controlled Trials, EMBASE, and SCOPUS, with information from 1 January 2007 to 20 July 2024. The qualitative analysis included three observational studies. The quantitative analysis included 74 patients across two observational studies that compared digital and traditional chest drainage systems. A fixed effects model was used to produce a pooled estimate for a meta-analysis of means if the studies were homogenous, otherwise a random effects model was used. Results The meta-analysis showed a statistically significant reduction in hospital length of stay (SMD − 0.63 days, [95% CI: -1.1;-0.16, p = < 0.01]) and number of chest x-rays performed (SMD − 1.2 x-rays, [95% CI: -1.7;-0.7, p = < 0.0001]) in the digital group compared to the traditional group. Although a reduction in chest tube duration was seen in the digital group, this was not statistically significant (SMD − 2.2 days, [95% CI: -14.5;10.07, p = 0.2622]). There were no significant differences in development of pulmonary complications between the digital and traditional drainage groups (p = 0.8392). Conclusion The use of digital chest drainage systems demonstrated a shortened hospital length of stay and quantity of chest x-rays performed in paediatric patients following pulmonary resection. The overall certainty of these findings is limited by the low quality of the available evidence.

A 58-year-old woman with no prior medical history, presented with a 5-month history of productive cough, worsening breathlessness and weight loss of 5 kg despite three courses of oral antibiotic therapy. On examination she was afebrile, there was reduced air entry in the right lung base to auscultation and oxygen saturations on room air were 86%. Serum C reactive protein was elevated at 26.2 mg/L (range 0–5 mg/L) and white cell count was 9.6×109/L (3.5–11×109/L), and evidence of eosinophilia was 1.7×109/L (0–0.5×109/L). Chest radiograph showed complete collapse of the right middle and lower lobes and bronchial cut-off sign of the right main bronchus (figure 1A). CT of the chest demonstrated a large endobronchial obstructing lesion in the right main bronchus highly suspicious for an endobronchial tumour (figure 1B,C) Figure 1 (A) Chest radiograph demonstrating bronchial cut of sign …

Alpha1-antitrypsin deficiency (AATD) disease is associated with several inflammatory conditions due to unprotected proteolytic activity of neutrophil elastase and proteinase 3. We observed that patients with ATTD develop early complications post-transplant. The aim of the study was to identify potential differences in outcomes between AATD and emphysema without AATD (E) following lung transplant. We retrospectively reviewed the data of 41 patients (27 E and 14 AATD) transplanted between 2005 and 2017. Data collection includes functional baseline of recipients and complications as primary outcome, and secondary end points of survival. The majority (79%) of AATD patients received double lung transplant. Main complications in AATD cohort included 3 bowel ischemia and perforation, 1 liver cirrhosis and 4 anastomotic complications causing death in 2 patients. Comparison rate of FEV1 decline in AATD and E group in year 1, 5 and 10 showed no statistical difference (P=0.18; P=0.67), same as FEV1 pre and post-transplant between groups. Mortality was higher in AATD (36%) compare to E (30%). Survival curve showed no difference between both groups with median survival AATD 10.8 years (95% CI 0.54 to 5.336) and E 6.4 years (95% CI 0.19 to 1.86, P=0.64). AATD transplant recipients are predisposed to complications related to their primary underlying disease when compare to E group. However, FEV1 decline had similar trends in both groups with no difference in overall survival.

Background: The diagnostic work-up for suspected interstitial lung disease often includes surgical lung biopsy or VATs (Video-Assisted-Thoracoscopy) biopsy. VATs is recommended where the underlying diagnosis is in question and has been shown in the past to have relatively high mortality and morbidity rates. Aims: To evaluate the mortality, morbidity, diagnostic efficacy and outcomes associated with surgical lung biopsy via VATs. Methods: We carried out a retrospective review of 144 patients with suspected interstitial lung disease who underwent VATs lung biopsy between 2010 and 2016. Biopsies were carried out in three Irish centres. Our main outcome measures were mortality at 30 and 90 days, morbidity, histological diagnoses and correlation with suspected radiological diagnoses. Results: 30 day mortality following VATs biopsy was 4.4%. All 6 patients who died within 30 days were in the Intensive Care Unit (ICU) at time of biopsy. 90 day mortality was 7.9%. 24% of patients had some morbidity at 30 days, primarily pain and pneumothorax. The most commonly diagnosed condition on biopsy was Hypersensitivity Pneumonitis in 25% of cases, followed by Usual Intersitial Pneumonia (UIP) in 16% of cases. There was no mortality in UIP cases. A definitive diagnosis was made at VATs biopsy in all cases, in 82% of cases it provided a new diagnosis or altered clinical treatment. Conclusion: This large review finds that mortality following VATs biopsy was low and in line with international findings. The 30 day mortality rate was 0% in patients not in ICU at the time of biopsy. We found that VATs biopsy is safe and effective and should be considered where the diagnosis is in question.

PTLD is common malignancy occurring after lung transplantation with incidences of 5-6% and mortality of 26-75%. Serum lactate dehydrogenase (LDH), can act as a prognostic marker at the time of diagnosis of the disease. No recommendations are in place for regular post-operative LDH monitoring in healthy recipients. We aimed to evaluate clinical outcomes and to review serum LDH levels for all our PTLD cases. We performed a retrospective chart review of lung recipients attending our service since 1/1/2005 to 31/12/2016. Patients were identified from Hospital In-patient Enquiry (HIPE). Subjects with unavailable charts were excluded. Demographics, diagnostic risk factors, prognostic indicators, therapies and outcomes were recorded. After 1 exclusion, 6 patients had histologically confirmed PTLD (N=281 in the programme). 5 males had lung transplantation at our institution, receiving induction with Basiliximab, 1 of whom required IV immunoglobulins for high-risk cross-match. 1 female had surgery in the UK. Allograft disease developed in 2 Epstein-Barr Virus seropositive recipients, while 4 seronaïve had extra-thoracic disease, predominantly intra-abdominal. 2 patients died. Bone marrow involvement showed a trend (P=0.067) towards death. 67% of subjects had high LDH prior to diagnosis, with medians of 354, 238, 289 and 320 IU/L respectively (normal reference range 120-220). High results were found at a median of 22 days prior to diagnosis. Our PTLD outcomes are in-keeping with recognised literature. Although confirmatory trials are needed, post-transplant LDH monitoring can raise clinical suspicion for PTLD in a rapid and inexpensive manner.

ABSTRACT More data are needed regarding the radiology, co-morbidities and natural history of smoking-related interstitial fibrosis (SRIF), a common pathological finding, mainly described heretofore in association with lung cancer, where respiratory bronchiolitis (RB) usually co-exists. We prospectively acquired high resolution CT scan data (edge-enhancing lung reconstructions) to detect any radiologic interstitial lung abnormality (ILA) in individuals who ultimately underwent surgical lobectomy for lung cancer (n = 20), for radiologic/pathologic correlation. We also re-examined other smoking-related benign histologic cases: chronic obstructive pulmonary disease (COPD lung explants, n = 20), alpha 1-antitrypsin deficiency (A1AT, explanted lungs n = 20), combined pulmonary fibrosis and emphysema (CPFE, n = 8) and idiopathic pulmonary fibrosis (IPF, n = 10). Finally, we pooled our data with all peer-reviewed published data describing histologic SRIF of known ILA status. SRIF was observed in 40% of cancer lobectomies, mean (±SD) age 65.8 ± 8.7 years, none of whom had ILA. SRIF was observed in other smoking-related benign diseases (COPD 35%, A1AT 20%, CPFE 25%, and IPF 10%). 71.4% of benign SRIF cases had no RB (nearly all ex-smokers) versus 0% of cancer-associated SRIF cases (P = 1.7 × 10−3). Pooled data showed that those SRIF subjects without ILA were 15.05 years older than those with ILA (95% confidence interval 8.99 to 21.11, P = 2.5 × 10−5) and more likely to be former smokers (P = 7.2 × 10−3). SRIF is frequently found without lung cancer, and mostly without RB in former smokers. SRIF is less likely to have ILA in older subjects and with smoking cessation, which could represent RB+/−SRIF regression.