Cavitary lung lesions manifest following a wide variety of pathological processes, which are typically delineated as infectious and non-infectious. With respect to noninfectious causes, malignancies are among the most worrisome, while autoimmune and embolic processes are less frequent and less severe in prognosis. While it is important to differentiate between these etiologies, treatment may resort to surgical procedures for both diagnostic and curative intent. This case involves the incidental finding of a cavitary lung lesion following pulmonary embolism evaluation. Following confirmation of deep venous thrombosis and pulmonary embolism, the patient was admitted to the hospital, administered anticoagulants, and monitored for changes in respiratory status. Outpatient follow-up showed vast improvement in the cavity without antibiotic/chemotherapeutic treatment. Embolic events were attributed to Factor V Leiden diagnosis. This manuscript aims to discuss etiologies of lung cavities and how treatment strategies may differ depending on pathological processes and concomitant patient comorbidities. Special attention will be paid to pulmonary cavity evaluation in the acute hospital setting.

UNASSIGNED: Reports are limited on video-assisted thoracoscopic surgery for lung malignancy of patients with situs inversus totalis (SIT). Patients with SIT have significant anatomic differences with implications that are important for surgery, anesthesia, and nursing to understand in order to provide care for this patient population.
UNASSIGNED: A 64-year-old man with SIT and lung adenocarcinoma needed flexible bronchoscopy and wedge resection of a 9×8 mm adenocarcinoma in the right upper lobe and underwent video-assisted thoracoscopic surgery.
UNASSIGNED: Preoperative planning, including collaboration with the surgical team, allowed safe monitoring, induction of anesthesia, and airway isolation in this patient allowing them to have successful resection of their pulmonary malignancy. Postoperative care was enhanced by detailed communication and understanding of the patient\'s anatomy and implications of this condition for post anesthesia care unit nursing care.
UNASSIGNED: Patients with rare clinical conditions and backgrounds may require surgical and anesthetic intervention. The authors describe important anesthetic considerations of preoperative evaluation, airway management, cardiac monitoring, and vascular access that should be noted and taken into account for patients with SIT. Proper preparation, planning, and communication allow for patients with SIT to safely undergo surgical procedures.

Non-Hodgkin\'s lymphomas (NHLs) are a heterogeneous group of lymphoproliferative malignancies that are very rarely seen in the lung. Although they generally have a favorable prognosis, the clinical symptoms and most efficient methods of diagnosis have not yet been clearly defined. This report highlights an interesting case wherein a 75-year-old male who presented with complaints of fever, cough, and generalized weakness for three weeks was diagnosed and treated as a case of pneumonia. He did not respond to conventional treatment with antibiotics and antipyretics. Hence, computed tomography of the thorax was done which showed consolidation in the right lower lobe along with a few enlarged right hilar nodes. To evaluate this unresolved pneumonia, he was further evaluated with a radial endobronchial ultrasound (EBUS) and biopsy, which helped in arriving at a diagnosis of NHL. This case illustrates the significance of advanced interventions such as radial EBUS to identify the exact etiology of the lesions. This is the first case to document the ultrasound images of NHL in the lung, obtained using a radial EBUS.

We examined device-measured physical activity (PA) and sedentary behaviour at the time of diagnosis in people with inoperable lung cancer and investigated their associations with 12-month mortality. The people with inoperable lung cancer wore an accelerometer for seven days prior to the treatment commencement. The analysed PA/sedentary behaviour variables included light-intensity PA, moderate-to-vigorous-intensity PA (MVPA), step count, the total time spent sedentary, and the usual sedentary bout duration. The data on the disease stage, clinical covariates and 12-month mortality were extracted from medical records. Cox regression models were used to estimate the association between the PA measures and 12-month mortality, and the sedentary behaviour measures and 12-month mortality. The models were adjusted for the stage and neutrophil-to-lymphocyte ratio. All the PA and sedentary behaviour variables were dichotomised at their medians for analysis. Eighty-nine participants (70 ± 10 years; 55 [62%] males) contributed valid data. The twelve-month mortality was 30% (n = 27). Compared to the participants who spent ≤4.6 min/day in MVPA (n = 45), those who spent >4.6 min/day (n = 44) had a relative risk of 12-month mortality reduced by 60% (hazard ratio, 0.40; 95% CI, 0.16 to 0.96; 18 versus nine deaths, respectively). The other variables of PA/sedentary behaviour were not associated with 12-month mortality. Higher device-measured MVPA was associated with reduced 12-month mortality in people who were newly diagnosed with inoperable lung cancer.

UNASSIGNED: Chronic eosinophilic pneumonia (CEP) is an idiopathic condition characterized by unusually high eosinophil infiltration in the lungs\' interstitium and alveolar spaces. It is extremely rare, accounting for fewer than 3% of all interstitial lung diseases. CEP is frequently misdiagnosed as lung cancer, which can have catastrophic consequences for sufferers. When assessing patients with lung disease, doctors should be aware of CEP\'s symptoms and take its prognosis into account because it is a curable disorder.
UNASSIGNED: A 40-year-old female presented in the outpatient department of gynecology with a history of abnormal vaginal bleeding for 3 months and mild shortness of breath without any other significant medical history or being under any medications. Physical examination findings were not significant.
UNASSIGNED: Ultrasound revealed adenomyosis and a hysterectomy was planned. Chest radiograph revealed lung mass and computed tomography scan showed a well-defined mass with a pleural-based nodule. Histopathology revealed interstitial fibrosis and eosinophilic microabscesses. CEP was diagnosed and oral prednisolone was started with a 0.5 mg/kg/day dose. Chest radiographic abnormalities resolved after one month of treatment. Currently, she is asymptomatic.
UNASSIGNED: Early recognition and diagnosis of lung masses are essential for prompt treatment with corticosteroids. CEP can mimic lung malignancy and should be considered in patients with related symptoms.

Infectious aortitis is a rare but devastating vascular infection with mortality exceeding 40%. Early diagnosis is crucial but often hampered by radiographic mimickers. We report a patient who was thought to have lung cancer but ultimately found to have an infected aortic aneurysm and bacteremia owing to Salmonella species. Owing to surgical contraindications, he was treated palliatively with an initial regimen of intravenous ampicillin/sulbactam followed by lifelong oral antibiotic suppression. He ultimately rejected his diagnosis, discontinued medications, and was lost to follow-up. (Level of Difficulty: Intermediate.).

BACKGROUND: Lung malignancy is one of the most common neoplasms worldwide. Accurate histology sub-typing and identification of gene mutations in lung tumours are considered important to administer targeted therapy for improved clinical outcome. Our aim is to determine the frequency of EGFR mutation and Programmed death ligand-1 (PD -L1) status of lung malignancies in patients attending a rural hospital in Central India.
METHODS: Formalin-fixed histology diagnosed lung malignancy (n=99) bronchoscopic/trucut lung biopsies were identified and the tissue blocks and slides were retrieved. Histology typing and staging of the lesions was assessed. PD-L1 expression on biopsy was detected by immunohistochemistry using commercially available primary antibody. PD-L1 expression was assessed and semi-quantified based on the intensity and proportion of tumour cells stained for the marker. EGFR gene mutation at exon19 and 21 was detected by polymerase chain reaction of tissue from paraffin blocks. Final analysis was performed on 87 biopsies for status of EGFR mutation and PD-L1 expression.
RESULTS: The average age of lung malignancies patients was 63 years, with a preponderance of males. Advance disease in stage III and stage IV was more common in squamous cell carcinoma as compared to adenocarcinoma (p < 0.01). Mutations at exon 19-21 of the EGFR gene were detected in 7/87 (8%) cases of adenocarcinoma and all of these patients were non-smokers. A total of 52.9% of biopsies showed PD-L1 expression, which was higher in adenocarcinoma patients (p=0.04), smokers (p=0.00), and stage II and III patients (p= 0.00).
CONCLUSIONS: EGFR gene mutations at exon 19 or 21 are seen in lung adenocarcinoma cases. PD-L1 expression was observed in EGFR mutated tissues. Our results should be further validated with large sample size and multicenter clinical data before extrapolation to design immunotherapy strategies.

Introduction: Up to 50% of non-small cell lung cancer (NSCLC) harbor EGFR alterations, the most common etiology behind brain metastases (BMs). First-generation EGFR-directed tyrosine kinase inhibitors (EGFR-TKI) are limited by blood-brain barrier penetration and T790M tumor mutations, wherein third-generation EGFR-TKIs, like Osimertinib, have shown greater activity. However, their efficacy has not been well-studied in later therapy lines in NSCLC patients with BMs (NSCLC-BM). We sought to compare outcomes of NSCLC-BM treated with either first- or third-generation EGFR-TKIs in first-line and 2nd-to-5th-line settings. Methods: A retrospective review of NSCLC-BM patients diagnosed during 2010-2019 at Cleveland Clinic, Ohio, US, a quaternary-care center, was performed and reported following \'strengthening the reporting of observational studies in epidemiology\' (STROBE) guidelines. Data regarding socio-demographic, histopathological, molecular characteristics, and clinical outcomes were collected. Primary outcomes were median overall survival (mOS) and progression-free survival (mPFS). Multivariable Cox proportional hazards modeling and propensity score matching were utilized to adjust for confounders. Results: 239 NSCLC-BM patients with EGFR alterations were identified, of which 107 received EGFR-TKIs after diagnosis of BMs. 77.6% (83/107) received it as first-line treatment, and 30.8% (33/107) received it in later (2nd-5th) lines of therapy, with nine patients receiving it in both settings. 64 of 107 patients received first-generation (erlotinib/gefitinib) TKIs, with 53 receiving them in the first line setting and 13 receiving it in the 2nd-5th lines of therapy. 50 patients received Osimertinib as third-generation EGFR-TKI, 30 in first-line, and 20 in the 2nd-5th lines of therapy. Univariable analysis in first-line therapy demonstrated mOS of first- and third-generation EGFR-TKIs as 18.2 and 19.4 months, respectively (p = 0.57), while unadjusted mPFS of first- and third-generation EGFR-TKIs was 9.3 and 13.8 months, respectively (p = 0.14). In 2nd-5th line therapy, for first- and third-generation EGFR-TKIs, mOS was 17.3 and 11.9 months, (p = 0.19), while mPFS was 10.4 and 6.08 months, respectively (p = 0.41). After adjusting for age, performance status, presence of extracranial metastases, whole-brain radiotherapy, and presence of leptomeningeal metastases, hazard ratio (HR) for OS was 1.25 (95% CI 0.63-2.49, p = 0.52) for first-line therapy. Adjusted HR for mOS in 2nd-to-5th line therapy was 1.60 (95% CI 0.55-4.69, p = 0.39). Conclusions: No difference in survival was detected between first- and third-generation EGFR-TKIs in either first or 2nd-to-5th lines of therapy. Larger prospective studies are warranted reporting intracranial lesion size, EGFR alteration and expression levels in primary tumor and brain metastases, and response rates.

The effects of inspiratory muscle training (IMT) with pulmonary rehabilitation (PR) on patients with non-small cell lung cancer (NSCLC) receiving radiotherapy (RT) have not previously been reported. This pilot study aimed to determine the effectiveness of IMT with PR on respiratory muscles and exercise capacity of NSCLC patients receiving RT.
We retrospectively analyzed 20 patients who underwent RT for NSCLC. The rehabilitation included IMT, stretching, strengthening, and aerobic exercises three times a week for 4 weeks with concurrent RT. IMT training lasted 10 min, consisting of one cycle of 30 breaths using the Powerbreathe KH1 device in the hospital by a physical therapist. Patients underwent two IMT sessions at home daily at an intensity of approximately 30%-50% of the participant\'s maximum inspiratory muscle pressure (MIP) using the threshold IMT tool. We analyzed the results from the respiratory muscle strength test, pulmonary function test, 6-min walk test (6MWT), cardiopulmonary function test, cycle endurance test (CET), Inbody test, grip measurement, knee extensor/flexor strength measurement, Cancer Core Quality of Life Questionnaire (EORTCQ-C30), and NSCLC 13 (EORTC-LC13).
There were no adverse events during evaluation and IMT with PR. MIP (60.1 ± 25.1 vs. 72.5 ± 31.9, p = 0.005), 6MWT (439.2 ± 97.1 vs. 60.7 ± 97.8, p = 0.002), CET (181.39 ± 193.12 vs. 123.6 ± 87.6, p = 0.001), knee extensor (14.4 ± 5.3 vs. 17.4 ± 5, p = 0.012), and knee flexor (14.0 ± 5.2 vs. 16.9 ± 5.5, p = 0.004) significantly improved after IMT with PR.
IMT with PR appears effective on respiratory muscles and exercise capacity without adverse events in NSCLC patients who underwent RT.

BACKGROUND: Thermal ablation has been increasingly used in the treatment of lung cancer in recent years. This meta-analysis aims to investigate the therapeutic effect and safety of thermal ablation plus chemotherapy as compared with chemotherapy alone in treating patients with lung malignancy in China based on current evidence.
METHODS: Databases including PubMed, Web of Science, Embase and the Cochrane Library were searched for clinical reports. Additional literature search was also performed by searching the reference list of included studies and latest reviews. Raw data including objective response rate, disease control rate, progression-free survival, overall survival and the incidence of major complication were extracted and pooled.
RESULTS: A total of 12 studies in China including 1282 patients with lung malignancy were included in this meta-analysis. The number of studies that reported data of objective response rate, disease control rate, progression-free survival, overall survival and major complication was 8, 7, 7, 6 and 7, respectively. The combination therapy of thermal ablation plus chemotherapy showed a significantly better efficacy in improving objective response rate (odds ratio = 2.73; P < 0.001) and disease control rate (odds ratio = 2.43; P < 0.001) as compared with chemotherapy alone. Thermal ablation was also a significant protective factor for progression-free survival (hazard ratio = 0.43; P < 0.001) and overall survival (hazard ratio = 0.49; P < 0.001). Besides, thermal ablation did not increase the risk of major complication (odds ratio = 0.75; P = 0.252).
CONCLUSIONS: The present meta-analysis based on these studies in China suggested that thermal ablation is a promising technique to provide better disease response and survival outcomes for patients with lung malignancy. Thermal ablation is worth further promotion in treating lung malignancy and application in clinical practice.