A 65-year-old man with a history of paroxysmal atrial fibrillation, OSA, and remote cigarette smoking was referred to the Thoracic Surgery clinic for a posterior mediastinal mass in the setting of progressively debilitating neurologic symptoms of the face and neck.

A 78-year-old woman with gastroesophageal reflux disease was admitted with 2 months of progressive dyspnea on exertion and leg swelling. At baseline, she could walk 10 blocks; at presentation, she managed less than 6 steps. For a month, she had been sleeping upright in a chair. She experienced no fever, cough, palpitations, or chest pain. With prompting, she shared a several-year history of discomfort and skin changes in her fingers; she attributed these symptoms to chemical exposures as a housecleaner.

A 13-year-old boy was transferred to our institution for evaluation of a large, unexplained pleural effusion. He had a 1-month history of progressive dyspnea, accompanied by a 2-week history of fevers and a 2-kg weight loss, which was notable given his lean build. A chest CT scan performed at an outside hospital had revealed a large left-sided pleural effusion with associated low-density lesions in the sternum and vertebrae. A thoracic drainage tube had been placed, draining approximately 500 mL of turbid fluid daily. The patient's family reported no history of recent travel or exposure to pets.

Calcitonin gene-related peptide (CGRP)-targeted therapies are a recent addition to the migraine field. Monoclonal antibodies became available in 2018 and gepants in 2020, both now widely used for migraine prevention and acute treatment. CGRP is also a potent endogenous pulmonary vasodilator, and its blockade worsens pulmonary hypertension in experimental models. Yet the cardiopulmonary risks of CGRP pathway inhibition in humans have not been studied systematically. We report 3 patients with hemodynamically confirmed pulmonary arterial hypertension (PAH) diagnosed while they were receiving CGRP-targeted therapy. Two patients lacked traditional PAH risk factors; the third patient had suspected portal hypertension. All patients presented with markedly elevated pulmonary vascular resistance, and 2 patients improved after CGRP-targeted therapy was discontinued and PAH treatment was initiated. Although causality cannot be inferred from these cases, the temporal association and biologic plausibility suggest a potential safety signal deserving of further study. Clinicians should remain vigilant for cardiopulmonary symptoms in patients receiving CGRP-targeted therapies.

Swimming-induced pulmonary edema (SIPE) causes acute respiratory symptoms during strenuous water activities and has been described in military trainees and open-water swimmers. Although SIPE typically presents bilaterally, asymmetric cases may relate to swimmer position. Chest x-ray (CXR) and lung ultrasound (LUS) are used in the clinical evaluation of SIPE, but whether they show similar edema lateralization patterns relative to swimmer position is unclear.

Simulation-Based Medical Education (SBME) is a learning tool for healthcare providers and medical teams. Despite widespread use across health systems and teaching hospitals, instructional guidelines and standardized approaches for its implementation are lacking. Furthermore, the diversity of techniques, methods, and curricula introduces variability in simulation program design. Many programs remain isolated within individual clinical units or departments and seldom integrate multidisciplinary teams, which limits opportunities for collaboration or system-level learning. We describe our critical care SBME program, ICU UNITED, at Seattle Children's Hospital and how it fits within the simulation landscape while addressing many SBME shortcomings. ICU UNITED is an innovative, cross-unit simulation program that integrates in situ sessions through a shared resource model across the pediatric, cardiac, and neonatal intensive care units. We present an instructional framework for longitudinal program organization and individual session design, emphasizing clear scenario objectives, learner participation, and measures of participant satisfaction to support program sustainability. This framework provides a pragmatic model for programs seeking to grow, develop, or expand an interdisciplinary simulation program capable of assessing and addressing system-level challenges.

Recurrent venous thromboembolism (rVTE) occurring during therapeutic anticoagulation represents a clinically challenging and high-risk condition.

Pulmonary endoscopy contributes substantially to medical waste generation. Previous studies have estimated the average waste per bronchoscopy at approximately 1.03 kg. However, scalable data are lacking.

Primary ciliary dyskinesia (PCD) is a heterogenous disease that is difficult to diagnose. Investigations for PCD are recommended with an appropriate phenotype of four "key PCD clinical criteria": (1) year-round wet cough from before 6 months old, (2) year-round nasal congestion from before 6 months old, (3) neonatal respiratory distress at term birth, and/or (4) an organ laterality defect. Accuracy of these symptoms was validated in children but not robustly explored in adults.

Magnetic resonance imaging (MRI) revealed a high prevalence of lung abnormalities in children with primary ciliary dyskinesia (PCD). However, longitudinal imaging data on the onset and progression are lacking.

Non-cystic fibrosis bronchiectasis (NCFB) is a heterogeneous chronic airway disease increasingly recognized worldwide and associated with a substantial burden of extra-pulmonary manifestations. Osteoporosis has emerged as a highly prevalent yet underappreciated comorbidity. Unlike cystic fibrosis, where bone health guidelines exist, no screening or management recommendations are available for NCFB despite overlapping risk factors, including chronic inflammation, malnutrition, hypoxia, medication exposure, and physical inactivity.

Dysregulated calcium and vitamin D metabolism poses unique challenges for clinicians caring for patients with sarcoidosis. These patients often require supplementation to support their metabolic bone health, yet such interventions may theoretically increase the risk of hypercalcemia and hypercalciuria, along with their associated complications. This article presents four clinical vignettes that illustrate common dilemmas encountered in managing these patients.

Deep learning-derived, chest radiographic (CXR) age may capture subclinical structural changes associated with spirometric impairment.

Low-dose computed tomography (LDCT) has been established in the past decade as an important and effective tool for lung cancer screening (LCS) in high-risk individuals, with large trials demonstrating significant lung cancer mortality reduction. Beyond pulmonary nodules, LDCT frequently detects a range of smoking-related additional findings, including emphysema, coronary artery calcium, interstitial lung abnormalities (ILA), osteoporosis, and sarcopenia. Accordingly, here we review current evidence on the prevalence, prognostic value, and clinical implications of such smoking-related findings in LCS, with a focus on the findings themselves, their relevance in COPD patients, emerging technologies and future directions for integration into screening protocols.

Pulmonary vascular remodeling is implicated in the pathophysiology of pulmonary hypertension (PH) in chronic lung diseases. Computed tomography (CT) metrics of pulmonary vessels may provide insight into the impact of vessel morphology on PH severity in chronic lung diseases (CLD).

Geographic equity in access to donor lungs is a central objective of U.S. organ allocation policy. In March 2023, lung allocation transitioned from rigid donor-candidate distance thresholds to a continuous distribution framework using the Composite Allocation Score (CAS). CAS prioritizes medical urgency, projected posttransplant survival, biological compatibility, and geographic efficiency (continuous donor-candidate distance). On May 7, 2026, a policy amendment was approved that increased the influence of proximity on candidate ranking.

Management of critically ill patients with pulmonary hypertension (PH) presents significant clinical challenges. Regardless of the underlying etiology or chronicity of PH, superimposed acute illness can precipitate decompensated right ventricular failure (RVF) and death. Hospitalization, particularly in the intensive care unit (ICU), is associated with high mortality, with RVF serving as the direct or indirect cause in most cases. In this article we will focus on the management of acute decompensated RVF in patients with known pulmonary arterial hypertension (PAH). ICU management of the PAH patient with RVF centers on the recognition and treatment of potentially reversible precipitants for decompensation and supportive strategies to optimize right ventricular (RV) function. Key goals include maintaining adequate oxygenation and tissue perfusion, correcting electrolyte and other metabolic abnormalities, optimizing fluid balance and RV preload, enhancing RV contractility, and reducing RV afterload. Continuous monitoring of cardiac function is essential, as is identifying and treating potential complications, such as arrhythmias or acute kidney injury (AKI). When RVF persists despite maximal medical therapy, extracorporeal life support may be considered as a bridge to recovery or transplantation. In patients with advanced disease multidisciplinary discussions aligned with patient and family preferences should guide the goals of care. Integration of palliative care specialists to manage symptoms and support caregivers remains a critical component of comprehensive ICU management for patients with PAH.

Patients with schizophrenia spectrum disorders (SSD) experience higher cancer mortality than the general population. Disparities in treatments for non-small cell lung cancer (NSCLC) among this population remain underexamined.

Diet may influence the pathogenesis of asthma, a heterogeneous syndrome comprising unique mechanisms or endotypes. Little is known about the relation between diet and asthma endotypes in children and adolescents.

Subsolid nodules (SSNs) and ground glass opacities (GGOs) are an increasingly common clinical problem. This unique subtype of lung adenocarcinoma poses a treatment dilemma as many can be safely monitored with radiographic observation alone and require no intervention. Improved understanding of the natural history and outcomes of patients with subsolid nodules is needed to improve clinical decision making and treatment recommendations.