A 72-year old man, who formerly used tobacco with a 60 pack-year history, was referred to our interventional pulmonology unit for evaluation of a severe stenosis of right main stem bronchus. This stenosis was discovered in a recent hospital admission for respiratory failure associated with right lower lobe pneumonia, which was considered postobstructive. After discharge, the patient continued to experience chest tightness and a persistent cough, which allowed him to expel mucus plugs only with considerable effort. He denied experiencing fever or weight loss. Three years earlier, in 2020, the patient had undergone a right upper lobectomy followed by adjuvant platinum-based chemotherapy for pT1cN1 squamous cell carcinoma. However, during the COVID-19 pandemic, he spontaneously declined any follow-up tests. His medical history was also significant for COPD, obesity, type II diabetes, myelodysplastic syndrome, aortic valve replacement for endocarditis, and rectal resection for pT3N0 adenocarcinoma.

A 72-year-old man with progressive dyspnea was referred to our hospital for evaluation of diffuse lung disease. His medical history was unremarkable except for a 20-year history of smoking 20 cigarettes per day. Abnormal findings were first identified on a chest radiograph during a routine medical checkup 11 months earlier. Chest CT scan showed diffuse ground-glass opacities with basilar predominant distribution and some areas of alveolar consolidation predominantly in the lower lobes. Based on clinical and radiographic findings, the patient was initially diagnosed with interstitial lung disease and treated with IV methylprednisolone pulse followed by oral prednisolone, but his condition did not improve. To exclude the possibility of infectious lung disease, empirical antibiotics were administered; however, the patient showed no clinical improvement. Subsequent treatments, including additional methylprednisolone pulses and immunosuppressive agents such as tacrolimus and cyclophosphamide, also failed to yield any significant benefit. His dyspnea progressively worsened, and home oxygen therapy was initiated 4 months before referral. Because of his deteriorating condition despite maximal medical therapy, he was referred to our hospital for comprehensive evaluation.

Acute aortic dissection is a rare and life-threatening emergency, with fatal outcomes often resulting from delayed or missed diagnoses. Type A aortic dissection, which typically presents with acute chest pain radiating to the back, is the most common cause of death associated with aortic lesions and requires urgent surgical intervention. We present an unusual case of type A aortic dissection that manifested solely with sudden paralysis and tingling of the right lower limb, without chest or back pain. Despite timely diagnosis in the emergency department, emergency surgical intervention failed to save the patient's life.

Low-tidal-volume ventilation (LTVV) improves outcomes in critically ill patients, but its impact in patients with acute brain injuries (ABIs) is less certain.

There is considerable variation in clinicians' approaches to decisions to withhold or withdraw life sustaining treatment (LST) across US hospitals. These differences are not explained by patient preferences alone and are likely influenced by other factors (eg, hospital policies, hospital culture, state laws, medical society guidelines).

Individuals with sarcoidosis face many sources of illness uncertainty, including diagnostic delays, unpredictable therapeutic efficacy and toxicity, and disease-associated morbidity and mortality. Patient perspectives on illness uncertainty in sarcoidosis have not been evaluated critically and offer an opportunity for providers to contextualize and prioritize gaps in care and patient support.

Chronic beryllium disease (CBD) is considered a phenocopy of sarcoidosis, generally caused by occupational exposure to beryllium. Its diagnosis relies on the demonstration of beryllium sensitization by the beryllium lymphocyte proliferation test (BeLPT).

Two studies recently demonstrated the noninferiority of sublobar resection to lobectomy in patients with T1a-bN0M0 non-small cell lung cancer (NSCLC). However, whether segmentectomy is associated with similar oncologic outcomes to lobectomy for patients with node-negative T1c tumors (ie, those 2-3 cm) remains unknown.

Light's criteria use pleural fluid protein and lactate dehydrogenase (LDH) to differentiate pleural effusions as exudative or transudative. In a subset of exudative pleural effusions, discordance occurs between LDH and protein (ie, protein high, LDH low, or vice versa).

Chronic bronchitis (CB) is characterized by excessive airway mucus production. Mucus plugs occluding the airway are common in CB, are associated with increased all-cause mortality, and can be identified on CT imaging.

Lung cancer remains the number 1 cause of cancer death in men and women in the United States and much of the world. This CHEST guideline examines the literature on primary treatment of patients with stage I and II non-small cell lung cancer (NSCLC) to provide evidence-based recommendations.

Successful procedural training is a universal concern for pulmonary and critical care medicine (PCCM) program directors. Bootcamps may provide a unique and often first opportunity for intense, immersive procedural learning without exposing patients to harm. New trainees must otherwise learn on the job while acclimating to unfamiliar environments and responsibilities. Our goal was to create a structured regional educational event conducted early in fellowship; we aspired to optimize familiarity with procedures and equipment, allay stress among trainees, and create a collaborative learning environment through sharing of simulation equipment and faculty among programs. This article outlines the design, implementation, and lessons learned from this 1-day, multidisciplinary PCCM and critical care medicine procedural bootcamp in the southwest region of the United States. The bootcamp program was designed as learner centered, with educational and experiential goals and feasibility in mind, using a flipped classroom model and testing to maximize time for psychomotor skills building. A multidisciplinary approach enriched the learning environment, modeled team-based procedural care, and fostered interprofessional collaboration. Assessments measured pre-knowledge and post-knowledge acquisition as well as gauged learner performance using checklists and small group interaction. Evaluation of feedback from learners, faculty, and participating programs allowed for yearly iterative improvements. We share these lessons learned as a model for other scalable and impactful medical education initiatives.

In 2012, the Global Lung Function Initiative (GLI) collected a large international database of spirometry measurements in healthy people from which predicted spirometric values were derived based on sex, age, and height for people from 4 different geographic ancestral groups. In 2023, a single set of predicted spirometry values was developed for the entire dataset, designed to be independent of ancestry.

Lung cancer screening (LCS) has evolved over the past decade with research advances and clinical experience helping to define target populations for screening, to improve lung nodule detection and management, and to identify structural components of programs that improve the quality of screening delivery. The 2015 American College of Chest Physicians and American Thoracic Society Policy Statement, "Components Necessary for High-Quality Lung Cancer Screening," identified 9 essential components for high-quality LCS. Ten years later, optimizing the balance between the benefits and harms of LCS and ensuring equitable screening among all population groups remain fundamental objectives. In this 2025 update, we aimed to summarize new knowledge and highlight critical components that are needed for providing high-quality LCS. A multidisciplinary group of LCS experts was assembled to review evidence from the past 10 years. The original components were reviewed and updated to develop 8 refined components that should be considered essential structural elements of screening programs. Each component recommended by the authors is supported by an evidence update. Applying this framework will allow screening programs across the country to ensure implementation of high-quality, net-benefit LCS.

Current indications for long-term oxygen therapy (LTOT) primarily are based on thresholds of arterial oxygen saturation (SaO2) or PaO2 that ignore fundamental mechanisms of adaptation and intolerance to hypoxia. In individuals exposed to chronic hypoxic conditions, the accumulation of hypoxia-inducible factors (HIFs) in the cell nucleus upregulates target genes that favor tolerance to hypoxia. Adaptations include hyperventilation, systemic vascular bed development, increased erythropoiesis, and cellular metabolic adjustments. Excessive responses to hypoxia also may develop, leading to pulmonary vasculature remodeling and other end-organ dysfunctions. Biomarkers of hypoxia may complement the measurement of SaO2 or PaO2 in personalizing oxygen prescription before end-organ dysfunction becomes clinically apparent.

The precise impact of cardiovascular risk factors (CVRFs) on the right ventricle-pulmonary circulation unit remains unclear.

With the sudden onset of the COVID-19 pandemic, countries rushed to implement guidelines for triage. Some were unprepared. In Germany, academic discourse had focused on criteria for triage, while often neglecting their translation into clinically applicable protocols in ICUs.

Pulmonary arteriovenous malformations (PAVMs) require therapeutic embolization and careful surveillance to prevent serious complications, including stroke, brain abscess, and hemoptysis. Although initial treatment guidelines are well established, posttreatment surveillance practices remain heterogeneous, with no standardized approach for monitoring treated lesions or detecting PAVM persistence. This variability in follow-up care may affect patient outcomes, particularly in high-risk populations such as those with hereditary hemorrhagic telangiectasia (HHT).

Pulmonary hypertension (PH) is a complex, life-threatening condition requiring noninvasive, accessible, and accurate diagnostic tools, particularly in resource-limited settings. Early and precise identification of PH and its subtypes is critical for effective management and timely intervention.

Increasing evidence supports lung cancer screening with low-dose CT (LDCT) imaging. However, the benefits of LDCT screening for lung cancer may not be immediate, making it unlikely to benefit patients with limited life expectancy.