Pneumologia Feed

Intrathoracic extramedullary haematopoiesis mimicking pulmonary malignancy in two patients with thalassaemia: A case series

Tue, 29 Sep 2026 00:00:00 GMT

IntroductionExtramedullary haematopoiesis (EMH) is the formation of haematopoietic tissue outside the bone marrow in response to ineffective erythropoiesis, as occurs in thalassaemia. Within the thorax, it forms posterior mediastinal or paravertebral masses that can mimic malignancy.Case PresentationWe report two patients with thalassaemia in whom thoracic masses were initially interpreted as suggestive of malignancy. A 59-year-old woman with beta-thalassaemia presented with progressive dyspnoea, severe anaemia, a right paravertebral mass and a left pleural effusion. A 47-year-old man with beta-thalassaemia intermedia with haemoglobin E presented with chronic dyspnoea and bilateral posterior mediastinal masses suggestive of lymphoma. In both, tumour markers were non-contributory and histopathology of percutaneous and transbronchial specimens showed haematopoietic cells with megakaryocytes, confirming the diagnosis.DiscussionThe radiological appearances overlapped with malignancy, but non-contributory tumour markers and tissue sampling established the diagnosis. Both patients were managed with transfusion and supportive haematological therapy rather than resection, with symptomatic improvement.ConclusionEMH should be considered for thoracic masses in patients with haemoglobinopathy, since tissue confirmation prevents unnecessary surgical or oncological interventions.

The role of the pulmonary artery–ascending aorta ratio as a non-invasive indicator of pulmonary hypertension in interstitial lung disease

Thu, 17 Sep 2026 00:00:00 GMT

English:Pulmonary hypertension (PH) represents a severe complication that significantly worsens the prognosis of patients with interstitial lung disease (ILD). While early identification of PH throughout the clinical course of ILD is paramount, referrals for the gold-standard right heart catheterization remain constrained, limited not only by availability or clinical suspicion but primarily by stringent indications. Historically, most patients with Group 3 PH did not benefit from treatment, as there were only very limited therapeutic options available in recent years. However, emerging pharmacological advancements have begun to expand the treatment landscape for PH-ILD, making early non-invasive screening more clinically pertinent than ever. This literature review evaluates the diagnostic utility and predictive significance of the non-invasively measured pulmonary artery-to-ascending aorta diameter ratio (PA:A ratio) via computed tomography as a robust screening tool for suspected PH-ILD. Contemporary evidence indicates that a PA:A ratio threshold of ≥0.9 serves as an optimal predictor for elevated (mean pulmonary artery pressure >20 mmHg) in patients with idiopathic pulmonary fibrosis, demonstrating a specificity of 83%. Furthermore, a ratio of ≥1.0 is established as an independent predictor of significant survival decline and increased mortality rates. Ultimately, the PA:A ratio is a pragmatic, reproducible, and highly accessible non-invasive marker that plays a pivotal role in early risk stratification, helping clinicians identify high-risk cohorts who may benefit from comprehensive diagnostic workups and emerging specialized therapeutic strategies.

E-cigarette or vaping product use-associated lung injury presenting with probable diffuse alveolar haemorrhage: A case report

Thu, 17 Sep 2026 00:00:00 GMT

English:E-cigarette or vaping product use–associated lung injury (EVALI) is an increasingly recognised cause of acute respiratory illness in young adults. While most cases present with acute lung injury or organising pneumonia, diffuse alveolar haemorrhage (DAH) is a rare and severe manifestation. A 24-year-old previously healthy male presented with fever and malaise following recent heavy vaping, which rapidly progressed to severe breathlessness. His clinical condition worsened rapidly, with severe hypoxaemia, haemodynamic instability and an acute fall in haemoglobin. High-resolution computed tomography showed diffuse ground-glass opacities and consolidation. Bronchoscopy demonstrated fresh blood within the segmental airways of both lower lobes. Investigations for infectious, autoimmune and vasculitic causes were negative. In the context of recent vaping exposure and exclusion of alternative diagnoses, EVALI presenting with probable DAH was considered. The patient was managed with supportive care, mechanical ventilation, antibiotics and systemic corticosteroids, resulting in gradual clinical and radiologic improvement. This case underscores the importance of obtaining a detailed vaping history despite the inability to perform sequential BAL. DAH is an uncommon but life-threatening presentation of EVALI, and a high index of suspicion is required in young patients with acute respiratory failure, falling haemoglobin and diffuse infiltrates, as early recognition and supportive management can be life-saving.

Sleep-disordered breathing and obstructive sleep apnoea in asthma: impact on disease control, exacerbation frequency and clinical outcomes – a systematic review and meta-analysis of observational studies

Tue, 18 Aug 2026 00:00:00 GMT

BackgroundSleep-disordered breathing (SDB), including obstructive sleep apnoea (OSA), is a common but underrecognised comorbidity in asthma that may worsen disease control and clinical outcomes. This systematic review and meta-analysis evaluated associations between OSA/SDB and asthma control, exacerbations, future-risk outcomes and treatment response.Methods:PubMed, Scopus, Embase, Web of Science and the Cochrane Library were searched from inception to March 2025. Observational studies reporting validated asthma outcomes in populations with OSA/SDB were included. Risk of bias was assessed using adapted ROBINS-I domains. Random-effects meta-analyses used restricted maximum likelihood estimation with Hartung-Knapp correction where appropriate.ResultsTwenty-one studies involving 922,748 participants from 12 countries were included. OSA was associated with persistent asthma symptoms in adults (OR 1.74, 95% CI 1.49-2.02), poor asthma control in children (OR 2.48, 95% CI 1.45-4.23), severe asthma (OR 3.49, 95% CI 1.49-8.15), hospital readmission (IRR 1.09, 95% CI 1.04-1.15), and mechanical ventilation in hospitalised children (OR 6.62, 95% CI 4.29-10.22). The pooled prevalence of OSA/SDB in asthma by objective sleep testing was 62.3% (95% CI 34.7%-83.7%). Asthma independently predicted incident OSA (OR/HR/RR 2.11, 95% CI 1.35-3.29). GRADE certainty was low to very low for most outcomes.ConclusionOSA/SDB is highly prevalent in asthma and consistently associated with poorer asthma control, greater exacerbation risk and increased healthcare utilisation. Routine SDB screening should be considered in poorly controlled asthma. Addressing this overlap supports Sustainable Development Goal 3.

Pulmonary hypertension and renal dysfunction: a narrative review

Tue, 18 Aug 2026 00:00:00 GMT

Pulmonary hypertension (PH) is a severe and highly prevalent complication of chronic kidney disease (CKD). Conversely, patients with pulmonary arterial hypertension (PAH) frequently develop renal dysfunction. These cardio–renal interactions predict poorer outcomes, yet their mechanisms are not entirely understood. This narrative review explores the pathophysiological inter-actions between the pulmonary circulation and the kidney and the impact on patient care. PH in CKD is driven by a combination of left heart disease, volume overload and endothelial dysfunction. Molecular mechanisms include an imbalance of endogenous vasoactive agents favouring increased vasoconstriction, as well as vascular remodelling induced by mediators of mineral bone metabolism (parathyroid hormone, fibroblast growth factor 23, α-Klotho). In haemodialysis patients, arteriovenous fistulas (AVFs) contribute to PH via a high cardiac output state. Management of CKD-PH relies on strict volume control, treating underlying comorbidities and modulating high AVF flow. Targeted PAH therapies are generally contraindicated in CKD-PH. Kidney transplantation can reverse PH in a significant proportion of patients. Pulmonary vascular remodelling in PAH can induce renal dysfunction through reduced renal perfusion and increased venous congestion (the right heart cardio–renal syndrome). Impaired kidney function in PAH predicts increased mortality and warrants more aggressive vasodilator therapy. The association of PH and CKD is frequent and confers a poor prognosis. Accurate diagnosis and effective management require a multidisciplinary approach involving pulmonologists, cardiologists and nephrologists.

The importance of fibrobronchoscopy in the diagnosis of pulmonary diseases

Fri, 31 Jul 2026 00:00:00 GMT

English:IntroductionBronchoscopy is an essential tool in the diagnosis and management of pulmonary diseases, with both diagnostic and therapeutic indications.Case PresentationWe present the case of a 67-year-old female patient with a family history of tuberculosis (TB), as her father was diagnosed with pulmonary TB during her childhood, for which she underwent chemoprophylactic treatment at the time. She presented to our pulmonology department complaining of fever, dyspnoea on moderate exertion and marked physical asthenia, symptoms that had begun 1 week prior to presentation. Radiological investigations indicated an area of pulmonary consolidation occupying nearly the entire middle lobe, raising suspicion of a bronchopulmonary neoplasm.The patient underwent fibrobronchoscopy, which revealed middle lobe atelectasis due to altered bronchial patency – a finding suggestive of sequelae of pulmonary TB, with no proliferative lesions identified, and the bronchial aspirate result confirmed the presence of Mycobacterium tuberculosis in cultures (10 BAAR-positive colonies).ConclusionIn the presented case, fibrobronchoscopy was absolutely necessary and proved highly useful in the diagnosis of pulmonary TB and the exclusion of neoplastic pathology.

Clinical impact of structured weight reduction on muscle mass in COPD with sarcopenic obesity

Wed, 22 Jul 2026 00:00:00 GMT

AimThis study was conducted to investigate the effect of using weight reduction programme on muscle mass in chronic obstructive pulmonary disease (COPD) patients with sarcopenic obesity (SO).Subjects and methodsFifty male patients, aged 50–65 years diagnosed with SO with COPD were assessed for intervention in this study. They were randomly assigned into two equal groups (n = 25). Group A: (n = 25) received weight reduction, which included healthy lifestyle control, diet-induced weight loss (1300–1500 Kcal/day), and aerobic exercise for 40 min, that is, 3 sessions/week for 10 weeks. Group B: (n = 25) was given general information about healthy food choices and low-calorie diet (1300–1500 Kcal/day) for the same period. Anthropometric measurement (weight and Body Mass Index (BMI)), skeletal muscle mass (SMM), skeletal muscle mass index (SMMI), handgrip, and Six-Minute Walking Distance (6MWD) were measured before and after the programme.ResultsWeight and BMI significantly decreased in both groups post-treatment, and there was a significant increase in SMM, SMMI, hand grip strength, and 6 Minute Walking Test (6MWT) of group A compared with that of group B post-treatment. Also in group B, there was no significant change in SMM or SMMI, whereas handgrip strength and 6MWT showed significant increases.ConclusionWeight reduction programme (low-calorie diets plus exercise) in sarcopenic obese patients with COPD can effectively reduce weight and BMI, and improve the SMM, SMMI, hand grip, and six-min walk distance test.

Smoke—free generation or tobacco endgame: How far have we come?

Tue, 30 Jun 2026 00:00:00 GMT

Tobacco-free generation policies and tobacco endgame strategies aim to reduce tobacco use to minimal levels via ambitious, time-bound measures. This article synthesises recent policy directions and implementation across countries. Narrative review of sources cited herein, focusing on WHO FCTC and MPOWER implementation and national endgame initiatives. Countries pursue mixes of product-, user-, market/supply- and institution-oriented measures. Implementation of FCTC and MPOWER remains uneven across Europe, with leadership examples (e.g., Finland’s legislative endgame; New Zealand’s comprehensive strategy) and persistent challenges (legal constraints, debates on e-cigarettes, tobacco industry interference). Progress is mixed but feasible pathways exist. Continued innovation and political commitment are needed to reach smoke-free generation targets.

Pancoast tumour in a 62-year-old smoker: Differentiating malignancy from cardiac emergency and tuberculosis

Tue, 12 May 2026 00:00:00 GMT

English:IntroductionPancoast tumours account for approximately 3%–5% of lung cancers. Their atypical presentation often mimics cardiovascular, neurological or infectious conditions, particularly in tuberculosis-endemic regions, leading to delays in diagnosis and treatment.Case PresentationA 62-year-old male smoker presented with progressive, severe left-sided chest pain radiating to the back, scapula, neck and left upper extremity, accompanied by paraesthesia and reduced grip strength. The pain led to an initial evaluation for acute coronary syndrome and pulmonary tuberculosis. Electrocardiography showed no ischaemic changes, and sputum testing for Mycobacterium tuberculosis was negative. Chest radiography and contrast-enhanced thoracic computed tomography demonstrated a solid apical mass invading the chest wall and adjacent soft tissues, consistent with a Pancoast tumour. Neurological findings suggested lower brachial plexus involvement without Horner’s syndrome. Histopathological assessment confirmed adenosquamous cell carcinoma of the lung.DiscussionThis case highlights the diagnostic complexity of Pancoast tumours, which may present without prominent respiratory symptoms and instead mimic cardiac emergencies or endemic infections such as tuberculosis. Neurological deficits helped localise tumour invasion, highlighting the importance of thorough neurological assessment and early imaging.ConclusionsEarly recognition of atypical Pancoast tumour presentations is essential to prevent diagnostic delay and neurological deterioration, particularly in tuberculosis-endemic settings.

Mortality-associated prognostic factors, survival rates, lung functions and complications in post-transplant chronic obstructive pulmonary disease patients: A systematic review and meta-analysis

Mon, 11 May 2026 00:00:00 GMT

English:BackgroundChronic obstructive pulmonary disease (COPD) remains a significant global health burden. Due to limited donor organs, it is essential to implement rigorous selection criteria for lung transplantation candidates to maximise survival outcomes.MethodsThis study is a systematic review and meta-analysis of mortality-associated prognostic factors, survival rates (SR), lung function and complications among COPD patients who underwent lung transplantation. We follow preferred reporting items for systematic reviews and meta-analyses 2020 guidelines and register this review in PROSPERO (CRD42024617160). Eligibility criteria guided article selection through Medline, Scopus, ProQuest, Central and manual searches. Study quality was assessed using the Newcastle–Ottawa scale (NOS). Data were extracted and analysed, including performing meta-analysis for relevant outcomes.ResultsOur analysis identified prognostic factors associated with post-transplant mortality, including increased age per year (HR: 1.03, 95% CI: 1.02–1.03; I2 = 0%), diabetes mellitus (HR: 1.38, 95% CI: 1.22–1.57; I2 = 0%), ECMO support (HR: 3.58, 95% CI: 1.95–6.57; I2 = 5%) and white donor race (HR: 0.81, 95% CI: 0.74–0.89; I2 = 0%). Other significant factors included previous lung surgery, non-alpha-1 antitrypsin deficiency, induction agent type, continuous mechanical ventilation, 6-min walk distance and pulmonary hypertension. Lung transplantation significantly improves survival in COPD patients, with pooled SR of 79.8% (95% CI: 69.2%–87.4%) at 1 year and 55.3% (95% CI: 47.3%–63.1%) at 5 years. Lung function also showed marked improvement. Reported complications included infections, metabolic complications, rejection and bronchiolitis obliterans syndrome.ConclusionsThis systematic review identifies the key prognostic factors associated with mortality in post-transplant COPD patients, as well as post-transplant SR, lung function improvements and common complications.

Pneumocystis jirovecii pneumonia mimicking interstitial lung disease: A case report

Wed, 15 Apr 2026 00:00:00 GMT

BackgroundPneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection frequently associated with human immunodeficiency virus (HIV). We report an atypical presentation of this disease, mimicking interstitial lung disease (ILD).Case PresentationWe report the case of a 26-year-old previously healthy man presenting with fever, cough and shortness of breath. Initial improvement under antibiotics was followed by persistent dyspnoea. Imaging revealed diffuse ILD with ground-glass opacities and subpleural sparing. Bronchoalveolar lavage (BAL) showed lymphocytic predominance. An extensive immunological workup, including antinuclear antibodies, rheumatoid factor, anti–cyclic citrullinated peptide antibodies, antineutrophil cytoplasmic antibodies, extractable nuclear antigen antibodies and myositis-specific antibodies, was negative. HIV serology was requested due to persistent diarrhoea, and its positive result proved to be the key diagnostic clue that prompted evaluation for opportunistic infections, ultimately leading to the confirmation of PJP. Treatment with trimethoprim-sulphamethoxazole led to clinical improvement.ConclusionThis case highlights that pneumocystis pneumonia may present atypically, simulating ILD. HIV screening should be considered in the aetiological workup of unexplained ILD to enable early diagnosis and appropriate management.

Novel biologic and molecular targets in COPD: Bridging precision medicine and lung regeneration

Wed, 15 Apr 2026 00:00:00 GMT

Chronic obstructive pulmonary disease (COPD) is no longer considered a homogeneous disorder, but rather a syndrome driven by diverse inflammatory and molecular endotypes. While inhaled therapies remain the cornerstone of treatment, many patients continue to experience exacerbations, progressive airflow limitation, and impaired quality of life. This state-of-the-art review synthesises current evidence on biologic and molecular therapeutics for COPD. Successes and failures of cytokine-targeted therapies, including interleukin-4 receptor alpha (IL4Ra), interleukin-5 and 5 receptor (IL-5/IL-5R), interleukin-33 (IL-33), thymic stromal lymphopoietin (TSLP), and C–X–C motif chemokine receptor 2 (CXCR2) antagonists, are critically appraised, and reasons for trial failure despite strong mechanistic rationale are explained. Novel concepts, including epithelial alarmin blockades, neutrophil extracellular trap (NET) suppression, small-molecule phosphodiesterase-3, 4 (PDE3/4) inhibitors, and molecular reversal of corticosteroid resistance, are summarised from a translational perspective. Beyond inflammation, the field is expanding towards lung regeneration through stem-cell-based therapies, exosomes, gene and RNA editing, and metabolic reprogramming of dysfunctional epithelium. Artificial intelligence, radiomics, multi-omics integration, and digital biomarkers promise individualised prediction of treatment response and early exacerbation detection, shifting COPD towards a ‘digital precision’ model.

Towards a collaborative approach in chronic obstructive pulmonary disease: an expert opinion paper on cardiopulmonary risk reduction in clinical practice in Romania

Sat, 04 Apr 2026 00:00:00 GMT

Chronic obstructive pulmonary disease (COPD) is frequently complicated by cardiovascular diseases (CVDs), worsening patient outcomes. Recognising COPD as a multimorbid and syndemic condition, we developed this position paper to provide evidence-based recommendations for reducing cardiopulmonary (CP) risk through integrated, guideline-directed management in Romania. In June–September 2025, the multidisciplinary task force (pulmonologists/cardiologists/internal medicine specialists/general practitioners GPs), with expertise in diagnosis and treatment of patients with COPD and CVDs, engaged in working groups and developed algorithms for COPD management, focusing on CP risk reduction. Expert recommendations were formulated using current guidelines, scientific literature evidence and clinical expertise as follows: (i) prioritise early COPD diagnosis in at-risk populations; (ii) address CP risk assessment at every visit, with urgent pulmonology referral for severe COPD symptoms and cardiology referral for severe dyspnoea with abnormal electrocardiogram; (iii) ensure adequate assessment and management of mild-moderate COPD exacerbations, with urgent emergency referral/hospitalisation when severity cannot be reliably determined; (iv) refer all patients with severe COPD exacerbations to emergency care and/or hospitalisation; (v) implement standardised COPD hospital discharge protocol; (vi) optimise pharmacotherapy by initiating long-acting β2-agonist (LABA) + long-acting muscarinic antagonist (LAMA) and escalating to triple therapy (LABA/LAMA/inhaled corticosteroid) when indicated and ensure structured follow-up as per GOLD guidelines. This expert opinion paper calls for urgent action to bridge the gap between guideline-directed recommendations and routine practice, with a strict policy of zero tolerance for treatment delays.

Association of sputum and peripheral blood eosinophils with clinical severity in bronchial asthma

Mon, 30 Mar 2026 00:00:00 GMT

ObjectivesTo correlate the sputum eosinophil count and peripheral absolute eosinophil count (AEC) with the clinical severity of bronchial asthma.Materials and MethodsThis was a hospital-based cross-sectional study conducted on 100 asthmatic patients attending the pulmonary medicine Outpatient Department (OPD). Severity was assessed using GINA guidelines, the Asthma Control Questionnaire (ACQ) and spirometry. Patients underwent blood sample collection for AEC and sputum induction for sputum eosinophilia. Statistical analysis utilised Pearson’s Chi-square test, Fisher’s exact test and correlation coefficients to determine associations between eosinophil levels and disease severity parameters.ResultsThe mean age of the study population was 43.8 years, with a slight male predominance (57%). A statistically significant correlation was found between the AEC and the sputum eosinophil percentage (P < 0.05). Furthermore, a significant association was noted between both AEC and sputum eosinophilia with the ACQ scores, indicating their utility in disease severity assessment. Risk factors associated with more severe asthma included female sex, obesity, smoking and longer duration of symptoms.ConclusionPeripheral blood AEC and sputum eosinophil count are simple, cost-effective and reproducible methods that track well with eosinophilic airway inflammation. They can be effectively utilised to assess disease severity, guide management and predict prognosis in bronchial asthma.

Shaping the future of paediatric sleep and sleep apnoea care in Romania: The 2025 Romanian Paediatric Sleep Conference

Mon, 09 Mar 2026 00:00:00 GMT

Towards precision medicine in obstructive sleep apnoea: A meta-analysis linking endotypic traits to disease severity

Wed, 04 Mar 2026 00:00:00 GMT

BackgroundObstructive sleep apnoea (OSA) is a heterogeneous disorder with distinct pathophysiological mechanisms. Four identified endotypes contribute to OSA pathophysiology. Despite their critical role, OSA endotypes have not been extensively applied in clinical practice, leading to a non-personalised treatment approach. This study aims to evaluate the correlations between these endotypes and OSA disease severity to guide prognostic stratification and targeted therapies.MethodsA comprehensive search across PubMed, Science Direct and Scopus databases was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Study quality was assessed using the Newcastle-Ottawa scale (NOS). A random-effects meta-analysis was performed to calculate pooled correlation coefficients.ResultsFrom 80 retrieved studies, 21 met inclusion criteria, with four reports (n = 1097) eligible for quantitative synthesis. Upper airway collapsibility demonstrated the strongest and most significant correlation with OSA severity (r = 0.323, P < 0.001). Both high loop gain and low arousal threshold showed significant, homogeneous positive correlations (r = 0.264, I2 = 0%, P < 0.001; and r = 0.250, I2 = 0%, P < 0.001, respectively). Muscle compensation was not significantly associated (r = 0.040, P = 0.29).ConclusionThis meta-analysis delineates that distinct endotypes are significantly correlated with OSA severity. Airway collapsibility emerged as a robust predictor of OSA severity. These findings underscore the clinical utility of pathophysiological endotyping to advance precision medicine in OSA management.

Assessment of the response to triple therapy in paediatric patients with cystic fibrosis using spirometry, sweat testing and chest computed tomography

Thu, 19 Feb 2026 00:00:00 GMT

English:IntroductionThe availability of combination therapy with cystic fibrosis transmembrane conductance regulator (CFTR) modulators, elexacaftor–tezacaftor–ivacaftor (ETI), has significantly improved pulmonary outcomes and quality of life in patients with cystic fibrosis. This study aimed to evaluate structural bronchopulmonary changes using computed tomography (CT) after 1 year of ETI treatment, assessed by the Bhalla score, and to correlate these findings with clinical response parameters.MethodsThis retrospective observational study included 11 patients under 18 years of age who underwent chest CT before and 1 year after ETI initiation. CT images were assessed using the Bhalla score. Scores range from 0 to 25, with lower values indicating more severe structural lung involvement. CT scores were correlated with changes in sweat test values and percent predicted forced expiratory volume in one second (ppFEV1). Statistical analysis included the paired Student’s t-test, Wilcoxon signed-rank test, and Pearson’s correlation coefficient.ResultsThe mean Bhalla score improved from 14.55 to 18.27 (P < 0.001), with the greatest improvements in mucus plugging (P = 0.002) and peribronchial thickening (P = 0.008). Bronchiectasis improved in some patients but did not reach statistical significance. Structural changes correlated with clinical response: ppFEV1 increased by 13.38% (P = 0.002), while sweat chloride levels decreased by 43.1 mmol/L (P < 0.001).ConclusionsETI therapy produced significant morphological and functional improvements. CT-detected structural changes correlated with clinical outcomes, and the Bhalla score proved useful for monitoring pulmonary disease.

Association between hypoalbuminemia and pulmonary CT severity in COVID-19 ICU patients: A cohort study

Thu, 19 Feb 2026 00:00:00 GMT

English:Background:Hypoalbuminemia is recognised as a significant prognostic factor in critically ill coronavirus disease 2019 (COVID-19) patients. This study investigates the association between serum albumin levels and pulmonary computed tomography (CT) severity, as well as patient outcomes, including mortality, in intensive care unit (ICU)-admitted COVID-19 patients.Methods:This cohort study was conducted between March 2020 and October 2021 at Imam Reza Hospital, Iran. ICU-admitted COVID-19 patients were evaluated for demographic characteristics, clinical and laboratory parameters, lung CT findings with severity scoring and outcomes. Data analysis was performed using SPSS version 25.Results:Among 200 patients (mean age: 63.6 ± 16.1 years; 58% male), 80.0% (n = 160) presented with hypoalbuminemia. The average initial serum albumin level was 3.13 ± 0.49 g/dL. The overall mortality rate was 81% (n = 162). Survivors had significantly higher albumin levels (P = 0.003) compared to non-survivors. Based on multivariable logistic regression, higher serum albumin was associated with a 61% reduction in mortality odds (OR = 0.39, 95% CI: (0.18, 0.90), P = 0.027). However, no statistically significant correlation was found between serum albumin levels and pulmonary CT severity scores.Conclusion:Hypoalbuminemia in ICU COVID-19 patients is strongly associated with poor clinical outcomes and increased mortality, but not with the radiological extent of lung involvement seen on CT imaging.

Case series of idiopathic obliterative bronchiolitis in adults: Insights into a rare condition

Mon, 16 Feb 2026 00:00:00 GMT

English:Obliterative bronchiolitis is a rare and complex obstructive pulmonary disorder involving inflammatory and fibroproliferative changes of the small airways. We report three adult cases of idiopathic bronchiolitis obliterans diagnosed at the “Marius Nasta” Institute of Pulmonology, Bucharest, between 2016 and 2025. The patients, aged 30–68 years, presented with exertional dyspnoea and fatigue, and all exhibited severe obstructive ventilatory impairment with significant oxygen desaturation during the 6-min walk test. Diagnosis was confirmed by high-resolution inspiratory–expiratory computed tomography in two cases and by lung biopsy in one case. Treatment consisted of systemic and inhaled corticosteroids, with one patient also receiving longterm intermittent azithromycin therapy. Outcomes varied: two patients achieved relative clinical stability, while one experienced progressive respiratory decline leading to death. These cases illustrate the diagnostic and therapeutic challenges of idiopathic bronchiolitis obliterans and highlight its unpredictable course. Early recognition and individualised management are essential, but further research is needed to establish effective treatment strategies and improve prognosis.

Pulmonary solitary fibrous tumour: A rare and challenging entity

Mon, 16 Feb 2026 00:00:00 GMT

English:Solitary fibrous tumours (SFTs) are rare mesenchymal neoplasms with an incidence of less than one case per million people per year, most often exhibiting benign behaviour. Their intrapulmonary localisation is exceptionally uncommon and illustrates the hetero-geneity of pulmonary tumours in both clinical presentation and histopathology. We report the case of a 76-year-old female, aformer smoker (10 pack-years, quit 20 years ago), with advanced cardiometabolic comorbidities. A recent chest computed tomography (CT) scan revealed a large, well-defined pulmonary mass (85 × 64 mm) in the lingular segment of the left upper lobe, associated with condensating-atelectatic changes and ground-glass opacities in the right lower lobe, suggestive of infection and minimal right pleural effusion. Empirical antibiotic therapy was initiated, and the patient was referred to the pulmonology department. Bronchoscopy excluded endobronchial invasion, and CT-guided transthoracic biopsy confirmed SFTs based on morphology and immunohistochemical profile signal transducer and activator of transcription 6, cluster of differentiation 34, pan-cytokeratin [AE1/AE3] and SRY-related HMG-box 10 (STAT6+, CD34+, CK-AE1/3- and SOX10-). Risk assessment using the modified Demicco score indicated a low metastatic potential. Given the patient’s age, comorbidities and low-risk profile, a ‘watchful waiting’ strategy with periodic clinical and imaging follow-up was adopted in agreement with the thoracic surgery team. This case highlights the complexity of SFTs regarding localisation and therapeutic management, emphasising the essential role of a rigorous multidisciplinary approach, particularly in the absence of validated treatment guidelines derived from large patient cohorts.