Introduction: Bronchiectasis is a chronic progressive respiratory disease characterized by permanent dilatation of the bronchi. It is a complex condition with numerous different etiologies, co-morbidities, and a heterogeneous presentation. As we know, there is a lack of studies that describe the differences and compare the characteristics between focal and multifocal bronchiectasis. The aim of this study is to identify differences in clinical characteristics presentation, severity or distribution in focal and multifocal bronchiectasis, and prognostic implications. Methods: 126 patients with computed tomography (CT)-verified bronchiectasis were enrolled. Baseline characteristics that included age, sex, smoking history, and respiratory symptoms were recorded, with special attention paid to hemoptysis appearance, body mass index, and comorbidities. The type of bronchiectasis determined by CT scan and the modified Reiff scores indicating radiological severity were recorded. Patients were divided in two groups (I is focal and II is multifocal). Results: There were no statistically significant differences in age, smoking status, comorbidity, and BMI between the two groups. Multifocality was associated with a significantly higher proportion of females (p = 0.014), the rate of hemoptysis (p = 0.023), and the number of hospitalizations, but not of exacerbations and prevalence of immunodeficiency (p = 0.049). Significantly, a high number of subjects with multifocality had bronchiectasis of moderate severity, and post-infective and asthma-associated phenotypes were the dominant in this group. Unexpectedly, the cystic and varicose radiological phenotype (which need more time to develop) were more dominant in the focal group. The cylindrical phenotype was equally observed in the multifocal and focal groups. Conclusions: Our study suggests that multifocality is not related to age, number of exacerbations, or radiological phenotype, but it seems to be associated with the clinical post-infective phenotype, immunodeficiency, frequent hospitalizations, and severity. Thus, the presence of multifocal bronchiectasis may act as a biomarker of severity and poor outcomes in these patients.

Three subtypes of achalasia have been defined using esophageal manometry. Several studies have reported that symptoms are experienced differently among men and women, regardless of subtype. All subtypes could have some impact on the appearance of respiratory symptoms and lung complications due to compression of the trachea or aspiration of undigested food. The aim of this research was to analyze the differences in respiratory symptoms and radiographic presentation of lung pathology depending on the diameter and achalasia types. One or more respiratory symptoms were reported in 48% of 114 patients, and all of them had two or more gastrointestinal symptoms. The symptom score (SS) is statistically significant for the prediction of subtype 1 (area under the curve = 0.318; p < 0.001, cut-off score of 6.5 had 95.2% sensitivity) and subtype 2 (area under the curve = 0.626; p = 0.020, cut-off score of 7.5 had 93.1% sensitivity). The most common type was subtype 2 (50.8%), and although only 14 patients had subtype 3, they had the largest esophageal diameter (mean 5.8 cm). The difference in esophageal diameter was significant between subtype 1 and 3 (p = 0.011), subtype 2 and subtype 3 (p = 0.011). Nine patients (6%) had mega-esophagus (four patients in type 1, three in type 2 and two in type 3). More than half of all patients (51.7%) had at least one parenchymal lung change on CT scan. Recurrent micro-aspirations led to changes in the structure of the airways and lung parenchyma such as ground glass (GGO) and nodular changes (12%) and fibrosis (14.5%), and they had higher esophageal diameters (p < 0.001). Patients with chronic lung CT changes had significantly higher esophageal diameter than with acute changes (p < 0.001). Awareness of the association of achalasia and lung disorders is important in early diagnosis and treatment. More than half (57.5%) of patients with achalasia had some clinical and/or structural pulmonary abnormalities. All three subtypes had similar respiratory symptoms, meaning they cannot be used to predict the subtype of achalasia; on the contrary, SS can predict the first two subtypes. A higher diameter of the esophagus is associated with chronic structural lung changes. Although unexpected, the pathological radiological findings and diameter were significantly different in subtype 3 patients, but those parameters cannot lead us to a specified subtype.

Sarcoidosis is a granulomatous disease of unknown etiology that can affect almost any organ. Although the acute form can have spontaneous regression, a certain number of patients can have a chronic form, which leads to an increase in mortality and a decrease in the quality of life. Considering that the risk factors are still unknown, we wanted to compare the characteristics of patients with acute and chronic forms of sarcoidosis in Serbia in order to determine significant differences between them with hopes of contributing to everyday clinical practice. A total of 2380 patients treated in our clinic were enrolled in this study. They were separated into the following two groups: 1126 patients with acute form and 1254 patients with chronic form. They were further compared by gender, smoking status, radiological status, exposition, biomarkers for sarcoidosis, organ involvement, and other comorbidities; the distribution of patients according to regions of Serbia was also noted. Statistical significance was found in radiological findings (p < 0.001), biomarkers (calcium in 24 h urine p < 0.001; chitotriosidase p = 0.001), and the affliction of organs (p < 0.001). The differences noted in this paper could help improve our understanding of this disease.

Introduction/aim Clinical signs and symptoms of pulmonary embolism (PE) are non-specific, which is why it is commonly not diagnosed on time or sometimes not diagnosed at all. We are presenting a case of pulmonary embolism manifesting with syncope as a dominant symptom. Case report A 74-year-old female patient was hospitalized at the Clinic for Pulmonary Diseases with PE manifested with syncope. At admission, she was afebrile, tachypneic, with normal cardiac function and normal blood tension. Upon auscultation, breathing was muffled with late inspiration crackles above the base of the left lung. There were no other significant findings. The chest X-ray recorded at admission showed a non-homogenous shadow towards the base of the left lung and minimal pleural effusion. The ECG and echocardiography findings were normal. Partial respiratory insufficiency was verified by the acid-base balance analysis. Inflammatory markers were significantly elevated, with erythrocyte sedimentation rate of 30mm/h, fibrinogen of 8.62g/l and D-dimer of 18.6mg/l. Anticardiolipin IgG and IgM antibodies were negative, as well as beta-2 GPI IgG and IgM antibodies. An MDCT lung angiography was performed because of the elevated values of D-dimer and tachypnea, which showed multiple emboli of various sizes in the distal part of the right pulmonary artery and all lobar branches, as well as an embolus in the lobar branch for the lower lobe of the left lung. After a neurology consult, a head CT was ordered because the patient had suffered from loss of consciousness, but there were no pathological densities in the brain. Colour Doppler Ultrasonography of the blood vessels in the lower extremities showed organized thrombosis of the left femoral vein. A vascular surgeon was consulted and he prescribed anticoagulant therapy and an elastic compressive stocking, with control Colour Doppler Ultrasonography to be performed in six months. Conclusion Although syncope is an easily detectable symptom, it is still an unregulated crossroad of many an internal and neurological disease.

Progressive pulmonary fibrosis (PPF) comprises interstitial lung diseases characterized by progressive fibrosis and lung function decline. Nintedanib slows disease progression by inhibiting FGFR, VEGFR, and PDGFR signaling, but treatment response varies among patients. We investigated whether VEGFR2, PDGFRB, and TGFB1 gene variants are associated with nintedanib treatment outcomes, including changes in pulmonary function, diffusing capacity and adverse effects. This prospective study included 75 patients with PPF diagnosed according to ATS/ERS/JRS/ALAT criteria and treated with nintedanib at the Clinic of Pulmonology, University Clinical Center of Serbia. Spirometry and diffusing capacity were assessed at baseline and after 6 and 12 months. Genotyping of VEGFR2 rs2071559 and rs1870377; PDGFRB rs2302273, rs2229562, and rs246395; and TGFB1 rs1800470 was performed using TaqMan^® assays. Carriers of the PDGFRB rs2302273 A allele more frequently experienced gastrointestinal adverse events (45.2% vs. 20.5%; p = 0.022; OR 3.2, 95% CI 1.156–8.866) and diarrhea (38.7% vs. 15.9%; p = 0.026; OR 3.3, 95% CI 1.129–9.869). Patients with the PDGFRB rs246395 TT genotype more frequently had a ≥15% decline in DLCO after one year (46% vs. 22%; p = 0.038; OR 3.0, 95% CI 1.045–8.394). No significant associations were observed for the analyzed VEGFR2 or TGFB1 variants. These findings suggest that PDGFRB variants may be associated with nintedanib treatment outcomes, although confirmation in larger cohorts is needed.

Introduction: Coronary artery calcifications (CAC) and emphysema are common findings detected during low-dose computed tomography (LDCT) lung cancer screening. This study investigated the association between CAC and pulmonary function parameters among individuals with CT-detected emphysema. Materials and Methods: This cross-sectional study included 323 participants with radiographically detected emphysema identified through a lung cancer screening program. All participants underwent pre-bronchodilator spirometry. We evaluated associations among CAC, pre-bronchodilator airflow limitation, and pulmonary function parameters. We used multivariable logistic regression to identify factors independently associated with CAC. Results: Coronary artery calcifications were present in 216 participants (66.9%). Participants with CAC were significantly older than those without CAC (68.2 ± 6.7 vs. 61.1 ± 7.1 years, p < 0.001) and were more frequently male (59.3% vs. 32.7%, p < 0.001). Pre-bronchodilator airflow limitation was significantly more common among participants with CAC (50.0% vs. 35.5%; p = 0.014). No significant differences were observed in FEV1 or FVC values. In multivariable logistic regression analysis, age and male sex were independently associated with CAC, whereas pre-bronchodilator airflow limitation was not independently associated with CAC after adjustment. Conclusion: Among individuals with CT-detected emphysema, coronary artery calcifications were associated with a higher prevalence of pre-bronchodilator airflow limitation. However, age and male sex were the strongest independent predictors of CAC, suggesting that shared demographic and cardiovascular risk factors may account for much of the observed overlap between pulmonary and cardiovascular abnormalities. These findings support the value of integrated cardiopulmonary assessment within lung cancer screening programs.