Background: Middle lobe torsion is a rare complication of right upper lobectomy. Middle lobe torsion can be critical; thus, various preventive measures are used. Case presentation: A 77-year-old man underwent thoracoscopic right upper lobectomy with partial middle resection and S6 segmentectomy for right upper lobe lung cancer located at the confluence of the three lobes and lower lobe lung cancer. Inversion of the middle lobe was observed during lung expansion before chest closure. A bridging structure with an absorptive sheet and fibrin glue was placed in the basal section of the middle lobe under lung expansion to prevent torsion. On postoperative day 1, the patient was tachycardic and was found to have decreased lung field permeability. The patient underwent emergency surgery for suspected middle lobe torsion. Dislocation of the bridging structure between the basal segments of the middle lobe was confirmed, and the middle lobe was deviated cephalad. In addition, pulmonary congestion in S4 due to pressure stenosis of V4 caused by the deviation of the middle lobe was observed, and middle lobe resection was performed. The postoperative course was uneventful. Conclusions: This case suggested that the reinforcement method with an absorptive sheet and fibrin glue lacked sufficient strength to prevent middle lobe torsion. Stronger fixation should be considered if the middle lobe rotation is thought to be sufficiently strong when the lung is reinflated before chest closure.

Background: Open-window thoracostomy (OWT) is an effective life-saving treatment for refractory empyema. Nonetheless, the patients’ mental and physical suffering due to OWT is not minimal, and open-window closure is desirable if infection control is possible. When planning a treatment strategy after OWT, it is important to predict whether open-window closure is possible before OWT. This study aimed to identify factors related to open-window closure based on patient background factors before OWT. Methods: This observational retrospective cohort study included 42 patients with empyema who underwent OWT at a single institution over a 10-year period from April 2011 to March 2021. Cases in which closure was possible (closure group) were directly compared with cases in which closure was not possible (non-closure group). To identify the factors affecting closure, a logistic regression analysis was conducted to explore the patient background factors immediately before OWT. Results: Closure was possible in 20 patients (closure group) but was not in 22 patients (non-closure group). The closure methods employed for closure were omentum filling in 11 patients, muscle flap filling in 6 patients, breast tissue filling in 1 patient, spontaneous closure in 3 patients, and vacuum-assisted closure (VAC) in 2 patients. The median duration of the open window in the closed-window group was 242 days (35–1,880 days). The strong factors influencing window closure were “no malignant tumor” [odds ratio (OR): 2.68, 95% confidence interval (CI): 0.77–9.38, P=0.12], “no fistula” (OR: 3.41, 95% CI: 0.74–15.68, P=0.12), “age <70 years” (OR: 2.8, 95% CI: 0.78–9.99, P=0.11)”, and “hemoglobin (Hb) level ≥9.0 g/dL” (OR: 2.77, 95% CI: 0.69–11.08, P=0.15),” with a significant difference observed for “performance status (PS) 0/1” (OR: 7.0, 95% CI: 1.729–28.336, P=0.006). Conclusions: The PS before OWT is an important factor that affects open-window closure. By preoperatively informing patients with poor PS regarding the possibility of the window not being closed after surgery, we believe that patients and their families will be able to make the necessary adjustments and informed decisions.

Background/Objectives: Circulating tumor cells (CTCs) are important biomarkers for predicting prognosis and evaluating treatment efficacy in cancer. We developed the “CTC-Chip” system based on microfluidics, enabling highly sensitive CTC detection and prognostic assessment in lung cancer and malignant pleural mesothelioma. However, the final identification and enumeration of CTCs require manual intervention, which is time-consuming, prone to human error, and necessitates the involvement of experienced medical professionals. Medical image recognition using machine learning can reduce workload and improve automation. However, CTCs are rare in clinical samples, limiting the training data available to construct a robust CTC image recognition system. In this study, we established a highly accurate artificial intelligence-based CTC recognition system by pre-training convolutional neural networks using images from lung cancer cell lines. Methods: We performed transfer learning of convolutional neural networks. Initially, the models were pre-trained using images obtained from lung cancer cell lines. The model’s accuracy was improved by training with a limited number of clinical CTC images. Results: Transfer learning significantly improved the CTC classification accuracy to an average of 99.51%, compared to 96.96% for a model trained solely on pre-trained cell lines (p < 0.05). This approach showed notable efficacy when clinical training images were limited, achieving statistically significant accuracy improvements with as few as 17 clinical CTC images (p < 0.05). Conclusions: Overall, our findings demonstrate that pre-training with cancer cell lines enables rapid and highly accurate automated CTC recognition even with limited clinical data, significantly enhancing clinical applicability and potential utility across diverse cancer diagnostic workflows.

Introduction and importance: Choosing the optimal surgical approach for intractable pneumothorax can be challenging for surgeons. Case presentation: A case describing the management of intractable pneumothorax has been presented. Clinical discussion: Resection is not suitable in a stiff lung from repeated pleurodesis, and multiple air leakage points would make it more intricate.The ideal alternative is the use of another material to cover the entire lesion. Conclusion: A thickened parietal pleura covering is an effective surgical approach for intractable pneumothorax.

A 65-year-old man was admitted for a tissue biopsy of suspected right middle and lower lobe lung cancer with multiple bone metastases. During hospitalization, he started to cough up blood, which recurred after intubation. The patient experienced asphyxia, which led to cardiopulmonary arrest, but was successfully resuscitated. For complete hemostasis, palliative right pneumonectomy was performed. The decision to perform a pneumonectomy at an early stage contributed to saving the patient’s life. By the time of reporting, he had survived for almost 6 years on tyrosine kinase inhibitors administered to control the primary disease.

Background: Traumatic pulmonary pseudocysts are a rare complication resulting from pulmonary contusion associated with blunt chest trauma. Case presentation: A 17-year-old male patient underwent emergency surgery for hemostasis of a traumatic lung injury caused by a car accident. Because the bleeding was from the peripheral lung, partial resection was performed with an automated suture machine. A routine leak test (positive pressure ventilation at 20 cm H₂O) was performed as a precautionary measure. Postoperative imaging revealed rapid enlargement of a comorbid traumatic pulmonary pseudocyst. The collapse of the obliterating bronchus due to the accident and the intraoperative positive pressure ventilation for the air leak test were considered to have caused the rapid enlargement of the traumatic pulmonary pseudocyst. A thoracoscopic right lower lobectomy was performed on postoperative day 5. The patient had an uneventful postoperative course. Conclusions: To our knowledge, this is the first report of a rapidly enlarging traumatic pulmonary pseudocyst captured on preoperative and postoperative computed tomography. It would serve as a learning point for respiratory surgeons. These results suggest that when patients with traumatic pulmonary pseudocysts are operated on under general anesthesia, excessive positive pressure ventilation may cause a rapid expansion of the pulmonary pseudocyst.