Early diagnosis and rapid treatment of respiratory abnormalities such as many lung diseases including pneumonia, TB, cancer, and other pulmonary problems depend on accurate and fast classification of chest X-ray images. Delayed diagnosis and insufficient treatment lead to the subjective, labour-intensive, error-prone features of current manual diagnosis systems. To tackle this pressing healthcare issue, this work investigates many deep convolutional neural network (CNN) architectures including VGG16, VGG19, ResNet50, InceptionV3, Xception, DenseNet121, NASNetMobile, and NASNet Large. LungVisionNet (LVNet) is an innovative hybrid model proposed here that combines MobileNetV2 with multilayer perceptron (MLP) layers in a unique way. LungVisionNet outperformed previous models in accuracy 96.91%, recall 97.59%, precision, specificity, F1-score 97.01%, and area under the curve (AUC) measurements according to thorough examination on two publicly available datasets including various chest abnormalities and normal cases exhibited. Comprehensive evaluation with an independent, real-world clinical dataset from King Hussein Cancer Centre (KHCC), which achieved 95.3% accuracy, 95.3% precision, 78.8% recall, 99.1% specificity, and 86.4% F1-score, confirmed the model’s robustness, generalizability, and clinical usefulness. We also created a simple mobile application that lets doctors quickly classify and evaluate chest X-ray images in hospitals, so enhancing clinical integration and practical application and supporting fast decision-making and better patient outcomes.

Background: Tumor volume in Wilms tumor (WT) guides risk stratification under the International Society of Pediatric Oncology (SIOP) protocol. While the radiological ellipsoid formula is the current protocol-specified reference method, modalities such as planimetry, intraoperative specimen weight, and pathological volume are often used interchangeably in practice without systematic evaluation. Methods: We reviewed 60 pediatric WT patients. Three measurements were compared against the SIOP-standard radiological ellipsoid volume: radiological planimetry, intraoperative specimen weight, and pathological tumor volume. Pearson and Spearman correlations and Bland–Altman analysis were performed. Results: Radiological planimetry showed near-perfect correlation with the SIOP ellipsoid (Pearson r = 0.993, p < 0.001; mean bias +21.1 cm³, 95% limits of agreement −82.8 to +124.9 cm³, percentage bias +6.1%). Intraoperative specimen weight (r = 0.730) and pathological tumor volume (r = 0.594) showed moderate-to-good correlations but wide limits of agreement and systematic biases of +46.6% and −34.1%, respectively. At the critical 500 cm³ treatment threshold, ellipsoid and planimetry showed 100% concordance. However, using pathology volume would have produced discordant (lower) risk categorization for 47% of ellipsoid-defined high-risk patients, a discordance whose clinical treatment implications were not directly assessed in this study. Conversely, relying on intraoperative weight would have upstaged 9.1% of patients to a higher risk category, which could correspond to a more intensive treatment category, including doxorubicin, under the SIOP protocol; whether this would translate into unnecessary treatment in practice was not directly assessed in this study. Conclusions: Radiological planimetry is a highly reliable surrogate for the SIOP ellipsoid formula across all stages and histologies. Intraoperative weight and pathological volume exhibit significant systematic biases and should not be used to revise radiological risk groups. These findings support continued anchoring of SIOP risk stratification to preoperative radiological volumetry, consistent with the currently validated protocol threshold, to avoid unintended deviations in treatment intensity.

Chest tubes have traditionally been inserted after thoracotomy to evacuate air and fluid, thereby preventing inadequate lung expansion or tension pneumothorax. However, this practice has recently been questioned. This study was aimed at assessing the safety of omitting chest tube insertion in pediatric patients undergoing thoracotomy. We conducted a retrospective study among all pediatric patients younger than 19 years who underwent thoracotomy between January 2016 and October 2018 at our center. Data including patient demographics and surgical outcomes were collected and compared between all patients with vs without intraoperative chest tube insertion. Among 66 identified patients, 38 (57.6 %) had a chest tube inserted (CT group), and 28 (42.4 %) had no chest tube inserted (NCT group) intraoperatively. The median patient age was 13 years (range 1–19 years). A total of 59 patients (89.4 %) underwent lung wedge resection, 4 (6.1 %) underwent rib excision, and 3 (4.5 %) underwent thoracotomy for mediastinal mass excision. Among the patients who underwent lung wedge resection, fewer than three lesions were resected from the lung in 24 patients (96.0 %) in the NCT group and 25 patients (73.5 %) in the CT group, representing a statistically significant difference (P = 0.034). The median hospital stay in the CT group (5 (range 2, 15) days) was significantly longer than that in the NCT group (2.50 (range 1, 8) days) (P ≥ 0.0001). Follow-up imaging indicated full lung expansion in 34 patients (89.5 %) in the CT group and 23 patients (82.1 %) in the NCT group (no significant difference; p = 0.47). No mortalities or readmissions were reported. In pediatric thoracotomy, especially with fewer than three lung wedge resections, chest tube insertion can be safely omitted. This approach does not increase the postoperative chest tube insertion rate and is associated with shorter hospital stays.

Despite advances in systemic therapy, pulmonary metastasectomy remains a key option for selected patients with metastatic solid tumors, offering long-term

Background: Renal angiomyolipomas (AMLs) are benign renal tumors arising from perivascular epithelioid cells and are often associated with tuberous sclerosis complex. Renal epithelioid angiomyolipoma (EAML) is a rare variant of AML, characterized by the predominance of epithelioid cells with malignant potential. Although EAML is typically seen in adults, especially females, its occurrence in children is extremely rare and can be difficult to distinguish from other renal tumors. Case Presentation: We report a case of an 8-year-old girl with a right renal mass that initially was suspected to be a Wilms tumor based on imaging results and was treated with Wilms-directed chemotherapy without response. Histopathological investigations after a radical nephrectomy revealed an EAML composed primarily of epithelioid cells. Immunohistochemistry confirmed the diagnosis with positive results for HMB45 and Melan-A, highlighting the importance of histopathological and immunohistochemical evaluation in pediatric renal masses with atypical clinical behavior. Conclusion: Renal epithelioid angiomyolipoma should be considered in pediatric renal masses with atypical imaging features or poor response to Wilms tumor chemotherapy. Accurate diagnosis relies on histopathological and immunohistochemical evaluation, which helps guide appropriate surgical management and postoperative surveillance due to the tumor’s variable malignant potential.