Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses.

Background: Endobronchial tumors represent a heterogeneous spectrum of benign and malignant histopathological types. Selecting the optimal surgical strategy remains a multidisciplinary challenge. This study evaluates how the integration of spirometry, DLCO, and CPET can objectively stratify cardiorespiratory risk and guide surgical decision-making regarding resection type, postoperative complications, and perioperative mortality. Methods: A single-center, retrospective study was conducted between 2020 and 2025, evaluating an initial screening cohort of 93 patients with endobronchial masses. Following multidisciplinary tumor board review based on functional and anatomical criteria, 36 patients were excluded from major resection due to extensive disease or prohibitive functional risk, while 57 underwent tailored surgical interventions, including sleeve resections, lobectomies, bilobectomies, and pneumonectomies. Preoperative evaluation included spirometry, DLCO, cardiological assessment, CT, and autofluorescence bronchoscopy (AFB). Results: Spearman correlation analysis demonstrated that advanced age and higher ASA scores significantly correlated with reduced preoperative DLCO (p < 0.0001). The overall postoperative morbidity rate was 36.84% (n = 21) and perioperative mortality was 5.26% (n = 3). Stratified analysis by surgical magnitude demonstrated a significant escalation in overall complication rates from parenchymal-sparing sleeve resections (17.6%, 95% CI: 3.8% to 43.4%) to standard lobectomies (40.7%, 95% CI: 22.4% to 61.2%), bilobectomies (50.0%, 95% CI: 15.7% to 84.3%), and radical pneumonectomies (60.0%, 95% CI: 14.7% to 94.7%; p = 0.042). Severe morbidity (Clavien–Dindo Grade III–IV) was significantly lower in the sleeve resection subgroup (5.8%) compared to pneumonectomies (40.0%, p = 0.015). Fatal outcomes occurred exclusively following major resections and were attributable to ARDS and acute cardiovascular events. Conclusions: A multi-parametric preoperative protocol provides an informative framework for risk stratification in endobronchial tumor surgery, helping to describe baseline reserves and explore post-resection trends. However, the anatomical and hemodynamic magnitude of radical pneumonectomy constitutes an independent risk modifier that cannot be fully captured by preoperative functional testing alone, highlighting the exploratory nature of these single-center retrospective observations rather than a definitive algorithmic validation.

Background/Objectives: Sleeve lobectomy serves as a parenchyma-sparing alternative to pneumonectomy for central non-small cell lung cancer (NSCLC). This study describes and compares early postoperative outcomes and overall survival between sleeve lobectomy and pneumonectomy and explores factors associated with survival. Methods: A retrospective cohort analysis was conducted on 97 consecutive patients with central NSCLC operated at the Marius Nasta National Institute of Pneumophthisiology between September 2021 and December 2022, with follow-up through 1 March 2025. Patients were divided into two groups: sleeve lobectomy (n = 41) and pneumonectomy (n = 56). Early morbidity, mortality, and overall survival were evaluated using univariate analysis and multivariable Cox proportional hazards regression. Results: After multivariable adjustment, surgical procedure was not significantly associated with overall survival. A low rate of major anastomotic complications was observed in the sleeve lobectomy group, with one case of early partial anastomotic leak (2.44%) requiring surgical reinforcement. In an exploratory multivariable model, pathological nodal involvement and the number of involved lymph nodes were associated with mortality. Conclusions: In appropriately selected patients where an R0 parenchyma-sparing resection is technically feasible, sleeve lobectomy is associated with acceptable morbidity and survival. After adjustment, the surgical procedure was not significantly associated with overall survival. Nodal disease burden was the factor most strongly associated with survival in this cohort.