eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 102 107 10.26663/cts.2025.019 265 article Monisha G 1 Manikanta KS 2 Department of Cardiothoracic and Vascular Surgery, Bangalore Medical College and Research Institute, Bangalore, IndiaDepartment of General Surgery, Bangalore Medical College and Research Institute, Bangalore, India Original Article Corresponding<b>Background: </b>Hemothorax is a common consequence of blunt chest trauma. A subset progresses to complicated hemothorax requiring repeat procedures. This study aimed to identify predictors of complicated hemothorax.<p> <b>Materials and Methods:</b> A retrospective cohort study was conducted, including 60 patients with blunt chest trauma and hemothorax managed at a tertiary care center. Patients were grouped into uncomplicated (n = 30) and complicated hemothorax (n = 30, requiring additional procedures). Logistic regression was performed to identify predictors.<p> <b>Results: </b>On univariate analysis, delay in ICD placement >3 days (OR 5.09, p = 0.015) and loculated/septated collections (OR 21.1, p < 0.001) were associated with complicated hemothorax. In multivariable analysis, only loculated/septated collections remained an independent predictor (adjusted OR 26.5, p = 0.006).<p> <b>Conclusions:</b> Loculated collections are the strongest predictor of complicated hemothorax. Early identification of septated/loculated collections on imaging should prompt timely surgical referral, preferably VATS, to reduce morbidity and minimize repeat procedures. In delayed-presentation trauma with loculated collections or comorbidities, early surgical intervention should be considered as simple chest drainage is often insufficient. https://cts.tgcd.org.tr/pdf.php?id=265 hemothoraxblunt chest traumavideo-assisted thoracoscopic surgeryempyemachest tubes eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 108 113 10.26663/cts.2025.020 266 article Nilay Çavuşoğlu Yalçın 1 Okan Karataş 1 Muharrem Özkaya 1 Department of Thoracic Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye<b>Background: </b>To evaluate the scientific accuracy, informational quality, and readability of artificial intelligence (AI) chatbots in providing postoperative education after thoracic surgery.<p> <b>Materials and Methods:</b> Five publicly available chatbots, GPT-5o, GPT-4o, GPT-4.1, Claude Opus- 4, and Gemini Pro were tested using a standardized prompt on postoperative care after lung resection. Each Chatbot’s response was independently assessed by a thoracic surgeon using two validated scoring systems: the Modified Ensuring Quality Information for Patients (mEQIP) and the Quality Analysis of Medical Artificial Intelligence (QAMAI). Readability was evaluated by the Average Reading Level Consensus (ARLC) index. Descriptive and comparative analyses were performed. As no human or patient data were used, ethical approval was exempt.<p> <b>Results: </b>The mean mEQIP score across models was 84.7 ± 5.5 %, indicating high content quality, and the mean QAMAI score was 27.2 ± 2.0 / 30, reflecting high accuracy and completeness. GPT-4.1 and GPT-5o achieved the highest scores, whereas Gemini Pro provided the least comprehensive content. The mean ARLC grade was 11.0 ± 0.6, corresponding to a college reading level.<p> <b>Conclusion: </b>AI chatbots can produce accurate, guideline-consistent postoperative information after thoracic surgery; however, their language complexity often exceeds that of most patients. Simplifying expressions and improving transparency are essential before chatbots can be safely integrated into postoperative patient education. https://cts.tgcd.org.tr/pdf.php?id=266 artificial intelligencechatbotthoracic surgerypostoperative carepatient educationreadability eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 114 123 10.26663/cts.2025.021 267 article Gamze Tanrıkulu 1 Hüseyin Melek 2 Tolga Evrim Sevinç 3 Erhan Özer 2 Eylem Yentürk 4 Ahmet Sami Bayram 2 Cengiz Gebitekin 2 Department of Thoracic Surgery, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, TürkiyeDepartment of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, TürkiyeClinical Research Center, Faculty of Medicine, Koç University, Istanbul, TürkiyeDepartment of Thoracic Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Türkiye<b>Background:</b> Compensatory hyperhidrosis (CH) is the most common complication following endoscopic thoracic sympathectomy (ETS) and significantly impairs quality of life (QOL). This study assesses and compares the QOL before and after our minimal invasive intercostal nerve reconstruction technique (the “Gebitekin Technique”, GT) in CH patients.<p> <b>Materials and Methods: </b>Between January 2014 and November 2016, 32 consecutive CH patients underwent GT. Patients’ satisfaction levels and demographic parameters were self-assessed before surgery and six months postoperatively using the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and institutional questionnaires.<p> <b>Results:</b> A total of 64 surgeries were performed in 32 patients with a mean age of 32.5 ± 6.77 years. All patients who underwent GT responded to the questionnaires. Improvement of CH symptoms was observed in 24 (75%) patients, along with improvement in dryness in 60%. None of the patients had recurrence of primary hyperhidrosis. Significant (p < 0.05) improvements were observed in all survey sub-areas following surgery.<p> <b>Conclusion:</b> This study demonstrates that GT improves QOL and alleviates related symptoms in the overwhelming majority of patients with CH. https://cts.tgcd.org.tr/pdf.php?id=267 compensatory hyperhidrosisintercostal nerve reconstructionsurveyquality of lifeGebitekin technique eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 124 130 10.26663/cts.2025.022 268 article Muhammad Shoaib Nabi 1 Zeeshan Sarwar 1 Department of Thoracic Surgery, Services Institute of Medical Sciences (SIMS), Services Hospital, Lahore, Punjab, Pakistan<b>Background: </b>Hepatic hydrothorax is a debilitating complication of advanced liver disease, often unresponsive to medical therapy. In settings where liver transplantation and TIPS are not readily available, talc pleurodesis may offer effective palliation. This study evaluates its outcomes, safety, and predictors of recurrence in such patients.<p> <b>Materials and Methods:</b> A retrospective observational review study was conducted on 52 patients undergoing talc pleurodesis for hepatic hydrothorax between January 2020 and June 2025. Data included demographics, liver disease etiology, Child–Pugh class, MELD score, serum albumin, chest tube duration, hospital stay, recurrence, and complications. Quantitative variables were expressed as mean ± SD, and correlations were analyzed using Pearson’s r.<p> <b>Results:</b> Mean age was 61.2 ± 7.2 years; 67.3% were male. Hepatitis C was the leading etiology (96.2%), and 82.7% were Child–Pugh class C. Mean MELD score was 15.2 ± 5.4, correlating with both Child–Pugh class (r = 0.67) and recurrence (r = 0.63). Baseline albumin was 2.78 ± 0.44 g/dL, inversely related to recurrence (r = –0.39). After albumin optimization (>3.4 g/dL), the correlation disappeared (r = 0.02). Mean chest tube duration was 12.8 ± 7.3 days, hospital stay 4.6 ± 2.5 days, with a strong correlation between tube duration and recurrence (r = 0.67). Clinical control was achieved in 77%; pain (19.2%) and empyema (11.5%) were the main complications.<p> <b>Conclusions: </b>Talc pleurodesis offers effective palliation and significant symptomatic relief in refractory hepatic hydrothorax, especially where advanced therapies are inaccessible, improving quality of life for patients with end-stage liver disease. https://cts.tgcd.org.tr/pdf.php?id=268 hepatic hydrothoraxtalc pleurodesiscirrhosispalliative managementrecurrence eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 131 138 10.26663/cts.2025.023 269 article Merve Ezgi Unal 1 Tevfik İlker Akcam 2 Funda Elmas Uysal 3 Ayse Gul Ergonul 2 Ali Ozdil 2 Kutsal Turhan 2 Alev Gurgun 3 Melike Ülker 4 Alpaslan Cakan 2 Ufuk Cagirici 2 Department of Thoracic Surgery, Nevsehir City Hospital, Nevsehir, TürkiyeDepartment of Thoracic Surgery, School of Medicine, Ege University, İzmir, TürkiyeDepartment of Chest Diseases, School of Medicine, Ege University, İzmir, TürkiyeDepartment of Thoracic Surgery, Avrasya Hospital, Istanbul, Türkiye<b>Background: </b>In this study, it was planned to improve the respiratory and metabolic capacities of patients who will be operated for lung cancer in the preoperative period. Thus, the effect of preoperative pulmonary rehabilitation (PPR) on postoperative morbidity / mortality rates and the duration of hospital stay was investigated.<p> <b>Materials and Methods: </b>Between July 2020 and February 2021, 43 patients who were operated for lung cancer were evaluated prospectively. Group I (n = 20) patients were included in the PPR program for 2 weeks preoperatively. PPR was not applied to the control group, Group II (n = 23) patients. Demographic findings of the cases, postoperative length of stay and drain duration, postoperative complication development were compared.<p> <b>Results:</b> The mean age of Group I was 63.60 ± 5.87 (54-75), while that of Group II was 60.78 ± 13.30 (32-83). Surgical mortality was not observed in any patient. While morbidity was observed in 7 (35%) patients in Group I and 13 (65%) patients in Group II (p = 0.158). The postoperative hospital stay of Group I was found to be statistically significantly lower than Group II (p = 0.026). It was determined that the drain stay time of Group I patients was shorter than Group II (p = 0.009).<p> <b>Conclusion:</b> It was seen that the importance of preoperative pulmonary rehabilitation was high in achieving less complications and shorter hospital stay in the postoperative period in patients who underwent pulmonary rehabilitation due to lung cancer surgery. https://cts.tgcd.org.tr/pdf.php?id=269 lung surgerynon-small cell lung cancerpulmonary rehabilitationmorbidity eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 139 146 10.26663/cts.2025.024 270 article Ozgur Ozturk 1 Kenan Can Ceylan 2 Onur Akcay 1 Seyda Ors Kaya 2 Ahmet Ucvet 2 Soner Gursoy 1 Aysen Evkan Ozturk 3 Ozgur Samancilar 4 Department of Thoracic Surgery, Bakırçay University Çiğli Training and Research Hospital, Izmir, TurkiyeDepartment of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, TurkiyeDepartment of Intensive Care Unit, University of Health Sciences, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, TurkiyeDepartment of Thoracic Surgery, Medicana International Izmir Hospital, Izmir, Turkiye<b>Background: </b>In case of failure or a presence of residual tumor after definitive chemotherapy and/or radiotherapy applied in advanced lung cancer treatment, surgical treatment with R0 resection can be performed in selected patients. Also called salvage resections, the indications for these operations remain unclear in the literature. Our study investigated the efficacy of "Salvage" operations using postoperative survival, intraoperative–postoperative morbidity, and mortality along with prognostic factors.<p> <b>Materials and Methods: </b>Patients operated on for non-small cell lung cancer between January 2006 and December 2016 were examined. Among these patients, 51 patients who underwent R0 resection after definitive chemotherapy and/or radiotherapy were evaluated.<p> <b>Results: </b>The mean age was 57.58 ± 6.78 (46-78) years in 46 male and 5 female patients. Thirty-two (62.74%) patients had chemotherapy at the definitive dose, 16 (31.37%) received chemoradiotherapy, 3 (5.88%) underwent high-dose radiotherapy. The mean duration between treatment and surgery was 14 ± 10.89 (6-74) weeks. Thirty-two patients were clinically evaluated as Stage 3A, while 19 as Stage 3B and referred to definitive therapy. Thirty (63%) patients underwent lobectomy and 19 (37%) pneumonectomy. Forty-two patients (82.35%) had no complications, and there were complications in 9 (17.65%) patients. Postoperative mortality occurred in four (7.8%) patients. Five-year survival was calculated as 36.6%, and the median survival was 34 months. Median progression-free survival was 26.23 months.<p> <b>Conclusion: </b>"Salvage surgery" has been considered a feasible method in experienced centers with acceptable morbidity and mortality in selected patients with advanced lung cancer. https://cts.tgcd.org.tr/pdf.php?id=270 definitive therapylung cancersalvage surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 147 153 10.26663/cts.2025.025 271 article Atilla Can 1 Halil Şen 2 Muhammet Ali Tiske 1 Tuba Şahinoğlu 1 Hüseyin Yıldıran 1 Department of Thoracic Surgery, Selçuk University Faculty of Medicine, Konya, TurkeyDepartment of Thoracic Surgery, University of Health Sciences, Beyhekim Training and Research Hospital, Konya, Turkey<b>Background:</b> Earthquakes are sudden and destructive natural disasters with significant health implications. Thoracic injuries are among the most prevalent and serious trauma types due to their high morbidity and mortality rates. This study aimed to evaluate the clinical features, types of injuries, and management processes of thoracic trauma cases following the February 6, 2023, earthquakes in Turkey.<p> <b>Materials and Methods: </b>The study was conducted at a tertiary trauma center and included 14 patients. Data on age, gender, types of trauma, chest trauma score (CTS), duration of entrapment under debris, and associated injuries were analyzed. Statistical analyses were performed using SPSS version 21.0 with appropriate parametric and non-parametric tests.<p> <b>Results:</b> The mean age of patients was 43.64 ± 16.58 years, with 64.3% female and 35.7% male. The most common injuries were rib fractures (57.1%), hemothorax (35.7%), and crush syndrome (28.6%). The mean CTS was 3.50 ± 2.68, and 80% of patients with CTS scores above 5 had significant complications. Entrapment duration under debris was shorter in older patients, showing a statistically significant negative correlation with age (Spearman’s rho = -0.568, p = 0.034). Prolonged entrapment was associated with longer hospital stays (Spearman’s rho = 0.634, p = 0.015).<p> <b>Conclusion:</b> Earthquake-related thoracic injuries represent serious medical challenges that require multidisciplinary approaches and early interventions. The CTS proved effective in assessing trauma severity and guiding clinical priorities. Entrapment duration and age were identified as critical factors influencing patient prognosis, emphasizing their importance in post-disaster healthcare planning. Future studies with larger samples are needed to further investigate these relationships. https://cts.tgcd.org.tr/pdf.php?id=271 chest traumaearthquake injurieshemothoraxrib fracturethoracic injuries eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 154 159 10.26663/cts.2025.026 272 article Esra Yamansavci Sirzai 1 Gizem Ozcibik Isik 2 Ufuk Cicek 1 Dilekhan Kizir 2 Yunus Turk 1 Celal Bugra Sezen 2 Ozkan Saydam 2 Ahmet Ucvet 1 Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, TürkiyeDepartment of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Türkiye<b>Background: </b>The aim of this study was to evaluate the prognostic impact of the Geriatric Nutritional Risk Index (GNRI) on survival in patients aged 70 years and older who underwent surgery for earlystage non-small cell lung cancer (NSCLC).<p> <b>Material and Methods: </b>The study included 234 patients with pathological stage 1-2 who underwent surgery at two centers between 2007 and 2020 and who did not receive preoperative neoadjuvant therapy. Patients were divided into two groups based on age: 70-75 years (Group 1) and ≥75 years (Group 2). GNRI was calculated based on serum albumin level and body weight. The difference in survival between the groups was evaluated using Kaplan-Meier analysis, and the prognostic value of GNRI was evaluated using ROC analysis.<p> <b>Results: </b>No significant association was found between the GNRI value and overall survival (p = 0.506). However, in the ≥75 age group, the survival predictive potential of the GNRI was found to be moderate in ROC analysis (AUC = 0.638). The GNRI cut-off value for this group was determined as 55.7. No significant association was found between the GNRI and clinical parameters such as age, gender, or tumor stage.<p> <b>Conclusions:</b> The GNRI may be a potential biomarker for predicting survival, especially in NSCLC patients aged 75 and older. Preoperative nutritional support may improve clinical outcomes in patients with low GNRI values. The GNRI may contribute to personalized treatment decisions in the evaluation of elderly NSCLC patients. https://cts.tgcd.org.tr/pdf.php?id=272 geriatric nutritional risk indexnon-small cell lung cancerelderly patientssurvivalnutritional statusprognostic biomarker eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 160 162 10.26663/cts.2025.027 273 article Hasan Yavuz 1 Fatih Yılmaz 2 Fulden Haşimoğlu 3 Department of Thoracic Surgery, Mardin Training and Research Hospital, Mardin, TurkeyDepartment of Pathology, Mardin Training and Research Hospital, Mardin, TurkeyDepartment of Thoracic Surgery, Kızıltepe State Hospital, Mardin, TurkeyHeterotopic supradiaphragmatic liver tissue (HSLT) is an extremely rare condition, with about 30 cases documented in the literature since its first description. Because it often shows no symptoms and looks similar to pleural or parenchymal tumors on imaging, HSLT poses a significant diagnostic challenge. Although the cause remains unknown, a definitive diagnosis usually requires surgery. While conservative treatment is suitable for clinically confirmed cases, surgical exploration becomes necessary when malignancy cannot be ruled out. In such cases, the videothoracoscopic approach (VATS) is considered the gold standard for both diagnosis and treatment. Here, we report a case of HSLT discovered incidentally during imaging for acute appendicitis. We review the diagnostic difficulties and recommend VATS as the primary surgical option for unclear lesions above the diaphragm. https://cts.tgcd.org.tr/pdf.php?id=273 choristomaliverthoracic surgeryvideo-assisteddiaphragmincidental findingdiagnosisdifferential eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 163 165 10.26663/cts.2025.028 274 article Selime Kahraman 1 Attila Ozdemir 1 Saliha Bayraktar 2 Recep Demirhan 2 Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, TurkeySpontaneous pneumothorax secondary to pulmonary metastasis is a rare but critical condition, particularly when it occurs in the single remaining lung of a patient who has undergone pneumonectomy. We present the case of a 62-year-old male with a history of left pneumonectomy for a malignant mesenchymal tumor who developed a right-sided pneumothorax one year postoperatively. Due to a persistent air leak resistant to tube thoracostomy, a chest CT was performed, revealing a subpleural metastatic lesion. The patient successfully underwent single-port Video-Assisted Thoracoscopic Surgery (VATS) wedge resection and apical pleurectomy under general anesthesia with transient apnea. This case highlights that despite the limited pulmonary reserve in pneumonectomized patients, single-port VATS offers a safe and effective approach for the definitive management of secondary pneumothorax caused by metastasis in the contralateral lung. https://cts.tgcd.org.tr/pdf.php?id=274 pneumonectomypneumothoraxvideo-assisted thoracic surgerylung neoplasmsneoplasm metastasis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 166 169 10.26663/cts.2025.029 275 article Caner İşevi 1 Mehmet Gökhan Pirzirenli 1 Feyza Bahar Doğan 1 Yurdanur Süllü 2 Burçin Çelik 1 Department of Thoracic Surgery, School of Medicine, Ondokuz Mayis University, Samsun, TurkeyDepartment of Pathology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey Case Report CorrespondingPleural capillary hemangiomas are exceptionally rare vascular tumors that may present with massive pleural effusion, often mimicking traumatic hematoma or malignancy. Due to nonspecific clinical features and inconclusive imaging, diagnosis is often delayed. We present a 52-year-old woman with progressive dyspnea and left-sided pleural effusion. Imaging revealed a pleural-based lesion, but malignancy was not confirmed by cytology or bronchoscopy. Video-assisted thoracoscopic surgery and histopathology confirmed capillary hemangioma. Surgical excision led to full recovery without recurrence. This case underscores the importance of considering benign vascular tumors in the differential diagnosis of unexplained pleural effusions. https://cts.tgcd.org.tr/pdf.php?id=275 capillary hemangiomapleurapleural effusionvideo-assisted thoracoscopic surgerydifferential diagnosis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 170 174 10.26663/cts.2025.030 276 article Mustafa Kazar 1 Tibet Uğur Kurak 1 Fatma Bağrıaaçık Ekinci 1 Mehmet Oğuz Köksel 1 Department of Thoracic Surgery, Faculty of Medicine, Mersin University, Mersin, TurkeyBronchobiliary fistula (BBF) is a rare condition characterized by an abnormal communication between the biliary tract and the bronchial tree. In developing countries, it most commonly occurs as a complication of hepatic hydatid cysts or amebic liver abscesses, whereas in developed countries, it is more frequently associated with trauma or previous biliary surgery. Bilioptysis, defined as the expectoration of bilestained sputum, is a pathognomonic symptom observed in most patients. The diagnostic and therapeutic management of BBF requires a multidisciplinary and patient-specific approach, beginning with noninvasive or minimally invasive procedures and sometimes requiring major surgical intervention. This case is remarkable because, despite clinical findings suggestive of BBF, preoperative imaging failed to demonstrate the fistulous tract. Moreover, the intraoperative discovery of gallstones within a destructed lung parenchyma makes this case exceptionally rare. https://cts.tgcd.org.tr/pdf.php?id=276 bronchobiliary fistulagallstonesbilioptysislung diseasesthoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 175 178 10.26663/cts.2025.031 277 article Muhammad Shoaib Nabi 1 Zeeshan Sarwar 1 Khalid Farooq 2 Department of Thoracic Surgery, Services Institute of Medical Sciences (SIMS), Services Hospital, Lahore, PakistanDepartment of Radiology, Lahore Medical and Dental College, Lahore, PakistanFibro-osseous lesions of the rib are rare benign entities that frequently mimic primary or secondary chest wall malignancies. They are most commonly reported in the sixth to eighth ribs, with lower rib involvement being exceptionally uncommon. Radiological findings are often nonspecific, thus, histopathological evaluation is crucial for establishing a definitive diagnosis. We report the case of a 32-year-old female presenting with left lower chest pain and a firm, gradually expanding swelling over the left posterolateral chest wall. Imaging revealed a lytic lesion of the left 11th rib, raising suspicion of a primary bone tumor. Given the diagnostic uncertainty, resection of the affected rib segment was performed. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. Histopathology confirmed a benign fibro-osseous lesion. Fibro-osseous lesions of the rib are rare and diagnostically challenging due to their radiological resemblance to malignant tumors. Involvement of the 11th rib is infrequent, and to our knowledge, has not been previously documented. This case showed the importance of surgical excision in achieving diagnostic certainty in the case of a fibro-osseous lesion. https://cts.tgcd.org.tr/pdf.php?id=277 fibro-osseous lesion of ribrib tumorbenign chest wall tumorchest wall resectionmalignancyimmunohistochemistry eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 179 183 10.26663/cts.2025.032 278 article Damla Hasgül 1 Nurefşan Okyay 2 Tibet Uğur Kurak 2 Erhan Ayan 2 Department of Thoracic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, TurkeyDepartment of Thoracic Surgery, Faculty of Medicine, Mersin University, Mersin, TurkeySmoking constitutes one of the most significant risk factors in the etiology of giant bullous emphysematous lung disease, leading to the development of massive bullous lesions. This clinical entity is one that poses a diagnostic challenge due to confusion with spontaneous pneumothorax on imaging modalities. In this case report, we present a 52-year-old male patient with underlying Chronic Obstructive Pulmonary Disease (COPD) and a significant history of smoking. The patient presented to the emergency department with chest pain and acute dyspnea. Following the detection of a giant bulla on thoracic computed tomography (CT), the patient was referred to our clinic due to respiratory limitation and the necessity for planned preventive surgical management. This presentation is primarily designed to address the identification of large lung bullae, their integrated management in conjunction with underlying COPD, the radiological criteria for differentiating a bulla from pneumothorax, and to share our operative observations regarding the surgical intervention. https://cts.tgcd.org.tr/pdf.php?id=278 giant bullapneumothoraxemphysemabullectomyvanishing lung syndrome eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 3 184 186 10.26663/cts.2025.033 279 article Attila Özdemir 1 Selime Kahraman 2 Saliha Bayraktar 1 Recep Demirhan 1 Department of Thoracic Surgery, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyHydrophilic gel fillers are associated with late complications, including migration. We present a rare case of intrathoracic migration in a 32-year-old female, seven years after bilateral breast augmentation. Despite multiple prior extrathoracic migrations, a new right paracardiac cystic lesion was identified on computed tomography. The lesion was successfully excised via video-assisted thoracoscopic surgery, and pathology confirmed filler material. This case underscores the potential for distant migration of hydrophilic gels and the need to consider this etiology in patients with mediastinal masses and a history of augmentation. https://cts.tgcd.org.tr/pdf.php?id=279 hydrophilic gel fillerintrathoracic migrationmediastinal massbreast augmentationvideo-assisted thoracoscopic surgery