The impact of ebus-tbna, f-18 fdg pet suv-max value, and tomographic measurement of lymph node density in the diagnosis of mediastinal malignant lymph nodes

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 1 6 10.26663/cts.2026.001 282 article The impact of ebus-tbna, f-18 fdg pet suv-max value, and tomographic measurement of lymph node density in the diagnosis of mediastinal malignant lymph nodes Necati Solak 1 Mehmet Cetin 1 Mehmet Buyukevli 1 Busra Ozdemir Ciftlik 2 Koray Aydogdu 1 Serdar Han 1 Tevfik Kaplan 1 Health Sciences University, Ankara Etlik City Hospital, Thoracic Surgery Clinic, Ankara, TürkiyeKirikkale University School of Medicine, Department of Thoracic Surgery Ankara, TürkiyeBackground: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive effective, simple procedure and has replaced mediastinoscopy in diagnosis of mediastinal lymphadenopathies. But still there is an effort to increase diagnostic value of EBUS-TBNA and to meet additional information to guide biopsy especially in false negative situations. Materials and Methods: In this retrospective study between December 2022 and December 2023, 90 patients, 176 lymph nodes were sampled with EBUS-TBNA. Patients' characteristics, lymph node density on CT, PET-CT findings, pathological diagnosis by EBUS-TBNA, and surgery were all written down. Results: Sensitivity, specificity, negative predictive value, and positive predictive value of EBUS-TBNA were 78.8%, 95.8%, 85%, and 90.3%, respectively. Mean SUV-max values in PET tomography were 2.66±0.56 in benign lymph nodes, whereas it was 9.26±2.34 in malignant lymph nodes and this was significantly higher than benign lymph nodes (p<0,001). For detecting malignancy, cut-off value of SUV-max was found 6.02±1.84 and sensitivity and specificity were 55.3%, 95.8% respectively (AUC= 0,895 95% CI (0,844- 0,946), p<0.001). Mean tomographic lymph node density was 25.05±4.67 HU in benign lymph nodes. Also mean tomographic lymph node density was 31.55±5.34 HU and significantly higher than benign lymph nodes (p=0.03). Cut-off value of density for detecting malignancy was found 29,05±4.78 and sensitivity and specificity were 65.0%, 56.2% respectively (AUC= 0,585 95% CI (0,500-0,670), p=0.05). Conclusions: EBUS has a key role in differential diagnosis of lymphadenopathies. PET tomography SUV-max value and tomographic lymph node density could help clinician to increase diagnostic value of EBUS in borderline suspicious lymphadenopathies. https://cts.tgcd.org.tr/pdf.php?id=282 densitySUV-maxEBUS-TBNAmediastinal lymph node eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 7 13 10.26663/cts.2026.002 283 article Development of a machine learning model for predicting mortality risk in thoracic surgery patients: a synthetic data study Okan Karatas 1 Nilay Cavusoglu Yalcin 1 Muharrem Ozkaya 1 Gungor Efe Ozkaya 2 Department of Thoracic Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, TürkiyeDepartment of Computer Engineering, University of Turkish Aeronautical Association, Ankara, TürkiyeBackground: Accurate prediction of postoperative mortality is crucial in thoracic surgery to guide clinical decisions and optimize patient care. The objective of this study was to demonstrate how to develop a reproducible machine learning–based model for predicting 30-day postoperative mortality in thoracic surgery patients, using a realistic synthetic dataset and clinically relevant perioperative variables. Materials and Methods: We developed a machine learning (ML) model to estimate 30-day mortality risk in thoracic (lung) surgery patients, using realistic synthetic data of 1000 patients to illustrate the approach. Risk factors (age, sex, comorbidities, pulmonary function, etc.) and surgery type (wedge/ segmentectomy, lobectomy, pneumonectomy) were incorporated. We tested logistic regression, random forest, and XGBoost algorithms. Results: Logistic regression yielded the best performance (AUC=0.82548) on our synthetic cohort of 1000 patients. The model also demonstrated good calibration (Brier score=0.040), indicating accurate probability estimation. Key predictors included advanced age, high ASA class, reduced FEV1, presence of COPD, and undergoing pneumonectomy consistent with known clinical factors. Model steps are detailed below. An appendix provides Python code for data generation and model training. Conclusion: This work demonstrates a reproducible pipeline for risk prediction in thoracic surgery using a synthetic dataset, aligning with modern approaches like the STS risk calculators and advanced ML models (e.g. Predicthor). This model is intended for methodological demonstration only and is not clinically validated for real-world use. https://cts.tgcd.org.tr/pdf.php?id=283 thoracic surgerymortality predictionmachine learningrisk stratificationlogistic regression eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 14 22 10.26663/cts.2026.003 284 article Evaluation of pneumonectomy outcomes in lung cancer: 18 years of surgical experience and prognostic factor analysis Bekir Elma 1 Ilkay Dogan 2 Ahmet Ulusan 1 Maruf Sanli 1 Ahmet Ferudun Isik 1 Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, TürkiyeDepartment of Biostatistics, Faculty of Medicine, Gaziantep University, Gaziantep, TürkiyeBackground: Despite the widespread use of methods developed to preserve lung parenchyma as much as possible, pneumonectomy remains an essential surgical treatment option, particularly for lung cancers located centrally and/or invading bronchovascular structures. However, pneumonectomy has historically been associated with high morbidity and mortality. This study presents the complications, survival outcomes, and prognostic factors of patients who underwent pneumonectomy for lung cancer, drawing on 18 years of single-center experience. Materials and Methods: Archived patient files from patients who underwent pneumonectomy at our center between 2006 and 2024 were retrospectively reviewed. Postoperative complications, 30- and 90-day mortality rates, overall survival, and recurrence-free survival were analyzed. Patients who underwent and did not undergo salvage surgery were analyzed as subgroups. Kaplan–Meier analysis was used for survival, and multivariate Cox regression analysis was used to examine prognostic factors. Results: A total of 304 patients were included in the study. Postoperative 30- and 90-day mortality rates were consistent with the literature. Although there was no significant difference in overall survival between right and left pneumonectomy (p=0.504), the complication rate was higher in right pneumonectomies. Multivariate analysis revealed that age, adenocarcinoma histology, N2 positivity, receipt of adjuvant radiotherapy, and receipt of neoadjuvant therapy were independent predictors of poor prognosis. Conclusions: Pneumonectomy remains an effective treatment option for selected patients with lung cancer. Advanced nodal disease, tumor size, and the presence of postoperative complications negatively impact survival. Effective use of a multidisciplinary tumor board, individualized treatment, and dedicated perioperative management are the most important criteria for improving long-term survival. https://cts.tgcd.org.tr/pdf.php?id=284 pneumonectomylung cancersalvage surgerypostoperative complicationsbronchopleural fistula eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 23 36 10.26663/cts.2026.004 285 article Global patterns of surgical research production: a bibliometric analysis of thoracic surgery literature Omer Yavuz 1 Mehlika Iscan 1 Eren Erdogdu 1 Reyhan Ertan 1 Muhammet Kertmen 1 Turkan Dubus 1 Ali Yeginsu 1 Department of Thoracic Surgery, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, TürkiyeBackground: Scientific studies with comparable methodological quality may not achieve similar levels of publication visibility. This study aimed to assess whether publication visibility in the thoracic surgery literature varies across institutional and geographic contexts, using primary spontaneous pneumothorax (PSP) as a homogeneous clinical framework. Materials and Methods: This descriptive bibliometric analysis included PSP-related publications indexed in the Web of Science Core Collection between January 1, 2000, and October 15, 2025. In total, 972 publications were analyzed. Author name origin and gender were inferred using the NamSor API (version 2). Author and institutional country income levels were classified according to World Bank definitions as high-income (HIC) or low- and middle-income (LMIC). Journal impact factor and quartile (Q1-Q4) rankings were obtained from the most recent Journal Citation Reports. Results: Based on name origin, 73.9% of first authors were from high-income countries (HICs), while 26.1% were from low-and middle-income countries (LMICs). According to institutional affiliation, 83.4% of publications originated from HIC institutions and 16.6% from LMIC institutions. Overall, 95.2% of publications were published in journals based in HICs. Studies led by authors from highincome countries were associated with publication in higher-impact and higher-quartile journals (p < 0.001). Gender distribution was comparable across groups, and variations in impact factor were more strongly associated with institutional income level than with gender. Conclusions: Despite comparable methodological characteristics, publications led by authors and institutions from high-income countries demonstrated greater publication visibility in the PSP literature. Greater transparency in editorial processes may help improve equity in research dissemination. https://cts.tgcd.org.tr/pdf.php?id=285 bibliometricsthoracic surgeryprimary spontaneous pneumothoraxinstitutional affiliationpublication visibility eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 37 44 10.26663/cts.2026.005 286 article Prognostic factors for recurrence after surgical resection in early-stage nonsmall cell lung cancer Gizem Özçıbık Işık 1 Akif Turna 2 Burcu Sena Aydın 3 Boran Polat 3 Burcu Kılıç 2 Ezel Erşen 2 Hasan Volkan Kara 2 Mehmet Kamil Kaynak 2 Department of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Education and Research Hospital, Istanbul, TurkiyeDepartment of Thoracic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul, TurkiyeDepartment of Emergency Medicine, Karamanoğlu Mehmet Bey University, Karaman, TürkiyeBackground: Non-small cell lung cancer (NSCLC) constitutes the majority of lung cancer cases, with surgical resection being the main treatment for stages 1 and 2. Despite advances, postoperative recurrence remains a major cause of mortality. Identifying recurrence risk factors could allow individualized follow-up strategies. Materials and Methods: We retrospectively analyzed 246 patients with stage 1-2 NSCLC who underwent surgery between 2005-2022. Stage 3 disease and neoadjuvant-treated cases were excluded. Clinical, laboratory, radiological, and surgical data were collected. Recurrences (locoregional or distant) within at least two years of follow-up were recorded. Comparisons were made using Student’s t-test or Chi-square test; survival was analyzed with Kaplan-Meier and Cox regression. Results: VATS (Video-assisted thoracoscopic surgery) was more frequent in non-recurrence cases (p=0.017), while pneumonectomy was more common in recurrence cases (p=0.017). Advanced T and TNM stages, lymphatic and vascular invasion were significantly associated with recurrence. Cox regression identified N1 disease, pleural invasion, and lymphatic invasion as independent predictors of poor survival. Pneumonectomy and lymphatic invasion were significantly associated with reduced recurrence-free survival. Conclusions: Recurrence after early-stage NSCLC surgery is linked to worse survival. Pneumonectomy and lymphatic invasion may predispose to recurrence, warranting closer follow-up and consideration of adjuvant therapy. https://cts.tgcd.org.tr/pdf.php?id=286 non-small cell lung cancerearly stagerecurrenceprognosis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 45 51 10.26663/cts.2026.006 287 article Changing phenotypes of pediatric empyema in the covid-19 era Asya Eylem Boztas 1 Ayse Demet Payza 1 Arzu Sencan 2 Department of Pediatric Surgery, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, University of Health Sciences, Izmir, TürkiyeDepartment of Pediatric Surgery, Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir Faculty of Medicine, University of Health Sciences, Izmir, TürkiyeBackground: This study aimed to investigate whether the disease phenotype of pleural effusion and empyema in children changed across the COVID-19 periods, by analyzing clinical, biochemical, and radiological parameters among culture negative pediatric patients. Materials and Methods: A retrospective analysis of 147 pediatric patients treated for thoracic empyema between 2012 and 2025 was conducted. Patients with current or previous SARS-CoV-2 infection were excluded. Patients were stratified into four groups: pre-COVID (≤2019), pandemic (2020-2021), early post-COVID (2022), and late post-COVID (≥2023). Worsening of the disease phenotype was assessed by the presence of lung abscess and necrotizing pneumonia. Demographic data, pleural fluid biochemistry (pH, glucose, lactate dehydrogenase (LDH)), and radiological findings were reviewed and compared. Results: The prevalence of empyema-associated lung abscesses showed a trend toward increase across periods, being higher during the pandemic (33.3%) and late post-COVID (15%) compared with the pre-COVID era (7.4%, p = 0.054). Necrotizing pneumonia also increased numerically, reaching 35% in the late post-COVID period. LDH levels were significantly higher in the escalation group (4614.54 ± 4504.62 U/L) compared with the non-escalation group (2493.74 ± 4415.49 U/L, p = 0.015). Oxygen requirement (p = 0.020), ICU admission (p < 0.001) and secondary intervention requirements differed significantly across periods (p = 0.046), with the highest rates observed in the early post-COVID group. Conclusions: In SARS-CoV-2 negative pediatric patients, empyema presenting in the post-pandemic period was associated with increased respiratory support requirements. These findings may reflect pandemic-related alterations in disease behavior and support earlier consideration of treatment escalation. https://cts.tgcd.org.tr/pdf.php?id=287 empyemaCOVID-19 erapediatrics eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 52 61 10.26663/cts.2026.007 288 article Inflammatory and nutritional biomarker changes at postoperative days 25-34 after uniportal minimally invasive anatomical lung resection for nonsmall cell lung cancer Mehlika Iscan 1 Omer Yavuz 1 Ali Yeginsu 1 Department of Thoracic Surgery, Başakşehir Çam and Sakura City Hospital, İstanbul, TürkiyeBackground: Blood-based inflammatory and nutritional biomarkers are increasingly used in non-small cell lung cancer (NSCLC), but their early postoperative behavior after uniportal minimally invasive anatomical lung resection remains unclear. This study evaluated perioperative changes in selected indices between the preoperative period and the standardized early postoperative outpatient assessment. Materials and Methods: This retrospective observational study included 48 consecutive patients with histopathologically confirmed NSCLC who underwent uniportal minimally invasive anatomical lung resection between January 2024 and December 2025. Patients who underwent completion resection, had non-NSCLC histology, or lacked paired laboratory data were excluded. Preoperative laboratory values were compared with those obtained at the postoperative outpatient assessment between postoperative days 25 and 34. The primary endpoint was the change in hemoglobin, albumin, lymphocyte, and platelet score (HALP). Secondary endpoints were changes in neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, prognostic nutritional index, C-reactive protein-to-albumin ratio, and systemic immune-inflammation index. Results: The cohort included 37 uniportal video-assisted thoracic surgery and 11 uniportal roboticassisted thoracic surgery patients. HALP decreased significantly, whereas platelet-to-lymphocyte ratio and C-reactive protein-to-albumin ratio increased significantly. Hemoglobin and hematocrit decreased, while platelet count and C-reactive protein increased. No significant changes were observed in neutrophil-to-lymphocyte ratio, prognostic nutritional index, systemic immune-inflammation index, white blood cell count, neutrophil count, lymphocyte count, creatinine, or albumin. Conclusions: The standardized postoperative outpatient assessment after uniportal minimally invasive anatomical lung resection for NSCLC suggested a selective biomarker pattern that may reflect a nonuniform early postoperative recovery process after uniportal anatomical lung resection. https://cts.tgcd.org.tr/pdf.php?id=288 carcinomanon-small cell lungbiomarkersthoracic surgeryvideo-assistedrobotic surgical procedureshemoglobinalbuminlymphocyteplatelet score eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 62 71 10.26663/cts.2026.008 289 article Extended lung resections for nsclc with adjacent structure involvement: a single-center experience Okan Karataş 1 Berkay Şen 1 Nilay Çavuşoğlu Yalçın 1 Gürhan Sinan Özgünlü 1 Ayşegül Güler 1 Emin Mert 1 Muharrem Özkaya 1 Department of Thoracic Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, TürkiyeBackground: Extended lung resections for non-small cell lung cancer (NSCLC) requiring en bloc resection of adjacent structures remain technically demanding procedures and are associated with considerable perioperative risk. This study analyzes the outcomes of 29 consecutive patients undergoing extended lung resections, focusing on survival outcomes and potential prognostic factors. Materials and Methods: We retrospectively analyzed 29 patients who underwent extended lung resections for non-small cell lung cancer (NSCLC) with suspected or confirmed invasion of adjacent structures between 2015 and 2023 at our institution. Extended resections included en bloc removal of structures such as the chest wall, pericardium, diaphragm, or vascular structures when necessary to achieve tumor clearance. Patient demographics, operative characteristics, pathological findings, postoperative complications, and long-term survival outcomes were evaluated using Kaplan–Meier survival analysis. Results: The cohort included 26 males (89.7%) and 3 females (10.3%) with a mean age of 64.4 ± 10.7 years. Squamous cell carcinoma was the predominant histology (65.5%). TNM staging revealed Stage IB (34.5%) and Stage IIA (20.7%) as most frequent. All patients underwent thoracotomy with extended resections: chest wall (58.6%), pericardium (20.7%), and combined procedures (20.7%). R0 resection was achieved in 51.7% of patients. Mean operative time was 159 ± 62 minutes. Postoperative complications occurred in 27.6% of patients, with zero 30-day mortality. Mean follow-up was 29.4 ± 24.1 months with overall mortality of 72.4% and median survival of 24.0 months. Chest wall resection patients had higher mortality (82.4%) compared to other extended procedures (58.3%). Conclusions: Extended lung resections may be performed with acceptable operative mortality in carefully selected patients. However, long-term survival remains limited, particularly in patients requiring chest wall resection. Rigorous patient selection and multidisciplinary evaluation are crucial for optimal outcomes. https://cts.tgcd.org.tr/pdf.php?id=289 extended lung resectionnon-small cell lung cancerchest wall resectionsurvival analysislocally advanced lung cancer eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 72 81 10.26663/cts.2026.009 290 article Video-assisted thoracoscopic lung-sparing tracheobronchial and carinal resections: a single-center experience Merve Ekinci Fidan 1 Volkan Erdoğu 1 Melike Ülker 1 Ali Cevat Kutluk 1 Ezgi Kılıçaslan 1 Meral Selin Onay Mahmuti 1 Nisa Yıldız 1 Ayşegül Çiftçi 1 Muzaffer Metin 1 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TürkeyBackground: In selected patients, lung-sparing airway resections may achieve complete oncological resection while preserving pulmonary parenchyma. With increasing experience in video-assisted thoracoscopic surgery (VATS), these complex procedures can now be performed using minimally invasive techniques. We aimed to present our single-center experience with VATS lung-sparing tracheobronchial and carinal resections, focusing on perioperative outcomes. Materials and Methods: Data from 7 patients who underwent VATS lung-sparing airway resections in our clinic between February 2022 and December 2024 were retrospectively evaluated in terms of surgical indications, as well as preoperative, intraoperative, and postoperative conditions. Results: The surgical procedures included isolated carinal resection and reconstruction in two patients, main bronchial bronchotomy with bronchoplastic resection and reconstruction in two patients, segmental sleeve resection of the right main bronchus in one patient, and segmental sleeve resection of the bronchus intermedius in two patients, including one posterior biportal and one anterior uniportal approach. The mean age was 46.4 ± 17.1 years (range: 26-67). Pathological diagnoses included four typical carcinoid tumors, one glomus tumor, one sarcoma, and one squamous cell carcinoma. All resections achieved negative surgical margins. Postoperatively, the mean time to chest drain removal was 1.86 ± 0.38 days, and the mean length of hospital stay was 4.43 ± 1.40 days. No intraoperative mortality occurred, and no major postoperative complications or anastomotic failures were observed. Conclusions: VATS lung-sparing tracheobronchial and carinal resections are feasible and safe in carefully selected patients. These procedures allow complete oncological resection while preserving lung parenchyma, with favorable perioperative outcomes and short hospital stays. Minimally invasive lung-sparing airway surgery may offers a valuable alternative to more extensive resections in selected tracheobronchial tumors. https://cts.tgcd.org.tr/pdf.php?id=290 VATStracheobronchial resectioncarinal resectionlung-sparing surgeryminimally invasive surgerybronchoplasty eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 82 88 10.26663/cts.2026.017 291 article Technological evolution of uniportal video-assisted thoracoscopic surgery in lung cancer: a comprehensive review Hussein Elkhayat 1 Celal Bugra Sezen 2 Department of Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, EgyptUniversity of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Thoracic Surgery, Istanbul, TürkiyeIn this review, we will examine how uniportal video-assisted thoracoscopic surgery (U-VATS) compares in the management of non-small cell lung cancer (NSCLC) in terms of effectiveness, safety, and advancements in technology, as supported by recent literature. The change from multiportal techniques to uniportal techniques has expanded the limits of minimal invasiveness in thoracic surgery. In all aspects evaluated in the literature included in this review, U-VATS is comparable to multiportal techniques in postoperative pain, drainage time, and oncologic outcomes. The learning curve criteria set by the ESTS consensus for the safe adoption of U-VATS provides a sound basis for promoting this technique. In essence, Uniportal VATS is an evolving technique that is equally minimally invasive and has great oncologic potential, given advancements in technology. https://cts.tgcd.org.tr/pdf.php?id=291 uniportal VATSlung cancerminimally invasive surgerysleeve resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 89 91 10.26663/cts.2026.010 292 article Traumatic pneumopericardium: a rare clinical condition developing on the fifth day after trauma Esra Şahiner 1 Hüseyin Yıldıran 1 Atilla Can 1 Tuba Şahinoğlu 1 Department of Thoracic Surgery, Selçuk University, Faculty of Medicine, Konya, TürkiyePneumopericardium is a rare pathology that may occur following blunt or penetrating thoracic trauma, iatrogenically after certain medical interventions, or due to specific infections. It is most commonly observed after trauma and presents with a wide spectrum of clinical manifestations. The presented case is noteworthy as it involves pneumopericardium that developed on the fifth day of follow-up for a rib fracture sustained after a fall from height. This case highlights the diagnosis, monitoring, and treatment approach to traumatic pneumopericardium. https://cts.tgcd.org.tr/pdf.php?id=292 traumapneumopericardiumrib fracture eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 92 95 10.26663/cts.2026.011 293 article Glomus tumour of the trachea: a rare case Ufuk Emre Keskin 1 Can Kutlay 1 Tevfik Kaplan 1 Eylem Pınar Eser 2 Serdar Han 1 Division of Thoracic Surgery, Ankara Etlik City Hospital, Ankara, TürkiyeDivision of Pathology, Ankara Etlik City Hospital, Ankara, TürkiyeThis case report presents a rare case of a benign tracheal glomus tumor in a 48-year-old male who presented with progressive cough and dyspnea. Imaging revealed a proximal tracheal mass causing partial airway obstruction, and bronchoscopy demonstrated a highly vascularized lesion. Due to the risk of bleeding, biopsy was not performed, and PET/CT findings supported a benign etiology. The tumor was excised via a cervical approach, and histopathological examination confirmed a benign glomus tumor with typical immunohistochemical features. Postoperative recovery was uneventful; no recurrence was observed during one year of follow-up. This case highlights the diagnostic challenges of tracheal glomus tumors, the importance of imaging and surgical flexibility in management, and the favorable prognosis achievable with complete surgical resection and vigilant long-term follow-up. https://cts.tgcd.org.tr/pdf.php?id=293 glomus tumortracheal neoplasmsairway obstructionbronchoscopy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 96 99 10.26663/cts.2026.012 294 article Chest wall epithelioid hemangioendothelioma unmasked by a hematoma: case report Ikram Arramach 1 Hicham Harmouchi 1 Marouane lakranbi 1 Yassine Ouadnouni 1 Mohammed Smahi 1 Thoracic Surgery Department, Hassan II University Hospital, Fès, MoroccoFaculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fès, MoroccoEpithelioid hemangioendothelioma (EHE) is a rare neoplasm originating from vascular endothelial cells, which can arise in varied tissue sites. We describe a case of EHE presented with submammary mass of the left chest wall in a 25-year-old male, and his chest CT scan revealed a hematoma. The patient underwent a resection of the mass and the pathologic examination confirmed the diagnosis of epithelioid hemangioendothelioma. Five months later, He developed a firm nodule at his surgical scar. He had a second surgery consisting of excision of the local recurrence and partial resection of the sixth rib, including the intercostal space of the chest wall. To cover the remaining defect, we used polypropylene mesh, with muscle advancement and primary skin closure. The patient subsequently received radiotherapy and remains under active surveillance. This case highlights the challenges of preoperative diagnosis and that EHE should be considered in the differential diagnosis of chest wall masses. https://cts.tgcd.org.tr/pdf.php?id=294 epithelioid hemangioendotheliomachest wall tumorvascular tumorsoft tissuessurgical treatment eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 100 104 10.26663/cts.2026.013 295 article Cough-induced spontaneous intercostal lung herniation: a case report Azat Özel 1 Onur Akçay 1 Özgür Öztürk 1 Tuba Acar 1 Soner Gürsoy 1 Department of Thoracic Surgery, Bakircay University, Cigli Training and Research Hospital, İzmir, TürkiyeSpontaneous lung herniation is a rare clinical entity caused by protrusion of lung tissue through a weakened chest wall in the absence of trauma. Due to its nonspecific presentation, diagnosis may be delayed or overlooked, particularly on initial imaging. We report the case of a 71-year-old obese male who presented with acute-onset right-sided chest pain following a severe coughing episode. Initial thoracic computed tomography revealed no significant pathology, and the patient was discharged with conservative treatment. Due to progression of symptoms, repeat imaging demonstrated a prominent lung herniation through the right 8th intercostal space, accompanied by minimal pleural effusion. Magnetic resonance imaging revealed a 9x1 cm intercostal defect. Surgical repair was performed via thoracotomy with reduction of the herniated lung tissue, approximation of the ribs, and reconstruction of the defect using a nonabsorbable polypropylene mesh. The postoperative course was uneventful, and the patient was discharged on postoperative day seven. This case highlights the diagnostic challenge of false-negative initial computed tomography and emphasizes the importance of repeat advanced imaging in patients with progressive symptoms. Spontaneous lung herniation should be considered in obese male patients presenting with localized chest pain and chest wall swelling following severe coughing. Initial imaging may fail to detect the condition, and repeat evaluation with computed tomography or magnetic resonance imaging is crucial in cases of clinical progression. Surgical repair is a safe and effective treatment option for symptomatic patients or those with large defects, leading to favorable outcomes and low recurrence rates. https://cts.tgcd.org.tr/pdf.php?id=295 spontaneous lung herniationintercostalcough-induced chest wall defect eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 105 108 10.26663/cts.2026.014 296 article Asymptomatic discovery of a rare congenital vascular anomaly in a 33-year-old male: a case of pulmonary sling syndrome Bayram Altuntaş 1 Hacer Bal 2 Department of Thoracic Surgery, Life Hospital, Antalya, TürkiyeDepartment of Radiology, Life Hospital, Antalya, TürkiyePulmonary sling (PS) syndrome is a rare congenital vascular anomaly characterized by the anomalous origin of the left pulmonary artery (LPA) from the right pulmonary artery (RPA). While it typically presents in infancy with severe respiratory distress, its diagnosis in adulthood is exceedingly rare and often incidental. A 33-year-old male presented with acute, severe right-sided pleuritic chest pain. Initial suspicion was pulmonary embolism (PE); however, laboratory markers (D-dimer, troponin) were normal. Pulmonary CT angiography ruled out PE but revealed an incidental pulmonary sling, where the LPA originated from the RPA and coursed between the trachea and esophagus. A 10 mm pleural effusion was noted. The patient was diagnosed with idiopathic pleurisy, treated with anti-inflammatory agents, and symptoms resolved. This case underscores the possibility of PS remaining asymptomatic until the fourth decade of life. Clinicians should be aware of such vascular variants, as they may have significant implications for airway management and thoracic surgery. https://cts.tgcd.org.tr/pdf.php?id=296 pulmonary arteryvascular ringincidental findings eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 109 113 10.26663/cts.2026.015 297 article Coexistence of achalasia cardia and hirschsprung’s disease in a child: a rare case report Bolaji A. Akanni 1 Akputa A. Obasi 2 Stephen A. Ezeanwu 1 Chukwunyere C. Obi 1 Godgift N. Offor 3 Kelvin I. Nweke 1 Kosisochukwu M. Igwe 3 Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, NigeriaDivision of Paediatric Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital; Ebonyi State University, Abakaliki, Ebonyi State, NigeriaDepartment of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, NigeriaAchalasia cardia and Hirschsprung’s disease are distinct pediatric gastrointestinal motility disorders that rarely manifest in a single patient. While both involve a failure of muscular relaxation within the enteric nervous system, they typically present with disparate clinical features. We report an exceedingly rare case of a 3-year-old girl who initially presented with classic signs of achalasia cardia, including progressive dysphagia and regurgitation. Following a successful Heller’s cardiomyotomy, the patient’s esophageal symptoms improved; however, her recovery was hampered by emerging constipation and significant abdominal distension. Initially attributed to protein-energy malnutrition, these lower gastrointestinal symptoms prompted further investigation, which ultimately revealed a concurrent diagnosis of Hirschsprung’s disease. The patient subsequently underwent a posterior anal myectomy, which led to the complete resolution of her symptoms and a full recovery. This case underscores the diagnostic complexity of dual motility pathologies. It emphasizes that persistent or evolving symptoms following a primary surgical intervention should prompt a high index of suspicion for additional underlying conditions, requiring a comprehensive and multidisciplinary diagnostic approach to ensure favorable pediatric outcomes. https://cts.tgcd.org.tr/pdf.php?id=297 achalasia cardiaHirschsprung’s diseasepediatric GI disordersHeller’s cardiomyotomyanal myectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 1 114 115 10.26663/cts.2026.016 298 article Calcified fibrothorax as a sequela of long-standing untreated empyema Zeeshan Sarwar 1 Muhammad Shoaib Nabi 1 Department of Thoracic Surgery, Services Institute of Medical Sciences (SIMS), Services Hospital, Lahore, Punjab, Pakistan https://cts.tgcd.org.tr/pdf.php?id=298 empyema thoracisfibrothoraxthoracotomycomputed tomography