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Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition
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Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 25 July 2026 | Viewed by 11685

Special Issue Editors

Dr. Damiano D’Ardes

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Guest Editor
"Clinica Medica" Institute, Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
Interests: cardiovascular risk; lipid metabolism; metabolic diseases; ultrasound
Special Issues, Collections and Topics in MDPI journals
Dr. Andrea Boccatonda

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Guest Editor
Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Via Massarenti n. 9, 40138 Bologna, Italy
Interests: ultrasound; lung disease; hemostasis and thrombosis; cardiovascular disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thoracic diseases continue to be a significant healthcare burden in both medical and surgical disciplines. In recent years, the epidemiology of pulmonary pathologies has continued to evolve, particularly in the realm of infectious and neoplastic diseases. Advances in imaging, molecular diagnostics, and point-of-care technologies have enabled earlier and more precise diagnoses, while novel medical and surgical treatments are reshaping the therapeutic landscape and improving patient outcomes. This second edition of the Special Issue “Clinical Management, Diagnosis and Treatment of Thoracic Diseases” builds upon the success of the first, offering an updated platform on which to explore emerging diagnostic strategies, minimally invasive interventions, and integrated care pathways in pulmonary medicine. It is intended for a broad range of specialists engaged in the management of chest diseases and aims to highlight the latest innovations and evidence-based approaches in this dynamic and rapidly progressing field.

Dr. Damiano D’Ardes
Dr. Andrea Boccatonda
Guest Editors

Manuscript Submission Information

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Keywords

  • lung
  • thorax
  • pneumonia
  • chest
  • imaging
  • ultrasound

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Related Special Issue

Published Papers (6 papers)

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Research

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19 pages, 777 KB  
Article
Hypercoagulability in Pulmonary Tuberculosis: Reduced Protein C and Free Protein S Predict Pulmonary Embolism—Evidence from a Prospective Romanian Cohort
by Denisa Maria Mitroi, Silviu Gabriel Vlasceanu, Ovidiu Mircea Zlatian, Mihai Olteanu, Oana Maria Catană, Radu Razvan Mititelu, Anca Lelia Riza, Georgiana Camen, Viorel Biciușcă and Ramona Cioboată
J. Clin. Med. 2026, 15(5), 1903; https://doi.org/10.3390/jcm15051903 - 2 Mar 2026
Viewed by 350
Abstract
Background/Objectives: Pulmonary tuberculosis (TB) is accompanied by inflammation-driven hypercoagulability and increased venous thromboembolism risk. We investigated whether the natural anticoagulants protein C and free protein S are reduced in active TB and whether baseline levels are associated with bacillary burden, treatment response, CT [...] Read more.
Background/Objectives: Pulmonary tuberculosis (TB) is accompanied by inflammation-driven hypercoagulability and increased venous thromboembolism risk. We investigated whether the natural anticoagulants protein C and free protein S are reduced in active TB and whether baseline levels are associated with bacillary burden, treatment response, CT evolution, and pulmonary embolism (PE). Methods: We conducted a prospective cohort study in Romania, including 63 adults with newly diagnosed, bacteriologically confirmed, drug-susceptible pulmonary TB and 30 TB-free controls (October 2024–December 2025). Venous blood was collected at baseline (before anti-TB therapy) and at 6 months to quantify inflammatory and coagulation parameters, protein C, and free protein S. Sputum AFB smear was assessed at baseline, 2 months, and 6 months; chest CT was performed at baseline and 6 months. Propensity score matching (age, sex, BMI, smoking) and multivariable regression were used to account for confounding. Logistic regression and ROC analyses evaluated the prediction of BK persistence. Results: Compared with controls, TB patients had substantially lower baseline protein C and free protein S levels, and higher D-dimer levels (all p < 0.001). In matched multivariable models, TB status remained independently associated with lower baseline natural anticoagulant levels. Lower baseline protein C and free protein S clustered with higher inflammatory markers and higher bacillary burden, and independently predicted BK persistence at 2 and 6 months (OR per 1%-point increase ~0.93–0.95 for protein C and ~0.92–0.94 for free protein S; all p < 0.001). Discrimination for BK persistence was high (AUCs ~0.88–0.89). Lower baseline levels of natural anticoagulants were also associated with greater residual CT abnormalities at 6 months. PE cases had significantly lower protein C and free protein S than PE-free patients. Conclusions: Active pulmonary TB is associated with marked depletion of protein C and free protein S. Baseline reductions identify patients with higher inflammatory/coagulation activation, higher bacillary burden, delayed microbiological clearance, more residual CT disease, and PE, supporting their potential role as adjunct risk-stratification biomarkers. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition)
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9 pages, 427 KB  
Article
Risk Factors of Requiring Tracheostomy in COVID-19 Patients: A Retrospective Analysis of Intubated Patients
by Annika Bharwani, Laith A. Ayasa, Camilo A. Avendano, Raymond C. Parrish, Juan C. Lara, Juan C. Cedeno, Kai Swenson, Jason Beattie, Adnan Majid and Mihir S. Parikh
J. Clin. Med. 2026, 15(4), 1342; https://doi.org/10.3390/jcm15041342 - 8 Feb 2026
Viewed by 399
Abstract
Background: Prolonged mechanical ventilation and tracheostomy in patients with COVID-19 is associated with longer hospital stays. Guidance on which patients are at risk for tracheostomy due to the progression of COVID-19 is limited. Objectives: This study aimed to identify risk factors [...] Read more.
Background: Prolonged mechanical ventilation and tracheostomy in patients with COVID-19 is associated with longer hospital stays. Guidance on which patients are at risk for tracheostomy due to the progression of COVID-19 is limited. Objectives: This study aimed to identify risk factors associated with the need for tracheostomy in patients intubated for COVID-19 between 1 March and 31 December 2020. Methods: The methodology for this study involved a single-center retrospective analysis of 120 patients who were intubated due to COVID-19 infection between 1 March 2020 and 31 December 2020. A comparison of variables was performed using the Wilcoxon test, Chi-squared test, and Fisher’s exact test alongside univariate analysis. Results: Several risk factors were found to be significantly associated with the need for tracheostomy, including age, P/F ratio, creatinine level, and history of arrhythmia. Conclusions: Initial exploration indicates the presence of certain factors that can help us understand future need for tracheostomy earlier in the patient’s clinical course. Further analysis should be performed with a larger sample size to validate these findings and increase the generalizability of the present study. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition)
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17 pages, 2501 KB  
Article
Nontraumatic Fat Embolism and Fat Embolism Syndrome in Patients with Purulent Bacterial Bronchopneumonia
by Beáta Ágnes Borsay, Barbara Dóra Halasi, Róbert Kristóf Pórszász, Katalin Károlyi, Teodóra Tóth and Péter Attila Gergely
J. Clin. Med. 2025, 14(17), 6097; https://doi.org/10.3390/jcm14176097 - 28 Aug 2025
Viewed by 2560
Abstract
Background: Fat embolism frequently occurs as a result of trauma, such as long bone fractures and orthopedic surgeries, as well as in certain non-traumatic conditions. The formation can be attributed to mechanical or biochemical processes. According to Hullman’s biochemical hypothesis, elevated C-reactive [...] Read more.
Background: Fat embolism frequently occurs as a result of trauma, such as long bone fractures and orthopedic surgeries, as well as in certain non-traumatic conditions. The formation can be attributed to mechanical or biochemical processes. According to Hullman’s biochemical hypothesis, elevated C-reactive protein levels facilitate the precipitation of very-low-density lipoproteins and chylomicrons, forming fat globules that may result in fat embolism. Based on the abovementioned hypothesis, this study aims to detect fat embolism in autopsy patients (postmortem) suffering from bronchopneumonia and determine its possible role as a cause of death. Methods: A group of autopsies of deceased individuals with bacterial purulent bronchopneumonia with confirmed or presumed elevated C-reactive protein levels was rigorously selected, excluding those with other potential causes of fat embolism such as cardiopulmonary resuscitation, hypothermia, and diabetes mellitus. Multiple organs were sampled for frozen section analysis using Oil Red O fat staining and assessed for the presence and extent of fat embolism. The Falzi score, as modified by Janssen, was employed for the lung tissue. Results: In 73% of the cases, predominantly sporadic, Grade 0 or Grade I fat embolism was observed; however, in none of the cases was fat embolism identified as the cause of death or as a significant contributing factor. Furthermore, neither fat embolism syndrome nor multiorgan fat embolism were detected. Conclusions: Although an elevated C-reactive protein level facilitates the formation of fat globules and fat embolism, its role as a direct cause of mortality remains uncertain. It may predispose individuals to such conditions and potentially interact with other factors, such as minor soft tissue trauma, to exacerbate the severity of fat embolism or its clinical manifestations. These findings underscore the necessity for further comprehensive investigations within the contexts of infection/inflammation, fat embolism, and dyslipidemia. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition)
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Review

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23 pages, 924 KB  
Review
Beyond the Lungs: Cardiovascular Risk in COPD Patients with a History of Tuberculosis—A Narrative Review
by Ramona Cioboata, Mihai Olteanu, Denisa Maria Mitroi, Simona-Maria Roșu, Maria-Loredana Tieranu, Silviu Gabriel Vlasceanu, Simona Daniela Neamtu, Eugen Nicolae Tieranu, Rodica Padureanu and Mara Amalia Balteanu
J. Clin. Med. 2026, 15(2), 661; https://doi.org/10.3390/jcm15020661 - 14 Jan 2026
Viewed by 1246
Abstract
Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) increasingly co-occur in low- and middle-income countries and aging populations. Prior pulmonary TB is a robust, smoking-independent determinant of COPD and is linked to persistent systemic inflammation, endothelial dysfunction, dyslipidemia, and hypercoagulability axes that also [...] Read more.
Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) increasingly co-occur in low- and middle-income countries and aging populations. Prior pulmonary TB is a robust, smoking-independent determinant of COPD and is linked to persistent systemic inflammation, endothelial dysfunction, dyslipidemia, and hypercoagulability axes that also amplify cardiovascular disease (CVD) risk. We conducted a targeted narrative non-systematic review (2005–2025) of PubMed/MEDLINE, Embase, Scopus, and Web of Science, selecting studies for clinical relevance across epidemiology, clinical phenotypes, pathobiology, biomarkers, risk scores, sleep-disordered breathing, and management. No quantitative synthesis or formal risk-of-bias assessment was performed. Accordingly, findings should be interpreted as a qualitative synthesis rather than pooled estimates. Prior TB is associated with a distinctive COPD phenotype characterized by mixed obstructive–restrictive defects, reduced diffusing capacity (DLCO), radiographic sequelae, and higher exacerbation/hospitalization burden. Mechanistic insights: Convergent mechanisms chronic immune activation, endothelial injury, prothrombotic remodeling, molecular mimicry, and epigenetic reprogramming provide biologic plausibility for excess CVD, venous thromboembolism, and pulmonary hypertension. Multimarker panels spanning inflammation, endothelial injury, myocardial strain/fibrosis, and coagulation offer incremental prognostic value beyond clinical variables. While QRISK4 now includes COPD, it does not explicitly model prior TB or COPD-TB outcomes, but data specific to post-TB cohorts remain limited. Clinical implications: In resource-constrained settings, pragmatic screening, prioritized PAP access, guideline-concordant pharmacotherapy, and task-shifting are feasible adaptations. A history of TB is a clinically meaningful modifier of cardiopulmonary risk in COPD. An integrated, multimodal assessment history, targeted biomarkers, spirometry/lung volumes, DLCO, 6 min walk test, and focused imaging should guide individualized care while TB-aware prediction models and implementation studies are developed and validated in high-burden settings. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition)
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25 pages, 1166 KB  
Review
Beyond Smoking: Emerging Drivers of COPD and Their Clinical Implications in Low- and Middle-Income Countries: A Narrative Review
by Ramona Cioboata, Mara Amalia Balteanu, Denisa Maria Mitroi, Sidonia Catalina Vrabie, Silviu Gabriel Vlasceanu, Gabriela Marina Andrei, Anca Lelia Riza, Ioana Streata, Ovidiu Mircea Zlatian and Mihai Olteanu
J. Clin. Med. 2025, 14(13), 4633; https://doi.org/10.3390/jcm14134633 - 30 Jun 2025
Cited by 11 | Viewed by 5210
Abstract
Chronic obstructive pulmonary disease (COPD) is an escalating global health burden, with a disproportionate impact on low- and middle-income countries (LMICs). Although tobacco smoking is a well-established risk factor, emerging evidence highlights the significant role of non-smoking exposure in driving the prevalence of [...] Read more.
Chronic obstructive pulmonary disease (COPD) is an escalating global health burden, with a disproportionate impact on low- and middle-income countries (LMICs). Although tobacco smoking is a well-established risk factor, emerging evidence highlights the significant role of non-smoking exposure in driving the prevalence of COPD in these regions. This narrative review synthesizes current data on key non-smoking contributors, including household air pollution, ambient urban pollution, occupational exposure, early-life respiratory insults, chronic infections, and socioeconomic adversity. These risk factors are associated with distinct COPD phenotypes, often marked by increased airway inflammation, reduced emphysema, and variable airflow limitation. Such presentations are particularly common among women and younger populations in LMICs. However, diagnostic and therapeutic challenges persist, owing to limited disease awareness, under-resourced health systems, restricted access to essential medications, and financial constraints impacting adherence. Despite the proven effectiveness of non-pharmacological measures and public health interventions, their implementation remains inadequate because of infrastructural and funding limitations. Bridging these gaps requires region-specific clinical guidelines, improved diagnostic infrastructure, expanded access to affordable treatment, and culturally sensitive interventions. Future priorities include identifying robust biomarkers, refining disease definitions to accommodate non-smoking phenotypes, and advancing implementation science to improve interventions. A coordinated, context-aware global response is essential to reduce the growing burden of COPD in LMICs and to ensure equitable respiratory health outcomes. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition)
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Other

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16 pages, 2679 KB  
Systematic Review
High-Flow Nasal Cannula Outside the ICU: A Systematic Review and Meta-Analysis
by Andrea Boccatonda, Alice Brighenti, Damiano D’Ardes and Luigi Vetrugno
J. Clin. Med. 2026, 15(1), 97; https://doi.org/10.3390/jcm15010097 - 23 Dec 2025
Cited by 2 | Viewed by 1208
Abstract
Background: Use of high-flow nasal cannula (HFNC) expanded from ICUs to internal medicine/respiratory wards during and after the COVID-19 pandemic, but safety and effectiveness in non-ICU settings remain uncertain. Methods: We performed a systematic review and meta-analysis of adults (≥18 years) [...] Read more.
Background: Use of high-flow nasal cannula (HFNC) expanded from ICUs to internal medicine/respiratory wards during and after the COVID-19 pandemic, but safety and effectiveness in non-ICU settings remain uncertain. Methods: We performed a systematic review and meta-analysis of adults (≥18 years) initiated on HFNC in non-ICU wards. Primary outcomes were in-hospital (or 28-day) mortality and ICU transfer; where available, we compared mortality for HFNC vs. conventional oxygen therapy (COT) in do-not-intubate (DNI) cohorts. Observational studies and trials were eligible. Random-effects models synthesized proportions and risk ratios; risk of bias (ROBINS-I/RoB 2) and certainty (GRADE) were assessed. Results: Ten studies met the inclusion criteria for any-ward HFNC; subsets contributed data to pooled analyses. Across all non-ICU wards (general wards plus step-up IMCU/HDU), pooled mortality was 14.0% (95% CI 4.6–35.5; I2 ≈ 92%). Pooled ICU transfer after ward/step-up HFNC start was 20.0% (95% CI 6.3–48.1; I2 ≈ 97%). Restricted to internal medicine/respiratory wards, pooled mortality was 19.8% (95% CI 7.1–44.2; I2 ≈ 95%) and ICU transfer 31.2% (95% CI 9.9–65.0; I2 ≈ 97%). In step-up units (IMCU/HDU), ICU transfer appeared lower and less variable (22.0% [95% CI 16.5–28.8]; I2 ≈ 10%), suggesting environment-dependent outcomes. In a multicenter DNI COVID-19 cohort, HFNC vs. COT showed no clear mortality difference (RR ≈ 0.90, 95% CI 0.75–1.08; adjusted OR ≈ 0.72, 95% CI 0.34–1.54). Certainty of evidence for all critical outcomes was very low due to observational design, high inconsistency, and imprecision. Conclusions: HFNC outside the ICU is feasible, but it is related to nontrivial mortality and frequent escalation—particularly on general wards—while step-up units demonstrate more reproducible trajectories. Outcomes appear strongly conditioned by care environment, staffing, monitoring, and escalation pathways. Given very low certainty and substantial heterogeneity, institutions should pair ward HFNC with protocolized reassessment and rapid response/ICU outreach, and future research should prospectively compare ward HFNC pathways against optimized COT/NIV using standardized outcomes. Full article
(This article belongs to the Special Issue Clinical Management, Diagnosis and Treatment of Thoracic Diseases: 2nd Edition)
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