Search Results (423)

Background/Objectives: Hepatic steatosis and metabolic dysfunction-associated steatotic liver disease (MASLD) are cardiometabolic phenotypes relevant to atrial fibrillation (AF), but their prevalence and acute procedural relevance in pulsed field ablation (PFA) are poorly defined. We estimated the prevalence of hepato-renal index (HRI)-detected hepatic steatosis, assessed liver marker concordance, and explored acute procedural characteristics. Methods: In this single-centre prospective study, 99 consecutive eligible patients undergoing first-time PFA for AF underwent B-mode hepatic ultrasound. Hepatic steatosis was defined a priori as HRI ≥ 1.28, measured offline by an investigator blinded to clinical and procedural data. HRI-based MASLD-compatible phenotype, Hepatic Steatosis Index (HSI), BARD score, and Fibrosis-4 index were analysed as secondary liver markers. Results: HRI-detected hepatic steatosis was present in 62/99 patients (62.6%, 95% CI 52.8–71.5), and HRI-based MASLD-compatible phenotype in 55/99 (55.6%, 95% CI 45.7–65.0). Agreement between HRI and HSI was poor (Cohen’s κ = 0.01; prevalence-adjusted bias-adjusted κ +0.06; positive agreement 62%). Acute pulmonary vein isolation was achieved in all patients. First-pass isolation was high in both groups (91.9% vs. 81.1%; p = 0.124). Most procedural metrics were similar. Fluoroscopy dose was modestly higher in patients with steatosis (median 226 vs. 207 mGy; p = 0.035), but this exploratory signal was inconsistent across sensitivity analyses. In-hospital complications were infrequent (4/99, 4.0%). Conclusions: In first-time PFA patients with feasible HRI assessment, hepatic steatosis was common, liver marker classifications showed limited patient-level agreement, and acute procedural conduct showed no consistent steatosis-specific signal. Long-term rhythm durability requires dedicated follow-up. Full article

Advances in navigational bronchoscopy, robotic platforms, and intraprocedural imaging have transformed bronchoscopy from a diagnostic modality into a potential therapeutic platform for localized treatment of lung cancer. These developments are particularly relevant for patients who are medically inoperable, have limited pulmonary reserve, or require lung-sparing treatment strategies. This narrative review summarizes current evidence regarding bronchoscopic ablative technologies and intratumoral therapies for lung cancer. We discuss technological foundations including robotic bronchoscopy, electromagnetic and shape-sensing navigation, cone-beam computed tomography, augmented fluoroscopy, and radial endobronchial ultrasound. Available ablative modalities, including radiofrequency ablation, microwave ablation, cryoablation, photodynamic therapy, and pulsed electric field ablation, are reviewed alongside bronchoscopically delivered intratumoral chemotherapy, immunotherapy, and gene-based therapies. Early clinical studies demonstrate high technical success rates and favorable safety profiles for multiple bronchoscopic ablative approaches, with substantially lower rates of pleural complications compared with percutaneous techniques. Intratumoral therapies enable delivery of high local drug concentrations while minimizing systemic toxicity and may enhance antitumor immune responses through modulation of the tumor microenvironment. Emerging evidence suggests potential synergy between local ablation and immunotherapeutic strategies. However, available data remain limited by small sample sizes, heterogeneous treatment protocols, and a lack of randomized comparative studies. Bronchoscopic ablation and intratumoral therapies represent promising additions to the thoracic oncology armamentarium. Continued advances in navigation, imaging, and therapeutic delivery systems are enabling increasingly precise, minimally invasive interventions. Prospective clinical trials are needed to define optimal patient selection, procedural strategies, and integration with surgery, radiation, and systemic therapies within multidisciplinary lung cancer care. Full article

Objective: Anterior saphenous vein insufficiency is an underappreciated but clinically significant source of superficial venous reflux. Catheter-directed foam sclerotherapy represents a minimally invasive treatment approach, yet optimisation of sclerosant-to-endothelium contact remains a recognised technical challenge. The Sclerosafe system (VVT Medical, Kefar Sava, Israel)—a dual-lumen aspiration-assisted sclerotherapy device—was developed to address this limitation. The aim of this study was to evaluate the safety and efficacy of the Sclerosafe device in the treatment of anterior saphenous vein insufficiency. Methods: Retrospective analysis of prospectively collected data from 56 patients treated for isolated anterior saphenous vein insufficiency between 2020 and 2023. All procedures were performed in an outpatient setting under local anaesthesia (2 mL of 1% lignocaine at the puncture site) without tumescent infiltration. The Sclerosafe catheter was introduced directly, without an introducer sheath, through a single ultrasound-guided puncture of the ASV at the lowest point of reflux, and its tip was positioned 2 cm distal to the confluence with the common femoral vein. Treated segment length ranged from 8 to 17 cm (mean 10 cm) and vessel diameter from 4 to 12 mm (mean 6 mm). Polidocanol 2% foam (5 mL per session, Tessari technique) was administered and a standardised compression regimen was applied. Duplex ultrasound follow-up was conducted at 1, 2, 6, and 12 months; no venous severity, pain or quality-of-life score was recorded. Results: Technical success was achieved in all 56 cases. Complete occlusion of the treated segment was confirmed by duplex ultrasound at one month in 52 of 56 patients (92.9%). Occlusion rates at 6 months and 12 months were 92.5% (49/53 evaluable) and 90.4% (47/52 evaluable), with 3 and 4 cumulative patients lost to follow-up, respectively. Five occlusion failures were recorded in total: four primary failures at one month and one recanalisation between 6 and 12 months. Kaplan–Meier estimates of primary occlusion probability were 92.9% at 1 month (95% CI 86.1–99.6%), 92.9% at 6 months (no interval events), and 90.9% at 12 months (95% CI 83.3–98.5%). Minor adverse events included superficial skin pigmentation (8 patients, 14.3%), localised tenderness (6 patients, 10.7%), and transient bruising (11 patients, 19.6%); all resolved without specific intervention. No deep vein thrombosis, pulmonary embolism, or neurological complications were observed. Conclusions: Aspiration-assisted catheter-directed foam sclerotherapy using the Sclerosafe device demonstrated promising safety and anatomical efficacy for the treatment of anterior saphenous vein insufficiency, with a 12-month Kaplan–Meier occlusion estimate of 90.9%, without tumescent anaesthesia and in a fully outpatient setting. In the absence of a control group and clinical outcome measures, the technique cannot be presented as an established alternative to thermal or non-thermal ablation, but it may be a technically attractive option in patients with clinical CEAP class C2–C4 disease. Prospective comparative studies are warranted to confirm these findings. Full article

Background: Endobronchial ultrasound (EBUS) is widely used for the diagnosis of pulmonary lesions. When combined with rapid on-site cytologic evaluation (ROSE), it can improve diagnostic accuracy and facilitate early identification of malignancy origin. However, differentiating primary lung cancer from metastatic tumors (e.g., breast or colorectal origin) during ROSE remains challenging due to limited cytopathology support and morphological similarities between tumor cells. This study aimed to develop a computer-aided diagnostic (CAD) system for classifying malignancy types from limited cytological samples to facilitate clinical decision-making. Methods: We utilized a retrospective dataset of cytological images obtained during EBUS procedures between November 2018 and June 2024. The study focused on classifying three malignancies: pulmonary adenocarcinoma, metastatic breast cancer, and metastatic colorectal cancer. A deep learning-based model (PLFCH) was developed, integrating few-shot learning, parameter-efficient fine-tuning, and a hybrid CNN–Transformer architecture to address limited annotated data. Results: A total of 41 patients with 346 cytological images were included. Under a 3-way 5-shot setting, the proposed model achieved an accuracy of 49.26%, outperforming existing few-shot learning methods, with precision, recall, and F1-score of 0.477, 0.493, and 0.480, respectively. Increasing the number of reference images to 20 per class further improved accuracy to 55.48%. Conclusions: The proposed framework demonstrated improved performance for cytological classification under limited data conditions. These findings provide an early proof of concept for applying few-shot learning to cytological assessment during EBUS procedures. Further improvements in model performance and validation in prospective, real-time clinical settings are required before its potential role in assisting diagnostic decision-making can be established. Full article

Background/Objectives: The mortality rate for acute high-risk and intermediate–high-risk pulmonary embolism (PE) was high despite treatment with heparin anticoagulation alone. Although adjunctive systemic thrombolysis can significantly reduce mortality, it still increases the incidence of major bleeding. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has been shown to reduce the incidence of major bleeding; however, the optimal treatment duration remains uncertain. Methods: This retrospective cohort study included 155 hospitalized patients with acute PE who underwent USCDT between January 2017 and June 2025 in the intensive care unit at China Medical University Hospital, Taichung, Taiwan. Patients were categorized into four groups based on average usage time: <20, 20–29, 30–39, and ≥40 h. The primary endpoints were 30-day all-cause mortality rate and major bleeding. Covariates associated with 30-day all-cause mortality were estimated and adjusted using logistic regression modeling. Results: Across all treatment groups, USCDT significantly reduced systolic pulmonary artery (PA) pressure (26.9%), mean PA pressure (21.0%), fibrinogen levels (25.2%), and right ventricle-to-left ventricle diameter ratio (21.5%) (all p < 0.001). Compared with the group with a USCDT ≥ 40 h, the group with a USCDT < 20 h had a lower odds ratio for 30-day all-cause mortality (OR: 0.36, 95% CI: 0.07–1.81). A similar benefit was observed for a USCDT 20–29 h. Conclusions: USCDT < 20 or 20–29 h (mean 15–20 mg alteplase) may provide an optimal balance between efficacy and safety by reducing 30-day all-cause mortality and major bleeding in patients with acute PE. Full article

Background/Objectives: Fibrosing interstitial lung disease (F-ILD) is associated with progressive respiratory impairment and substantial symptom burden. Diaphragmatic ultrasound (DUS) is a non-invasive method for assessing diaphragmatic structure and function, but its clinical role in F-ILD remains uncertain. This systematic review evaluated the available evidence on DUS in adults with F-ILD. Methods: This systematic review was conducted and reported according to the PRISMA guidelines. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched and observational studies evaluating DUS in adults with F-ILD were included. Risk of bias was assessed using the QUADAS-2, and outcome-level certainty of evidence was evaluated by GRADE framework. Results: Six cross-sectional observational studies involving 232 participants were included. Diaphragmatic excursion (DE) was assessed in all six studies, while diaphragm thickness (DT) and thickening fraction (TF) were evaluated in four. Some studies reported abnormalities in DUS parameters during deep breathing and cross-sectional associations with pulmonary function, exercise capacity, dyspnoea, or radiological severity. Substantial heterogeneity in study populations, ultrasound protocols, and outcome reporting precluded meta-analysis. The certainty of evidence was very low. Conclusions: Current evidence suggests that DUS may detect diaphragmatic abnormalities in patients with F-ILD and may have future complementary value alongside established clinical assessments. However, the evidence is limited, heterogeneous, and of very low certainty and does not establish diagnostic accuracy, prognostic value, or usefulness for longitudinal monitoring. Accordingly, DUS cannot currently be recommended for routine clinical implementation in F-ILD, and prospective longitudinal validation is required. Full article

Severe pulmonary diseases, including atelectasis, pneumonia, and meconium aspiration syndrome, are major causes of neonatal respiratory distress, weaning difficulties, ventilator or oxygen dependence, prolonged oxygen requirements, extended hospitalization, and poor prognosis. The lack of simple and effective treatment strategies seriously endangers the survival and health of newborns, particularly premature infants. Recent advances in lung ultrasound (LUS) technology have made LUS-guided non-fiberobronchoscopic bronchoalveolar lavage (NFB-BAL) a promising solution. This approach addresses the limitations of conventional BAL in neonates by enabling accurate diagnosis, precise lesion localization, and dynamic procedural monitoring, hence reducing complications. Based on international expert consensus, these guidelines were developed to improve knowledge and promote the application of this technology and enhance operational standardization to ensure its effectiveness and safety. These guidelines contain 17 recommendations on 13 key clinical issues for reference and implementation in clinical practice. The wide application of these guidelines is expected to help significantly improve the prognosis of critically ill newborns with atelectatic pulmonary diseases. Full article

Background: Point-of-care ultrasound (POCUS) use continues to expand across specialties caring for pediatric patients in the perioperative period, offering noninvasive, diagnostic information that complements clinical assessment in real time. Although many POCUS applications were developed and validated in adults, pediatric POCUS requires unique considerations. This review examines the current evidence of diagnostic POCUS within pediatric perioperative care. Methods: A structured search of PubMed was performed for literature published through December 2025, using terms related to point-of-care ultrasound, perioperative care, cardiac, lung, gastric, and airway ultrasound, as well as focused assessment with sonography in trauma (FAST). Priority was given to systematic reviews, meta-analyses, randomized controlled trials, clinical practice guidelines, and landmark observational studies, while supplemented by recent high-quality publications. Findings: POCUS in each of the following areas is discussed: cardiac, pulmonary, airway, gastric, and FAST. Topics for each of the areas include a general overview, considerations for devices and probe selection to optimize imaging, specific uses and applications of the imaging, and potential limitations. Conclusions: POCUS is a valuable tool to complement comprehensive clinical evaluation of children in the perioperative period. Widespread adoption will require additional pediatric normative data, standardized protocols, and structured training for providers. Future research should continue to validate POCUS algorithms and clarify the role of artificial intelligence in enhancing image interpretation and accessibility. Full article

Background: Maintenance hemodialysis is characterized by repetitive changes in fluid distribution, blood pressure, and organ perfusion. Conventional clinical examination, empirical dry-weight adjustment, and biomarkers do not fully resolve the compartment-specific nature of congestion in this population. This narrative review reframes ultrasound-based volume assessment as a multimodal diagnostic problem involving pulmonary congestion, intravascular filling, systemic venous congestion, cardiac reserve, tissue response, and perfusion vulnerability. Methods: We synthesized clinically relevant evidence indexed in PubMed and Google Scholar for studies published between January 2016 and April 2026, prioritizing dialysis-specific randomized trials, prospective cohorts, systematic reviews, consensus statements, and methodological studies related to diagnostic ultrasound, Doppler-based congestion assessment, contrast-enhanced ultrasound, elastography, artificial intelligence, point-of-care ultrasound, and remote ultrasound monitoring. Results: Lung ultrasound currently has the strongest dialysis-specific evidence for detecting and tracking pulmonary congestion. Inferior vena cava ultrasound provides adjunctive information on intravascular filling and right-sided pressure but is not a surrogate for total body water. Echocardiographic parameters help characterize filling pressure and cardiac tolerance to fluid removal, whereas venous Doppler and the Venous Excess Ultrasound Score provide an emerging approach to systemic venous congestion. Elastography and contrast-enhanced ultrasound remain investigational tools for tissue characterization and perfusion vulnerability, while AI-assisted analysis, handheld point-of-care ultrasound, and tele-ultrasound may improve standardization, automated B-line quantification, and scalability. Conclusions: Different ultrasound modalities answer different diagnostic questions in maintenance hemodialysis. A compartment-specific framework integrating congestion, perfusion, and cardiac-reserve domains may better support individualized ultrafiltration planning, hemodynamic risk assessment, and future outcome-oriented research. Full article

A 12-year-old neutered male domestic shorthair cat presented with recurrent pleural effusion following repeated thoracentesis. Initial analysis of the pleural effusion did not reveal neoplastic cells. Thoracic imaging demonstrated pleural effusion without identifiable nodular lesions. However, abdominal computed tomography and histopathological examination of an ultrasound-guided percutaneous core liver biopsy identified a large hepatic mass, confirmed to be cholangiocarcinoma, with suspected metastases to the spleen. After exclusion of other potential causes, the effusion was suspected to be a paramalignant pleural effusion. Despite palliative management, the disease progressed, and the cat was euthanized 98 days after definitive diagnosis. Postmortem examination revealed widespread metastatic cholangiocarcinoma involving the lungs, spleen, and intercostal muscles. No gross mass lesions were identified in the pulmonary parenchyma. Histological results demonstrated neoplastic cell infiltration within both the pulmonary lymphatic and blood vessels, a finding consistent with lymphovascular spread, which can contribute to the development of pleural effusion. This case show that while the characteristics of neoplasia-associated pleural fluid may vary according to disease stage, cholangiocarcinoma-associated pleural effusion may occur in the absence of cytologic evidence of malignancy, pulmonary nodules on thoracic imaging, or typical hepatobiliary signs. Full article

Clinical Rationale and Objectives: Refractory out-of-hospital cardiac arrest (OHCA) is associated with very poor outcomes when treated with conventional cardiopulmonary resuscitation alone, particularly when low-flow time is prolonged. Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) may shorten the interval to extracorporeal perfusion, but its implementation requires a highly standardized operational framework to ensure appropriate patient selection, procedural safety, and efficient use of specialized resources. This manuscript describes the PrehospECPR-GOKVI operational framework, a standardized prehospital ECPR protocol developed by the Gottsegen National Cardiovascular Center in cooperation with the Hungarian National Ambulance Service and the Hungarian Air Ambulance. ECPR Pathway: The programme is based on a dedicated two-person ECPR team, consisting of an experienced physician and a paramedic, deployed with mobile ECPR-specific equipment, including point-of-care ultrasound, a pre-primed VA-ECMO circuit, an ECMO console, and a mobile oxygenator/gas blender. The protocol defines strict inclusion and exclusion criteria, emphasizing witnessed OHCA, age below or apparently below 50 years, initial shockable rhythm or selected pulseless electrical activity with suspected pulmonary embolism, refractory cardiac arrest lasting at least 15 min, no-flow time below 5 min or signs of life, and the feasibility of establishing ECMO flow within 60 min from collapse or emergency call. Two mandatory sonographic STOP criteria are incorporated before cannulation: relevant pericardial effusion or suspected aortic dissection, and inability to safely visualize the femoral artery, femoral vein, and bifurcation. The operational workflow further specifies dispatch activation, ALS continuation, equipment layout, ultrasound-guided femoro-femoral cannulation, failed-access management, air-free circuit connection, post-flow stabilization, receiving-centre notification, and transport to GOKVI. A target interval of no more than 15 min from initiation of ECPR-specific steps to ECMO flow is mandated. Conclusions: The PrehospECPR-GOKVI framework describes a locally developed, standardized operational pathway intended to support early identification, safe procedural preparation, and structured delivery of prehospital ECPR for selected patients with refractory OHCA. The protocol is designed to reduce avoidable delays, standardize ALS–ECPR coordination, and incorporate predefined sonographic safety checkpoints before cannulation. As no patient-level data are reported in this manuscript, feasibility, safety, complication rates, survival, neurological outcomes, resource utilization, and transferability remain to be evaluated prospectively after programme launch. Full article

Background: Prenatal diagnosis of congenital heart defects (CHD) is important for perinatal planning, yet the gestational week at which CHD is diagnosed varies considerably. In referred cohorts, diagnostic timing may be influenced by maternal, fetal, temporal, and lesion-specific factors. This study examined factors associated with the gestational week of prenatal diagnosis among pregnancies with prenatally recognized and subsequently confirmed CHD referred to a national tertiary fetal cardiology centre. Methods: This study analyzed 833 pregnancies with confirmed CHD managed between 2005 and 2020. The primary outcome was the gestational week of prenatal diagnosis. Univariable associations with binary predictors were assessed using Student’s t-test, Welch’s t-test, or the Mann–Whitney U test according to distributional assumptions. A primary fully adjusted multivariable linear regression model with heteroscedasticity-robust standard errors was used to evaluate variables associated with the gestational week of diagnosis. The model included maternal age, calendar year as a continuous variable, twin pregnancy, amniotic fluid abnormalities, chromosomal status, and selected lesion-specific diagnoses. Chromosomal status was modelled hierarchically as no chromosomal abnormality, Down syndrome, or other chromosomal abnormality. Results: In univariable analyses, advanced maternal age, Down syndrome, and chromosomal abnormalities were associated with earlier diagnosis, whereas oligohydramnios was associated with later diagnosis. In the primary fully adjusted multivariable model, increasing maternal age was associated with earlier diagnosis (β = −0.169 weeks per year, 95% CI −0.238 to −0.099; p < 0.001), as was later calendar year (β = −0.211 weeks per year, 95% CI −0.311 to −0.111; p < 0.001). Coarctation of the aorta/aortic arch stenosis (β = 2.276 weeks, 95% CI 0.787 to 3.764; p = 0.003), pulmonary stenosis (β = 1.996 weeks, 95% CI 0.376 to 3.617; p = 0.016), and oligohydramnios (β = 2.097 weeks, 95% CI 0.228 to 3.965; p = 0.028) were associated with later prenatal diagnosis. Down syndrome showed a borderline association with earlier diagnosis (β = −1.350 weeks, 95% CI −2.702 to 0.002; p = 0.050). The model explained 12.2% of the variability in the gestational week of diagnosis, with an adjusted R² of 0.107. Conclusions: In this tertiary referral-centre cohort of pregnancies with prenatally recognized and confirmed CHD, the gestational week of prenatal diagnosis was associated with maternal age, calendar year, oligohydramnios, and selected lesion-specific diagnoses. These findings should be interpreted as observational associations within an already recognized referral cohort rather than determinants of prenatal CHD detection in the general pregnant population. Future studies should incorporate referral pathways, screening history, ultrasound quality, operator experience, fetal position, and lesion-specific imaging characteristics to better characterize factors influencing the timing of prenatal CHD diagnosis. Full article

Subclinical atherosclerosis (SCA) has been associated with lung function in many populations. Accordingly, those factors involved in respiratory health may contribute to the mechanisms linking pulmonary and cardiovascular disorders. Since the airway microbiome plays a key role in respiratory pathophysiology, microbial abundance and diversity in the upper airway may be associated with SCA risk. This study aimed to assess the association of upper airway microbiome abundance and diversity with SCA risk. A nested case–control study was carried out among adults from the Southern Caribbean. SCA was defined by carotid Doppler ultrasound as a carotid intima-media thickness ≥ 0.8 mm or the presence of carotid plaque. Oropharyngeal mucosal samples were collected under fasting conditions, and the V3-V4 region of the 16SRNA gene was sequenced. Differences in genus-level abundance were assessed using Microbiome Multivariable Association with Linear Models 2 (MaAsLin2). Alpha-diversity indices were compared through Wilcoxon tests. Principal coordinates analysis (PCoA) and Permutational Multivariate Analysis of Variance (PERMANOVA), adjusted for age, body mass index, and smoking status, were performed to assess associations between Bray–Curtis distances and SCA. MaAsLin2 was also applied to determine predicted metabolic pathway enrichment. A total of 40 cases and 40 controls were analyzed. The oropharyngeal microbiomes composition was dominated by three genera: Prevotella (cases: 26.0%; controls: 29.8%), Veillonella (cases: 16.3%; controls: 13.7%) and Fusobacterium (cases: 7.5%; controls: 8.0%). Significant differences in relative abundance were found for Streptococcus, Aureimonas, Mogibaecterium, Candidatus Saccharimonas, Pseudomonas, Segatella, Stomatobaculum, Oribacterium and Lachnoanaerobaculum, with lower abundance in cases for all these genera. Alpha-diversity was lower in cases than in controls, as reflected by the Shannon index (cases: 5.95 IQR [4.87; 6.35] vs. controls: 6.49 IQR [6.29; 6.75], p < 0.001), Simpson index (cases: 0.994, IQR [0.989; 0.996] vs. controls: 0.997 IQR [0.997; 0.998], p < 0.001) and Chao1 richness (cases: 1076.2 IQR [345.2; 1473.4] vs. controls: 1136.1, IQR [841.1; 1635.3], p = 0.04) were compared. In adjusted-PERMANOVA, 8.2% of microbiome variations were associated with SCA (pseudo-F = 7.49, R² = 0.082, p < 0.001), although this finding may have been influenced by intra-group dispersion among cases (PERMDISP: pseudo-F = 5.62, p = 0.018; Tukey’s HSD test: mean difference = −0.071, 95% CI [−0.118, −0.025], p = 0.003) Predicted enrichment of phenylalanine metabolism and indole alkaloid biosynthesis was higher in cases. In conclusion, these exploratory analyses suggest that reduced oropharyngeal microbiome diversity is associated with SCA. Further studies are warranted to clarify the role of the airway microbiome on cardiovascular outcomes. Full article

Background and Objectives: Patients with cirrhosis and acute kidney injury (AKI) frequently receive albumin, although plasma volume expansion may contribute to pulmonary or venous congestion. Point-of-care ultrasound (POCUS) may complement bedside assessment when formal echocardiography or advanced hemodynamic monitoring is not immediately available. This study evaluated baseline pulmonary and venous congestion using POCUS in patients with cirrhosis and AKI receiving albumin therapy. Materials and Methods: This exploratory prospective cohort included adults with cirrhosis, ascites, and ICA-AKI stage 1B or higher who were managed under an institutional protocol prescribing intravenous 20% or 25% albumin at 1 g/kg/day for two consecutive days, capped at 100 g/day. Before albumin administration, B-line-defined pulmonary congestion was assessed using a 28-site lung protocol, and IVC-defined venous congestion was assessed using inferior vena cava (IVC) diameter and collapsibility. Serum creatinine was recorded within 12 h before treatment and 48 h after initiation. Complete renal response was defined as serum creatinine within 0.3 mg/dL of the pre-AKI baseline; partial response was defined as regression by at least one ICA-AKI stage without complete response. Results: Twenty-two patients were included. B-line-defined pulmonary congestion was present in 18/22 (81.8%). IVC assessment was technically evaluable in 20 patients, of whom 6/20 (30.0%) met the criteria for IVC-defined venous congestion. The Hodges–Lehmann estimate of the median paired creatinine difference was +0.03 mg/dL (95% CI, −0.52 to 1.31) without pulmonary congestion and −0.33 mg/dL (95% CI, −0.67 to −0.20) with pulmonary congestion. Renal response occurred in 1/4 (25.0%) and 12/18 (66.7%), respectively (two-sided Fisher exact p = 0.264). Among patients with evaluable IVC examinations, renal response occurred in 8/14 (57.1%) without and 3/6 (50.0%) with IVC-defined venous congestion (p = 1.000). Conclusions: Baseline POCUS frequently identified ultrasound-defined congestion, but congestion status did not clearly distinguish short-term renal response. These exploratory findings support the feasibility of bedside POCUS phenotyping but do not establish that congestion modifies albumin response or clinical outcomes. Full article

Background/Objectives: Accurate diagnosis of lymph node pathology is essential for the management of both malignant and benign diseases. This study compares the diagnostic performance of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a real-world cohort. Methods: A single-center retrospective observational study was conducted, including 91 patients who underwent both cryobiopsy and EBUS-TBNA for lymph node evaluation. EBUS-TBNA was performed with a 19-G needle and cryobiopsy with a 1.1 mm flexible cryoprobe. Clinical characteristics, positron emission tomography–computed tomography (PET–CT) findings, ultrasonographic characteristics of the lymph nodes, diagnostic yield, and procedure-related complications were analyzed. Diagnostic accuracy, sensitivity, specificity, and factors associated with correct diagnosis were assessed. Results: The median age of the cohort was 65 years [interquartile range-IQR-56–74], 63.7% were male, and 74.7% were former or current smokers. Malignant disease was ultimately diagnosed in 60 patients (65.9%), of whom 78.3% had non-lymphoproliferative tumours and 21.7% had lymphoproliferative malignancies. The diagnostic accuracy of cryobiopsy was 89%, compared with 82.4% for EBUS-TBNA. The paired comparison between the two techniques did not reach statistical significance. After exclusion of non-diagnostic samples, sensitivity was numerically higher for cryobiopsy (96.4%, 95% CI 90.7–100) than for EBUS-TBNA (88.9%, 95% CI 79.6–98.2). Factors associated with correct diagnosis included chronic obstructive pulmonary disease for cryobiopsy, cardiovascular comorbidities, and maximum SUV for EBUS-TBNA. In malignant lesions, cryobiopsy showed higher diagnostic accuracy than EBUS-TBNA (90% vs. 80% accuracy), particularly in lymphoproliferative diseases. In benign lesions, both techniques agreed in 17 (54%) of cases, with cryobiopsy showing a higher yield for sarcoidosis and contributing to the diagnosis of tuberculosis. Complications were infrequent and minor, with no major adverse events reported. Conclusions: Cryobiopsy showed numerically higher diagnostic accuracy and sensitivity compared with EBUS-TBNA, particularly in malignant and lymphoproliferative disorders, with a favorable safety profile. These findings support its role as a valuable complement—or alternative—to conventional EBUS-TBNA in the assessment of mediastinal lymph nodes. Full article