Thorax最新文献

{"title":"Journal club","authors":"George Doumat","doi":"10.1136/thorax-2025-223657","DOIUrl":"https://doi.org/10.1136/thorax-2025-223657","url":null,"abstract":"Neutrophilic inflammation is a key driver of bronchiectasis progression and exacerbations. Brensocatib, an oral inhibitor of dipeptidyl peptidase 1 (DPP1), prevents activation of neutrophil serine proteases. The phase III randomised double-blind ASPEN trial (N Engl J Med 2025;392:1569–1581) evaluated the efficacy and safety of once-daily brensocatib at 10 mg or 25 mg compared with placebo over 52 weeks in 1721 patients with non-cystic fibrosis bronchiectasis across 35 countries. The annualised rate of adjudicated pulmonary exacerbations was significantly reduced with brensocatib. Patients receiving 10 mg and 25 mg experienced 1.02 and 1.04 exacerbations per year respectively, compared with 1.29 in the placebo group. This corresponded to rate ratios of 0.79 (95% CI, 0.68 to 0.92; p=0.004) and 0.81 (95%CI, 0.69 to 0.94; p=0.005). Time to first exacerbation was delayed with both doses, and nearly half of brensocatib-treated patients remained exacerbation-free at 1 year compared with 40.3% in the placebo group. Lung function decline was smallest in the 25 mg group, with an average decline of 24 milliliters compared with 62 milliliters with placebo (p=0.04). Quality of life, as measured by the Respiratory Symptoms domain of the Quality of Life–Bronchiectasis questionnaire, improved more with brensocatib, especially at the higher dose. The incidence of adverse events was …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"22 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting OSA endotypes with drug therapy: dream or reality?","authors":"Peter A Cistulli, Anna Mohammadieh","doi":"10.1136/thorax-2025-223409","DOIUrl":"https://doi.org/10.1136/thorax-2025-223409","url":null,"abstract":"","PeriodicalId":23284,"journal":{"name":"Thorax","volume":" ","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for atopic and non-atopic asthma in school-age children from high-income and low- and middle-income countries","authors":"Charlotte E Rutter, Harriet Mpairwe, Camila A Figueiredo, Mary Njoroge, Steven Robertson, Hajar Ali, Collin Brooks, Jeroen Douwes, Philip J Cooper, Martha Chico, Natalia Romero-Sandoval, Álvaro A Cruz, Pius Tumwesige, Mauricio L Barreto, Neil Pearce, Lucy Pembrey","doi":"10.1136/thorax-2024-222118","DOIUrl":"https://doi.org/10.1136/thorax-2024-222118","url":null,"abstract":"Background It is well established that there are different asthma phenotypes, but whereas determinants of atopic asthma (AA) are well studied, little is known about non-atopic asthma (NAA). We compared risk factors for atopy, AA in atopics and NAA in non-atopics in children in a wide variety of countries. Methods Using four studies, across 23 countries, we assessed asthma status and atopy (skin prick tests) for children aged 6–17, plus risk factors from housing, heating, pets, family, diet and air quality categories. Using mixed-effects logistic regression models, we assessed risk factors over four pathways: pathway 1—non-atopic non-asthma to NAA; pathway 2—non-atopic non-asthma to atopy (no asthma); pathway 3—atopic non-asthma to AA; pathway 4—non-atopic non-asthma to AA. We compared the log odds of risk factors between pathways using the Pearson correlation coefficient (PCC). Results Our final sample of 32 741 children comprised 67% with neither atopy nor asthma, 15% with atopy but without asthma, 8% with AA and 10% with NAA. Risk factors were similar between pathway 1 and pathway 3 (PCC=0.81, 95% CI 0.68 to 0.94). In contrast, risk factors differed between pathway 2 and pathway 3 (PCC=−0.06, 95% CI −0.29 to 0.17). Discussion These findings indicate that although atopy increases the risk of asthma, the risk factors for subsequently developing asthma are generally the same in those with and without atopy. This raises important questions about the role of atopy in asthma, particularly whether it is an inherent part of the aetiological process or is coincidental. Data are available in a public, open access repository. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. ISAAC data are publicly available at the UK Data Service archive (<http://discover.ukdataservice.ac.uk/catalogue?sn=8131>) . ALSPAC data can be accessed after application to the ALSPAC Executive Team; application instructions and data use agreements are available at [http://www.bristol.ac.uk/alspac/researchers/access/][1]. The relevant data from the WASP and SCAALA studies will be shared on reasonable request to the corresponding author. [1]: https://www.bristol.ac.uk/alspac/researchers/access/","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"39 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day-to-day variability indices improve utility of oscillometry in paediatric asthma","authors":"Minh Trang Hoang, Alexander Wong, Kate Hardaker, Sashritha Peiris, Brett Dyer, Ediane de Queiroz Andrade, Anneliese Blaxland, Penny Field, Dominic A Fitzgerald, Geshani Jayasuriya, Chetan Pandit, Hiran Selvadurai, Gregory G King, Cindy Thamrin, Paul D Robinson","doi":"10.1136/thorax-2024-222744","DOIUrl":"https://doi.org/10.1136/thorax-2024-222744","url":null,"abstract":"Background Oscillometry may provide the feasible and sensitive tool for objective remote monitoring of paediatric asthma. Methods Observational study of school-aged healthy, well-controlled and poorly-controlled asthma performing daily home-based oscillometry for 3–4 months, alongside objective measures of asthma control (Asthma Control Questionnaire weekly and Asthma Control Test monthly), medication use and exacerbations. Day-to-day variability calculated as coefficient of variation (CV) for resistance at 5 Hz (R5), reactance at 5 Hz (X5) and area under reactance curve (AX). Our objective was to examine feasibility, whether day-to-day variability was increased in asthma and correlations with asthma control and exacerbation burden. Clinical exacerbation patterns were examined using principal component analysis and k-means clustering of oscillometry, symptoms, breathing parameters and adherence. Results Feasibility was 74.9±16.0% in health (n=13, 93.7±16.2 days) and 80.6±12.9% in asthma (n=42, 101.6±24.9 days; 17 well-controlled and 27 poorly-controlled asthma). Increased day-to-day variability in all oscillometry indices occurred in asthma versus health (all p≤0.002), with CV R5 the best discriminator (area under receiver operating characteristics curve 0.88, p<0.001). CV R5 increased during exacerbation and correlated with all asthma control measures and exacerbation burden. Correlations remained when examining non-exacerbation oscillometry data. Two exacerbation patterns were found based on oscillometry data in the pre-exacerbation period, characterised by severity of impairment of R5, X5, AX and CV R5 (n=12, more severe). Findings were similar using post-exacerbation period oscillometry data (n=8, more severe). Symptoms did not differ across exacerbation patterns. Conclusions Home-based oscillometry monitoring was highly feasible over extended periods in school-aged asthmatics. Day-to-day oscillometry variability was increased in asthma compared with health, reflected asthma control and exacerbation burden and identified differing exacerbation patterns. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Further data may be available upon reasonable request to the corresponding author.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"51 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fourteen-year-old girl with multifocal complex cysts in the right lung","authors":"Lele Kang, Yue Liu, Shengli Shi, Libing Fu, Yuelin Shen","doi":"10.1136/thorax-2024-222706","DOIUrl":"https://doi.org/10.1136/thorax-2024-222706","url":null,"abstract":"A 14-year-old girl was diagnosed with pectus excavatum at birth and underwent corrective surgery at the age of 4. Preoperative chest CT scan incidentally revealed multiple cystic lesions in the right upper and middle lobes (figure 1A), which were not specifically addressed at that time. Since the age of 7, she experienced reduced exercise tolerance. Over the past 6 months, she presented with intermittent fever, cough and haemoptysis. The patient was referred to our hospital for further evaluation and management. Physical examination revealed significantly reduced breath sounds in the right lung compared with the left. No clubbing was observed. A chest CT scan revealed that, compared with 10 years ago, the cysts in the right upper and middle lobes had increased in size. The largest lesions, originally two adjacent cysts, had merged into a single cyst, growing from 21.5×33.8×21.0 mm to 60.2×56.9×70.6 mm, with multifocal solid masses appearing within the merged cyst (figure 1). Serum Aspergillus fumigatus -specific IgG antibody was positive, and tests for tuberculosis and HIV were negative. Immunological function was normal. Figure 1 Chest CT demonstrating significant growth of the cystic lesions over 10 years. (A) A chest CT scan at age 4 revealed multiple cystic lesions in the right upper …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"25 1","pages":"thorax-2024-222706"},"PeriodicalIF":10.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"33-year-old woman with mixed connective tissue disease and rapid onset breathlessness","authors":"Helena Crawshaw, Matthew Wells, Anthony Edey, Shaney L Barratt, Harsha Gunawardena","doi":"10.1136/thorax-2024-222780","DOIUrl":"https://doi.org/10.1136/thorax-2024-222780","url":null,"abstract":"We present a 33-year-old woman with anti-U1 ribonucleoprotein antibody positive mixed connective tissue disease (MCTD) since the age of 13. Predominant features were of inflammatory arthritis, Raynaud’s phenomenon and fatigue. She had been stable on combined methotrexate and hydroxychloroquine. She presented acutely in 2022 with breathlessness and sudden onset chest pain. Clinical examination revealed reduced air entry bibasally but was otherwise unremarkable. C-reactive protein (CRP) and double-stranded DNA were raised (46 mg/L and 26 IU/L) with normal complement. CT pulmonary angiogram (CTPA) excluded pulmonary emboli but revealed small bilateral effusions and a 3 cm pericardial effusion confirmed on subsequent echocardiogram. She received a tapering course of prednisolone to continue on 10 mg with initial improvement. She re-presented 5 months later with progressive breathlessness over weeks, particularly when lying flat. There were no clinical symptoms or signs suggestive of connective tissue disease flare or active infection. Lung function testing demonstrated reduced forced vital capacity (FVC) of 1.72 L (46% predicted) with a ratio of 79.7. The diffusing capacity of the lungs for carbon monoxide (TLCO) was reduced (59.6% predicted) but correctable (carbon monoxide transfer coefficient (KCO) 108.9%), in keeping with a rapidly progressive restrictive pathology (figure 1) for which she was admitted for inpatient investigation. CRP was elevated (74 mg/L) with lymphopenia (0.53 109/L). N-terminal pro B-type natriuretic peptide (NT-pro BNP), …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"34 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and future applications of artificial intelligence in lung cancer and mesothelioma","authors":"Joshua J Roche, Farzaneh Seyedshahi, Kai Rakovic, Akari Win Thu, John Le Quesne, Kevin G Blyth","doi":"10.1136/thorax-2024-222054","DOIUrl":"https://doi.org/10.1136/thorax-2024-222054","url":null,"abstract":"Background Considerable challenges exist in managing lung cancer and mesothelioma, including diagnostic complexity, treatment stratification, early detection and imaging quantification. Variable incidence in mesothelioma also makes equitable provision of high-quality care difficult. In this context, artificial intelligence (AI) offers a range of assistive/automated functions that can potentially enhance clinical decision-making, while reducing inequality and pathway delay. Aims In this state-of-the-art narrative review, we synthesise evidence on this topic, focusing particularly on tools that ingest routine pathology and radiology images. We summarise the strengths and weaknesses of AI applied to common multidisciplinary team (MDT) functions, including histological diagnosis, therapeutic response prediction, radiological detection and quantification, and survival estimation. We also review emerging methods capable of generating novel biological insights and current barriers to implementation, including access to high-quality training data and suitable regulatory and technical infrastructure. Narrative Neural networks trained on pathology images have proven utility in histological classification, prognostication, response prediction and survival. Self-supervised models can also generate new insights into biological features responsible for adverse outcomes. Radiology applications include lung nodule tools, which offer critical pathway support for imminent lung cancer screening and urgent referrals. Tumour segmentation AI offers particular advantages in mesothelioma, where response assessment and volumetric staging are difficult using human readers due to tumour size and morphological complexity. AI is also critical for radiogenomics, permitting effective integration of molecular and radiomic features for discovery of non-invasive markers for molecular subtyping and enhanced stratification. Conclusions AI solutions offer considerable potential benefits across the MDT, particularly in repetitive or time-consuming tasks based on pathology and radiology images. Effective leveraging of this technology is critical for lung cancer screening and efficient delivery of increasingly complex diagnostic and predictive MDT functions. Future AI research should involve transparent and interpretable outputs that assist in explaining the basis of AI-supported decision making.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"38 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PM2.5 as a risk factor for sleep oxygen desaturation in COPD: identifying susceptible individuals by smoking and inflammatory phenotypes","authors":"Wenlou Zhang, Baiqi Chen, Masayuki Shima, Chen Zhao, Liqiong Guo, Yoshiko Yoda, Shurun Li, Shaowei Wu, Yahong Chen, Xinbiao Guo, Furong Deng","doi":"10.1136/thorax-2025-223140","DOIUrl":"https://doi.org/10.1136/thorax-2025-223140","url":null,"abstract":"Background Nocturnal hypoxia is prevalent in chronic obstructive pulmonary disease (COPD) and contributes significantly to poor disease prognosis. However, its key environmental risk factors and susceptible phenotypes remain poorly understood. Methods This prospective repeated-measure study included 96 patients with COPD with real-time personal monitoring of fine particulate matter (PM2.5) and oxygen saturation (SpO2) during sleep (84 971 observations), aiming to investigate the association of PM2.5 with oxygen desaturation and identify susceptible individuals by smoking and inflammatory phenotypes. Inflammatory phenotypes were determined by exhaled biomarkers (nitric oxide and hydrogen sulfide) and blood leucocytes (neutrophils and eosinophils). Generalised linear mixed models were applied to estimate the risk of oxygen desaturation associated with PM2.5. Results Personal PM2.5 exposure was significantly associated with sleep SpO2 decline within hours. The highest risk of oxygen desaturation associated with PM2.5 was observed in current smokers (OR=1.53, 95% CI: 1.22 to 1.92), followed by former smokers (OR=1.14, 95% CI: 1.02 to 1.28), with no significant effect in never smokers. Notably, current smokers exhibited higher neutrophilic inflammation, and those with higher airway neutrophilic inflammation were more susceptible to PM2.5-related oxygen desaturation (p interaction<0.001). For former smokers, those with higher small-airway eosinophilic inflammation were more susceptible (p interaction <0.001). Both former and current smokers with a systemic mixed granulocyte phenotype were at greater risk of oxygen desaturation. Furthermore, individuals with constant high inflammation are more susceptible to PM2.5-related oxygen desaturation than those without inflammation. Conclusions Airborne PM2.5 is an important risk factor for sleep hypoxia in patients with COPD, especially for individuals with smoking history and specific inflammatory phenotypes. Trial registration number [NCT05076630][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05076630&atom=%2Fthoraxjnl%2Fearly%2F2025%2F06%2F20%2Fthorax-2025-223140.atom","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"70 1","pages":"thorax-2025-223140"},"PeriodicalIF":10.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basement membrane repair response biomarker PRO-C4 predicts progression in idiopathic pulmonary fibrosis: analysis of the PFBIO and PROFILE cohorts","authors":"Jannie M B Sand, Peder Frederiksen, Alison E John, Filipa B Simões, Nils Hoyer, Thomas S Prior, Adnan Avdic-Belltheus, Philip L Molyneaux, Iain D Stewart, Hernan P Fainberg, Simon R Johnson, Morten A Karsdal, Diana J Leeming, Elisabeth Bendstrup, Saher B Shaker, Toby M Maher, Gisli Jenkins","doi":"10.1136/thorax-2024-221868","DOIUrl":"https://doi.org/10.1136/thorax-2024-221868","url":null,"abstract":"Background Idiopathic pulmonary fibrosis (IPF) is characterised by damage to the epithelial layer, closely associated with the alveolar basement membrane (BM). We aimed to investigate how type IV collagen (COL4) in the BM changes with the progression of IPF. Methods COL4 synthesis (PRO-C4) was detected in blood by the nordicPRO-C4 biomarker in patients with IPF from the two prospective, multicentre, observational, longitudinal cohorts, pulmonary fibrosis biomarker (PFBIO) and prospective observation of fibrosis in the lung clinical endpoints (PROFILE). PRO-C4 trajectories over 12 months were compared between progressors and non-progressors by linear mixed effects regression models. Rate of change in PRO-C4 and lung function were compared by Bayesian bivariate longitudinal models. Cox proportional hazards models analysed baseline PRO-C4 and 3 years mortality. COL4 staining in IPF and non-IPF lungs was evaluated by immunohistochemistry. Results In PFBIO and PROFILE, 51/220 (23.2%) and 221/459 (48.1%) patients, respectively, had progressive disease at 12 months. Longitudinal PRO-C4 levels were higher in progressors versus non-progressors (average differences: PFBIO 21.5% (95% CI 3.4% to 42.9%, p=0.0184); PROFILE 10.9% (95% CI 0.8% to 22.1%; p=0.0340). Monthly rate of change in PRO-C4 was steeper in non-survivors versus survivors (mean difference up to 3.12% (95% CI 0.35% to 5.91%)) and was inversely correlated with the change in lung function. High baseline PRO-C4 was associated with increased mortality risk in PFBIO (HR 2.55 (95% CI 1.27 to 5.12), p=0.0083). COL4 staining was higher in IPF versus non-IPF lung but was less obvious in end-stage tissue. Conclusions High and increasing serological PRO-C4 levels were prognostic for progression in two independent IPF cohorts. This study suggests that COL4 synthesis assessed by PRO-C4 is a pathologically relevant biomarker of alveolar BM repair in IPF. Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"56 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All that pops is not necessarily a pneumothorax!","authors":"Amr Youssef, Elinor Bradley, Marcin Szostok, Seema Brij, James Wingfield Digby","doi":"10.1136/thorax-2025-223340","DOIUrl":"https://doi.org/10.1136/thorax-2025-223340","url":null,"abstract":"A 71-year-old man presented to the emergency department with sudden onset sharp left-sided chest pain following a severe coughing episode. He was an ex-smoker with a background of chronic obstructive pulmonary disease, obesity (body mass index 31), type 2 diabetes and an umbilical hernia. Physical examination revealed left lateral chest wall bruising (figure 1A) and tenderness, as well as a bulging swelling on the left lateral chest wall on coughing. Chest auscultation showed vesicular breathing with prolonged expiration with no wheezes or crepitations. Chest X-ray showed lung protrusion outside chest wall (figure 1B). CT thorax demonstrated widening of the intercostal space laterally between the seventh and eighth ribs, consistent with an intercostal muscle tear and lung tissue herniation (figure 2). Figure 1 Chest wall bruise (1A) and chest X-ray showing protruded lung tissue (1B). Figure 2 CT chest showing …","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"5 1","pages":""},"PeriodicalIF":10.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}