Krupa Shingada

The number of pulmonary nodules detected is steadily increasing. While some are low or high risk, most are indeterminate. Within the indeterminate group, the vast majority are benign. Statification of indeterminate pulmonary nodules (IPNs) is challenging. Validated risk calculators are not routinely employed in clinical practice because they are cumbersome. Most clinicians rely upon clinical gestalt. This strategy often results in unnecessary biopsies, which are costly, stressful, and have the potential for iatrogenic injury. There are a number of commercially available lung cancer risk biomarkers, which each have their own strengths and weaknesses. Barriers to widespread adoption include lack of guideline support, clinical practice inertia, and limited clinical utility data. Upcoming multicenter trials aim to provide high quality data that could lead to guideline incorporation.

Alveolar–pleural or broncho-pleural fistulas, leading to persistent air leaks (PALs), are associated with prolonged hospitalization and substantial morbidity. While guidelines advocate surgical repair as the primary treatment, its efficacy is limited. For patients recently subjected to thoracic surgery or those for whom surgery is contraindicated due to severe illness, viable treatment alternatives have been lacking. This article reviews the newer and less invasive treatment options for PALs. Further research is crucial, including randomized controlled trials comparing these options, and long-term monitoring of intervention outcomes is warranted.