Bullous lung disease (BLD) is frequently associated with spontaneous pneumothorax and may require surgical intervention. The use of vacuum-assisted chest tube drainage after bullectomy is controversial. This study aimed to compare the results of vacuum versus non-vacuum assisted chest tube drainage in patients after bullectomy. This randomized controlled study included 80 patients who underwent bullectomy between September 2023 and July 2024 at Kasr Al-Ainy Hospitals. Patients were randomly allocated to either vacuum-assisted or non-vacuum chest tube drainage. Postoperative outcomes including chest tube duration, air leak duration, drainage volume, pain scores, length of hospital stay, and complication rates were compared between the two groups. No statistically significant differences were observed between the two groups regarding chest tube duration (7.0 ± 1.5 vs. 6.7 ± 4.03days), duration of air leak (4.67 ± 1.36 vs. 4.43 ± 3.7days), or amount of drained fluid (726.7 ± 161.7mL vs. 669.5 ± 299.1mL) in the vacuum and non-vacuum groups, respectively. Postoperative pain scores, length of hospital stay, and complication rates (including bleeding, wound infection, empyema, residual cavity, and mortality) were also comparable between groups. By focusing exclusively on bullectomy patients (a group under-represented in prior trials that mainly combined lobectomy and other resections), our study provides procedure-specific evidence showing no clinical advantage of routine suction. These findings help clarify inconsistencies in the literature by demonstrating that the benefit of suction may not extend to bullectomy, where postoperative physiology differs from major lung resections.

Assessment of air leakage through nonuniform cracks of reinforced concrete plates

Influence of air leakage on negative pressure attenuation in coal seam directional boreholes: Modeling, simulation, and validation

In the delivery room, newborn respiratory failure precedes cardiac failure, emphasizing the importance of effective ventilation. Face masks for ventilation may cause air leakage around the mask with subsequent suboptimal lung pressure, and intubation requires skilled providers. Laryngeal mask airways (LMA) may provide a more stable airway interface, with improved seal and more consistent ventilation that is less dependent on provider technique. An evaluation of the feasibility, acceptability, and initial outcomes of implementing the laryngeal mask airway as the first-line approach for ventilation in late preterm and term infants was conducted in a high-resource, urban safety-net hospital with a level III neonatal intensive care unit (NICU). The LMA was introduced and promoted as the firstline for delivery room ventilation in infants ≥35 weeks gestational age and ≥1.5 kg from August 2023 to August 2024. Implementation was supported by comprehensive training, survey feedback, and multidisciplinary involvement. The program evaluation spanned a 2-year period from August 2022 to August 2024. Feasibility and acceptability data were collected via provider surveys, and neonatal outcomes were compared pre- and post-implementation from electronic health record data. During implementation, LMAswereused as first-line in 58.7% of eligible neonates indicated for delivery room ventilation. Provider surveys showed increased knowledge and confidence in LMA use after education and high comfortability with LMA implementation in the delivery room. NICU admission rates, delivery room endotracheal intubations, chest compressions, and epinephrine use were similar across groups. Providers across experience levels successfully inserted LMAsafter brief training. LMA as first-line ventilation yielded similar outcomes to face mask in an urban safety-net hospital. Future research should explore broader applicability.

BackgroundPneumothorax is a condition where air leaks into the space between the visceral and parietal pleura. Community acquired pneumonia is a rare cause of pneumothorax in children. Pneumothorax can sometimes develop as a complication of pneumonia when infection erodes the distal airway into the pleural cavity causing air leak. If the air leak persists for more than 7 days, then it is termed a persistent air leak.Case SummaryA 6‐year‐old South Asian girl presented with right upper and middle lobe pneumonia with empyema, for which a chest tube drain was inserted, which progressed to a persistent pulmonary air leak. Despite initial hospital management, the air leak persisted, necessitating home‐based care with meticulous follow‐up. Later on, after home‐based care, the child improved and the chest tube could be removed without complications. The management of persistent air leak complicated by pneumonia necessitates a multidisciplinary approach.ConclusionThis case highlights an innovative approach to managing complex pediatric respiratory conditions outside the hospital setting. The incorporation of domiciliary care introduces a novel dimension. This requires meticulous training of the parents with no medical exposure before monitoring and guiding them via online video and ensuring they adhere to treatment protocols. This report highlights the possibility of conservative domiciliary management for persistent air leak before going into definitive surgery.

To determine the effective dose of ciprofol in combination with remifentanil for successful laryngeal mask airway (LMA) placement without the use of muscle relaxants. A two-phase, biased-coin, up-and-down sequential allocation trial. Single tertiary hospital; general anesthesia induction. 106 American Society of Anesthesiologists (ASA) physical status I-II adult patients (aged 18-75 years) scheduled for elective surgery under LMA anesthesia. • Phase 1: Ciprofol was fixed at 0.4 mg/kg, while remifentanil doses were adjusted using a biased-coin design to estimate the median effective dose (ED₅₀) and 95% effective dose (ED₉₅). • Phase 2: Remifentanil was fixed at the ED₅₀ determined in Phase 1, and ciprofol doses were similarly titrated to determine its effective dose. Successful LMA placement was defined as the absence of coughing or gagging, along with an effective seal (air leak pressure > 20 cmH₂O). Secondary outcomes included hemodynamic fluctuations (ΔMAP > 20%), apnea, and injection pain. The ED₅₀ of remifentanil was 0.7 μg/kg when combined with ciprofol 0.34 mg/kg. Adverse events included hypotension (12.7%) and bradycardia (9.5%). The combination of ciprofol 0.34 mg/kg and remifentanil 0.7 μg/kg provides effective conditions for LMA placement without muscle relaxants. This regimen reduces opioid requirements and may promote faster recovery. Chinese Clinical Trial Registry ChiCTR2200062686; registered on August 15, 2022 (retrospectively registered).

Fissureless lobectomy has been shown to prevent air leaks in patients with fused or incomplete interlobar fissures or emphysema. The technique is also beneficial in advanced lung cancers involving adjacent lobes, where interlobar manipulation is technically difficult. Although this technique is widely used in standard lobectomies, reports on bilobectomy remain scarce. A 57-year-old woman with left-sided tongue cancer (pT2N0M0, Stage II) underwent subtotal glossectomy followed by postoperative concurrent chemoradiotherapy. Eighteen months after the surgery, imaging revealed a mass in the right lower lobe. Bronchoscopy confirmed squamous cell carcinoma, and the patient was referred to our department with suspected pulmonary metastasis. Over the 3weeks following initial presentation, the lung tumor enlarged rapidly. The tumor was centered in the lower lobe with invasion of the middle and upper lobes, and the distal lung parenchyma was complicated by obstructive pneumonia. Although antibiotics were administered, the fever and inflammatory markers persisted; thus, we decided to proceed with surgery for infection control. Due to the presence of incomplete lung fissure and the lower lobe tumor invading the other lobes, pneumonectomy was the initial option. However, to preserve lung capacity, we decided to perform a fissure-last right middle and lower bilobectomy with division of the interlobar pulmonary artery prior to resection of the bronchus. The patient was discharged 16days after surgery without complications. We report a case of bilobectomy using a modified fissureless technique and describe the technical details of how we dissect the pulmonary artery prior to resection of the bronchus. Being familiar with the fissureless bilobectomy technique is an important option for avoiding right pneumonectomy.

Non-small cell lung cancer (NSCLC) is associated with high malignancy, mortality, and recurrence. While early symptoms are subtle, timely surgery significantly improves outcomes. Video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy is an increasingly important technique in early-stage NSCLC management. This study evaluates its effects on postoperative pain, stress response, respiratory function, and quality of life (QOL). This study aims to investigate the impact of VATS anatomic segmentectomy on stress response and pulmonary function in early-stage NSCLC patients. From December 2021 to December 2023, 98 early-stage NSCLC patients were allocated by surgical method: 45 underwent VATS pulmonary lobectomy (control group) and 53 underwent VATS anatomic segmentectomy (observation group). Perioperative outcomes, stress markers (cortisol, growth hormone, adrenocorticotrophic hormone, prostaglandin E2), complications, pain (visual analog scale scores), pulmonary function (forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal voluntary ventilation, transfer factor for carbon monoxide of the lung), and QOL were compared. Surgical duration and lymph node retrieval did not differ significantly (P > .05). However, the observation group showed less intraoperative bleeding, lower postoperative drainage, shorter extubation time, and reduced hospital stay (P < .05). Preoperative stress markers were similar between groups. Postoperatively, cortisol and prostaglandin E2 were significantly lower in the observation group, while growth hormone and adrenocorticotrophic hormone levels showed no group difference (P < .05). Rates of complications (pneumonia, atelectasis, atrial fibrillation, prolonged air leak, empyema, hoarseness, arrhythmia) were comparable (P > .05). Pain scores at 24, 48, 72 hours, and day 5 were lower in the observation group (P < .05). Preoperative lung function was similar, but at 1 month, the observation group demonstrated higher forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, maximal voluntary ventilation, and transfer factor for carbon monoxide of the lung (P < .05). QOL was initially comparable, but at 1 and 3 months, the observation group reported significantly better QOL (P < .05). VATS anatomic segmentectomy provides favorable clinical outcomes for early-stage NSCLC. It reduces postoperative stress and pain, enhances lung function recovery, and improves QOL, supporting its value as a surgical option.

The hinotori™ surgical robot system is the second Japanese-made surgical robotic system to be approved for use in thoracic surgery, following Saroa. Although the feasibility of robotic systems has been demonstrated primarily in the field of abdominal surgery, evidence for thoracic surgery remains scarce. This study aimed to evaluate the early clinical outcomes of anatomical pulmonary resections performed with this system and to assess its feasibility as a routine platform for thoracic oncology. A prospective observational study was conducted, including 36 consecutive patients undergoing anatomical lung resection for primary lung cancer with the hinotori™ system between July 2024 and February 2026. Perioperative data were extracted from institutional records and were compared between experienced robotic surgeons and surgeons performing their first robotic surgery with the hinotori™ system. The average console and total operative times were 139.9min and 203.1min, respectively. The mean estimated blood loss was 68.3mL, and the average duration to chest drain removal was 4days. Major perioperative complications, corresponding to Clavien-Dindo grade III or higher were observed in four cases (11.1%) including persistent air leakage in three cases and cerebral infarction in one case. No complications due to hinotori™ use, and no 30-day mortality or readmission events occurred. Perioperative outcomes were comparable between experienced and inexperienced surgeons. The hinotori™ surgical robot system enabled safe and reproducible anatomical lung resection for primary lung cancer indicating its potential for broader clinical use in thoracic surgery.

To improve the proactive prevention and control of coal spontaneous-combustion disasters in the goafs of deep coal mines, this study identifies the factors associated with hazard-source recognition for coal spontaneous combustion in the goaf of a coal mine in Hebi, China. The mine is characterized by coal-seam explosibility and spontaneous-combustion proneness, large quantities of residual coal under fully mechanized top-coal caving, a complex air-leakage field, and concealed fire sources that are difficult to detect in a timely manner. On the basis of systems engineering theory and accident-causation theory, literature analysis, field investigation, and expert evaluation were integrated to conduct hierarchical identification of hazard sources related to goaf coal spontaneous combustion. A risk-evaluation indicator system was then established from four dimensions: human factors, equipment factors, environmental factors, and management factors. The results indicate that goaf coal spontaneous combustion is not governed by a single factor; rather, it is a dynamic disaster process driven by the coupled effects of residual-coal oxidation and heat accumulation, air leakage and oxygen supply, production organization, equipment reliability, and management execution. Among the identified indicators, the accuracy of early hazard recognition, reliability of standby power supply and emergency equipment, matching degree between longwall face advance rate and the spontaneous-combustion period, and closed-loop rate of hazard investigation and rectification exert critical influences on risk evolution. The findings provide theoretical support for precise prevention and control of goaf coal spontaneous-combustion risk in the studied mine and offer a reference for fire-prevention and fire-extinguishing management in similar deep, fully mechanized top-coal-caving mines.

We conducted a cadaveric feasibility study of two intrapleural applications of single-use bronchoscopes. In Approach 1, a 2.7 mm bronchoscope was used as a visual stylet inside a 20-Fr trocar catheter to confirm pleural entry and drain-tip position. In Approach 2, a 5.0 mm bronchoscope was used as a flexible thoracoscope for limited pleural inspection, aspiration, and direct-vision forceps biopsy; a sprayed-instillation maneuver was performed only to confirm technical deliverability. Approach 1 was attempted and feasible in six hemithoraces of three Thiel-embalmed cadavers. Approach 2 was attempted and feasible in four hemithoraces; it was not attempted in two hemithoraces due to time constraints and a large persistent air leak after Approach (1) No negative-to-positive conversion (new persistent air leak) was observed after Approach (2) These techniques may offer complementary approaches to conventional methods for observing the intrathoracic space and therefore warrant stepwise clinical validation.

The management of chest tubes after pulmonary resection remains non- standardized, and suction levels are often determined by the surgeon's preference. This retrospective study aimed to compare the clinical outcomes of low suction -2cmH2O-2cmH2​O versus the conventional suction level used in our institution -15cmH2O-15cmH2​O using digital drainage devices after videoassisted thoracic surgery (VATS) lobectomy for suspected or confirmed lung cancer in a thoracic surgery centre. We analysed 120 patients who underwent pleural drainage after VATS lobectomy between January 2023 and September 2024. The primary outcome was drainage duration. Secondary outcomes included hospital stay, prolonged air leak, complications, and readmissions. No significant differences were observed in drainage duration (2.0 vs. 4.0 days; p=0.125p=0.125) or hospital stay (3.0 vs. 4.0 days; p=0.104p=0.104 ). The incidence of prolonged air leak was similar between groups (20.3% vs. 24.6%; p=0.578p=0.578 ). However, subcutaneous emphysema occurred more frequently in the low suction group (22% vs. 8.2%; p=0.04p=0.04 ), with a higher need for intervention, despite comparable baseline forced expiratory volume in the first second (FEV1) values between suction level groups. Importantly, patients who developed subcutaneous emphysema had significantly lower baseline FEV1 values, regardless of suction level. COPD was identified as a significant predictor of longer drainage duration, longer hospital stay, and higher complication rates. Although suction level did not significantly influence postoperative recovery, the higher incidence of subcutaneous emphysema in the low suction group warrants further investigation. The presence of COPD and impaired baseline lung function should be considered when selecting suction levels after VATS lobectomy.

This study aimed to compare the clinical outcomes of three surgical methods (wedge resection, segmentectomy and lobectomy) in non-small cell lung cancer (NSCLC). We retrospectively analyzed 130 NSCLC patients who underwent thoracoscopic surgery. Patients were categorized into wedge resection (n = 50), segmentectomy (n = 40) and lobectomy (n = 40) groups. Baseline characteristics, perioperative parameters (operative time, drainage time, length of hospital stay, intraoperative blood loss), postoperative adverse events (reoperation, atrial arrhythmia, pulmonary embolism, prolonged air leak, pulmonary infection, pneumothorax, pleural effusion, atelectasis), and survival rates stratified by tumor diameter (< 1.0cm, 1.1-2.0cm) were recorded and compared. Baseline characteristics were comparable among the three groups (P > 0.05). For tumors < 1.0cm, the overall survival (OS) rates were similar among wedge resection, segmentectomy, and lobectomy groups (88% vs. 90.48% vs. 91.30%) (P > 0.05). In tumors measuring 1.1-2.0cm, the observed OS rates were 92.00% for wedge resection, 63.16% for segmentectomy, and 64.71% for lobectomy (P < 0.05). The three surgical approaches showed significant differences in the number of lymph nodes sampled, the detection rate of positive lymph nodes, and the resection method (P < 0.05), while no statistically significant difference was observed in the margin status (P > 0.05). Wedge resection was associated with the shortest operative time and drainage time (P < 0.05), while length of hospital stay and intraoperative blood loss did not differ significantly across the three approaches (P > 0.05). The incidence of postoperative adverse events presented no discernible difference in the three surgical approaches (P > 0.05). For tumors smaller than 1cm, wedge resection was associated with OS similar to that of segmentectomy and lobectomy. For selected tumors measuring 1.1-2.0cm, wedge resection was associated with higher observed OS in this cohort and with shorter operative and drainage times; prospective validation is needed.

To evaluate the safety and efficiency of a novel computed tomography (CT)-guided hookwire localization technique, aiming to enable parenchyma-sparing wedge resection using video-assisted thoracoscopic surgery (VATS) for small, hilar-proximal, ground-glass opacity (GGO)-dominant nodules. Localizing hilar-proximal GGOs remains challenging. For small, hilar-proximal, GGO-dominant lung nodules, there is no consensus regarding the optimal surgical approach. This was a multicenter retrospective study from January 2023 to July 2025 including 79 patients with subpleural pulmonary nodules ≤ 2cm in diameter and consolidation-to-tumor ratio (CTR) ≤ 0.25 located near the hilum. Patients underwent preoperative CT-guided hookwire localization using transfissural or traversing-lobe approach, followed by uniportal VATS wedge resection. Resection was performed using ultrasonic dissection with limited stapler use to maximize lung preservation. 79 nodules (median, 7mm, range 6-20mm) were successfully localized. Minor asymptomatic pneumothorax occurred after localization in 12 patients and small pulmonary hemorrhage in 10 patients. The median operative time was 15.0 minutes (range 10-28 minutes). Histopathology confirmed 9 adenocarcinoma in situ, 53 minimally invasive adenocarcinoma, 14 invasive adenocarcinoma, and 3 benign lesions. 10 patients experienced persistent air leak > 72h and no other major complications occurred. Median postoperative hospital stay was 3 days (range 2 - 6d). At a median follow-up of 17.3 months, no local recurrences or deaths have been detected. This novel CT-guided hookwire localization strategy proved highly effective for small, hilar-proximal, GGO-dominant lung nodules, facilitating their successful removal by VATS wedge resection with parenchyma-sparing technique.

Preoperative pulmonary function tests (PFTs) contain numerous physiologic parameters, yet surgeons typically rely on forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) to assess surgical risk. This study aimed to evaluate whether artificial intelligence (AI) could utilize more PFT data to predict the occurrence of prolonged air leak (PAL) following lung resection. An optical character recognition (OCR) model was used to extract structured data from PFT reports. These data were combined with clinical and demographic features from our institutional Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD) between 2016 and 2023. A feature selection algorithm was used to select the most predictive features, and a neural network was trained and tested on an internal validation cohort to predict PAL. Model performance was compared to previously published models. There were 410 patients undergoing lung resection who had PFTs successfully digitized by the OCR system. A total of 76 available PFT features were extracted per patient. The final AI model included 10 key input variables, including three PFTs and seven clinical variables. On validation, the model achieved a specificity of 73%, sensitivity of 60%, overall accuracy of 72%, and an area under the curve of 0.74. This performance exceeded most existing PAL prediction models. AI-driven models using structured PFT and clinical data can enhance prediction of prolonged air leak after lung resection and outperform conventional regression-based models. Further research may focus on external validation and integration into clinical workflows.

The cracking problem of cement-based materials seriously threatens their mechanical properties and durability. This study innovatively develops a fast-response self-healing capsule based on superabsorbent polymers (SAPs) and crystalline admixture to enhance the crack self-healing ability of cement mortar. The study systematically investigates the release and migration behavior of healing agents within cracks, with a particular focus on the influence of environmental humidity, as well as the effects of different capsule dosages on the pore structure and hydration heat of the mortar. In addition, the enhancing effects of the capsules on crack self-healing performance, including healing width and volume filling rate, and on impermeability performance, including permeability coefficient and plugging air leakage rate, are evaluated. The results indicate that environmental humidity significantly raises the release behavior, migration area, and migration distance of healing agents. Increasing the capsule dosage moderately increases the porosity of the mortar and reduces the total hydration heat release. A key finding is that the incorporation of the capsules significantly improves the self-healing efficiency of the mortar, as the maximum crack healing width reaches 453 μm, the internal volume filling rate reaches 90.25%, and the permeability coefficient is significantly reduced by 92.62%. In contrast, the air permeability is reduced by 93.34%. Microscopic analysis confirms that the healing products within the cracks are mainly composed of calcium carbonate (CaCO3), calcium hydroxide (Ca(OH)2), SAP residues, and hydrated calcium silicate (C-S-H) gel. This study provides an important theoretical and practical basis for the development of efficient self-healing cement-based materials.

ABSTRACT The substantial accumulation of oxidized coal in goaf areas poses significant coal spontaneous combustion (CSC) risks, threatening coal mine safety and ecological preservation. To systematically investigate the influence of pre-oxidation temperature (POT) on the oxidation characteristics and CSC limit parameters of non-caking coal, temperature-programmed experiments were conducted under varying pre-oxidation conditions. The evolution of CO emissions and oxygen consumption behavior was analyzed, three oxidation stages were delineated, and key oxidation kinetic parameters alongside CSC limit parameters were determined. The experimental results revealed that in the slow and rapid oxidation stages, oxidized coal samples exhibit higher oxygen consumption rates and heat release intensities than raw coal, with these values decreasing as POT increases, while in the deep oxidation stage, coal samples with high pre-oxidation degrees (YH160, YH200) show significantly greater reactivity than other samples. Apparent activation energy displays distinct stage-dependent responses to POT: it decreases with increasing POT in the slow oxidation stage, increases with rising POT in the rapid oxidation stage, and first decreases then increases as POT increases in the deep oxidation stage. This also confirmed that the “promotion-inhibition-promotion” dual effect of POT on the secondary oxidation of coal. Additionally, POT exerts a non-negligible influence on spontaneous combustion limit parameters. As POT increased, the lower limit of coal thickness(hmin) and the lower limit of oxygen concentration (cm) decreased, whereas the upper limit of air leakage intensity (Qmax) increased, collectively amplifying combustion risks of spontaneous. The research findings can provide a theoretical reference for the prediction of re-ignition in coal mine goafs and the development of fire prevention and extinguishing technologies.

Multidrug-resistant pulmonary tuberculosis (MDR-TB) complicated by recurrent pneumothorax and bronchopleural fistula (BPF) presents a major clinical challenge. We report a 41-year-old man with primary MDR-TB and a history of moderate smoking who developed recurrent secondary spontaneous pneumothorax due to BPF. Initial management included individualized MDR-TB therapy, chest tube drainage, and intrapleural catheter placement. Persistent air leak (PAL) and recurrent pneumothorax required surgical intervention. After 2 months of anti-TB therapy, he underwent video-assisted thoracoscopic surgery (VATS) for fistula repair, followed by open thoracotomy with decortication and lung laceration repair 3 months later. Imaging revealed paraseptal emphysema, loculated hydropneumothorax, and bilateral fibrocavitary changes consistent with active pulmonary tuberculosis. The patient showed clinical and radiological improvement up to 9 months of therapy, without recurrent pneumothorax or significant air leak. This case highlights the importance of early diagnosis, timely surgery, and multidisciplinary management in managing complex MDR-TB complications and preventing recurrence.

Abstract Introduction Spontaneous pneumomediastinum typically results from elevated intra-alveolar pressure leading to alveolar rupture and air leakage into the mediastinum, triggered by vomiting, exertion, coughing, drug use, iatrogenic injury, or trauma. Patients with prior pulmonary diseases are particularly susceptible, as fragile alveoli are more prone to rupture under stress. Most cases of spontaneous pneumomediastinum are self-limited but do carry the potential for serious complications, such as pneumothorax, cardiovascular compression or compromise, pneumopericardium, and, rarely, pneumorrhachis. Given these risks, patients warrant close monitoring and thoughtful management to exclude complications. Description We report the case of a 19-year-old female with an eating disorder and chronic marijuana use who presented with 4 days of intractable vomiting, up to 10 episodes per hour at its peak. Initial evaluation at an outside hospital revealed pneumomediastinum on chest CT, prompting transfer for higher-level care and exclusion of esophageal perforation. X-ray esophagram showed no esophageal tear, and imaging and examination revealed no subcutaneous emphysema. She was managed with aggressive antiemetic therapy to control vomiting and prevent complications. Given her heavy cannabis use and recurrent emesis, the presentation was most consistent with cannabis hyperemesis syndrome, and she was counseled on cessation. Her symptoms improved, and she was discharged home. Discussion While pneumomediastinum is usually a benign, self-limiting condition treated conservatively, prompt recognition is critical to exclude life-threatening causes. Chest CT remains the diagnostic gold standard while fluoroscopic x-ray esophagography is preferred when perforation is suspected given high sensitivity and bronchoscopy may be warranted to evaluate tracheobronchial connections. When due to severe vomiting, Boerhaave Syndrome should be considered, as esophageal rupture carries high morbidity and mortality. Tracheobronchial injury, whether traumatic or iatrogenic, should also be excluded when a persistent air leak is suspected. Most spontaneous cases resolve with supportive care—including oxygen, analgesia, and antiemetics—though surgical repair may be required in complicated cases. Careful evaluation differentiates benign from critical etiologies, guiding management, and optimizing outcomes. Our patient had a rare case of vomiting-induced pneumomediastinum without esophageal rupture. This abstract is funded by: None

Surgical outcomes using 3-dimensional image simulation for segmentectomy planning in patients with stage IA1-2 non-small cell lung cancer.