In this retrospective study, we investigated 1,036 patients with interstitial lung disease (ILD) referred to our hospital to examine the associations between referral distance, the characteristics of referring institutions, and clinical features at presentation. In group comparisons, patients referred from distant institutions (≥50 km) appeared to be younger and more likely to show lower %FVC, lower %D_LCO, and lower minimum SpO₂ during the 6-minute walk test, as well as more advanced disease stages. However, these physiological variables were not independently associated with referral distance after multivariable adjustment, whereas younger age and male sex remained significant factors. Patients referred from institutions with respiratory specialists were also younger and had lower %D_LCO in multivariable analysis, suggesting that referral may be triggered by earlier physiological changes. These findings indicate that referral distance does not necessarily reflect disease severity and highlight the importance of strengthening collaboration between respiratory specialists and specialized centers to facilitate earlier referral in regional ILD care.

Lung metastases of pancreatic cancer may present with atypical patterns that sometimes mimic pneumonia or primary lung cancer, making an accurate diagnosis challenging. We retrospectively analyzed chest CT findings of 12 cases of pathologically confirmed pulmonary metastases of pancreatic cancer diagnosed at the study center between November 2010 and March 2025, and we evaluated the distribution of opacities and other imaging findings, as well as the presence of lymph node metastases. The CT findings were classified as either typical or atypical using the criteria proposed by Aissaoui et al. Of the 12 cases examined, 11 had been diagnosed via bronchoscopy. Four, two, and six cases had only typical features, only atypical features, and both typical and atypical features, respectively. Eight cases presented with at least some atypical findings. Regardless of whether the lesions were solitary or multiple, all the cases involved the lower lobes. Among the eight cases with atypical findings, five had lymphadenopathy in the abdominal or mediastinal regions. All the cases were TTF-1 negative, and six of the 12 cases (50%) were CK7+/CK20− on immunohistochemical staining. These findings suggested that pancreatic cancer may metastasize to the lungs both hematogenously and lymphatically, thereby producing diverse radiological presentations. If multiple pulmonary opacities are observed, pancreatic cancer metastases should be included in the differential diagnosis even if the imaging findings are atypical of metastatic lung tumors. Comprehensive evaluation, including pathological analysis and systemic imaging, is essential for an accurate diagnosis.

A 76-year-old woman with rheumatoid arthritis treated with methotrexate developed multiple pulmonary nodules and infiltrative shadows. Early bronchoscopy led to a diagnosis of pulmonary cryptococcosis with secondary organizing pneumonia. The condition developed during terbinafine therapy and worsened despite fluconazole treatment. Based on the minimum inhibitory concentration (MIC) of 8 µg/mL and the clinical course, an inadequate therapeutic response to standard-dose fluconazole was considered, and therapy was switched to itraconazole. The patient improved with the addition of corticosteroids. This case highlights the importance of early diagnosis and MIC-guided individualized treatment.