[Sodium valproate-induced pleural effusion: When it changes sides!] / Pleurésie induite par le valproate de sodium : quand ça change de côté !

INTRODUCTION: Pleural fluid effusion is a possible harmful effect of sodium valproate. It most often consists in polynuclear eosinophilic pleurisy and occurs within months of treatment initiation. CASE REPORT: We report on a case of sodium valproate-induced pleural effusion occurring more than 12years after initiation of treatment. The original formula was variegated and not eosinophilic. The patient exhibited contralateral recurrence with continued treatment. Once treatment was discontinued, there was no recurrence during three-year follow-up. CONCLUSION: Sodium valproate-induced pleural effusion can present an atypical polymorphous picture leading to erroneous diagnoses.

[Thoracic endometriosis and lymphangioleiomyomatosis: Coincidence or hormonal rational?] / Endométriose thoracique et lymphangioléïmyomatose : coïncidence ou rationnel hormonal?

INTRODUCTION: Lymphagioleiomyomatosis (LAM) and endometriosis are two diseases that occur in young women. The main thoracic complication of both diseases is pneumothorax. CASE REPORT: We describe the case of a 45-year-old woman who presented with a right-sided pneumothorax. The clinical context and the perioperative findings were suggestive of thoracic endometriosis, while the histology of the pulmonary biopsy and the evolution of her case were in favour of LAM. This presentation indicates the coexistence of the two diseases, which has never previously been described in the literature. The case raises the question as to whether it should be policy to systematically undertake a pulmonary biopsy in cases of thoracic endometriosis. CONCLUSIONS: LAM and endometriosis are both diseases under hormonal influence. To date, we do not know if there is any direct link between the two diseases or if the presentation that we describe here occurred by chance.

Tracheal obstruction due to tumour: use of veno-venous extracorporeal membrane oxygenation during rigid bronchoscopy.

Tracheal tumour is rare but can lead to upper airway obstruction and acute respiratory distress. Its management includes surgical resection, radiotherapy or interventional bronchoscopy. Ventilation or difficulties with tracheal intubation can occur during the peri-operative course resulting in serious adverse consequences. We report the case of an 83-year-old man with an obstructive tracheal chondrosarcoma resected by rigid bronchoscopy undergoing veno-venous extracorporeal membrane oxygenation. Such support should be considered when the patient's airway patency cannot be ensured by conventional methods.

[Cerebral air embolism: A rare complication of flexible fiberoptic bronchoscopy]. / Embolie gazeuse cérébrale : une complication rare de la fibroscopie bronchique souple.

INTRODUCTION: Cerebral air embolism is a rare complication of flexible fiberoptic bronchoscopy. It is a serious, life-threatening complication. The treatment consists of hyperbaric oxygen therapy. CASE REPORT: We report the case of cerebral air embolism that occurred in an 80-year-old woman after a flexible bronchial fibroscopy with bronchial spur biopsies. The patient showed neurological signs after the procedure. The brain CT-scan found disseminated air emboli. The progress was fatal in the absence of specific treatment, taking account of the context, the patient's comorbidities and the wishes of the family. CONCLUSIONS: Cerebral air embolism is a serious complication that can occur during a bronchial biopsy even though this complication is rare.

[A conus medullaris tuberculoma: a case report and literature review]. / Tuberculome du cône médullaire: à propos d'un cas et revue de la littérature.

BACKGROUND: Tuberculosis affecting the central nervous system is well recognized, but only rarely localizes to the medullary conus. OBSERVATION: We report the case of a 69 year old man who was admitted to our unit with cauda equina syndrome. The MRI demonstrated ring-enhanced necrotizing lesions involving the medullary conus, the cervical cord and the brain. His chest CT scan showed a miliary infiltrate. The clinical presentation was associated with an inappropriate secretion of antidiuretic hormone. Quadruple antituberculous therapy was initiated, with corticosteroids in the initial phase of the treatment. Evolution was favorable, and follow-up MRI imaging demonstrated complete resolution of the cervical cord and brain lesions.