Massive pleural effusion in systemic lupus erythematosus: thoracoscopic and immunohistological findings.

Small to moderate, bilateral pleural effusions are common during the course of systemic lupus erythematosus (SLE). These are related to several complications, particularly, congestive heart failure, nephrotic syndrome, pulmonary embolism or SLE itself. Thoracoscopy performed for a massive unilateral pleural effusion in a patient with SLE and inferior vena cava thrombosis revealed several small nodules on the visceral pleura. Immunofluorescence studies of biopsy samples showed immunoglobulin deposits confirming the lupus-related origin of the pleuritis.

[Multiple hydatid cysts of the thigh: the role of magnetic resonance imaging]. / Hydatidose multiple de la cuisse: place de l'imagerie par résonance magnétique.

Hydatid cysts of the thigh are uncommon in our country despite a high frequency of hydatic disease which is estimated to affect 5.33% of the general population. Diagnosis is usually made late in the clinical course. Ultrasonography, CT scan and magnetic resonance imaging are the most helpful diagnostic tools. We report a case of a 76-year-old female smoker who had undergone surgery for a hydatic cyst of the right lung at the age of 56 years. In June 1997, the patient was admitted for decompensation of chronic obstructive lung disease. Physical examination revealed a 6 cm painless mass in the right thigh which had developed progressively over the last year. Ultrasonography showed multiple hydatic cysts. Magnetic resonance imaging confirmed the diagnosis, showing interconnected multivesicular cystic formations. Medical treatment was given due to respiratory failure and patient refusal of a surgical procedure.

[Pulmonary embolism of hydatic origin]. / Embolie pulmonaire d'origine hydatique.

BACKGROUND: The right ventricle is an exceptional localization for hydatic cysts. There is a risk of hydatic embolism and chronic or acute cor pulmonale. CASE REPORT: A 63-year-old-man with an uneventful history was hospitalized for dry cough, exercise-induced dyspnea and bloody expectorations which had developed over the previous year. Multiple and bilateral opacities were visualized on the standard chest x-ray and the right border of the heart showed a bulge in the middle portion. Signs of right-sided hypertrophy were seen on the ECG. Imaging findings led to the diagnosis of multiple organ hydatiasis involving the lung, the liver the mediastinum and a ruptured hydatic cyst in the right ventricle. The cavogram revealed defect images in the superior vena cave and the pulmonary angiogram confirmed the diagnosis of hydatic embolism. Medical treatment was given but the patient died 8 months after diagnosis. DISCUSSION: Hydatic pulmonary embolism generally occurs after rupture of a hydatic cyst in the right ventricle or due to venous migration of daughter vesicles to the right heart then the pulmonary artery. Clinical manifestations are not specific although hemoptisy is the most frequent sign. Positive diagnosis, guided by echocardiographic findings, is based on the pulmonary arteriogram. Prognosis is particularly poor and depends of the patient's general status as well as the number and size of the embolized vessels. Survival rate is poor. Open heart surgery is indicated in localized forms.

[Costal chondrosarcoma. 4 cases]. / Chondrosarcome costal. 4 observations.

BACKGROUND: Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominates, accounting for 40% of all cases of malignant costal tumors. CASE REPORTS: Four patients (3 women, 1 man, mean age 28.2 years) were hospitalized for costal chondrosarcoma. Pain and tumefaction dominated the clinical presentation. Calcifications suggested the diagnosis in 3 cases. Curative surgery was performed in all cases. Postoperative radiotherapy was unable to improve prognosis in 2 patients. DISCUSSION: Chondrosarcoma of the ribs is characterized by a strong potential for invasive extension. Diagnosis is suspected on the basis of imaging findings and confirmed at pathology. Surgery is required. Chemotherapy and radiotherapy do not improve prognosis significantly.

[Broncho-pulmonary cancer associated with pulmonary tuberculosis. Report of 4 cases]. / Association cancer broncho-pulmonaire et tuberculose pulmonaire. A propos de 4 cas.

The association between bronchopulmonary carcinoma and pulmonary tuberculosis would not be fortuitous but related to increased susceptibility to opportunistic infections and tuberculosis in cancer patients. We present four cases demonstrating the gravity of the situation and the difficulties encountered in diagnosis and treatment. Diagnosis of tuberculosis in patients with bronchopulmonary carcinoma requires pathological evidence from histology biopsies or bacteriology samples. The diagnosis is further complicated in early stage neoplasms. In case of tuberculosis, surgical treatment of bronchopulmonary carcinoma may have to be postponed or even contraindicated. Inversely, chemotherapy and radiotherapy may favor extension of the tuberculosis.

[Reexpansion pulmonary edema]. / Oedèmes pulmonaires à vacuo.

Reexpansion pulmonary edema is an uncommon complication which sometimes occurs after evacuation of a large amount of air or fluid from the pleural space. We report two cases that illustrate the diversity of the clinical expression, severe in one case and latent in the other. The pathophysiology of reexpansion pulmonary edema remains obscure. Increased pulmonary capillary permeability, favored by previous atelectatic parenchyma and rapid reexpansion appears to be the main cause. Treatment is basically preventive. Curative treatment is based on adequate oxygenation and circulation. Lower aspiration pressure and oxygenation were sufficient in our patients. Severe clinical prognosis has been reported in the literature with a 15 to 20% mortality despite use of mechanical ventilation in particularly serious situations.

[Tuberculosis of the thoracic wall. Presentation of 4 personal cases and review of the literature]. / La tuberculose de la paroi thoracique. Mise au point à partir de 4 observations personnelles et d'une revue de la littérature.

The thoracic wall is an uncommon localization for tuberculosis, accounting for an estimated 1 to 5% of all cases of bone and joint tuberculosis which themselves account for 15% of all extrapulmonary localizations. Four patients were hospitalized for tuberculosis of the thoracic wall. The first patient, aged 22 years, had sternal tuberculosis with multiple bone localizations. The second patient was 37 years old and had a cold abscess of the peristernal soft tissues with several other bone localizations devoid of clinical manifestations. A third 37-year-old patient had a cold intercostal abscess revealed by a mass in the upper left quadrant of the left breast. In the last patient, 50 years old, tuberculosis of the ribs was associated with a cold tumor of the knee. Together with cases reported in the literature, these observations demonstrate the difficult diagnostic situation presented by tuberculosis of the thoracic wall. Treatment is based on long-duration multi-drug therapy. Surgical resection is rarely indicated. Cure was achieved in our four cases.

[Bronchoesophageal fistula with late revelation]. / A propos d'une fistule broncho-oesophagienne de révélation tardive.

Bronchoesophageal fistula is an uncommon clinical problem which can either occur as a congenital or acquired condition. A 40-year-old male had productive cough with production of sputum mixed with food particles and cough when eating and drinking. There was no weight loss nor weakness. Clinical examination led to the diagnosis of a fistula between the lower esophagus and the Nelson bronchus associated with bronchiectasis. The congenital nature of this fistula was suggested by the clinical, operative and pathology findings. Postoperative recover was uneventful. Esophageal respiratory tract fistula presenting in adult life are rare and can cause severe debilitation and suppurating lung disease. Surgical treatment provides complete resolution of the symptoms. Endoscopic obliteration can be considered as an alternative to surgery.

[Tracheobronchopathia osteochondroplastica. Personal observation and review of the literature]. / La trachéobronchopathie chondro-ostéoplastique. Mise au point à propos d'une observation personnelle et d'une revue bibliographique.

Tracheobronchobathia osteoplastica (TBO) is a benign disease first described in 1855 and rather rare since only 371 cases have been reported so far. The disease is characterized by the presence of subepithelial osteocartilaginous focal lesions without any relation to tracheal rings. The mechanism of its occurrence remains controverted. We report a case of TBO which is particular in that is was associated with atrophic rhinitis, polydactylia and disorder of oesophageal motricity. From a compilation of 113 cases published by French and Anglo-Saxon authors since 1970, it appears that the clinico-radiological and laboratory picture is of little help in the positive diagnosis which in fact rests on three key-points: bronchial endoscopy, pathological examination of bronchial biopsy fragments and thoracic imaging techniques including computerized topography and magnetic resonance imaging. The usually benign course of the disease can be marked by severe complications, such as infections, haemorrhages, acute dyspnoea by extension to the larynx or significant narrowing of the tracheal lumen which may need tracheotomy or surgical resection of the lesions.

[Management of spontaneous pneumomediastinum in the adult: 14 cases and a review of the literature]. / Prise en charge du pneumomédiastin spontané chez l'adulte: à propos de 14 cas avec revue de la littérature.

The authors report a series of 14 patients hospitalized for spontaneous pneumomediastinium between 1992 and 2006. They included 10 men and four women with an average age of 27.84 years. Dyspnoea dominated the symptoms. The pneumomediastinum was idiopathic in five patients and secondary in the other nine patients, involving an attack of severe asthma in half of the patients, polymyositis in one patient and idiopathic pulmonary fibrosis in one patient, respectively. The patients presenting polymyositis and pulmonary fibrosis died due to respiratory distress. The other patients benefited from asthma treatment or thoracic drainage, and were kept at rest. Their outcome was good. No cases of relapse were observed after an average follow up of 2.11 years.

[Hydatid cyst of the chest wall mimicking metastatic colon cancer]. / Kyste hydatique de la paroi thoracique mimant une métastase de cancer colique.

Chest wall hydatidosis, rare even in the endemic countries, represents 0.09 to 0.3 % of all cases of thoracic echinococcosis. The authors report the case of a 76 year-old man presenting a chest wall mass 4 years after surgery for colic carcinoma. The mass presented both hypoechoic and hyperechoic structures in the ultrasound chest echography. Therefore, metastastic colon cancer was suspected. The pathological study of the mass revealed hydatid membranes. Thoracic tomodensitometry supported the diagnosis of costovertebral and soft tissue hydatid cysts. The patient underwent the surgical resection of two rib arches, a transverse apophysis and the neighbouring soft tissue associated with pre- and post-surgical albendazole. No clinical manifestations were noted in the follow-up after 1 year.