Rasmussen aneurysm: A forgotten complication of tuberculosis in the COVID-19 era.

COVID-19 pandemic has led to an overwhelming healthcare system causing a delay in management of other infectious diseases such as tuberculosis. Rasmussen aneurysm (RA) appears in chronic cavitary tuberculosis. We report here, three cases of pulmonary tuberculosis complicated by RA admitted to Department 1 of Abderrahmane Mami hospital in Tunisia. Data were collected from June 2020 to September 2021. All patients presented with hemoptysis. Sputum was positive for the acid-fast bacilli. Computed tomographic pulmonary angiography showed RA. Only one patient underwent emergent glue embolization. These cases give an insight into the importance of timely therapeutic care for tuberculosis.

[Paradoxical reaction following antituberculosis therapy in immunocompetent patient]. / Réaction paradoxale à la fin du traitement antituberculeux chez le sujet immunocompétent.

INTRODUCTION: The features of paradoxical reactions (PR) that occurred in non-HIV infected patients are rare and not well known. CASE REPORT: The authors reported the case of a 21years old, non-immunocompromised, and HIV negative patient treated for disseminated tuberculosis. PR occurred after 8months after initiation of antituberculous treatment. PR presented as left cervical lymphadenopathy, pulmonary, pleural, costal and spinal location of the tuberculosis. The antituberculous drugs were prolonged. Patient's clinical symptoms improved initially. However, left inguinal lymphadenopathy appeared after 20months of antituberculous therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis. The patient has a good compliance to the treatment. The patient was continued on same antituberculous treatment for a total of 28months. The cervical and inguinal lymphadenopathy disappeared and CT scan showed regression of thoracic, abdominal, costal and spinal lesions. CONCLUSION: PR during antituberculous treatment must be considered after exclusion of other causes. No consensus on the therapeutic management of this entity has been developed to date.

Coinfection with Mycobacterium tuberculosis and Pneumocystis Jirovecii in immunocompetent young woman.

Pneumocystis pneumonia is a severe opportunistic infection in immunocompromised patients, caused by Pneumocystis jirovecii (P. jirovecii). The co-infection with community-acquired P. jirovecii and Mycobacterium tuberculosis (M. tuberculosis) is exceptionally described in non immunocompromised patients. We herein report the case of a young woman, with no medical history, who developed an acute respiratory failure due to P. jirovecii pneumonia associated with miliary tuberculosis. An extensive immunological investigation ruled out any acquired or primary immunodeficiency, suggesting that she was most likely immunocompetent. This report shows that such infections are not restricted to immunocompromised hosts. Moreover, it is tempting to speculate that the development of M. tuberculosis infection in this patient could be a risk factor for transition from colonization status of respiratory tract by P. jirovecii to pneumocystosis.

[Silicoproteinosis: a specific clinical and radiological entity]. / La silicoprotéinose : une entité radioclinique à part.

INTRODUCTION: Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust. CASE REPORT: A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids. CONCLUSION: Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

[Erasmus' syndrome with pseudo-tumour masses]. / Un syndrome d'Erasmus avec des masses pseudo-tumorales.

INTRODUCTION: Erasmus' syndrome involves the association of systemic scleroderma (SS) and exposure to silica. Silicosis may precede the SS but the latter may be the presentation, in which case a history of exposure to silica should be sought as part of the diagnosis. CASE REPORT: A 46-year-old man with history of pulmonary tuberculosis presented with dyspnoea and dysphagea. Clinical examination revealed thickening of the facial skin with a pointed nose, erythema and telangiectasia, Raynaud's syndrome and sclerodactyly. A thoracic CT scan revealed bilateral, fibrotic, pseudo-tumoural masses. Antinuclear antibodies, anti-topoisomerase 1 and antihistone were positive. CONCLUSION: The clinical presentation of Erasmus' syndrome associating systemic scleroderma and pulmonary pseudo-tumours may pose a problem of differential diagnosis from lung cancer. This condition requires regular clinical and radiological monitoring, particularly as both scleroderma and silicosis increase the risk of lung cancer.

Bilateral elastofibroma dorsi. A case report and review of the literature.

Elastofibroma is a rare benign soft tissue lesion, typically located deep under the lower pole of the scapula. It is characterized by a fibrous and adipose tissue proliferation and most frequently affects older females. Its characteristic location and its specific aspect in imaging studies most often provides the diagnosis following an incidental discovery. Nevertheless, anatomic and pathologic confirmation is necessary to formally rule out a malignant tumor diagnosis. We report a 66-year-old woman original observation; this lady's occupation involved a number of strenuous manual activities; she consulted for chronic pain related to a left subscapular mass. MRI demonstrated, in fact, two symmetrical tumor masses under each scapula. The only symptomatic lesion was surgically excised.

[CT features of pseudotumoral bronchopulmonary tuberculosis]. / Aspects tomodensitométriques de la tuberculose broncho-pulmonaire pseudotumorale.

Pulmonary tuberculosis may at times simulate lung carcinoma on bronchoscopic examination or imaging studies. Diagnosis can be delayed and lead to surgical resection. Based on a review of 25 cases, the different CT features are reviewed.

[Thoracic involvement in Behçet's vasculitis]. / Angio-Behçet à localisation thoracique.

Thoracic involvement of Behcet's disease is unusual but serious. It is related to the well known vascular tropism of the disease. It may involve the superior vena cava, pulmonary arteries, aorta and subclavian vessels. Imaging is useful for diagnosis and assess the degree of thoracic involvement. CT scan and MRI are obviously more accurate than angiography. The spectrum of thoracic manifestations of the disease is presented based on a review of 22 cases.

[Hydatid cyst of the mediastinum: 14 case reports]. / Kyste hydatique primitif du médiastin: 14 cas.

PURPOSE: The objective of this study was to describe the different radiological features of the hydatid cyst of the mediastinum. MATERIALS AND METHODS: We conducted a retrospective study on 14 patients (seven women, seven men), diagnosed with mediastinal hydatid cyst, aged 13-67 years (mean, 48 years) over a period of 16 years in our hospital where 71 cases of hydatid disease are annually diagnosed. The patients were explored by chest radiography (n=14), chest ultrasonography (n=10), abdomen ultrasonography (n=14), computed tomography (CT scan) (n=13), and magnetic resonance imaging (MRI) (n=8). RESULTS: The chest x-ray showed an opacity of the anterior (n=11), middle (n=1), and posterior (n=1) mediastinum. The thoracic ultrasound confirmed the liquid nature of the mass with a multivesicular aspect (n=9). CT and thoracic MRI made it possible to precisely locate the mediastinal compartment involved and study the relationship to adjacent structures. A purely mediastinal location was found in only six cases. In the remaining cases, it was associated with hepatic (n=7) and pleural (n=1) locations. CONCLUSION: Hydatid cysts of the mediastinum are very uncommon. Diagnosis can be made by chest sonography. CT scan is the main tool for diagnosis and the study of possible extension. Our study showed a more frequent location to the anterior mediastinum.

[Hydatid cyst: another unusual localization]. / Le kyste hydatique: encore une localisation insolite.

UNLABELLED: We report a case of a 39-year-old woman who presented a right basicervical tumefaction. The chest X rays show a right cervicomediastinal opacity. Ultrasonography and computed tomography failed to describe the nature of the opacity. Because of the strong suspicion of neoplasm or a tuberculosis abscess, a needle aspiration of the cervical mass was performed and surprisingly revealed the presence of a cyst membrane allowing surgical resection. CONCLUSION: Hydatid disease is a likely diagnosis in endemic areas in patients presenting a cystic mediastinal opacity of unknown orign.

[Pleural effusion revealing multiple myeloma]. / Pleurésie révélatrice de myélome multiple.

Pleural effusion is rarely observed in multiple myeloma, its frequence is estimated at 6%, and its myelomatous origin occurs in only 1% of the cases. It is exceptionally the first sign of multiple myeloma. We report two cases of IgA and IgG multiple myeloma revealed by pleural effusion. The first case was a 61-year-old woman who developed pleural effusion with a bone endobronchial and pericardial location of multiple myeloma; the second case was a 65-year-old man who had isolated pleural effusion. These pleural effusions were found to be caused by myeloma and were verified by the presence of the same monoclonal immunoglobulin in both plasma and pleural liquid. Atypical plasma cells were found in the pleural fluid.

[Costo-vertebral hydatid disease: the role of MRI]. / Hydatidose costo-vertébrale: intérêt de l'IRM.

INTRODUCTION: Hydatid disease of bone is very rare accounting for 0.5% - 3% of all localisations. CASE REPORT: We report the case of a woman of 30 years who presented with posterior chest pain. The chest radiograph showed an extra-pulmonary mass associated with a lytic rib lesion. Thoracic ultrasound revealed a multiloculated soft tissue and fluid mass. CT scan showed a fluid filled costo-vertebral cyst. MRI identified extension into the spinal canal. Pathological examination of the surgically resected material confirmed the diagnosis. CONCLUSIONS: This observation emphasises the role of MRI in assessing the extent of hydatid cysts of the posterior chest wall and in particular invasion of the spinal canal.

[Ultrasonographic, CT, and MRI findings of chest wall hydatidosis]. / Apport de l'imagerie au diagnostic du kyste hydatique de la paroi thoracique.

The chest wall is an uncommon localization for hydatid disease even in countries where echinococcosis is endemic. Only isolated sporadic cases have been reported in the literature. We reviewed retrospectively 15 patients who underwent surgery for chest wall hydatid disease. Various imaging techniques were used for diagnosis of our cases. These included chest radiograph, thoracic ultrasonography, computed tomography and magnetic resonance imaging. Hydatid cyst involved soft tissues (n=5), ribs and vertebrae (n=5), ribs (n=4) and sternum (n=1). Imaging techniques were of value for diagnosis (radiographs and sonography) and for evaluation of the extent of involvement (CT and MRI). Chest wall hydatidosis requires surgical treatment but recurrence is frequent.

[Thymolipoma. A case report]. / Le thymolipome. A propos d'un cas.

Thymolipoma is an uncommon benign tumor of the thymus. Asymptomatic, it is an incidental discovery. Pathogenesis remains controversial. We report a new case in a 36-year-old woman that was discovered on a chest x-ray ordered for pneumonia. The MRI findings suggested the diagnosis which was confirmed at the pathology examination of the surgical specimen.

Hydatid disease of the liver with thoracic involvement.

Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithorax. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed preoperatively in 30 of the 40 cases. Posterolateral thoracotomy was performed in all patients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed 15 lobectomies, 10 wedge resections, 16 decortications, and in one patient simple drainage of a voluminous pleuropulmonary and hepatic purulent hydatic collection. The postoperative course was uneventful in 26 cases, but 14 patients had complications, from which 3 patients died. The therapeutic approach depends on ultrasonographic findings. We believe ultrasonography to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and is sufficient if the biliary tract is safe. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.

[Muscle metastasis of a primary bronchial carcinoma]. / Metastase musculaire d'un carcinome bronchique primitif.

Intra muscular metastasis are rare. They usually occurs during the course of a cancer. The primary bronchial carcinoma is the most common. Clinical features include painful mass, frequently, they are symptomatic. Sonography CT scan and MR imaging shows a non specific abnormally, but they defined their seat and their extension. The authors report a case of metastases of epidermoid bronchial carcinoma to left adductor muscle and gives a review of the literature.

[Hydatid pulmonary embolism. Two case reports]. / Embolies pulmonaires hydatiques. A propos de deux cas.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report two cases of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. One case progressed to chronic cor pulmonale. We examine the pathophysiological mechanisms as well as the clinical, therapeutic and evolutive aspects.