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1.
Rev Pneumol Clin ; 63(2): 119-22, 2007 Apr.
Artigo em Francês | MEDLINE | ID: mdl-17607219

RESUMO

Hemothorax is generally secondary to trauma, invasive thoracic surgery or specific lung of pleural disease. Hemothorax secondary to aortic dissection is rare. We report a case in a 69-year-old man with a history of smoking and hypertension. The patient was referred for exploration of a left pleural opacity with mediastinal widening. Pleural puncture produced a hemorrhagic fluid. The thoracic scan led to the diagnosis of Stanford type B aortic dissection. The patient was given antihypertensive treatment and now has a sixteen month follow-up. Aortic dissection can give rise to hemothorax, especially in a hypertensive subject with an anomalous aortic arch or mediastinal widening on the chest X-ray. Computed tomography generally gives the diagnosis. Treatment may be medical or surgical, depending on the site of the lesion and the severity of the clinical presentation. Aortic dissection is a cause of hemothorax, particularly in patients with favorable conditions or a suggestive radiological anomaly.


Assuntos
Aneurisma da Aorta Torácica/complicações , Dissecção Aórtica/complicações , Hemotórax/etiologia , Idoso , Humanos , Masculino
2.
Rev Pneumol Clin ; 62(4): 243-6, 2006 Sep.
Artigo em Francês | MEDLINE | ID: mdl-17075549

RESUMO

Solitary plasmocytoma is a rare tumor accounting for 5% of all plasma cell neoplasias. The diagnosis is based on identification of the localized tumor composed of monoclonal plasma cells identical to those observed in multiple myeloma, and absence of the signs in favor of a disseminated form. We report the case of a52-year-old man who presented a growth of the chest wall in the left axillary region. Imaging disclosed a mass of tissue with a large zone of osteolysis of the 6th rib and infiltration of the chest wall. Surgical biopsy for pathology study and immunohistochemistry enabled the diagnosis of costal plasmocytoma. Blood protein immunoelectrophoresis revealed a monoclonal kappa type IgG. Bence-Jones proteinuria was positive. Search for other localizations was negative and the diagnosis of solitary plasmocytoma was retained. Radiotherapy was delivered and the patient has remained in remission at one year. Costal localization is rare for solitary plasmocytoma. The diagnosis is based on imaging findings and pathology. Radiotherapy is the treatment of choice but with the risk of progression with other bone lesions, the development of medullary plasmocytosis and multiple myeloma. Factors predictive of systemic recurrence have not been identified. Regular surveillance is required.


Assuntos
Neoplasias Ósseas/diagnóstico , Plasmocitoma/diagnóstico , Costelas , Neoplasias Ósseas/radioterapia , Humanos , Cadeias kappa de Imunoglobulina/sangue , Masculino , Pessoa de Meia-Idade , Plasmocitoma/radioterapia , Proteinúria/etiologia
3.
Rev Pneumol Clin ; 61(4 Pt 1): 270-4, 2005 Sep.
Artigo em Francês | MEDLINE | ID: mdl-16208193

RESUMO

Pulmonary hydatid cyst is exceptional in our country. The diagnosis is generally established on the basis of imaging. Surgical treatment is indicated in most patients. We report a case of pulmonary hydatid cyst in a 74-year-old smoker (11 package-years) who presented cough with mucopurulent expectoration and occasional hemoptysis. The chest x-ray demonstrated a poorly delimited heterogeneous opacity in the upper third of the left lung which persisted after antibiotic therapy. Bronchial fibroscopy revealed a hydatid membrane in the left superior bronchus which was totally removed by aspiration. A control radiography after the fibroscopy demonstrated a clear regression of the opacity. A thoracic CT-scan was performed and revealed a residual cavity in the left upper lobe with bronchial dilatation. The indication for surgery was not retained. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event. Our exceptional case illustrates an atypical radiological presentation and the use of "therapeutic" fibroscopy.


Assuntos
Broncoscopia , Equinococose Pulmonar/cirurgia , Idoso , Animais , Tosse/parasitologia , Equinococose Pulmonar/diagnóstico , Hemoptise/parasitologia , Humanos , Masculino
5.
Rev Pneumol Clin ; 61(1 Pt 1): 31-6, 2005 Feb.
Artigo em Francês | MEDLINE | ID: mdl-15772577

RESUMO

Hydatid pulmonary embolism is a rare condition. Diagnosis is difficult and there is no consensus on treatment. Prognosis is generally poor. We conducted a retrospective analysis of patients hospitalized between 1994 and 2002 who had a diagnosis of hydatid pulmonary embolism. Seven cases were identified. All patients had a cyst which spontaneously ruptured into the bloodstream. All patients were symptomatic. Chest x-ray revealed images of metastatic pulmonary echinococciasis in all patients. Thoracic CT and/or angioscan provided the diagnosis in five patients. In one, the diagnosis was established with pulmonary angiography. For one other, the diagnosis was established at the pathology examination of the surgical specimen. Searching for the primary localization of the hydatid disease revealed hepatic cysts in all patients, associated in one with a cyst in the right atrium. The cardiac cyst was not operated and all hepatic cysts were removed. Embolectomy was performed in one patient. Medical treatment with albendazole was given in five patients. The clinical course was marked by death in two patients, due to abundant hemoptysia. The five other patients are followed regularly and were doing well at six months to five years. The diagnosis of hydatid pulmonary embolisms is basically obtained with imaging. Treatment is surgical resection of the embologenic focus then embolectomy. The role of medical treatment is not clearly defined. The short- and mid-term prognosis is generally poor.


Assuntos
Equinococose Pulmonar/complicações , Embolia Pulmonar/etiologia , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Equinococose Pulmonar/diagnóstico , Evolução Fatal , Feminino , Hemoptise/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Embolia Pulmonar/diagnóstico , Estudos Retrospectivos
6.
Rev Pneumol Clin ; 60(1): 55-7, 2004 Feb.
Artigo em Francês | MEDLINE | ID: mdl-15107670

RESUMO

Inflammatory pseudo-tumors of the lung are generally unifocal lesions with a benign prognosis. The pathogenesis is unknown. We report the case of a 71-year-old man who underwent exploration for dyspnea and chest pain associated with weight loss and a heterogeneous opacity in the lingula. This radiological and clinical presentation suggested a malignant bronchopulmonary tumor. Surgery was performed and the histologocial examination of the surgical specimen corrected the diagnosis: inflammatory pseudo tumor. No recurrence has been observed at three years.


Assuntos
Neoplasias Pulmonares/diagnóstico , Granuloma de Células Plasmáticas Pulmonar/diagnóstico , Idoso , Dor no Peito/etiologia , Dispneia/etiologia , Humanos , Neoplasias Pulmonares/complicações , Masculino , Granuloma de Células Plasmáticas Pulmonar/complicações , Granuloma de Células Plasmáticas Pulmonar/cirurgia , Prognóstico , Redução de Peso
7.
Presse Med ; 32(38): 1802-4, 2003 Nov 29.
Artigo em Francês | MEDLINE | ID: mdl-14663381

RESUMO

INTRODUCTION: Cardiac echinococcosis is rare and only represents around 0.5% of all hydatic locations. Right ventricular location is exceptional. OBSERVATION: We report the case of a 72 year-old man having a chronic obstructive pulmonary disease. During an acute respiratory failure, cardiac ultrasonography showed a right ventricular tumour. After respiratory stabilisation, surgical intervention found the tumour, the histopathological study of which concluded in a dead and calcified hydatic cyst. DISCUSSION: This case report demonstrates the limits of modern imaging and the difficulties in diagnosing a calcified right intra-ventricular hydatidosis. It is important to emphasize the exceptional nature of this form and the scarcity of its localisation. Surgical treatment is crucial in the majority of cases and helps to confirm the diagnosis. CONCLUSION: In endemic areas, the discovery of an intra-cardiac tumour must evoke and eliminate echinococcosis. Calcification of a cardiac location remains exceptional.


Assuntos
Calcinose/diagnóstico , Cardiomiopatias/diagnóstico , Equinococose/diagnóstico , Doença Aguda , Idoso , Biópsia , Calcinose/complicações , Calcinose/epidemiologia , Calcinose/cirurgia , Cardiomiopatias/complicações , Cardiomiopatias/epidemiologia , Cardiomiopatias/cirurgia , Equinococose/complicações , Equinococose/epidemiologia , Equinococose/cirurgia , Ecocardiografia/normas , Ventrículos do Coração , Humanos , Imageamento por Ressonância Magnética/normas , Masculino , Doença Pulmonar Obstrutiva Crônica/complicações , Radiografia Torácica/normas , Doenças Raras/complicações , Doenças Raras/diagnóstico , Doenças Raras/epidemiologia , Doenças Raras/cirurgia , Insuficiência Respiratória/etiologia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/normas
8.
Rev Mal Respir ; 20(5 Pt 1): 767-71, 2003 Nov.
Artigo em Francês | MEDLINE | ID: mdl-14631258

RESUMO

INTRODUCTION: Misdiagnosed and complicated diaphragmatic hernia can lead to diagnostical and therapeutical difficulties. CASE REPORT: A strangulated post-traumatic diaphragmatic hernia in a 53 years old woman was at the origin of whole hemithoracic hydroaeric opacity. The hernia diagnosis based on digestive opacification and thoraco-phreno-abdominal ultrasonography. Emergent intervention is critical and allowed aetiologic and lesional assessment. CONCLUSIONS: After thoracic traumatism, it's necessary to carry on observation and realize, in front of any suspicion, radiological investigations especially modern imaging.


Assuntos
Hérnia Diafragmática/diagnóstico , Traumatismos Torácicos/complicações , Tórax/patologia , Diagnóstico Diferencial , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia
10.
Presse Med ; 31(20): 921-7, 2002 Jun 08.
Artigo em Francês | MEDLINE | ID: mdl-12148137

RESUMO

OBJECTIVES: Despite the efforts in the fight against tuberculosis (Tb) and the decrease in its incidence, severe forms persist. Tubercular pyothorax (TP), which was a frequent complication, is still difficult to treat. We studied the epidemiological, diagnostic, therapeutic and progressive aspects of this particular localization. METHODS: Retrospective study collecting all the TP reported between 1990 and 1999 in the department of pneumology in Ariana. The inclusion criterion was any patient presenting with pleural-parietal empyema of tubercular origin. We excluded patients presenting with negative bacilliferous pyothorax cultures. RESULTS: Twenty-eight cases of TP were retained among 875 cases of tuberculosis, i.e., 3.2%. The mean age of patients was of 44 years (range: 15-75) and they were moderate smokers: 27 PA. Infectious fever concomitant to a pleural syndrome was the typical clinical manifestation. In some patients empyema (3 cases) or cutaneous fistula (2 cases) were the circumstances in which the disease was discovered. Thoracic imaging is a very useful tool: standard radiography, tomodensitometry and magnetic resonance imaging permit analysis of the pleural wall and cavity. In 9 cases, pneumothorax was concomitant. A co-infection with pyogenic germs was present in 4 patients. Treatment of TP is triple; it associates specific poly-chemotherapy, thoracic draining and respiratory physiotherapy. The progression was satisfactory in the recent forms concomitant to a bacilliferous pulmonary Tb. Complications such as pleural-pulmonary after effects are inherent to the severe forms. Surgery was necessary for 9 patients (5 drainages, 2 rib resections and 2 decortications). CONCLUSION: TP is a menace for functional prognosis. Treatment is double: early, curative and effective, and preventive of Tb and its risk factors.


Assuntos
Empiema Tuberculoso/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Estudos Transversais , Diagnóstico por Imagem , Empiema Tuberculoso/tratamento farmacológico , Empiema Tuberculoso/epidemiologia , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico , Pneumotórax/tratamento farmacológico , Pneumotórax/epidemiologia , Estudos Retrospectivos , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
11.
Nephrologie ; 23(3): 135-40, 2002.
Artigo em Francês | MEDLINE | ID: mdl-12087811

RESUMO

BACKGROUND: Because of the immunity depression, patients with chronic renal failure undergoing haemodialysis are at increased risk for developing infections, Mycobacterium tuberculosis (MTb) in particular. OBJECTIVE: To evaluate, in a prospective longitudinal study over 36 months period, the frequency of Tb among these patients and underline the diagnostic difficulties. PATIENTS AND METHODS: Sixty dialysis patients were interested. The Tb assessment comprised: a questionnaire, a meticulous clinical examination, a chest X-ray, a tuberculin skin testing, as well as MT bacilli screening in biological fluids. RESULTS: Tb was seen in six among dialysis patients(10%), this rate represents 15 times the general population tuberculosis incidence in our country (23/100,000). Tb has occurred early compared to the beginning of the haemodialysis. The Tb localizations were: 4 cases of extra-pulmonary tuberculosis (3 peritoneal and one ganglionic) and only 2 cases of pleuro-pulmonary localization. The positive diagnosis represents a real problem: no bacteriological confirmation in all patients and only in one, the histological diagnosis was obtained. CONCLUSION: There was a high rate of tuberculosis in our study. The prognosis appears to be closely related to therapeutic precocity, thus specific chemotherapy started sometimes without diagnostic confirmation.


Assuntos
Diálise Renal/efeitos adversos , Tuberculose/epidemiologia , Humanos , Incidência , Prognóstico , Diálise Renal/estatística & dados numéricos , Tuberculose/etiologia , Tunísia/epidemiologia
12.
Tunis Med ; 79(6-7): 378-82, 2001.
Artigo em Francês | MEDLINE | ID: mdl-11771435

RESUMO

The pleural fibroma is an uncommon tumor of pleura. Its Diagnosis is guided by chest imaging and confirmed by surgery and histological exam. We respectively report two observations of solitary pleural fibroma in 68 and 27 old years patients. The authors expose the circumstances of discovery and present clinical features, diagnosis explorations and therapeutical methods. Prognosis depends primary on histological findings and malignant recurrences are possible.


Assuntos
Fibroma/patologia , Neoplasias Pleurais/patologia , Adulto , Idoso , Diagnóstico Diferencial , Fibroma/terapia , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Pleurais/terapia
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