[Complete extraction of a hydatid membrane by bronchial fibroscopy]. / Extraction complète d'une membrane hydatique par fibroscopie bronchique.

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.

[Intrathoracic strangulated diaphragmatic hernia. A diagnostic trap to avoid]. / Hernie diaphragmatique étranglée intrathoracique. Un piège à ne pas méconnaître.

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.

[A dead and calcified right ventricular hydatic cyst. The limits of imaging]. / Kyste hydatique mort et calcifié du ventricule droit. Limites de l'imagerie.

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.

[Tuberculous pyothorax. 28 cases]. / Le pyothorax tuberculeux. 28 cas.

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.

[Extra-pulmonary thoracic hydatid cyst (Pneumology and radiology services of the Military Hospital of Tunis)]. / Kyste hydatique thoracique extra-pulmonaire (Services de pneumologie et de radiologie de l'Hopital Militaire de Tunis)]

The authors report, in a retrospective study 11 cases of thoracic extra-pulmonary hydatic cyst observed during 4 years of pneumopathology practice. They stress the rarity of this localization and the variability of the clinical data. Chest X-Ray was found no specific whereas, computed tomography led often to the right diagnosis and helped in some cases a puncture of the hydatic cyst.

[Bronchial caliber study: a continuous challenge in pneumology]. / L'etude du calibre bronchique: défi continu en pneumologie.

The caliber and the bronchial wall represent the anatomical substratum of several diseases of the respiratory tract. Many investigations allow qualitative and quantitative approaches but none can appreciate exactly the injuries degree and the lesions extent. The radiological methods are powerful in particular the high resolution computed tomography with great in-depth descriptive capacity. The respiratory functional tests with a variable sensitivity allow a dynamic but indirect analysis, the provocation test studies bronchial hyperresponsiveness and the plethysmography measures the airways specific resistance. The bronchoscopy explores the bronchi directly but is confronted with the problem of the image distortion. The fields of studies of the bronchial gauge are vast including all bronchopulmonary pathology and the correlation of two different methods allows a better evaluation.

[Solitary pleural fibroma: report of two cases and review of the literature]. / Le fibrome pleural solitaire: a propos de deux cas et revue de la litterature.

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.

[Inflammatory pseudo-tumor of the lung. A pathology clinical study of one case]. / Les pseudo-tumeurs inflammatoires du poumon. Etude anatomo-clinique d'une observation.

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.

[Tuberculosis in hemodialysis patients in Tunisia]. / Tuberculose des patients hémodialysés en Tunisie.

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.