Severe diffuse interstitial pneumonitis induced by carmustine (BCNU).

We report a fatal case of acute interstitial pneumonitis in a patient treated with carmustine (BCNU) for a brain tumor. Bronchoalveolar lavage (BAL) revealed lymphocyte alveolitis with a low CD4/CD8 ratio (0.36), consistent with an immunoallergic phenomenon, rather than the most often evoked toxic hypothesis.

Azygos vein aneurysm: contribution of transesophageal echography.

We report a case of idiopathic aneurysm of the azygos vein associated with lung cancer. This abnormality is exceptional because we could find only 8 previous published cases. Computed tomographic scan and especially transesophageal echography were of major importance in identifying the vascular nature of the radiographic abnormality and thus excluding extension of lung cancer.

Biodistribution of monoclonal antibody Po66 in a human lung tumour-bearing mouse model: effect of blood exchange on tumour antibody uptake.

We report a method designed to improve the specificity of tumour uptake after intravenous injection of an anti-tumour monoclonal antibody (MAb). It consists in increasing the blood clearance of the MAb injected in order to diminish its tissue activity, without altering tumour binding. Po66, an MAb directed against lung squamous cell carcinoma, was radiolabelled with 125I and injected i.v. into tumour-bearing nude mice. Radioactivity uptake by the tumour reached a plateau on days 3-5 which persisted up to day 14 after antibody injection. The radiolabelled Po66 remaining in the circulation on day 5 after injection was removed by means of exsanguination and blood transfusion. This blood exchange technique depleted circulating radiolabelled MAb by 60%, whenever mice had been injected with Po66 or an unrelated control IgG1. The proportion of radiolabelled Po66 taken up by the tumour 5 days after blood exchange did not differ substantially from that of non-exsanguinated controls (96.1% of controls). In contrast, there was a significant decrease in blood radioactivity (46% of control values on day 5). Blood exchange provoked a 1.8 fold increase in the tumour/blood and a 1.5-1.8 fold increase of the tumour/organ radioactivity ratios. After injection of unrelated radiolabelled IgG1, blood exchange reduced by 50% both blood and tumour radioactivity, and did not increase the tumour/blood or tumour/organ ratios. Hence, removal of 60% of circulating Po66, 5 days after its injection, did not affect the binding or retention of the antibody by the tumour, but would probably constitute a marked improvement if the antibody is used for two-phase radioimmunotherapy.

Alveolar haemorrhage revealing epithelioid haemangioendothelioma.

Epithelioid haemangioendothelioma of the pulmonary vessels is a rare neoplasm which usually has a minimal clinical expression. The present case report describes an exceptional case with severe inaugural alveolar haemorrhage which led to death by acute respiratory failure within a few weeks.

[Adult bronchiectasis revealing familial ciliary anomaly]. / Dilatations des bronches localisées de l'adulte révélatrices d'une anomalie ciliaire familiale.

We report a case of bronchiectasis in a 26-year-old man associated with the following congenital abnormalities: deafness, purulent bronchorrhea, nasal polyps, dysmorphic physical pattern and chronic sinusitis. Situs inversus was absent. A sampling was performed on the posterior nasal mucous membrane and displayed structural ciliary abnormality: a deficiency of the intern dynein-arm. The patient's bother was affected and had similar features: congenital bronchiectasis, deafness, mental deficiency and sinusitis. Young's syndrome was relevant in this case. Hereditary ciliary dyskinesia should be considered in adults with bronchiectasis together with rhinologic and alimentary canal disorders. Nasal biopsies are safe and allow cilia examination.

[Intrathoracic cavernous hemangioma. Apropos of a case]. / Hémangiome caverneux intrathoracique. A propos d'un cas.

A cavernous haemangioma of the mediastinum is a rare benign vascular tumour. Generally it is totally asymptomatic and the diagnosis is most often made in a child or young adult. The treatment is surgical. We report a case in a 60 year old man who was a smoker.

[Pleural involvement of myeloma. Apropos of 2 cases]. / Atteinte pleurale du myélome. A propos de deux observations.

The authors report two cases of myelomatosis localised to the pleura, one of which was associated with an adenocarcinoma. Pleural effusions are relatively rare during the course of multiple myeloma and most often occur with non-specific disorders of the disease. The myelomatous origin of a pleural effusion can only be made by analysis of the pleural fluid and should be recognised early enough to enable aggressive treatment to be instituted even if the prognosis associated with such a localisation is very poor.

[Desmoid tumor of the thoracic wall]. / Tumeur desmoïde de la paroi thoracique.

Desmoid tumor are rare connective tissue tumors currently considered as sarcoma of low grade malignancy. They are most often encountered in young women of child-bearing years. Abdominal localisation is the most frequent site. The main aim of treatment is to avoid recurrences. We report a case of desmoid tumor developing in the thoracic cage in a patient who had been operated on six years earlier for an epidermoid carcinoma of bronchus.

[Isolated pleural amebiasis: about one case in France]. / Amibiase pleurale isolée.

INTRODUCTION: Isolated pleural amebiasis is exceptional in the world and specially in France. CASE REPORT: We report a case of acute isolated pleural amebiasis in a 56 year old man who did not travelled in endemic countries for the 20 past years. Chocolate-colored pus from the pleural puncture suggested the diagnosis. Positive amebic serology and above all, trophozoites (Entamoeba histolytica) in the pleural liquid confirmed the diagnosis of pleural amebiasis. Drainage was required and metronidazole was introduced. Other antibiotics were necessary to treat bacterial co-infection, which is frequent. Of interest, a nurse developed an acute intestinal amebiasis probably infected by pleural pus, an indirect confirmation of diagnosis. CONCLUSION: This diagnosis should be suspected even in low endemic areas in case of infectious pleurisy resistant to traditional antimicrobial regimens.

[Pulmonary metastases with a prolonged development. Two cases of thyroid cancers]. / Métastases pulmonaires d'évolution prolongée. A propos de deux cas de cancers thyroidiens.

The authors report two cases of differentiated carcinoma of the thyroid with pulmonary involvement showing as miliary shadowing radiologically which preceded the diagnosis of the thyroid neoplasm by 35 and 6 years respectively. The two patients had undergone cervical radiotherapy in infancy for lymphadenopathy whose aetiology had not been determined. The scintigraph with iodine 131 showed tht in two cases there was a bilateral and diffuse pulmonary uptake in keeping with pulmonary lesion of metastatic origin. Our observations recall the possibility of a slow evolution of pulmonary metastases and carcinoma of the thyroid and the role of cervical irradiation in the development of such cancers. With miliary shadowing a metastatic origin, in particular that of the thyroid, should be considered and in the majority of cases the proof could be supported using iodine 131 scintigraphy. The delay in appearance of pulmonary metastases during the course of cancer of the thyroid is variable. They occur most often after the initial diagnosis or more rarely preceding the discovery of a primary thyroid cancer. The pulmonary metastases may be asymptomatic. This neoplasm may benefit from a specific effective therapy and prolonged remissions have been described even with metastases.

[Diffuse alveolar hemorrhage secondary to oral anticoagulant use]. / Hémorragie alvéolaire diffuse secondaire à l'utilisation d'anticoagulants oraux.

We report a case of alveolar haemorrhage in all probability, attributable to the use of anti-vitamin K. The favourable outcome of this type of disease has rarely been reported with anticoagulants and fibrinolytics, most frequently in a disturbed haematological setting with disseminated intravascular coagulation or profound thrombocytopaenia. One should not forget this diagnosis in cases of acute respiratory failure in association with an alveolar syndrome in an exposed patient due to the fact that the outcome is generally favourable after correcting the disturbed coagulation.

[Bronchial dilatation and rheumatoid arthritis: a little known association]. / Dilatation des bronches et polyarthrite rhumatoïde: une association méconnue.

Since Ellmann's description in 1948 numerous authors have studied the respiratory manifestations associated with rheumatoid arthritis. Amongst the numerous disorders described, dilatation of the bronchi, although one of the most frequent, remains largely under-estimated. The authors report a series of 21 patients presenting jointly with both rheumatoid arthritis and bronchiectasis which was documented using thoracic computed scanning. All the subjects were female. For 20 of these patients, the appearance of bronchial suppuration preceded that of the articular manifestations by several years. Bronchial dilatation in these cases can, only with difficulty, be considered as a complication of arthritis as has been previously suggested. Rather it appears as a possible pre-disposing factor in the occurrence of the rheumatoid disease. These hypotheses explain the pathophysiological mechanisms implicated in this association are discussed.

[Thoracic actinomycosis. Two aspects of an infection with protean manifestations]. / L'actinomycose thoracique. A propos de 2 aspects d'une infection protéiforme.

The authors report two cases of thoracic actinomycosis with contrasting presentations, just as the diagnosis was obtained by different tests underlying the varied aspects of this disease. Indeed this infectious pathology does infrequently mimic tuberculosis or lung cancer with similar clinical and radiological appearances. The particular characteristic of the bacteriological culture and the quasi specific character of the pale, yellow grains on histology are recalled, as well as the different treatments necessary to ensure a cure in 90% of cases.

[Mediastino-pulmonary sarcoidosis]. / La sarcoïdose médiastino-pulmonaire.

Sarcoidosis is diffuse granulomatosis disease. The aetiology and pathogenesis are unknown. Many different localizations have been described together with immunological disturbances. Generally, the prognosis is favourable. Here we describe the pulmonary manifestations and their staging. Extra-pulmonary manifestations are then presented. Finally, the principle elements of the diagnosis and the treatment of sarcoidosis are discussed.

[Acute respiratory insufficiency after pleural talcage of pneumothorax. Apropos of a case]. / Insuffisance respiratoire aiguë après talcage pleural d'un pneumothorax. A propos d'un cas.

The authors report about one case of respiratory distress occurring after pleural talcage for pneumothorax. Although few cases have been published, this complication is known, and it should lead to carefully consider the indication of this technique and to limit the total amount of talc used.

[Mycobacterium chelonei pulmonary infections. Apropos of a case]. / Les infections pulmonaires à Mycobacterium chelonei. A propos d'un cas.

Infections caused by Mycobacterium chelonei are rare. We report a case of pulmonary infection in a 57-year-old non-immunocompromised woman. Most of the abnormalities were observed at radiology which showed bilateral apical excavated opacities. The disease could only be diagnosed on surgical biopsies. Beside diagnostic problems, M. chelonei infections are a source of therapeutic problems.

[Pleural amyloidosis. Apropos of a case and review of the literature]. / Amylose pleurale. A propos d'un cas et revue de la littérature.

The main respiratory manifestations of amylosis are tracheobronchial involvement and modular or diffuse parenchymal disease. Amyloid deposits in the pleura are exceptional. We observed transsudative pleural effusion and heart failure in a patient with multiple myeloma, leading to the discovery of pleural amylosis. Amyloid deposits in the pleura may be fortuitous discoveries since pleural effusion is not necessarily observed. It is however important to be aware of this possibility since the localization is easily accessible for diagnosis. Specific stains are effective diagnostic tools even for transsudative effusions, particularly in suggestive clinical conditions such as multiple myeloma.

[A rare cause of superior vena cava syndrome: extramedullary plasmocytoma]. / Une cause rare de syndrome cave supérieur: le plasmocytome extramédullaire.

We report the case of a 79-year-old man for whom investigations of superior vena cava syndrome have revealed extramedullary plasmocytoma. Extramedullary plasmocytoma (EMP) is the less frequent form of plasma cell neoplasms. The mediastinal location of EMP is rare, and its compressive nature is exceptional. Another particular feature we observed is that the EMP was associated with an authentic kappa light chain multiple myeloma.

[Sarcoidosis presenting as a splenic pseudotumour]. / Rate pseudotumorale révélatrice de sarcoïdose.

INTRODUCTION: Multinodular splenomegaly is a rare form of extrathoracic sarcoidosis. It may be the presenting feature of the disease. It poses problems of differential diagnosis, in particular with lymphoma, tuberculosis and other granulomatous diseases. In the absence of typical associated lesions, particularly thoracic, histological roof is essential. CASE REPORT: We report the case of a 55-year-old caucasian woman with multinodular pseudotumoural splenomegaly, associated with some small mediastinal lymph nodes and some non-specific parenchymatous pulmonary nodules. The diagnosis of sarcoidosis was made on the basis of splenectomy after eliminating other causes of granulomatosis. CONCLUSION: This case report describes a rare presentation of sarcoidosis and discusses the differential diagnosis of multinodular splenomegaly. It underlines the necessity of an exhaustive aetiological investigation of splenic granulomatosis as the diagnosis of sarcoidosis remains one of elimination.