Spontaneous hemothorax and neurofibromatosis type 1: How to explain it, how to explore it and how to treat it?

Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen's disease is an autosomal dominant genetic disorder. It is the most common of phacomatoses. Pulmonary complications have been rarely described in the literature. It is generally a benign disease, but has the potential for rare and fatal complications, such as spontaneous hemothorax. We reported two cases of patients with a history of von Recklinghausen's disease. Both of them suffered sudden chest pain. Chest-X ray revealed a hemi-thoracic opacity. Enhanced chest computed tomography showed massive hemothorax, but no evidence of tumors or an obvious bleeding point in the thorax. After we had ensured a stable hemodynamic condition, we performed video-assisted thoracic surgery to remove the hematoma. No evidence of bleeding was noticed in the first patient whereas an active bleeding was observed in the second patient. We could not determine which vessel was responsible of the hemorrhage. Electrocoagulation and clot removal were performed.  Evolution was favorable for both patients. Spontaneous hemothorax is a rare and potentially life threatening NF1's complication. A tumor like neurofibroma or more rarely vascular involvement of large or small caliber arteries may be at hemothorax's origin.

Interstitial lung diseases: Imaging contribution to diagnosis and elementary radiological lesions.

Interstitial pneumonias comprise a heterogeneous group of disorders in which a multidisciplinary approach is important for accuracy in diagnosis; indeed, one might say, even mandatory. The team of collaborators should include radiologists, because high resolution computed tomography (HRCT) of the thorax is the first, and most of times, the only imaging examination to be prescribed after chest X-ray. Elementary lesions of the interstitium can be accurately described with HRCT, inasmuch as lung windowing with sharp filtering in this technique reproduces the microscopic features of the lung. Guidance of bronchoalveolar lavage and biopsy procedures is also possible with HRCT.

Posterior mediastinal angiomyxolipoma with spinal canal extension.

BACKGROUND: Angiomyxolipoma is a benign tumor considered as a variant of lipoma and that occurs mainly in the subcutis. The mediastinal location hasn't been previously reported. AIM: To describe the radiological features of this tumor in its posterior mediastinal location and to confront them to the pathological features. CASE REPORT: We report the case of a 49-year-old woman who was admitted for chest wall pain and neurologic disturbance of her two lower limbs. The chest X-ray showed a posterior mediastinal opacity. On CT examination, this mass contained some small areas of fat and enhanced intensely. Microscopic examination of the excised mass confirmed the diagnosis of posterior mediastinal angiomyxolipoma. CONCLUSION: Mediastinal location of angiomyxolipoma hasn't been previously reported. Clinicians and radiologists should be aware that this diagnosis should be suggested, among others, when there is a posterior mediastinal mass that contains fat and that intensely enhances with a possible spinal cord extension.

Imaging of thoracic textiloma.

OBJECTIVE: Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. METHODS: Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magnetic resonance imaging (MRI). RESULTS: In patients with a history of abdominal surgery, the foreign body was located in the parenchyma of the right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textiloma in three of the five patients by demonstrating a non-calcified hyperechoic mass with acoustic shadow. At CT, the gossypiboma was a low-attenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. CONCLUSIONS: The CT aspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CT signs helps to have a preoperative diagnosis.

Acute pulmonary embolism: epidemiologic and tomodensitometric study.

BACKGROUND: Acute pulmonary embolism is a common disease with substantial morbidity and mortality in untreated patients. It requires an urgent positive diagnosis. AIM: To assess the prevalence of acute pulmonary embolism and calculate the sensitivity and specificity of multidetector CT for the diagnosis of acute pulmonary embolism in a hospital specialized in cardio-thoracic diseases. METHODS: This is a prospective study conducted at Abderrahmen Mami Hospital, which included 200 consecutive patients suspected of acute pulmonary embolism and explored by a multidetector CT pulmonary angiography (16 slices). RESULTS: Prevalence of acute pulmonary embolism was calculated at 37.5%. The multidetector CT has enabled an alternative diagnosis in 46 patients (40%). The sensitivity and specificity of multidetector CT were calculated respectively 89.6% and 100%. CONCLUSION: The prevalence of acute pulmonary embolism, in a hospital specialized in cardio-thoracic diseases, is higher than that found in general hospitals. High sensitivity and specificity of multidetector CT makes it the gold standard for the diagnosis of pulmonary embolism.