Atypical emphysema formation in a never-smoker with scleroderma-related interstitial pneumonia: a case report.

Scleroderma is an autoimmune connective tissue disorder which is characterized by fibrosis of visceral organs, blood vessels and skin. The most common manifestations of lung disease in systemic sclerosis are interstitial lung disease and pulmonary hypertension and, together, are the leading cause of mortality in systemic sclerosis. Recently, we notice a new pattern called Combined-pulmonary emphysema and lung fibrosis. Most patients with this entity are male smokers or ex-smokers. This entity is characterized by the coexistence of both centro-lobular and para-septal emphysema in the upper lobes and interstitial lung disease in the lower lobes. Here, we present a case of a nonsmoker adult woman with systemic sclerosis, in which High Resolution Computed Tomography of lung showed combined fibrosis and emphysema with atypical radiological presentation and unusual distribution. This case outlines the importance of recognizing the presence of combined fibrosis and emphysema in patient with systemic sclerosis even without smoking history.

Unusual case of spontaneous hemopneumothorax in a Tunisian pulmonology department: a case report.

Spontaneous hemopneumothorax is a rare encountered entity in clinical practice. It can be life threatening, so a prompt diagnosis and therapeutic intervention are required. We report a case of a right spontaneous hemopneumothorax in a 31-year-old man, complicated with hemorrhagic shock. Conservative therapy with only thoracic drainage with close monitoring of outflow and hemodynamic parameters was performed. In front of hemodynamic instability, an emergency video-assisted thoracoscopic surgery was performed. An apical bulla adhering to the parietal pleura has been identified as the source of the bleeding. The resection of the bullae and electrocauterization of the bleeding adhesion were effectuated. The hemostasis was easily achieved. The actual experience suggests that video-assisted thoracoscopic surgery should be performed as soon as possible after the diagnosis of spontaneous hemopneumothorax. Indeed, conservative therapy with chest drainage should only be performed as bridge to recovery for the stabilization before the video-assisted thoracoscopic surgery.