Intra-pulmonary migration of a clavicle osteosynthesis pin: a case report.

BACKGROUND: Fractures of the clavicle are common injuries, which often require reduction and internal fixation. Although Kirschner pins have been commonly used to treat these fractures with good results, migration of these devices may result in severe internal lesions. CASE PRESENTATION: We report herein the case of 61-year-old man, who presented for intrapulmonary migration of a Kirschner pin, 25 years after closed reduction and fixation of a clavicle fracture. CONCLUSION: Migration of an osteosynthesis pin can be lethal. Patients with osteosynthesis pins, should have a regular follow, until the removal of the wires.

A huge mediastinal teratoma in a 14-year-old girl.

INTRODUCTION AND IMPORTANCE: Mediastinal teratoma is the most common mediastinal germ cell tumor. Mature mediastinal teratomas are infrequent and often found incidentally. CASE PRESENTATION: We report the case of a 14-year-old girl who was presented dyspnea for 2 years. A computed tomography of the chest revealed a 19 cm heterogenous right-sided anterior mediastinal mass suggesting mature teratoma. The mass compressed vital structures. The tumor was considered resectable. By hemiclamshell approach, we punctured the tumor and aspirated its contents. The tumor was totally resected en bloc with a cuff of pericardium, phrenic nerve and azygos vena. The pericardial defect was repaired using Mersilene mesh. Histopathology of the tumor revealed a mature cystic teratoma. Postoperative course was uneventful. CLINICAL DISCUSSION: Complete surgical excision is the treatment of choice for mediastinal mature teratoma. The choice of incision for removing the tumor depend on the tumor size, location and the relashionships with the associated vital structures. Lengthy incisions were required for the safe mobilization of the tumor. In addition, contents aspiration through a small incision in the giant tumor wall helped improve tumor mobilization. CONCLUSION: Appropriate surgical strategy for a well selected case maintains functional status and results total tumor resection.

Cervical Benign Teratoma: Case Report and Review of Literature.

Cervical teratomas are extremely rare germ cell tumours and it is much more common in newborn than adults, and in contrast to the paediatric cases adult teratomas have been highly malignant. Cervical teratoma incorporates lesions arising in the anterior and posterior triangles of the neck. This tumor can reach enormous size and cause airway obstruction and patients should be quickly treated. Surgery is the primary modality of treatment as malignant transformation can occur. Hereby, we present a case of benign teratoma of neck in adult which was completely misdiagnosed preoperatively due to its rare occurrence in adults.Even though cervical teratoma of adult is extremely rare, it should be considered as an important differential diagnosis in patient of midline cystic neck swelling. Preoperative radiological investigations requires high index of suspicion. Complete surgical resection is recommended. We believe that upper cervicotomy approach is a safe and effective method for the treatment of mature cervical teratoma with a few protruding into the superior mediastinum. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03748-8.

Drainage of tuberculous pneumothorax in a Northern African country: Characteristics and difficulties.

INTRODUCTION-AIM: Tuberculous pneumothorax (TP) is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to identify TP drainage characteristics and difficulties. METHODS: This was a retrospective multicenter study of patients hospitalized for TP between 1999 and 2021 in three hospitals from Tunis (Tunisia): Abderahmen Mami, La Rabta, and Charles Nicolle. Clinical, biological, radiological, therapeutic and evolutionary data were collected. RESULTS: Seventy-three patients were enrolled. The mean±standard-deviation (SD) of age was 37±17 years. The sex ratio was 3.3. TP was isolated in 39 patients (53.4%) and was associated with a purulent effusion in 34 patients (46.6%). It was bilateral in three patients (4.1%). Chest drainage was indicated in 67 patients (91.7%). It was performed with a chest drain in 61 cases, with a pleuro-catheter in one case, and with a pleuro-catheter then a chest drain in five cases. The mean±SD (ranges) duration of drainage was 43±39 (3-175) days. Drainage was prolonged in 36 cases (53.7%). The duration of drainage for pyopneumothorax was significantly longer than for isolated TP (p=0.04). The mean±SD (ranges) number of drains inserted in each patient was 2.02 ±1 (1-7) drains. Spontaneous drain fall was observed in 13 patients. Drainage failure was observed in 16 patients, and was more frequent in cases of pyopneumothorax (p=0.039). Recurrence of pneumothorax was noted in nine patients (13.4%). CONCLUSION: The drainage of TP is often extended and requires the use of multiple drains. It is associated with several complications. Failure of thoracic drainage is not negligible.

Hemodynamic profile of pulmonary arterial hypertension in a Tunisian center.

INTRODUCTION: Pulmonary hypertension (PH) management can only be conceived in a specialized center. We aimed to report the experience of a Tunisian ICU about PH invasive hemodynamic exploration and to describe consequent therapeutic decisions. METHODS: Retrospective descriptive study including all patients admitted to the medical ICU of Abderrahmen Mami Hospital for right heart catheterization (RHC), between 2005 and 2019 as part of the investigation of PH. Patients' characteristics, procedure safety and arising therapeutic decisions were then reported. RESULTS: Forty patients were admitted for hemodynamic evaluation. RHC confirmed PH in 31 patients and exploration was then completed with NO reactivity test. Mean age was 41.3±15 years, gender ratio M/F was 1.06. PH was classified into: group 1 (n=13), group 2 (n=14), group 4 (n=2) and group 5 (n=2). NO vasoreactivity test was positive in 50% of post-capillary PH and in 28% of pre-capillary PH. The therapeutic decision following the reversibility test was: prescription of calcium channel blockers (n=5), a specific pulmonary vasodilator (n=10), operability (n=6), heart-lung transplant (n=3) and therapeutic abstention (n=7). Two minor complications were reported. CONCLUSION: The medical ICU in Abderrahmen Mami Hospital represents an experienced team in hemodynamic investigations despite low annual RHC number. NO reactivity test is an indispensable tool that enables important decisions during PH management.

Management peculiarities of costovertebral hydatidosis.

Background: Costovertebral hydatidosis is a rarely reported clinical and radiological entity, estimated at less than 1% of thoracic hydatid locations. Its management is still not codified. Objective: The aim of our study was to specify the management peculiarities of costovertebral hydatidosis. Methods: Between January 2000 and December 2018, 14 patients were managed for costovertebral hydatidosis in a thoracic surgery department. Results: The mean age of our patients was 48 years. The history of a prior hydatid disease was found in 7 patients. Imaging features were suggestive in 13 cases. They showed: involvement of the spinal canal (6 cases), of the soft tissues (5 cases) and spinal cord compression (3 cases). Costovertebral resection of the hydatid lesions was complete in 12 cases. Four patients presented postoperative complications. Conclusion: Costovertebral hydatid involvement, may threaten the functional and vital prognosis. Therefore, early diagnosis and management are mandatory, before the occurrence of irreversible neurological impairment. Surgical resection remains the treatment of choice and must be complete whenever possible. Relapse is frequent, hence the importance of a regular follow-up.

Giant pulmonary hydatid cyst in children.

BACKGROUND: Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related to higher lung tissue elasticity. AIM: To compare clinical and imaging features, types of surgical interventions, and postoperative complications in pulmonary GHC and non-giant pulmonary hydatid cysts (NGHC) in children. METHODS: A retrospective study was undertaken. The data analyzed were taken from medical records of children with pulmonary hydatid cyst (PHC) hospitalized in a pulmonary department in Tunisia between January 2004 and February 2019. Cysts were divided according to their size into GHC ( ≥10cm) and NGHC (<10cm). RESULTS: In the study period, 108 PHC were recorded in 84 children. GHC accounted for 21 (19.4%) and NGHC for 87 (80.6%). The median of age of the children was 11 years (IQR 1-9, IQR 3-14) and the mean age was 11.6 years (10.5 in GHC vs. 11.4 years in NGHC). Hemoptysis was found in 25% of the GHC group vs. 48.4% of the NGHC group (P=0.27). Cysts were multiple in 23.8% of cases and predominated in the right in 64.3% of cases and in the inferior lobes in 71.4% of the cases. GHCs were less frequently complicated (60% vs. 78.1% in NGHC, P≤0.11), although not significantly. Parenchymal resection was realized in 50% of GHC vs. 18.8% of NGHC (P=0.006). No significant difference was found in postoperative complications between the two groups and there was no recurrence in either group. CONCLUSION: GHC is a special clinical entity in children. It requires major surgery with parenchymal resection, and therefore early diagnostic and therapeutic management is warranted.

Distance education in times of covid 19: a leap into the future?

INTRODUCTION: Online education has grown a lot in recent months in our country during the global health crisis (COVID19). It has been widely used at all levels and fields of education ranging from elementary school to graduate and postgraduate studies. The aim of this study is to evaluate this teaching method compared to classical face-to-face teaching by referring to the learner's point of view. METHODS: It was a prospective and descriptive cross-sectional study targeting residents in medical imaging (all levels approximately 200 people) It was based on an online questionnaire sent to all residents after attending synchronous online teaching sessions at the College of Medical Imaging and Nuclear Medicine. The assessment was done by the learners using a 5 points Likert scale. RESULTS:    Ninety-seven residents answered the questionnaire. Sixty percent of our learners were satisfied with this new way of teaching. 73% of the students found the logistical means suitable for this course. The main advantages noted by our residents were accessibility to sessions from any location and the ability to replay lessons later. The weaknesses put forward were the lack of interaction with the teacher compared to face-to-face teaching and the occurrence of technical problems which could sometimes hamper the smooth running of the sessions. CONCLUSION: Our study allowed us to get feedback from our learners on this teaching. The multiplication of learning means, in particular a hybrid education should be considered to overcome the shortcomings of exclusive online teaching.

Unusual cause of laryngeal dyspnea and swallowing troubles in a 2-year old child.

Plexiform neurofibromas are rare benign tumors developed from peripheral nervous system often associated with neurofibromatosis type 1. We report the case of multifocal plexiform neurofibromas in a 2-year-old child with cervical mass obstructing the trachea causing respiratory distress. A cervical ultrasound examination was performed followed by enhanced CT and MRI. Imaging revealed an expansive cervical mass extended from the base of the skull to the mediastinum associated with similar pelvic and sacral foraminal masses. The target like MRI aspect on T2-weighted images was suggestive of the neural origin. Biopsy under ultrasound control confirmed the diagnosis of plexiform neurofibroma.

Radiofrequency ablathermia of pulmonary nodules : CT follow-up and prognostic study.

INTRODUCTION: Radiofrequency ablathermia of pulmonary nodules is a local curative treatment whose efficacy assessment is still a current topic. AIMS: To specify the monitoring protocol, the scannographic aspects of treated lesions, deduce criteria of incomplete ablation, and identify the prognostic factors influencing overall and progression-free survivals. METHODS: A prognostic descriptive retrospective study conducted in the medical imaging department of Abderrahman Mami Hospital. The nodules were monitored at 24-hour, 2.4,6,9,12,15,18 and 24 months after treatment and then once a year. The study of overall and progression-free survivals was done using Kaplan Meier's method. RESULTS: Sixteen patients with 21 nodules were included, 20% of them were pulmonary carcinomas and 80% were secondary nodules. 6 nodules presented an incomplete response.The appearance of a convex outline was the first sign of incomplete ablation. 5 out of 6 nodules had a nodular focal enhancement. The cumulative probability of overall survival at 12, 36, and 60 months was 80%, 66% and 39% with a median survival of 31 months. The number of nodules treated was found to be directly related to overall survival. The cumulative probability of progression-free survival was 65% at 12, 36 and 60 months. Pleural contact was the factor influencing progression-free survival. CONCLUSION: Radiofrequency ablathermia is an effective technique. Regular CT monitoring allows early detection of tumor recurrence.

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.

Surgical management of a simultaneous aortic valve replacement and pneumonectomy.

Combined heart surgery and lung resection remains a controversial issue. The treatment of two major conditions in the same operative time may be attempted in certain cases. We report the case of a 68-year-old man who presented for dyspnea on exertion. The chest computerized tomography scan showed an infiltrating tumor which involved the right interlobar artery. A pneumonectomy was indicated and the preoperative echocardiography detected a calcified aortic valve with severe stenosis and significant pressure gradient. The patient had combined pneumonectomy and aortic valve replacement through median sternotomy and was discharged 18 days after surgery. Cardiac valve replacement is feasible in conjunction with pulmonary resection. However morbidity is increased in case of associated pneumonectomy.

Major pulmonary resections by exclusive VTS. a first in Tunisia.

Although thoracoscopic surgery had been introduced in Tunisia since 1993, there were no anatomical resections performed that way. We report herein the first 3 cases of lobectomy performed by exclusive video-thoracoscopic surgery (VTS). Three female patients presenting with bronchiectasis (2 cases) and cystic adenomatoid malformation (1 case) have underwent a thoracoscopic lobectomy with different outcomes.