Bronchobiliary fistula [thoracobilia]: Report of two cases

Bronchobiliary fistula is a rare condition, defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the development of such a communication. Infection is the most common setting in which bronchobiliary fistulae occur [Amebic abscesses, echinococcic liver cysts and pyogenic liver abscesses]. Biliary tract obstruction secondary to various causes also has served as a common etiology. Congenital cases of bronchobiliary fistulae have been noted. The condition also usually seen as a complication of thoraco-abdominal trauma. Adult patients with bronchobiliary fistulae present with one of two clinical syndromes: either acute fulminating bronchiolitis or chronic intermittent episodes of expectoration of bile-stained sputum [billoptysis] which is a pathognomonic feature of bronchobiliary fistula. Diagnosis is confirmed by means of either the percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, or 99m Tc-HIDA cholescintigraphy [HIDA scan]. Herein, we reported two cases, the first one due to transdiaphragmatic rupture of a hepatic echinococcal cyst and the second case detected after a right hepatic labectomy for hepatocellular carcinoma

Diagnostic value of BCG test in adulthood tuberculosis

This study was carried out on 80 tuberculous patients [pulmonary, extrapulmonary or combined tuberculosis] and 30, age and sex matched healthy subjects as a control group. The aim was to evaluate the diagnostic value of BCG test in adulthood tubercubus patients and comparing it with tuberculin test. All subjects were tested with purified protein derivative and BCG vaccine. The study showed that. the BCG test was positive in 77 patients [96.34%] while tuberculin test was only positive in 52 patients [65%]. In the contrary BCG test was positive in 3 healthy control subjects [10%] while tuberculin test was positive in only two healthy subjects [6.6%]. It can be concluded that BCG test is more reliable and sensitive than the tuberculin test in diagnosis of tuberculosis specially in malnourished and immunocom-promised patients. Furthermore BCG test is safe if it is injected properly

Detection of intrapulmonary vascular dilatations [IPVD] in patients with chronic liver disease by contrast-enhanced echocardiography using indocyanine green dye VS. isotonic saline

Intrapulmonary vascular dilatations [IPVD] are extrahepatic complications of acute and chronic liver disorders that can result in severe hypoxemia. Contrast-enhanced [CE] echocardiography provides a noninvasive method to detect right-to- left shunting associated with IPVD. We studied 23 patients with chronic liver disease to determine the prevalence of positive CE echocardiography suggesting the presence of IPVD and its relationship to arterial blood gases. None of our patients had schistosomal cor pulmonale. Five [21.7 percent] of.23 patients were hypoxemic [PaO 2<70mm Hg]. Eighteen patients [79.3 percent] had PaO 2>70mm Hg. Positive CE echocardiograms suggesting IPVD were found in 6 [26.08 percent] of 23. Three [16.7 percent] of the 18 patients with PaO 2>7Omm Hg had positive CE echocardiograms. Three [60 percent] of the five hypoxemic patients had positive CE echocardiograms. Patients with positive CE echocardiograms using indocyanine green [ICG] dye solution as a contrast were the same patients who had positive CE echocardiograms using isotonic saline solution alone as a contrast. No significant difference in the mean value of PaO 2 was noted between patients with positive and negative CE echocardiograms. We conclude that for our group of patients with chronic liver diseases, [1] IPVD as suggested by CE echo-cardiography were common [26.08 percent], [2] positive CE echocardiography could be documented in patients who were not hypoxemic [16.7 percent], [3] isotonic saline solution alone can be used as a reliable and cheap alternative for ICG dye solution in CE echocardiographic studies, [4] the presence of positive correlation between IPVD and spider naevi and esophageal varices, and [5] the absence of correlation between the Child's classification of liver dysfunction and the presence of IPVD