Tracheal stenosis after intubation and/or tracheostomy

The tracheal iatrogenic stenosis remains a frequent, sometimes severe tracheal resection, anastomosis is the treatment of choice. However, the endoscopic treatment is used as an alternative therapy. We report a retrospective study for a period of 8 years. 174 patients had an iatrogenic tracheal stenosis of intubation [55.17%] and/or tracheotomy [44.82%]. The appearance and extent of stenosis were assessed by bronchoscopy, we noted a tracheal mala-cia [15%], a circumferential stenosis [58%], a little tight stenosis [12%] and diaphragm [5%]. Some patients have benefited from several therapeutic procedures, 90 patients were operated on early interventions with 53 and 37 after surgery, an improvement of the patient's clinical status have been postponed earlier, after failure of endoscopic methods. 293 interventional bronchoscopies were performed, 192 stenting, 45 Nd-YAG laser, 55 patients required a recalibration in the tube of the bronchoscope and one patient received cryotherapy, knowing that there are the patients who received combination therapy. We lamented death in the immediate postoperative sepsis, a recurrence of stenosis in 117 patients, and among the 192 implants placed we identified 37 migrations, 52 congestion, development of granulomatous lesions, an overhaul of the prosthesis is noted in 7.29%, three implants were embedded in the tracheal mucosa and there was only one spontaneous rejection. The long-term evolution was satisfactory in 92 patients. Nevertheless, the management of post intubation tracheal stenosis and/or post tracheostomy cannot be that requiring a multidisciplinary collaboration

Pulmonary tuberculosis in its pseudotumoral form; one new case

Pulmonary tuberculosis in its pseudo tumoral form is a rare entity. This pseudo tumor is suggested by a radiological parenchymal lesion or neoplastic-like presence in bronchoscopy of a bud or lung infiltration. The diagnosis is confirmed by bacteriological and/or different histological samples. We report a patient aged 26 with no history conditions, no notion of contagious tuberculosis and without toxic habits, who reports with three months isolated type left chest pain operating in a context of significant weight loss but not encrypted, evening fever and altered general condition. The clinical syndrome is a condensation of apical left and the rest of the examination is unremarkable. The chest radiograph shows an opaque round, dense and homogeneous apical left chest scan objective mass density tissue. Bronchoscopy was performed of a small bud at the apex of the segmental left upper lobe whose biopsy was inconclusive. Transparietal puncture with histological study confirmed the diagnosis of pulmonary tuberculosis. The patient was then put under treatment with antibacillaire. The diagnosis of tuberculosis should be considered in any tumor-like lung, as well as to step up bronchoscopic radiation, especially in an epidemiological context and is suggestive. This will allow early treatment of tuberculosis. The aim of our study is to report the rare and special appearance of pulmonary tuberculosis pseudo-tumoral form in imaging

[ tracheal adenoid cystic carcinoma]

Adenoid cystic carcinoma [CACC], also called cylindroma, are rare epithelial malignant tumors, their favorite seat is at the salivary glands [95% of cases], they represent 20 to 40% of tracheal carcinoma and 0,1% of respiratory tract cancers. Bronchial localization is rare, estimated only between 0.3 and 2%. This is a retrospective study ranging from 1997 to 2006 concerning five patients treated in the thoracic surgery department, for tracheal tumor and whose final histological diagnosis was in favor of adenoid cystic carcinoma [ACC]. All the patients had inspiratory dyspnea. Bronchoscopy showed a smooth tracheal tumor, the biopsy revealed a ACC. Four of our patients underwent resection of the tumor-by-end anastomosis and one patient was deceased prior to surgery. Adjuvant radiotherapy was indicated in one case. The short term, outcome was good, but local recurrence with lung and cervical lymph node metastases appeared after 6 years in one patient. The adenoid cystic carcinoma of the trachea is a rare tumor. Its diagnosis and surveillanse based on bronchial Bibroscopy combined with biopsy. CT better evaluates the scope and extent of the peri tracheal tumor. The therapeutic management is based mainly on surgery combined with radiotherapy. adenoid cystic carcinoma of the trachea are rare malignant tumors issues to think about before a lesion at this level

[Inflammatory pseudo-tumor of the chest]

The inflammatory pseudotumor are rare benign tumors that are the subject of a recent interest, motivated in part by the discovery of a chromosomal abnormality, and secondly, by the existence of rare malignant forms. We report a retrospective study spread over 8 years [1999- 2006] during which we have reported 6 cases of inflammatory pseudotumor. The diagnosis was based on clinical, radiological and histological findings. The incidence of ITP was 1.14% among tumors, patients' age ranged between 14 and 58 years and the sex ratio was 5 women for every man. One patient had a history of treated pulmonary tuberculosis and a history of sarcoma of the thigh treated was reported in one case. Clinical signs were dominated by hemoptysis, chest pain and cough with purulent sputum. The clinic and paraclinical objectified, a heterogeneous left process basal [one case], an excavated lesion of the right hemi thorax [two cases], right upper lobe mass [two cases] and endotracheal process [one case]. All patients underwent surgery for diagnostic and therapeutic reasons and confirmation was based on a pathological examination of surgical specimens. The immediate postoperative course was uneventful and no recurrence was noted. The etiology of these tumors is unclear, the clinical, radiological, and the preoperative cytohistologie can not put a definitive diagnosis, so that the surgery is performed for diagnostic and therapeutic reasons. Careful monitoring is necessary to prevent any recurrence or malignant transformation which is rare but certainly formidable. Through these observations and a literature review, the authors propose an update on the clinical, paraclinical and therapeutic aspects of these cases

[ fibrous osseous dysplasia]

The fibrous osseous dysplasia is a rare congenital condition characterised by the replacement of the medullary canal spongy os by a fibrous tissue proliferation. we reported a case of a young girl, 21 years old, who suffered from thoracic pain since more than one year, with apparation of the axillary arch which progressivaly increase in volume since six months. Examination revealed a fixed hard tumefaction, the thoracic radiography showed two souffle osteolytic images near the medium arc of the fifth left rib and fourth right rib. The osseous scintigraphy revealed an hyperfixation touching the right hemiface. The cranio-facial scan showed an interesting aspect of [frosted glass] of the clivus. The remodeling mark dosage of the osseous alkaline phosphatase was of 2321U/L. A mass biopsy was done which confirmed the diagnosis. the combination of costal and clivus fibrous dysplasia which had been never reported in literatures and the difficult therapeutic decision in front of this polystotic picture makes our case a particular case