ABSTRACT
INTRODUCTION: Mediastinal parathyroid adenomas are a rare condition. AIM: Analysis of epidemiological data, clinical manifestation of mediastinal parathyroid adenoma (MPA), including imaging modalities, and therapeutic approach to this condition. MATERIAL AND METHODS: A retrospective study of documented cases of mediastinal parathyroid adenoma that were managed at our Department of Thoracic Surgery of the Military Teaching Hospital Mohammed V, between January 2010 and December 2019. RESULTS: During a 9-year period in our department, 21 documented cases of MPA were treated surgically. Patients ranged in age from 20 to 69 years, with a mean age of 45 years, and there was no gender predominance. The most frequently reported manifestations were osteoarticular, with bone pain in 66.6% (14/21), pathological fractures in 28.5% (6/21), and osteoporosis in 23.8% (5/21). Cervical ultrasound, MIBI scintigraphy and cervico-thoracic computed tomography scan were performed respectively in 28.5% (n = 06/21), in 47.6% (n = 10/21) and 100% (n = 21), and allowed positive diagnosis of MPA. All patients benefited from resection surgery, through a classical transverse cervicotomy which was extended in some cases to the manubrium, and in only one case treated with thoracotomy. CONCLUSIONS: Management of mediastinal parathyroid adenoma is based on the diagnosis imaging assessment step, usually by MIBI scintigraphy. Surgical ablation is a radical treatment. Peroperative hormonal evaluation is mainly recommended.
ABSTRACT
BACKGROUND: Tuberculosis is a public health problem in developing countries. Tuberculosis of the chest wall is rare and often presents as cold abscess (to differentiate from pyogenic abscess) or pseudotumoral mass whose diagnosis is difficult and often requires a surgical biopsy. PATIENTS AND METHODS: The medical series of 16 patients with cold chest wall abscess treated with surgery in association to anti-tubercular therapy were analysed retrospectively for the period of 7 years between January 2011 to December 2017 at Mohamed V Military Teaching Hospital - Rabat - Morocco. RESULTS: The clinical examination provided a correct preoperative diagnosis of the abscess in all cases. Five patients had a past history of pulmonary tuberculosis and three patients had concomitant active infection. There were 6 cases on the left side, 9 cases on the right side and one case on the anterior chest wall. All patients underwent surgical drainage and debridement with specimens for bacteriology and histology. It was not necessary to resect ribs or sternum in all cases (sample costal or sternal curettage in one case each). Anti-tubercular treatment was routinely administered (6-9 months) with drug combinations of Isoniaside, Rifampicin, Pyrazinamide and Ethambutol. The evolution was favorable in all cases without complications or recurrences. CONCLUSION: Drainage of chest wall abscess and complete debridement provide adequate treatment. Post-operative anti-bacillary therapy should be combined with surgical procedures to minimize local complications and recurrence of infection.
