Pulmonary aspergilloma simulating bronchogenic carcinoma.

When a pre-existing lung cavity is colonized by Aspergilius fumigatus, it forms a fungal ball (pulmonary aspergilloma) and the presenting symptom is usually haemoptysis that may be massive and often-times life threatening. The radiological finding is that of a ball-like structure within a lung cavitation and the typical air crescent around the ball both on plain radiography and CT scan of the chest. The present case is of a 50-year-old male who had a 25-year history of heavy smoking (40 cigarettes per day) and haemoptysis. Although the cavitating lesion, ball-like structure and the crescenteric rim of air were present on the radiographs, the possibility of bronchogenic carcinoma was held high in view. Flexible fibreoptic and transbronchial biopsies were negative for malignancy. Sputum and bronchoalveolar lavage examinations showed neither malignant cells nor fungal elements. Right thoracotomy, cavernostomy, removal of the fungal ball and obliteration of the cavity by suturing (capitonnage) were done with an uneventful postoperative period.

Ectopic chest tube insertions: diagnosis and strategies for prevention.

In the six-month period from October 1999 to March 2000, the authors carried out a prospective study of ectopic chest tube placements (ECTP) diagnosed at the Assir Central Hospital, Abha, Saudi Arabia. During the reference period, 63 chest tube placements were carried out in 44 patients while one patient was from a medium-sized general hospital within a neighbouring city. The grades of the surgeons who had performed the ECTP were: surgeon specialists based at peripheral hospitals--5 (83.3%), and surgical resident in training at the regional referral centre--1 (16.7%). Mean age = 29.7 years; M:F ratio = 2:1. A total of 6 cases of ECTP were found constituting 9.5% of all chest tube insertions mostly from small hospitals situated in the peripheral, non-urban areas. The diagnosis of ECTP was made on plain chest radiographs in 3 patients (50%) and on the CT scans of the chest in 3 patients (50%). The ECTP was into the lung (2 cases--33.3%), subdiaphragmatic. intraabdominal (3 cases--50%), and chest wall, subcutaneous (1 case--16.7%). Misdiagnosis and failure to carry out a finger exploration of the pleural cavity prior to the placement of the chest tube rather than the use of chest tubes with trocars was to blame. The incidence of ECTP (9.5%) is high and underlines the need for proper training in the methodology of chest tube insertion for junior surgical cadre.