[Lymphocytic interstitial pneumopathy in AIDS-related complex. Presence of the LAV virus in the bronchoalveolar lavage fluid]. / Pneumopathie lymphocytaire interstitielle au cours d'un ARC. Présence du virus LAV dans le liquide de lavage broncho-alvéolaire.

A new case of lymphocytic interstitial pneumonitis developed in the course of a persistent generalized lymphadenopathy syndrome is reported. The patient was a 30-year old Haitian woman with only her ethnic risk factor. Broncho-alveolar lavage showed high cellularity with mostly major lymphocytosis (76%) and a fall of the OK T4/OK T8 ratio to 0.23. The LAV was isolated from the lavage fluid lymphocytes on the same day and within the same culture time as from blood, using lymphocyte culture and measurement of reverse transcriptase activity in the supernatant fluid of cell cultures. This, together with the strongly positive (1/80) LAV serology in fluid as compared with blood (1/640), suggested that the LAV virus was directly or indirectly involved in the pneumonitis, being responsible for lymphocyte proliferation as it is in lymph nodes. No superinfection with a bacterial, fungal or other than LAV viral agent was found in blood or in lavage fluid. Lymphocytic interstitial pneumonitis is uncommon in AIDS or ARC (13 cases reported), but its incidence no doubt is underestimated, as it may be latent. It certainly accounts for the high lymphocyte count observed in broncho-alveolar lavage fluid in the absence of superinfection and, most probably, for many cases of so-called "non-specific pneumonia". In 1986, patients with apparently primary lymphocytic interstitial pneumonitis should be investigated for AIDS or ARC.

[Cardiac contusion with dissecting hematoma of the apex of the heart and interventricular communication]. / Contusion cardiaque avec hématome disséquant de la pointe du coeur et communication interventriculaire.

The authors report the case of a post-traumatic ventricular septal defect diagnosed after the detection of a systolic murmur in a 39 year old man, 18 months after a car accident. Two-dimensional echocardiography and angioscintigraphy showed an abnormal cavity at the apex of the heart. At cardiac catheterisation there was a moderate left-to-right ventricular shunt through this cavity. There were no traumatic or atheromatous lesions of the coronary arteries. The operative appearances were of stunned myocardium which had caused a dissecting haematoma of the cardiac apex which ruptured into both ventricular cavities. The lesions were corrected surgically and the systolic murmur disappeared.

[Spontaneous pneumomediastinum in adults]. / Pneumomédiastin spontané de l'adulte.

Pneumomediastinum is an uncommon, often overlooked, condition resulting from the rupture of perivascular alveoli and the migration of air along the pulmonary vessels. Diagnosis, which is usually difficult, rests on three major signs: cervical subcutaneous emphysema, Hamman's sign and roentgenological findings. Prognosis is good and the course is uneventful. Cervico-mediastinotomy is only rarely reeded.