Pleuropulmonary nocardiosis, an unusual radiological presentation: Case report.

Nocardiosis is caused by strict aerobic filamentous bacteria of the genus Nocardia belonging to the order Actinomycetales with Actinomyces, Streptomyces and Mycobacterium. The radio-clinical presentation in the chest is often misleading. We report a case of pulmonary nocardiosis with an unusual radiological presentation. A 54-year-old patient, chronic smoker, never treated for pulmonary tuberculosis, who presented with a chronic cough complicated by moderate hemoptysis, all evolving in a context of altered general condition and feverish sensations. The radiological aspect was in favor of a hydro-pneumothorax, the pleural puncture brought back a chocolate colored purulent liquid with the presence of numerous yellow grains and the direct examination showed numerous branched gram-positive bacilli. The bacteriological study allowed to retain the presumptive diagnosis of nocardiosis, the patient was put under antibiotic treatment with a clear clinical and radiological improvement. This observation illustrates the diagnostic difficulty of pulmonary nocardiosis and emphasizes the importance of thinking about nocardiosis in front of any dark thoracic syndrome.

Tracheobronchomegaly (Mounier-Kuhn Syndrome) with CT and bronchoscopic correlation: A case report.

Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a clinical and radiological entity characterized by marked dilatation of the trachea and bronchi as a result of severe atrophy of the elastic fibers, with thinning of the muscularis, and the formation of diverticula between the cartilaginous rings. The etiopathogenesis is uncertain and may be congenital or acquired. The clinical signs are not specific and are frequently revealed by recurrent respiratory infections and chronic cough. The diagnosis of Mounier-Kuhn syndrome is based on well-documented measurements of the trachea and main bronchi performed on a chest computed tomography scan. The management of patients is based on symptomatic treatment and may require, in severe cases, the use of endoscopic treatment by stent placement or surgical tracheobronchoplasty. We present a case of a 59yearold patient with recurrent respiratory infections that required several hospitalizations. Diagnosed with Mounier Kuhn syndrome, the thoracic computed tomography scan demonstrated a dilated trachea until the bifurcation and focal points of bronchial dilatation. Bronchoscopic examination showed a dilated and deformed trachea with the presence of diverticula on the tracheal anterior wall. The diameter of the trachea was reduced by more than 50% during expiration and coughing. For this reason, Mounier-Kuhn syndrome should be considered in cases of recurrent respiratory infection or persistent respiratory symptoms.