Spontaneous pneumomediastinum in patients with COVID-19 pneumonia.

INTRODUCTION: Spontaneous pneumomediastinum (SPM) is a rare affection in general population. Only few cases have been reported during this ongoing global pandemic of Coronavirus-2019 (COVID-19). The ethipathogeny of this complication is poorly understood. OBSERVATIONS: we reported ten cases of SPM complicating coronavirus pneumonia. There were six me and four women. Age varies from 32 to 66 years. Pneumonia was severe for all cases defined by a bloo oxygen saturation < 90% on admission. All patients were hospitalized in intensive care unit and treated by high-flow oxygen for nine patients and non-rebreather masks for one patient. Repeated chest computed tomography (CT) scan showed resolution of the pneumomediastinum and appearance of signs of pulmonary fibrosis for four cases. CONCLUSIONS: Chest CT scan must be performed in front of any sudden deterioration in respiratory status of patients with COVID-19 pneumonia to not miss mechanical complication such as SPM. This complication seems to be associated with severe forms of COVID-19.

Middle lobe syndrome revealing Broncholithiasis: A Case Report.

Middle lobe syndrome is a rare but important clinical entity worth investigating in local obstructive or inflammatory cause. One of its rare etiologies is broncholithiasis. We report the observation of a young female patient who presented with recurrent hemoptysis. Chest CT scan showed atelectasis of the middle lobe and suggested the diagnosis of broncholithiasis by objectifying, within the collapsed lobe, a calcification located in the bronchial lumen. Bronchial fibroscopy was of little help. Recurrent hemoptysis and doubt about pulmonary neoplasia led to a diagnostic and therapeutic lobectomy. In front of MLS, broncholithiasis should be suspected in the presence of calcifications on imaging. Surgery may be required in case of uncertain cases to not ignore an underlying tumor.

Outcomes of bronchial artery embolization for the management of hemoptysis.

INTRODUCTION:   Hemoptysis is an alarming symptom that requires immediate investigation and management. Bronchial artery embolization (BAE) is a minimally invasive procedure that has become the treatment of choice of recurrent and massive hemoptysis. AIM: To assess the efficacy and safety of BAE for management of recurrent and/or massive hemoptysis. METHODS: A retrospective analysis was carried out of the medical records of 46 patients who were hospitalized in our department of pneumology in Mohamed Taher Maamouri hospital for hemoptysis and who underwent bronchial arteriography (BA) for the purpose of transarterial embolization. RESULTS: The most frequent causes of hemoptysis included idiopathic bronchiectasis (32.6%), pulmonary tumors (26%) and tuberculosis (8.6%) Embolization was successfully performed in 97.5% of cases. Immediate cessation of haemoptysis was achieved in 95%. Recurrence of haemoptysis was noted in 12% of cases. No major complication involving the vital or the functional prognosis, related to BAE was noted.   Conclusions: Our study confirms the safety and the efficacy of the BAE for management of massive and/or recurrent hemoptysis.

Cutaneous manifestations of COVID-19: report of three cases.

Coronavirus disease 2019 (COVID-19) shows rapid spread around the world. Its classic presentation is a respiratory illness. However, cutaneous manifestations have rarely been described as the first clinical manifestation in patients with this infection. The aim of this article is to describe cutaneous manifestations in patients with COVID-19 through three case reports.

Yellow nail syndrome: a genetic Disorder?

BACKGROUND: Yellow nail syndrome is a very rare disorder. The classic clinical presentation includes a triad involving yellow nail discoloration, chronic pulmonary manifestations and lower limb lymphedema. Its etiology remains unknown and the genetic disorder is still controversial. OBSERVATION: We report a case of a young man diagnosed with this syndrome and for who the same affection was found in several members of his family Conclusion: The diagnosis of yellow nail syndrome in several members of the same family supports the fact that it is a genetic disorder.

Unusual radiologic and histologic manifestations of primary pulmonary lymphoma.

Pulmonary parenchymal involvement in lymphoma is unusual and is reported more commonly in Hodgkin's disease than non-Hodgkin's lymphoma. Radiological appearances are manifold and may mimic other pulmonary diseases. We report the case of a patient with Hodgkin's disease who demonstrated multiple cavitating lung lesions with aberrant immunophenotypic expression of T-cell antigens.

Inflammatory myofibroblastic tumor of the lung: a benign lesion with aggressive behavior.

Inflammatory myofibroblastic tumor is a rare solid tumor that most often affects children and young adults. They present as myofibroblastic cell proliferations accompanied by inflammatory cells made up mostly of plasma cells. Although benign, the tumor may be very aggressive locally. In this report we describe a 22-year-old woman with primary invasive myofibroblastic tumor of the left lower lobe leading to a left pneumonectomy.

[Idiopathic chylothorax: usefulness of aetiologic survey and the follow-up]. / Chylothorax spontané idiopathique: intérêt de l'enquête étiologique et du suivi.

Chylothorax is an uncommon condition. It's characterized by the presence of chyle in the pleura. The most common causes are malignancy and trauma. When an underlying cause is excluded, the chylothorax is called idiopathic. We report a case of a 68 aged woman, admitted for abundant chylothorax. Thoraco-abdominal computed tomography, magnetic resonance imaging of the chest and thoracotomy showed no lesion of the lymphatic duct. Fibrothorax has developed after pleurodesis. Stable clinical and radiological condition was noticed during 3 years. We discuss the difficulty in the exclusion of a malignancy and the necessity of the follow up for these patients.

[Pulmonary sequestrations: from radiologic to preoperative diagnosis: 2 cases with review of the literature]. / Les sequestrations pulmonaires: du diagnostic radiologique au diagnostic per-opératoire. A propos de deux cas avec revue de la littérature.

Pulmonary sequestrations are defined by the presence of a non fonctional pulmonary parenchyma with an abnormal vascularisation. Their incidence ranges from 1.1% to 1.8% of all the malformations in the general population. Two types of sequestrations are described: Intralobar sequestrations: the most common, localised within a normal parenchyma. Extralobar sequestrations: totally separate from the lung with their own pleural covering. We report two cases of sequestrations. In the first case, the radioclinical presentation was strongly suggestive of this diagnosis in a 32-year old woman with recurrent hemoptysis, airspace opacity in the left retrocardiac region and a systemic vascularisation of this mass on tomodensitometry. Pathological studies after surgery confirmed the diagnosis of intralobar sequestration type I in the classification of PRYCE. In the second case a thoracoscopy performed on a 14-year-old boy who had a serohematic pleural effusion, revealed a left costodiaphragmatic mass. Surgical removal of this mass confirmed its extralobar pulmonary nature.

[Hydatid cyst of the heart and vessels, four cases]. / Kyste hydatique du coeur et des vaisseaux, 4 observations.

INTRODUCTION: The lung is the most frequent location of hydatid cysts (HC). Cardiac and vascular HC are rare, and the primary location in the pulmonary artery is exceptional. OBSERVATIONS: We report three cases of right cardiac HC cyst revealed by pulmonary hydatidosis, and 1 case of a primary HC of the pulmonary artery revealed by haemoptysis. Treatment consisted in surgical resection of the cardiac and pulmonary artery HC. Post-surgical antiparasite chemotherapy, based on albendazole, was prescribed for all patients. The evolution was towards a post pneumonectomy syndrome in the patient with a HC in the pulmonary artery, major pulmonary hypertension in the case of pulmonary embolic hydatidosis and an extension of the hydatid lesions in the third patient. Treatment is ongoing in the fourth patient with the development of many parenchymatous cysts. DISCUSSION: Cardiac and vascular hydatid cysts are rare and of bad prognosis. These cardiac and vascular cysts are of poor prognosis because of the risk of rupture and hematogenic dissemination. Treatments are only partially effective and more importance should be given to preventive treatment.

[Acute chest syndrome during sickle cell disease: unusual etiology. Apropos of 3 cases with review of the literature]. / Les syndromes thoraciques aigus au cours de la drepanocytose: des etiologies surprenantes. A propos de trois cas avec revue de la litterature.

The Acute Chest Syndrome is a frequent complication of sickle cell disease characterised by chest pain, fever and new infiltrate on chest X ray image. Early diagnosis and treatment are needed for Acute Chest Syndrome, which the aetiology remains unknown on more than half of cases. We report 3 cases of Acute Chest Syndrome with different aetiology due to a fat embolism in the first case, a pleuro-pneumonia infection in the second case and to tuberculosis in the third case. This report illustrates the importance of the bronchoscopy and the brochoalveolar lavage in the determination of the aetiology of Acute Chest Syndrome allowing to isolate microbial agents in pulmonary infections or fatty macrophages in fat embolism.