Biomedical subjects
Publications and source records attributed to M Beji.
Respiratory manifestations are rarely observed in pyonephrosis. We report a new case revealed by lower respiratory infection with Escherichia coli empyema. Ultrasound and computed tomography rectified the diagnosis.
The authors report a case of cervico-thoracic region hydatid cyst suspected by the presence of a palpable right lower neck mass. This location is very rare. Neck ultrasound and computed tomography showed the cyst. Magnetic resonance imaging can be useful for diagnosis and provided the best anatomo-topographic evaluation before surgery.
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In the course of cirrhosis, severe chronic hypoxemia (< 60 mmHg) is exceptional, it is the most often in contact with intrapulmonary vascular anomalies and necessitates complex investigations. Authors reported a case of 16-years old patient, breach of cirrhosis with underdevelopment and that presents a severe chronic respiratory insufficiency not improved by the addition of oxygen. The different practiced explorations are in favor of an hepatopulmonary syndrome secondary probably to intrapulmonary shunting.
The choice of the antibiotic should be based on clinical, chest X-ray radiography and essentially microbiologic criteria. Incurrent practice treatment is more often empiric based on epidemiologic characteristics of the microbiologic agents and the particularities of each patient. A satisfactory approach requires, in addition, a perfect knowledge of different available antibiotics and the resistance of certain etiologic pathogens to these latters. because S. Pneumoniae is the most frequently encountered pathogen, B lactams and especially Penicillin G. and amoxicillin remain the most useful drugs prescribed for adults with risk factors. However, in advanced age patients and those with comorbidity, the spectrum should be enlarged and should include, besides S. Pneumoniae, H. influenzae and other Gram negative bacilli. When the pneumonia is more severe and has required hospitalization, the antimicrobial therapy must be immediate, multiple and large. The causal agent must be searched for desperately, so that the antimicrobial therapy can be adapted secondary to the results of the antibiogram.
Aspergilloma is the most common form of pulmonary aspergillosis, generally developing pre-existing lung cavities. Fiberoptic bronchoscopy is required in case of hemoptysis. We report the case of a 74-year-old man with pulmonary aspergilloma where fiberoptic bronchoscopy visualized mycetoma and cavitation. Visualization and biopsy of the fungus ball during fiberoptic bronchoscopy is rare.
A 72-year-old patient was admitted for exploration of an opacity of the left base discovered fortuitously on a routine chest x-ray. Initial blood tests were normal. Fiberoptic bronchoscopy was normal. Computed tomography (CT) led to the diagnosis of a left kidney which had risen into a retro-cardiac position. Magnetic resonance imaging established the sub-diaphragmatic position of the kidney. Renal excretion was normal on intravenous urography. An ectopic kidney in an intrathoracic position is very uncommon and may raise a major challenge when visualized as a mediastinal or pulmonary opacity. Computed tomography or intravenous urography can provide the diagnosis and magnetic resonance imaging demonstrates its precise sub-diaphragmatic or supra-diaphragmatic position.
The cases of vasculitis associated to malignant tumour are uncommon, their course which is often parallel suggests a direct link between them. We report the observation of periarteritis nodosa associated with a lung cancer discovered in the following of vasculitis; whereas the course is favorable in 83 years old man without particular history. The frequency of neoplasia with vasculitis is estimated between 3 and 8%, and periarteritis nodosa can't be a paraneoplastic syndrome. Lung and colic tumours are the most frequent reported of the solid tumours. The delay of appearance of vasculitis varies from 25 months before to 9 months after cancer diagnosis. There are many factors, either some treatment, the neoantigens involve the formation of immune complexes, lymphokines and some vasoactive substances.
We report a case in a patient aged 28 admitted with haemoptysis and dyspnoea. The chest x-ray showed multiple disseminated hydatid cysts throughout the lung fields. Computerized tomography and an abdominal echo found a hydatid cyst of the liver in contact with inferior vena cava which was probably responsible for the secondary pulmonary dissemination. Subsequently there was a multiplication of the lesions with rupture and infection of several cysts. After two years the disease progressed into chronic respiratory failure with the appearance of chronic cor pulmonale. The respiratory state rapidly worsened with several episodes of cardiorespiratory failure. Death occurred six months after the appearance of CPC.
Pseudotumoral manifestations in the thorax is an unusual presentation of sarcoidosis. We report three such cases including two which mimicked pulmonary metastases with a classic image of multiple lesions in two women aged 31 and 30 years. In the third case, a 51-year-old male smoker had an opacity in the upper left lobe on chest x-ray then developed endobronchial hemorrhage suggestive of a primary bronchogenic cancer. In most cases, bronchial or transbronchial biopsies are sufficient for diagnosis. Surgical biopsy may be required however to eliminate the possibility of tumoral proliferation or an other granulomatous etiology.
A 56-year-old patient with an uneventful history was hospitalized for investigation of recent dypnea. The physical examination was normal and chest X-ray showed localized interstitial lesions in the upper right lobe. Endoscopy showed evidence of diffuse infiltration of the bronchial mucosa and narrowing of the lumen. Transbronchial histology showed evidence of bronchopulmonary amyloidosis. There were no signs of extrapulmonary localizations. Search in other organs was negative demonstrating the primary nature of the lung disease. Primary bronchopulmonary amyloidosis is rarely encountered.
Aspects of tuberculosis on the standard chest X-ray in a population of 18 AIDS patients in Tunisia were examined. The diagnosis of pulmonary tuberculosis was confirmed in all cases with bacteriology tests. Diffuse lesions of the parenchyma predominated contrasting with the exceptional nature of cavernous formations. Localized infiltrations were infrequent and intrathoracic node enlagement was rare. Cases with no abnormal radiological signs were also seen in advanced HIV infection. Such atypical cases, in agreement with data in the literature, would be explained by immunoradiologic correlation. Thus it is necessary to search for the tuberculosis bacilli in all patients with HIV infection whatever the aspect on the standard chest X-ray.
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Pulmonary emphysema can be defined in precise anatomical terms. Only histological examination of an entire lung will enable the extension and the severity of the emphysema to be fully assessed. The authors propose a visual score, using computed tomography to quantify emphysema in 61 subjects. 51 had chronic airflow obstruction (BPCO) and were divided into 31 chronic bronchitics (BC) and 20 emphysematous subjects (EP). 10 volunteers who were free of any respiratory pathology were chosen as controls. A visual score for the computed tomography was established for the subjects as a whole. Double reading of the data enabled the reproducibility of the method to be checked in 10 subjects (r = 0.98, p < 0.001). No emphysema was found in the 10 controls, the computed tomography score was appreciably more elevated in the EP subjects than in the BC group at 1.3 and 0.44 respectively (p < 0.001). In the BC, the computed tomographic score was not correlated with the PaO2 (r = 0.54, p < 0.001) and the FEV1 (VEMS) (r = < 0.44, p < 0.05). On the other hand, in the PE group, the score was correlated with the FEV1 (r = 0.52, p < 0.05) and the residual volume (r = 0.06, p < 0.05) and the total lung capacity (r = 0.63, p < 0.05) and the TLCO (r = 0.56, p < 0.05) and the TLCO/VA (r = 0.59, p < 0.05). The adoption of a visual computed tomographic score enabled the authors to find the correlations between pulmonary emphysema and the most specific tests of respiratory function.
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The authors report a case of a child, aged fourteen, who had a primary malignant pulmonary haemangiopericytoma. The diagnosis could only be made following the histological study of the excised pneumonectomy specimen and after silver staining. There was a fatal outcome some six months after the operation, despite satisfactory surgery and complementary chemotherapy. The rarity of this type of tumour, notably in children, justifies the presentation of this case report.