[An unusual diagnosis of post-traumatic hemothorax].
We report the case of malignant pleural mesothelioma revealed by a post-traumatic hemothorax.
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Publications and source records attributed to M Smahi.
We report the case of malignant pleural mesothelioma revealed by a post-traumatic hemothorax.
Mature teratoma is the most frequent primary germ-cell occurring in the anterior mediastinum. We report a case of a 67-year-old man with mature teratoma of the posterior mediastinum. Computed tomography was helpful in suggesting a diagnosis of mature teratoma by demonstrating the presence of fat and calcification.
AIM OF THE STUDY: Describe as series of post-pneumonectomy empyema episodes, with or without bronchial fistula treated at the department of Thoracic Surgery, University of Ibn Sina, Rabat, Morocco. PATIENTS, METHOD AND RESULTS: Twenty-four patients with post-pneumonectomy pyothorax cared for between 1991 and 2000 were reviewed retrospectively. There were 15 men and 9 women, mean age 34 years. Pneumonectomy was indicated for tuberculous pyothorax and destroyed lung (n = 8), 8 destroyed lung (n = 8), pulmonary aspergilloma (n = 2), pulmonary hydatidosis (n = 2), bronchial dilatation (n = 2), lung cancer (n = 1), and bullet wound (n = 1). The patients were divided into two groups according to presence or absence of bronchial fistula: group 1, 19 patients with without bronchial fistula, and group 2 5 with bronchial fistula. Fourteen patients in group 1 (73.7%) achieved definitive cure, 12 after drainage and washout (63%) at mean delay of 45 days and 2 after drainage and washout with thoracoplasty. Five patients did not respond to hospital drainage and washout and remained under definitive ambulatory drainage as they declined further surgical treatment. One death occurred in this group. Two patients in group 2 (40%) achieved definitive cure, one after daily aspiration, and the other after thoracoplasty. Two fistulae in one patient were treated with nitratage. For this patient, we also attempted revision of the bronchial stube via posterior throacotomy, the closure of the bronchial fistula using an intercostal muscle flap associated with thoracoplasty. All these methods failed. There were two deaths in this group. CONCLUSION: Sixteen patients were definitively cured (66.6%). Eight patients (33.3%) remain in a chronic condition. Patients with pyothorax on a pneumonectomy cavity should be managed in specialized centers before reaching the chronic stage. Thoracomyoplasty with preparation of the cavity by thoracostomy should be proposed.
We describe a mediastinal myxoid liposarcoma in a 47-year-old man who developed recurrent lung infection, treated by surgery associated with radiotherapy. The report of this case and a review of literature bring the authors to outline the epidemiological, clinical and therapeutic profile of this rare tumor.
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STUDY AIM: The aim of this retrospective study was to report a series of 12 cases of mature teratoma of the mediastinum operated during a 10-year period in the same center. PATIENTS AND METHOD: From 1990 to 2000, 12 patients (7 females and 5 males with a mean age of 32 years) were operated for mature mediastinal teratoma. Chest pain was present in 10 cases; cough, dyspnea and septic episodes were present in 5 cases and X-ray detected the mediastinal tumor in 10 cases. CT scan showed a tumor with liquid and fatty components and calcifications in 5 out of 9 cases. Tumors were resected via a posterolateral thoracotomy in 11 cases and an anterior thoracotomy in one case, associated with pneumonectomy in 1 case, basal segmentectomy in 1 case and thymectomy in 1 case. RESULTS: There were no postoperative deaths. Morbidity included 2 phrenic nerve palsies, 1 pyothorax after pneumonectomy, 1 case of bleeding and 1 pleural effusion. No recurrences have been observed with a follow-up of 5 to 87 months. Nine of the 10 tumors reviewed by pathologist contained multiple tissue components and one only contained a single tissue. CONCLUSION: Mature teratomas are usually detected in young patients: they are usually located in the middle part of the anterior mediastinum and are only diagnosed by pathologic examination of the specimen. They have an excellent prognosis when tumor resection is complete and in the absence of immature tissue in the tumor.
Nephrobronchial fistulas following pyonephrosis associated with urolithiasis are a rare occurrence. The possibility of severe problems arising during surgery should be taken into considerations; both the surgeon and the anesthetist should be fully informed of the specific risk factors involved. A favorable outcome mainly depends on the appropriate treatment and timely management of any thoracic complications. Although this rare pathology has been described in detail in the literature, the problems encountered during anesthesia and surgery have not been fully reported. This study therefore provides new data, as a case has been reported of a 38-year old female who underwent surgery for pyonephrosis; disease management and prognosis problems have been discussed.
Descending necrotizing mediastinitis which may occur as a complication of neglected oropharynx infection is an uncommon disease, although it is lethal in most cases. Trismus and dyspnea are usual with palpable crepitation located in the cervico-thoracic area. Early diagnosis can be confirmed with accuracy by CT scan. Treatment is based on early mediastinal drainage by cervical approach, intravenous antibiotics and reanimation. The reported case had a favorable outcome.