[Pulmonary actinomycosis requiring differentiation from pulmonary tuberculosis, lung cancer and lung abscess].
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In order to assess the value of transbronchial biopsy (BTB) in the diagnosis of local pulmonary opacities, we have carried out a prospective study from October 1981 to August 1982 on 180 patients with a localised pulmonary opacity radiographically. 73 presented with a tumour visible fibreoptically in whom the diagnosis was made by bronchial biopsy. In 56 patients the clinical and biological picture were not suggestive of a malignancy and the lesion disappeared in 15 days on antibiotic treatment. Finally in 51 subjects the cancerous nature of the opacity was strongly suspected and the indication for a BTB were met. We obtained the following results: among 51 patients 11 were suffering from the sequelae of non-progressive disease and 40 of progressive disease; namely a sensibility of 80% and a specificity of 100%. The results vary as a function of the size of the tumour and its localisation. The best results were obtained for tumours with a diameter of greater than 3 cm, in the middle third of the lung (diagnosed by BTB 9 times out of 10). Thus transbronchial biopsy seems to be the first invasive examination to contemplate in the diagnosis of localised pulmonary opacities.
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A case of pseudotumorous pulmonary torulosis (or toruloma) clinically suggestive of protracted pneumopathy is reported. The main pathological, clinical and histological forms of this mycotic infection are recalled. The pathologist plays an essential part in the diagnosis of toruloma since the fungus can be demonstrated in bronchial biopsy specimens, bronchial aspirates and sputum.
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