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A pericardial cyst is a rare and benign lesion, most commonly of congenital origin. A female patient of 35 years old was admitted to the emergency department of our institution, for non-irradiating thoracic pain associated with a dyspnea. A CT-Scan was performed, and a pericardial cyst of a large size was found. A surgical procedure through thoracoscopy was performed to enhance the symptomatology of the patient and to eradicate the cyst. The diagnosis of these lesions is most commonly sporadic after a radiography performed for other causes. Most of the time these lesions are asymptomatic (although thoracic pains, chronic cough and dyspnea amongst others may be observed). In case of suspicion (related to radiography or an eventual symptomatology) a thoracic scan is performed with a contrasting product for the confirmation and localization of the cyst. In addition to the diagnosis and the localization, it is best to perform a transthoracic ultrasound which enables a differential diagnosis with other lesions (lipoma, aortic aneurysm, solid tumour, and a left ventricle aneurysm etc.). A surgical treatment is recommended in symptomatic cases. In non-symptomatic cases, a transthoracic ultrasound is recommended.

Introduction: Due to the absence of consensual definition and agreed-upon pediatric treatment, pneumothorax (PNO) in children and adolescents often remains difficult to properly apprehend., State of the Art: While initial diagnostic suspicion is clinical, confirmation necessitates chest imaging, and lung ultrasound has become increasingly prevalent, often at the expense of chest radiography. The goal of treatment is twofold, on the one hand to a fully re-expand the lungs, and on the other hand to forestall PNO recurrence. Depending on PNO severity and clinical tolerance, it may be advisable to envision conservative management, oxygen supplementation, needle exsufflation, or chest tube drainage., Perspectives: In order to harmonize clinical practices, guidelines for the precise definition and graduated management of PNO in children and adolescents are highly advisable., Conclusions: Idiopathic spontaneous PNO frequently occurs in teenage populations, and its likewise frequent recurrence is not satisfactorily predicted by chest CT findings. It is of paramount importance that patients be fully informed of the risk of recurrence., (Copyright © 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Probe based confocal laser endomicroscopy (pCLE) is a new endoscopic imaging technology. It uses mini probes which can be introduced through the working channels of endoscopes. Whenever applied on the tissue of interest, they allow imaging of tissue at a cellular level., State of Art: In the filed of pleuropulmonary malignancies, pCLE showed mostly its ability to guide biopsies samplings. Those results need to be validated in larger prospective studies. In interstitial lung diseases, pCLE provides information complementary to other clinical and paraclinical data. The valuability of these informations need to be investigated further, prospectively in randomized trials. In obstructive pulmonary diseases, pCLE is able to investigate the structural and functional relationships between pulmonary structures. pCLE showed good ability in the identification of acute cellular rejection after lung transplantation., Perspectives and Conclusion: For the time being, pCLE is not part of routine clinical practice. The data available need to be validated in larger randomized prospective trials, before it can be recommended as a guiding tool for biopsies or as a diagnostic tool for pathologic process. New fluorophores are now available. They are specific of some molecular sequences, allowing the enhancement of specific targets within the sample studied., (Copyright © 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

An interventional pulmonologist possesses expertise in minimally invasive diagnostic and therapeutic procedures involving the airways, lungs and pleura. A malignant pleural effusion (MPE), which occurs in 20% of cancer patients, can be a daunting diagnostic challenge insofar as the pleural cavity is a closed cavity. In these patients, treatment may consequently be delayed before a precise diagnosis can be given. In the meantime, an interventional pulmonologist is called upon to carry out a wide range of examinations in order to establish the etiological diagnosis and to treat the symptoms of an MPE patient. Classical medical thoracoscopy, also called "pleuroscopy", is the reference method in MPE diagnosis because it allows visualization of the pleural cavity, pleural biopsy under direct visual control, providing excellent diagnostic yield. Over the past decade, new diagnostic methods have emerged, such as ultrasound-guided biopsy, as well as different interventions, such as indwelling pleural catheters, aimed at improving the quality of life of MPE patients, for whom therapeutic options are limited. The objective of this review of the literature is to point out the role of the interventional pulmonologist in the management of MPE by detailing the various diagnostic and therapeutic methods he possesses at the present time., (Copyright © 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Malignant pleural mesothelioma (MPM) is a rare and aggressive tumor, secondary to occupational asbestos exposure. Clinical and radiological signs are unspecific. The diagnosis of MPM is based on histology and on biopsies best obtained by thoracoscopy. Prophylactic irradiation of chest scars and drains is validated by French guidelines. Surgery, extrapleural pneumonectomy or pleurectomy/decortication is not recommended outside a clinical trial. Firstline chemotherapy with pemetrexed remains the standard treatment. Bevacizumab was tested in an randomized phase 3 trial, MAPS, until December 2013. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Évaluer la pratique actuelle de l’analgésie après thoracotomie et thoracoscopie en France. Type d’étude: Enquête transversale de pratiques professionnelles. Matériel: Médecins anesthésistes-réanimateurs référents pour les structures pratiquant la chirurgie thoracique au cours de l’année 2012. Méthode: Questionnaire électronique concernant l’activité du centre en chirurgie thoracique et les modalités et fréquences estimées de différentes techniques d’analgésie. L’évaluation principale était en pourcentage estimé d’actes, après imputation sur les données originelles. Résultats: Quatre-vingt-quatre centres sur 103 (82 %) ont répondu à l’enquête. Le couplage d’une anesthésie locorégionale à une anesthésie générale représentait 74 % des thoracotomies et 35 % des thoracoscopies. Une pratique était déclarée par 68 centres (81 %) pour l’analgésie péridurale, et par 27 centres (32 %) pour le bloc paravertébral. Les caractéristiques les plus fréquentes pour la pratique du bloc paravertébral étaient : ponction thoracique, début peropératoire, ropivacaïne 0,2 % plus sufentanil, administration autocontrôlée avec infusion plus bolus, durée supérieure à 48heures après chirurgie. Les voies d’abord du bloc paravertébral étaient, en taux de pratique : postérieure par perte de résistance 34 %, postérieure échoguidée 24 %, chirurgicale 42 %. L’analgésie systémique la plus fréquente était la morphine intraveineuse autocontrôlée. La kétamine était utilisée pour 60 % des actes. Conclusions: La pratique française de l’analgésie après chirurgie thoracique a suivi au cours de la dernière décennie l’évolution dictée par les données de la science, mais plus du quart des thoracotomies ne bénéficieraient pas des techniques recommandées d’analgésie péridurale/paravertébrale, contre 8 % seulement au Royaume-Uni en 2005. [ABSTRACT FROM AUTHOR]

Summary: Liver and splenic abscesses are rare extra-intestinal complication of Crohn''s disease (CD). Clinical manifestations of these abscesses are not specific and mimic the reactivation of CD and diagnosis can be delayed. The authors report two cases patients who developed a liver or splenic abscess as a complication of CD. The first case is a 15-year-old boy presented with an aseptic liver abscess at first manifestation of CD, treated by corticosteroids and ultrasound guided percutaneous aspiration of the abscess. The second case is a 17-old-year girl with pyogenic splenic abscess as a consequence of CD which was complicated by thoracic empyema. Antibiotic therapy and thoracoscopy drainage resulted in complete recovery. Pyogenic abscesses usually result from bacteraemia, whereas aseptic abscesses are an extra-intestinal manifestation secondary to an inflammatory process. [Copyright &y& Elsevier]

Congenital diaphragmatic hernia is no longer considered a surgical emergency. It is now current practice to delay the correction of the diaphragmatic defect until haemodynamic stabilization is obtained. Minimal invasive procedures, thoracoscopy and laparoscopy, are interesting new strategies. Patching is required to close large defects. Because of the high risk of gastroesophageal reflux, it may be advisable to perform an antireflux procedure at the same time. Long term follow-up is justified by the high incidence of complications and sequelae in more severely affected patients. [ABSTRACT FROM AUTHOR]

Malignant pleural mesothelioma (MPM) is a rare tumour, secondary to professional asbestosis exposure. MPM incidence is rising since the late sixties and this increase will continue till 2020–2030, with curently 800 to 1000 new cases in France. Molecular carcinogenesis of MPM is still poorly understood but gene alterations of NF2, c-met, WT1 RASSF1, and p16, have been described. These genes are involved in cell invasion and motility, cell division and apoptosis control. The histological diagnosis remains critical since the morphology of this neoplasm is extremely variable, but immunohistochemical analyses have been precisely described by the French Mesopath Group. The clinical diagnosis relies on thoracos-copy and large pleural biopsy. The therapeutic strategy always includes the irradiation of drainage channels or pleural punctures with 3 × 7 Grays within the four weeks following these procedures. Rarely, in carefully selected patients, extensive extra-pleural pneumonectomy can be performed. The recommended first-line chemotherapy is based on a doublet of pemetrexed and cisplatin that has demonstrated in a phase III setting, an overall increase in survival and improvement of quality of life when compared to a cisplatin-based monotherapy. Antiangiogenic agents such as bevacizumab could be of interest but they have to be tested in randomized phase III trials. [ABSTRACT FROM AUTHOR]

Abstract: This article is a state-of-the-art about the main diagnostic and therapeutic indications of paediatric surgical thoracoscopy. The authors stress the features of this surgery in children, in terms of anatomy, anaesthesia and postoperative analgesia. For experienced teams, almost any pleural, mediastinal or pulmonary lesion can be approached thoracoscopically [Copyright &y& Elsevier]

Abstract: Community-acquired pleural infection is a life-threatening complication of pneumonia in children. It seems to be more prevalent actually. This pathology is associated with an high morbidity and frequently requires prolonged hospitalization and invasives procedures. However, there is no consensus on its management in pediatrics, especially because of the lack of trials. To improve the quality of the future studies and to compare the series, a child-adapted classification is required. To date, in attempt of evidence, chest drainage or thoracocentesis-thoracoscopy are questionable. For treatment, high regimens of synergic and intravenously-delivered antibiotics seem to be the better choice. [Copyright &y& Elsevier]

Abstract: The prevalence of pleural effusion due to Streptococcus pneumoniae has increased in the 15 past years. Introduction of the conjugated hexavalent vaccine has diminished the incidence of this infection. Morbidity is significant but in spite of the absence of consensus guidelines on the management, the middle- and long-term prognosis is good. Concerning the management of this condition, pleural echography and aspiration of the pleural fluid (thoracocentisis), with biochemical, cytological and microbiological analyses of the fluid, are necessary. Light''s criteria for thoracocentisis are not always suitable for children. The technique of and indications for drainage are discussed here. In cases with poorly tolerated effusion, a thoracic CT scan can guide drain placement; it can also detect complications. Intrapleural fibrinolytic agents have been shown to have a certain degree of efficacy in para-pneumonic effusion and empyema; however, only urokinase has been studied in randomized clinical trials. Surgical intervention, either video-thoracoscopy or mini-thoracotomy, are indicated when medical therapy is ineffective. Of course, local organization and practices play an important role in the indications for drainage and the technique to be used. Guidelines need to be developed for the management of this condition in children. [Copyright &y& Elsevier]

Copyright of EMC-Endocrinologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Pneumologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Chirurgie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Chirurgie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pulmonary hyalinising granulomas (PHG) are rare. They are defined by the presence of collagen lamellar fibrosis. One third are associated with retroperitoneal or mediastinal fibrosis. Two cases of PHG are presented. They were revealed by dysphagia due to tight oesophageal stricture from associated mediastinal fibrosis. PHG are considered as a benign and slowly evolving disease, but associated mediastinal fibrosis may evolve on its own. Only steroid therapy may slow down progression. This makes an accurate diagnosis necessary. It relies on large surgical biopsies. [Copyright &y& Elsevier]

The authors evaluate the quality of thoraco-mammary reconstructions in Poland’s syndrome. There was 34 patients in our serie, and 27 were operating between 1982 and 2001. There was 19 women and 8 men ; the mean age was 19 years (9–40 years). Because of the clinical variability, the authors propose a classification of the malformation’s importance in 3 degrees. In our serie, there is 35% of degree I, 53% of degree II and 12% of degree III. Each patient had an average of 2 general anaesthesias (1–6). For the first operation time, men had translation of the homolateral latissimus dorsi muscle flap in 25%, and a thoracic prosthese in 75%. Women had mammary prosthese in 50%, expansion prosthese in 20%, mammary prosthese and thoracic prosthese in 20%, muscle flap in 10%. The same person analysed the results in terms: good, middle or bad. The results are good in 67%, middle in 22%, poor in 11%. In degree 1, the results are always good ; in degree II, they are good in 59%, middle in 29% and poor in 12%; in degree III, the results are good, middle and poor in 33%. [Copyright &y& Elsevier]

The perception of ventilatory effort is common in oncology, especially but not exclusively in the advanced stages of neoplastic disease. Dyspnea is a symptom whose discomfort and anguish it generates in the patient and his/ her entourage require constant management throughout the illness. The first step is to identify and optimize the treatment of comorbidities associated with tumour disease. Relief of respiratory oppression as a symptom requires a multidisciplinary approach. Opiates and benzodiazepines are at the forefront of pharmacological management. The mechanical obstruction that limits ventilatory flow and/or chest ampliation may justify more invasive management, including endoscopic techniques. Oxygen therapy will be considered on a case-by-case basis. Finally, global management includes respiratory revalidation, psychological support and improvement of environmental quality.

Summary: Penetrating thoracic trauma by a needle or pin is rarely described in children. Localization of the needle may sometimes be difficult. The needle can migrate from the entrance site into many organs with time and cause little initial morbidity. We describe the case of a 14-year-old male patient with a sewing needle accidentally inserted through the chest wall. The foreign body had migrated spontaneously to the pericardium. A computed tomography scan of the chest is needed to determine the location of the needle and show any complications. Pericardium foreign bodies are dangerous and need electrocardiography and cardiac ultrasound before treatment. Removal of the needle by thoracotomy or thoracoscopy is indicated. [Copyright &y& Elsevier]

Abstract: We report a case of seromuscularis rupture of the oesophagus occurring after an episode of vomiting and revealed by a left hemothorax. Diagnosis was established at thoracoscopy and was related to the nosologic setting of post-emetic syndromes. All unusual pleuropulmonary symptoms after vomiting must make evoke this diagnostic hypothesis. [Copyright &y& Elsevier]

Introduction: Because of its rarity and lack of specific symptoms, the diagnosis of Marfan's syndrome can be delayed. Though cardiovascular, skeletal and ophthalmological manifestations are the most frequent features, the respiratory system can also be involved., Observation: We report the case of a 35-year-old patient who presented with a large, right sided, encysted pyopneumothorax. The history revealed two episodes of spontaneous pneumothorax, cataract surgery ten years before his admission, and a similar case in the family. Clinical examination showed skeletal abnormalities of the wrist and thumb as well as deformity of the hindfoot with a flat foot. He had no characteristic thoracic deformity. Ophthalmologically, the right eye had a subluxed lens and the left eye had a totally subluxed cataract., Conclusion: The development of the third episode of pneumothorax led to the diagnosis of Marfan's syndrome thanks to the patient's combination of symptoms. To avoid diagnostic delay, criteria were established in 1996 and revised in 2010 to ensure an early diagnosis of this condition., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Lung cancer treatment is a heavy workload for radiation oncologist and that field showed many evolutions over the last two decades. The issue about target volume was raised when treatment delivery became more precise with the development of three-dimensional conformal radiotherapy. Initially based upon surgical series, numerous retrospective and prospective studies aimed to evaluate the risk of elective nodal failure of involved-field radiotherapy compared to standard large field elective nodal irradiation. In every setting, locally advanced non-small cell lung cancer, localized non-small cell lung cancer, localized small cell lung cancer, exclusive chemoradiation or postoperative radiotherapy, most of the studies showed no significant difference between involved-field radiotherapy or elective nodal irradiation with elective nodal failure rate under 5% at 2 years, provided staging had been done with modern imaging and diagnostic techniques (positron emission tomography scan, endoscopy, etc.). Moreover, if reducing irradiated volumes are safe regarding recurrences, involved-field radiotherapy allowed dose escalation while reducing acute and late oesophageal, cardiac and pulmonary toxicities. Consequently, major clinical trials involving radiotherapy initiated in the last two decades and international clinical guidelines recommended omission of elective nodal irradiation in favour of in-field radiotherapy., (Copyright © 2019. Published by Elsevier Masson SAS.)

Introduction: The incidence of pleural disease continues to increase worldwide. Medical thoracoscopy remains the standard method for exploration of the pleural cavity., Method: We report the retrospective evaluation, the efficacy and the observed complications in 1024 medical thoracoscopies undertaken in the University Hospital of Liège between 2000 and 2017., Results: In total, 100 pneumothoraces and 400 benign and 501 malignant pleural diseases were identified. The main indication for thoracoscopy remains the diagnosis of an exudative, lymphocytic pleural effusion of unknown aetiology after thoracocentesis. The diagnostic sensibility of thoracoscopy was 99.2% in distinguishing benign from malignant pleural disease. Talc pleurodesis was performed in 69.5% of the total population and in 66.1% of pleural effusions or thickening. Failure of pleurodesis was observed in 11% of the patients with recurrent pneumothorax and in 7.8% of neoplastic pleural effusion. We report a mortality of 0.6% in the 30 days post procedure, long duration of drainage in 8.3% and serious complications in 4.7%. In 22/1024 (2.1%) thoracoscopic evaluation was not feasible because of dense pleural fibrosis., Conclusion: Medical thoracoscopy is a safe, well-tolerated procedure with high accuracy in the diagnostic and therapeutic management of pleural disease., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Until now, the traditional procedure to treat intralobar pulmonary sequestration (ILS) in adults has been a lobectomy performed by open thoracotomy. We have reviewed our data to observe if the surgical management of these lesions has evolved over the last years., Methods: We retrospectively reviewed the records of the patients who were operated for an ILS either by posterolateral thoracotomy (PLT group), or by thoracoscopy (TS group) between 2000 and 2016., Results: Eighteen patients were operated for a SIL during this period. Prior to 2011, all resections were performed by thoracotomy (n=6) and after 2011 the surgical approach was either a thoracotomy (n=5) or a thoracoscopy (n=7). There was one conversion because of dense pleural adhesions and this patient was integrated in the PLT group for further analysis. ILS were more frequently encountered on the left side (n=12, 66.6 %) than on the right one (n=6, 33.3 %) and exclusively in the lower lobes. All patients of the PLT group underwent a lobectomy. In the TS group, 5 patients underwent a sublobar resection (2 segmentectomiesS 9+10 , 1 basilar segmentectomy and 2 atypical resections). There was no mortality. In the PLT group, 5 patients (45 %) had complications versus one patient (14 %) in the TS group. The mean hospital stay was 7.4 days in the PLT group versus 5.4 days in the TS group., Conclusions: These data confirm that ILS can be safely treated by a sublobar resection that should be performed, whenever possible, thoracoscopically., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent., State of Knowledge: Knowledge about MPM has evolved. Thoracoscopy is essential for diagnosis of MPM. It allows performing pleural biopsies, to study the extent of the disease and to relieve dyspnea. The pathological diagnosis is also better codified with immunohistochemistry and with analysis by expert of Mesopath group. Curative surgical treatments are pleurectomy decortication and extended pneumonectomy in combination with chemotherapy and/or radiotherapy. Those heavy treatments improve survival in highly selected patients. For the other patients, supportive measures will be considered to reduce pain and dyspnea., Prospect: Radical surgical treatment is only offered in therapeutic trials or multimodal treatment. Its place is not formally established. New therapies associated to surgical treatment are being studied., Conclusions: Surgical management of MPM has to be operated in specialized teams where the survival benefit and quality of life is discussed case by case., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)