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Introduction: Hydatid disease remains a real public health problem in many traditional pastoral farming countries. Its prevention is the most effective solution. Aim: Our study aimed to assess the knowledge of patients managed for a lung hydatid cyst concerning their pathology. Methods: Between November 2018 and July 2019, we carried out a descriptive cross-sectional study, in a thoracic surgery department, about the knowledge and information that patients with hydatid cyst had about the disease. Results: Thirty-four patients responded to our survey. The mean age was 37.18 ± 18.43 years old. Most of our patients came from rural areas. Among the 30 patients under the age of 60, 12 (40%) were housewives. Three patients (8.8%) had already been operated on for a cyst. Thirty patients (88.3%) reported having contact with dogs and sheep. If a cyst was suspected in the sheep’s offal, 20.6% (7 cases) threw them in the trash and 14.8% gave them to the dog (5 women). Among the respondents, 50% (17 cases) did not know the modes of human contamination. Knowledge of clinical signs suggestive of the disease and modes of contamination were correlated with the level of education. Fourteen patients (41.2%) raised the possibility of disease recurrence. Among the means of prevention, thorough washing of fruits and vegetables was cited in 3 cases (21.4%) and incineration of soiled offal in 1 case (7.2%). Conclusion: Assessment of patients9 knowledge about hydatid disease must be systematic in countries with high endemicity of hydatidosis, in order to identify false practices and correct them, to break the parasitic cycle. Educational messages should target the rural population and be adapted to their level of education.

Introduction: Primary tracheal tumors are rare. They represent less than 1% of primary tumors of the chest. However, they are diagnostic and therapeutic challenges. Our aim was to study the characteristics and management of primary tracheal tumors Methods: We retrospectively reviewed the clinical data from patients who were operated for primary tracheal tumors within 17 years at the thoracic surgery department of Abderrahmen Mami Hospital Ariana – Tunisia Results: There were 5 women and 4 men.The main symptom was dyspnea, accompanied with dysphonia in 1 case and dysphagia in another case. Bronchoscopy showed the lesion within the lumen in all cases. The median size of the tumor was 32.5 mm.The tumor was located in the upper third of the trachea (2 cases), the middle third (4 cases) and the lower third (3 cases). A tissue diagnosis was obtained in all patients by direct biopsy at bronchoscopy. Pathological study revealed : adenoid cystic carcinoma (4 cases), mucoepidermoid carcinoma (1 case), carcinoma with lymphoid stroma (1 case), schwannoma (1 case), glomus tumor (1 case) and cylindroma (1 case). All patients were managed by resection with reconstruction by primary anastomosis. Neck-collar incision was used in 4 cases, median sternotomy in 3 cases and posterolateral thoracotomy in 2 cases. Negative margin resection was achieved in 6 cases. The postoperative course was complicated in 3 cases. Two weeks postoperatively, bronchoscopy showed satisfactory lumen (6 cases), a lesion in the carina (1 case) and a reduced lumen (2 cases) Conclusion: Primary tracheal tumors are the least common neoplasic lesions of the airways. Non specific symptoms delay diagnosis. Resection with primary reconstruction should be preferred in initial treatment

Introduction: Cystic echinococcosis, which is commonly contracted during childhood or adolescence, is still a serious health problem in many countries. Pulmonary hydatid location is more frequent than hepatic, in children. Material and Methods: The records of 75 children managed for LHC between 2010 and 2019 in a thoracic surgery department were retrospectively reviewed. Results: There were 47 boys and 28 girls, with a mean age of 11.31 years (2–15 years). Parasitic exposure was found in 80% of the cases. The most common signs were: cough (62%), chest pain (49%), hemoptysis (42%) and fever (36%). Imaging tools showed a single LHC in 74 cases and bilateral in one case. It was right seated in 33 cases (45.3%) and left in 42 (56%). Mean size of LHC was 7 cm. Associated hydatic lesions were seen in the liver in 11 cases and in the spleen in one case. All the patients were operated. The most used approach was a video-assisted mini-thoracotomy. LHC was complicated in 34 cases and non-complicated in 41 cases. For the treatment of the residual cavity, parenchyma-saving procedures were performed most of the time: cystectomy in 64 cases (85.3%) and pericystectomy in 6 cases (8%). Anatomical resection was performed in 5 cases (6.6%): 4 complicated cysts and one simple cyst. The postoperative course was uneventful in 97% of the cases. Complications were seen in 2 patients: fever (1 case) and hemothorax (1 case). Secondary pleural hydatidosis was reported in one case during follow-up. conclusion: LHC are often asymptomatic and diagnosed at a later stage in children. Intact cysts should be operated rapidly to avoid rupture and parasitic dissemination. Parenchyma-saving procedures should be performed whenever possible, even in infected cysts.

Background: Bronchogenic cysts (BC) result from a congenital abnormality in the development of the tracheobronchial tree. BC remain asymptomatic for a long time and the occurrence of clinical signs points towards complication. The aim of our study was to assess the clinical and therapeutic characteristics of BC discovered in adulthood. Methods: We retrospectively reviewed the records of 106 patients managed between 1985 and 2018 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia. Results: There were 47 women and 59 men, with a mean age of 42 years [18-83 years]. The most common signs were chest pain (51 cases), cough (44 cases) and dyspnea (31 cases). Dysphagia was reported in 3 cases, dysphonia in 1 case and 11 patients were asymptomatic. Chest X-ray showed a homogeneous opacity (37 cases), an air-fluid level (23 cases), a suspicious opacity (14 cases) and was normal in 16 cases. Fiberoptic bronchoscopy showed: inflammation (26 cases), signs of extrinsic bronchial compression (8 cases) and an endobronchial bud (3 cases). CT-scan revealed 67 intra-parenchymal BC and 37 mediastinal BC, mainly at the subcarinal level (28 cases). All patients were operated. The most common surgical approach was thoracotomy (82 cases). Cystectomy was total in 68 cases and subtotal in 13 cases. Lobectomy was required in 23 cases and segmentectomy in 2 cases. The postoperative course was uneventful in 102 cases (96.2%). Reported complications were pulmonary infection and pneumothorax. Conclusion: Because of the risk of complications, which make surgical management more difficult, surgical resection of BC is recommended, whatever the age of discovery.

Background: Liver Hydatid cyst with intrathoracic rupture is a rare complication, which may be life-threatening. Currently there is a lack of consensus about the best way of management. The aim of our study was to assess the characteristics and outcomes of patients presenting with liver hydatid cyst ruptured into the thorax and managed through a thoracic approach. Methods: The records of 113 patients managed between 1994 and 2018, in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia, were retrospectively analyzed. Results: There were 64 women and 49 men. The mean age was 48 years [13-86 years]. Reported signs were: chest pain in 68 cases (60.1%), fever in 49 cases (43.3%), dyspnea in 41 cases (36.2%), cough in 30 cases (26.5%), or pain in the right upper quadrant of the abdomen in 5 cases (4.4%), and 21 patients (18.5%) were admitted in emergency. The cysts were assessed with abdominal ultrasonography, CT-scan or both. Surgery was performed in 106 cases. The main procedure was cystectomy through thoraco-phrenotomy and ‘Lagrot’ on the liver in 57 cases (53.7%). Lung resections were performed in 17 cases: segmentectomy (2 cases), bilobectomy (2 cases), lobectomy (12 cases) and right pneumonectomy (1 case). Twenty three patients had a decortication. Mortality rate was 2.6% and morbidity rate was 23.5%. Conclusion: Intrathoracic rupture of liver hydatid cyst may be managed through an abdominal or a thoracic approach. The thoracic approach should be preferred whenever the lung or the pleura are involved. In some cases, a combined thoracic and abdominal approach should be considered in order to prevent recurrences.

Primary adenoid cystic carcinoma (ACC) of the trachea is the second most frequent malignant tumor in this setting. Although ACC growth is slow, its management is often problematic. Our purpose was to study the peculiarities of management of primary ACC of the trachea according to their features through our series. Between 1998 and 2018, 9 patients were managed for a primary ACC of the trachea, in the thoracic and cardiovascular surgery department of Abderrahmen Mami hospital in Tunisia. The mean age of our patients was 46.1 years. There were 4 men and 5 women. Presenting symptoms were respiratory in all cases: upper dyspnea (6 cases), dry cough (6), hemoptysis (3) and dysphagia was associated in two patients. Chest X-ray showed an endotracheal opacity (2 cases), narrowing of the tracheal lumen (2 cases), and was normal in 5 cases. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a tissue mass of the tracheal wall. Fiberoptic Bronchoscopy revealed a budding formation in 7 patients. The treatment was surgical in 8 cases. Tracheal resection and anastomosis was performed in 7 patients. Pneumonectomy with extended resection to the carina and the trachea was reported in 1 case. Endoscopic treatment was performed in 1 case, given the extent of the lesions. Histological examination showed ACC with a mean size for operated tumors of 4.06 cm [1.5 to 7.8 cm]. The outcomes were favorable in 7 patients. Primary ACC of the trachea are malignant tumors which have to be kept in mind. Their treatment is mainly surgical combined with radiotherapy. The extent of the lesion and the limits of surgical resection have a strong impact on prognosis.

Iatrogenic tracheal stenosis is a severe late complication of tracheal intubation and tracheotomy. Its features have a strong impact on the therapeutic strategy. The records of 73 patients managed for iatrogenic tracheal stenosis in the department of thoracic surgery ofAbderrahmenMami hospital, between January 1995 and December 2015, were reviewed in order to study the clinical, radiological and therapeutic features of this disease. The mean age of the patients was 31years (10 to 64 years). All the patients reported a past history of intubation, associated with tracheotomy in 34%of the cases. Mean intubation time was 12days. The mean interval between extubation and the diagnosis was 106days. Fiberoptic bronchoscopywas performed in 67cases(92%). It showed a circumferentialstenosis in87.6% of the cases and a complex stenosis in12%. Chest CT scan or MRI was performed in95.5% of the cases. The mean distance between the stenosis and vocal cords was 3.17 cm[1-7.5cm]. The mean length of the stenosis was 2.2 cm. Thirteen patients(17.8%) underwent endoscopic treatment before surgery(dilatation 8cases, laser treatment 5 cases)with good immediate results in 53%of the cases. In our study, all the patients underwent tracheal resection and reconstruction. Postoperative complications were observed in 10.9%of cases. One patient died in the immediate postoperative period secondary to hemorrhage. The follow-up periods ranged from 2 to 69 months and showed a recurrence in one patient. Tracheal stenosis is a serious cause of morbidity and mortality in patients who underwent intubation, tracheotomy, or both. Its management is challenging and requires a multidisciplinary team. Its features have to be well analyzed in order to adopt the suitable therapeutic choice.

Background: Hydatid disease remains a serious health problem in Mediterranean countries. Complicated forms are frequent and require a complex management with significant morbidity and mortality rates. Thoracic rupture of hydatid liver cyst is rare and may cause lifethreatening complications. Methods: It is a retrospective study extending over a period of 24 years from 1992 to December 31, 2016 and investigating cases with hydatid cysts of the liver with thoracic rupture, treatment modalities, and factors of morbidity and mortality analyzed by a multivariate analytical study. Results: There were 47 women and 39 men, the mean age was 48 years with the age ranging from 13 to 85 years. Nineteen patients (22. 1%) were admitted in emergency. The most common symptom was the chest pain which occurred in 58 cases (67.4%); the other findings were cough [n:25 (29.06%)], dyspnea [n:37 (43.02%)] and fever [n:47 (54.65%)]. The main procedure was cystectomy and capitonnage with thoracophrenotomy and ‘Lagrot’ on the liver in 50 cases. Two patients underwent segmentectomy, two bilobectomy and 12 underwent lobectomy. Twenty three patients had a decortication. The overall mortality rate was 3.48% while the overall morbidity rate was 23.5%. Predictors of morbidity included advanced age (p=0.03), cysts larger than 7 cm (p=0.04), cysts with bilious contents (p=0.03), type II, III and IV on ultrasound classification (p=0.02)and patients operated lately(p=0.04), patients who underwent decortication or lobectomy(p=0.01). Conclusion: The hepatic hydatid cyst with rupture into thorax is a major complication of the hydatid cyst with a high morbidity and mortality.

Background: Paragangliomas are rare tumors with a slow progress representing difficulties in diagnosis and treatment. Thoracic location is exceptional. Methods: Our aim is to study this rare entity from a series of 9 thoracic paragangliomas (PG) and demonstrate the benefits of surgery. Results: Nine patients (5 men / 4 women) with a mean age of 42 year-old (range:5-17 years) were operated for thoracic PG. The majority of patients were symptomatic. The main symptoms were chest pain and hemoptysis. The predominant radiological aspect was that of a posterior hypervascularized mediastinal mass in 5 cases, a balloon release in 2 cases and a left lower lobe mass in 2 cases. Fibroscopy was normal in the majority of cases. Two patients had associated extrathoracic PGs (upper limb). Tumor markers were negative in all 9 cases. Patients were operated by Video-assissted thoracic surgery (2) or left posterolateral thoracotomy (6). Five patients had complete tumor resection. For one patient the resection was deemed impossible, he had a diagnostic biopsy by mediastinoscopy. Two patients had a lower left lobectomy associated in one case with a lingulectomy and with tumor resection in the other case. The surgical follow-up was simple for all patients. The two patients who had a complete resection had a survival of 6 and 8 months respectively. Non-metastatic patients who had R0 resection had prolonged survival. Conclusion: mediastinal PGs are suspected on the highly vascular aspect of the tumor on CTKey words: chest, mediastinal, tumor. The treatment of choice of thoracic PG is a surgical resection R0.