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PurposeGastrosplenic fistula (GSF) is a rare and potentially fatal complication of various diseases, of which lymphoma is the most common cause. We aim through our work to relate two cases of GSF and to review literature. Methods We reviewed two cases treated in our department of GSF and made a research in Pubmed using the keywords “Gastrosplenic fistula” and “Splenic lymphoma”.Results GSF is a rare condition that can occur spontaneously or after initiation of chemotherapy. It arises from the rapid growth of tumour and invasion of surrounding organs. Diagnosis may be difficult to make and confused with splenic abscess. Treatment modalities include surgical resection, chemotherapy or a combination of both. Here we report two cases of GSF due to diffuse large B cell lymphoma patients. The first case is of a 54-year-old woman with a spontaneous fistula in the stomach. The second one is of a 48 year-old- male patient presenting a fistula after chemotherapy. Both patients died after surgery. ConclusionGSF is a rare but dangerous condition in which surgery is currently the preferred treatment.

Résumé Les lymphomes pulmonaires primitifs sont des tumeurs rares représentant moins de 1% des tumeurs malignes du poumon. La forme la plus fréquente est le lymphome de type Mucosa-Associated Lymphoid Tissue (MALT). L'atteinte oculaire est aussi rare et elle est dans la plupart du temps localisée dans les glandes lacrymales. Nous rapportons l'observation d'un patient ayant présenté un lymphome pulmonaire de type MALT associé à une atteinte synchrone des glandes lacrymales. Cette observation illustre les aspects cliniques, radiologiques et évolutifs de cette entité qui sont peu spécifiques.

Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.

Resume Objectifs Relever l’ensemble des anomalies cardiaques decouvertes au cours des angioscanners thoraciques realises pour suspicion d’embolie pulmonaire (EP). Patients et methodes Etude retrospective portant sur 780 patients ayant ete explores par angioscanner pulmonaire avec determination des anomalies cardiaques notees associees ou non a une embolie pulmonaire. Resultats Des anomalies cardiaques ont ete notes dans 80 cas, associees dans uniquement 20 % des cas a une embolie pulmonaire. Les anomalies les plus frequentes etaient la dilatation des cavites cardiaques et les calcifications coronaires. Conclusion Il est important de verifier sur un angioscanner pulmonaire s’il existe ou non des anomalies cardiaques pouvant expliquer une symptomatologie thoracique en l’absence d’embolie pulmonaire.

Thymomas are the most common neoplasms of the mediastinum. It is common that thymoma invades neighboring structures in the thorax, but direct polypoid tumor growth into the airway is extremely rare. We report a rare case of invasive thymoma with polypoid endobronchial growth in a 66-year-old woman. Computed tomography demonstrated an anterior mediastinal tumor which extended into the right upper lobe. Endoscopic examination revealed a polypoid tumor which occluded the right upper bronchus. A biopsy specimen obtained from the intraluminal mass was very suggestive of thymoma. The patient had no parathymic syndrome. The tumor was resected with the right upper lobe. The final post-operative tissue findings confirmed a type B2 thymoma of the World Health Organisation classification.

Objective: Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. Methods: Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magneticresonanceimaging(MRI).Results:Inpatientswithahistoryofabdominalsurgery,theforeignbodywaslocatedintheparenchymaofthe right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textilomainthreeof thefivepatientsbydemonstratinga non-calcifiedhyperechoicmasswithacousticshadow.At CT, thegossypiboma wasa lowattenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. Conclusions:The CTaspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CTsigns helps to have a preoperative diagnosis. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Resume Introduction Les lymphomes pulmonaires primitifs (LPP) sont des tumeurs rares, dont les aspects radiologiques sont souvent peu connus. Methodes Afin d’illustrer les differentes presentations radiologiques des LPP, nous rapportons une serie retrospective de neuf cas de LPP colliges dans notre service sur une periode de quatre ans, six LPP type MALT, deux LPP-B diffus a grandes cellules et un cas de granulomatose lymphomatoide. Le diagnostic a ete confirme histologiquement, soit par une biopsie bronchique, soit par une biopsie pulmonaire chirurgicale. Resultats En TDM, le LPP type MALT se presentait sous la forme soit d’une ou plusieurs condensations (quatre patients sur six) evoluant sur un mode chronique dans deux cas, soit de nodules pulmonaires associes a des condensations ou a des masses, soit enfin d’un aspect de « verre depoli » diffus. Dans le LPP-B diffus a grandes cellules, l’aspect tomodensitometrique etait celui d’une ou plusieurs masses avec envahissement locoregional, simulant un carcinome bronchopulmonaire primitif. Dans le cas de la granulomatose lymphomatoide, la presentation TDM etait celle d’une pneumopathie infiltrante diffuse fibrosante. Conclusion Les aspects radiologiques des LPP sont tres polymorphes. C’est le LPP type MALT qui pose le plus de probleme diagnostique en raison d’une presentation radiologique faussement rassurante.

We report two observations of unusual mass in the posterior mediastinum: hemangioma, with different imaging features. In one case, it was a sharply marginated mass of the paraspinal region with limited extension into the adjacent foramina. In the second case, it was a posterior mediastinal mass with a large intra-spinal extension. On CT, the two masses did not contain calcifications according to phleboliths. In CT and MRI, they showed moderate enhancement in the first case and intensive enhancement in the second case. On T2 weighted sequences, the two masses showed a very high signal. These imaging features are relatively unspecific but indicative to think about mediastinal hemangioma as important differential diagnosis. Therefore MRI is very important to give the clues for the diagnosis, even if neurogenic tumors are the most frequent masses in this location.

Pseudotumoral mediastinal amyloidosis Purpose Amyloidosis involvement of mediastinal nodes is rare. Isolated pseudotumoral involvement without extra-thoracic disease is a diagnostic challenge and typically raises concern for underlying malignancy. We present 3 cases of pseudotumoral mediastinal amyloidosis. Methods We report the cases of 3 patients presenting with recent onset of respiratory symptoms. Bronchoscopy showed mucosal infiltration suspicious for lymphangitic spread of tumor. The patients underwent chest radiography complemented by CT of the chest and abdomen, and laboratory and immunological work-up. A diagnosis of pseudotumoral mediastinal amyloidosis was confirmed by mediastinoscopic biopsy in all cases. Results CT showed a pulmonary and mediastinal tumor process in 2 cases and pericarinal tumor in 1 case. Diffuse bronchial wall thickening was present in all cases. Review of biopsy material showed tracheobronchial amyloidosis in 1 case. Patient work-up showed no evidence of extra-thoracic amyloidosis. Rapid progression of bronchial obstruction was observed in 1 case. Conclusion The imaging features of mediastinal amyloidosis are non-specific. Pseudotumoral involvement of mediastinal nodes associated with pulmonary amyloidosis accelerates the degree of airway obstruction.

Inflammatory myofibroblastic tumors of the lung: Imaging features Inflammatory myofibroblstic tumors are ubiquitous but most frequently affect the lung. The imaging features are non-specific but the diagnosis may be suggested in the presence of solitary pulmonary nodule or mass in children or young adults. The tumor may appear locally and regionally aggressive suggesting malignancy. Diagnostic confirmation is obtained from histological evaluation of the surgical specimen. Treatment is surgical with oncologic surgical resection.

Mediastinal fibrosis or fibrosing mediastinitis is a rare condition characterized by chronic fibrosis occurring in mediastinal structures, in proliferating fibrous scar tissue. The disease may be secondary or idiopathic. The authors report the case of a 46-year-old woman, without a particular past history, who, in December 2006, presented dyspnoea on exertion and a superior vena cava syndrome. Her chest X-ray showed a right laterotracheal opacity. Fiberoptic bronchoscopy revealed concentric tracheobronchial narrowing, severe hyperemia and mucosal edema. The chest computed tomography documented the obstruction of the superior vena cava, the right main bronchus and the right upper lobe bronchus secondary to a mediastinal mass. Mediastinoscopy revealed a hard and dense mass, surrounding the different structures of the mediastinum. Pathologic examination corroborated mediastinal fibrosis. No cause was determined. Prednisone and anticoagulant were prescribed during 2 years with a regression of dyspnoea and the superior vena cava syndrome and an important regression of radiological lesions. In conclusion, prolonged corticosteroids may be efficient in the treatment of idiopathic mediastinal fibrosis.

Resume La tuberculose bronchopulmonaire pseudotumorale est une entite radiologique rare. La malignite est evoquee soit sur l’aspect radiologique devant une lesion focale parenchymateuse d’allure tumorale soit par la presence a l’endoscopie d’un bourgeon ou d’une infiltration bronchique. Cette suspicion de malignite peut parfois pousser l’escalade des explorations jusqu’a la thoracotomie. Le recours a la tomodensitometrie permet de mieux caracteriser les lesions parenchymateuses et de preciser les signes associes. A travers l’analyse de 25 cas de tuberculose pseudo-tumorale explores par tomodensitometrie, nous illustrons les differents aspects de cette maladie en precisant les difficultes diagnostiques qui peuvent etre rencontrees.

Pulmonary hyalinizing granuloma is a rare fibrosing nodular disease of the lung characterized by solitary or multiples pulmonary nodules. This report describes two cases of this rare disorder. MRI was available in one case. For the first case, the stability of the lesions and past history of retroperitoneal fibrosis suggested the diagnosis. For the second case, open lung biopsy was required for diagnosis. When multiple nodules are present, metastatic disease cannot be excluded and biopsy may be required. Evolution is usually benign but follow up is necessary.

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disorder affecting the trachea and occasionally the bronchi. We report a case of TO presenting as a respiratory insufficiency. Chest radiograph revealed an irregular narrowing of the intra thoracic trachea and a parenchymal consolidation of the left lower lobe. Magnetic resonance examination of the chest showed a diffuse irregular thickening of the trachea and central bronchi, which had an intermediate signal intensity with punctiform low signal intensity suggesting calcifications and no contrast enhancement. The diagnosis was confirmed by bronchoscopy and biopsies.

Introduction Obstructive sleep apnea (OSA) is associated with oxidative stress, risk factors including hypertension, and with binary presence of coronary artery disease (CAD). However, whether OSA contributes to the severity of CAD and to future adverse events in patients with CAD remains unknown. Aim The aim of this study was to investigate the association between severe OSA and multivessel CAD. Methods We examined the apnea hypopnea index (AHI) using polygraphy (PG) in 60 consecutive patients with ACS who underwent coronary angiography. OSA was defined by AHI≥5 events per hour and was considered severe if the AHI≥30 events per hour. The Friesinger score was calculated for each patient from the coronary angiography to evaluate the severity of CAD. Results The average age of patients was 59.73 years±10.1 years. The sex ratio was 1, 5. 61, 7% of patients had an AHI≥5 and 21,7% had severe OSA with AHI≥30. The Friesinger score was significantly greater in the group with multivessel CAD (11, 28±4, 17 versus 5, 35±3, 96, p=0,0001). There were no differences between patients having multivessel CAD and those with single-vessel CAD regarding clinical characteristics. Table summarizes these results. Abstract 0218 – Table: Comparison of patients with multivessel CAD and with single vessel CAD. Multivessel CAD (n=33) Single vessel CAD (n=27) P Age 59,3±9,1 60,26±11,47 0,72 Male 35% 25% 0,51 Bmi 27,75±3,43 28,27±4,61 0,62 Smoking 31,7% 20% 0,31 Hypertension 33,3% 28,3% 0,85 Diabetes 35% 23,3% 0,35 Severe OSA 11,7% 10% 0,83 Conclusion In summary, these data suggest a high occurrence of obstructive sleep apnoea in patients with CAD, which should be taken into account when considering risk factors for CAD. However, severe OSA is not more frequent in the group of multivessel CAD. Further studies are needed to evaluate the impact of the presence of severe OSA on short and long term prognosis.