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Objective: To report our experience in the management of intra-thoracic extra-pulmonary hydatid cyst, and to discuss the etio-pathogeny of this affection., Patients and Methods: Among 80 patients who underwent surgery in our department for intra-thoracic hydatid cysts between September 2001 and September 2005, six patients (7.5%) had an extra-pulmonary localization. There were 4 men and 2 women with a mean age of 43 years. The lesions were pleural, diaphragmatic or mediastinal. Thoracotomy was performed in all patients., Results: One patient had multiple localizations (diaphragm, anterior mediastinum and pleura). The cyst was simple in 5 cases and complicated (rupture) in one case. The diagnosis of hydatid cyst was suspected on the basis of the radiological data and confirmed intra-operatively. No complications or recurrences were observed during the follow-up period., Conclusion: Intra-thoracic extra-pulmonary hydatid cyst is uncommon even in endemic countries such as Morocco. Surgery is the best treatment and must be proposed early in order to prevent complications. Medical treatment is reserved for complicated forms.

Objectives: To analyse the radioclinical forms of pulmonary hydatid cyst in children, and to evaluate the results of surgical treatment., Patients and Methods: During a period of 4 years (2002-2005), 26 surgical procedures were performed for pulmonary hydatid cyst in 23 children (16 boys and 7 girls, mean age 13, 5 years). Symptoms were chest pain (87%), broncho-pulmonary infection (32%) and hemoptysis (22%). Chest x-ray showed a non-complicated cyst in 62% of cases. The CT scan was performed in 15 cases (65%), mainly for complicated forms. Abdominal echography for all patients showed 3 hepatic localisations of hydatid cyst. All the patients underwent surgical treatment by thoracotomy., Results: In a total of 34 cysts, 21 were uncomplicated, 13 complicated (intra-bronchial rupture: 11 cases, pleural rupture: 2 cases). Cystectomy or pericystectomy were performed in 91% of cases, segmentectomy in 6% and a lobectomy in 3%. Decortication was done in the 2 pleural-ruptured cases. There was no mortality. One lower left lobe atelectasis was observed post-operatively., Conclusion: Conservative surgical techniques for pulmonary hydatid cysts in children are preferred to parenchyma resection. In our practice the treatment of bilateral hydatidosis in 2 times decreases the complication rate.

Pulmonary sequestration is a rare congenital malformation characterized by a non-functional portion of pulmonary parenchyma devoid of any connection with the bronchial tree and pulmonary artery. If not identified antenatally or at birth, the sequestration may not be discovered until complications, mainly repeated infections, arise. Hemorrhage is another but much rarer complication which is generally severe. We report a new case of intralobular pulmonary sequestration revealed by hemoptysis then massive hemothroax with shock requiring emergency thoracotomy for hemostasis.

The appearance of left strangulated diaphragmatic hernia doesn't seem to have been described in the past as a progressive complication after gastric bypass surgery. The authors describe the case of a 54 year old patient suffering from a strangulated gastric hernia pushing through a diaphragm defect located next to the gastric band. The gastric band had been placed two years previously in this patient suffering from morbid obesity. Strangulation of the hernia resulted in the sphacelation of the entire stomach fundus. Therefore a partial gastrectomy and removal of the band was necessary. Recovery from procedure was without complications. The past history of a major spinal trauma in this patient, could have led to a discussion regarding the etiology of this hernia, however the delay between the two events (28 years) makes this unlikely. It seems, therefore, that the placement of a gastric band was the responsible factor. The authors emphasize the importance of pre-procedure pulmonary X-ray, prior to any general anesthesia, as well as a post procedure cliché following any intervention that might have lead to diaphragmatic lesion.

Objectives: Intrathoracic gossypiboma are exceptional, but diagnosis and treatment are difficult. The purpose of this study was to recall the clinical and radiological aspects of intrathoracic gosssyibomas and discuss the medicolegal consequences., Material and Methods: From January 1990 to June 2003, eight cases of gossypiboma were treated in our unit. The patients were aged 31 to 60 years (mean 40.5). Six had a history of thoracic surgery and two a history of biliary surgery. Clinically, the main symptom was hemoptysia (7 patients, 87.5%). Four patients (50%) presented thoracic pain and one a pleurocutaneous fistula. The chest x-ray revealed a poorly delimited opacity in six patients, a liquid effusion in one and a raised left diaphragm in one. The thoracic scan performed in two patients demonstrated an air image in one and a liquid image in the other., Results: Surgical removal was difficult in all eight patients. Pulmonary parenchyma had to be sacrificed in certain patients. Two patients developed postoperative complications (one pneumothora and one thoracic wall infection)., Conclusion: The diagnosis of intrathoracic gossypiboma should be suggested in all patients with a pulmonary mass and a history of thoracic surgery, more rarely laparotomy. Prevention remains the best treatment.