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Mediastinal paraganglioma presented as a large dumbbell tumor is a rare entity. We report a case of a 47 year old woman who suffered from spinal pain and sporadic lower limb paresis. The imaging studies showed a voluminous mass occupying the posterior mediastinum with right foraminal extension. For excellent results, a combined effort was necessary including thoracic and neurosurgeons teams. Complete resection was successfully performed without laminectomy. The operative course was uneventful.

Lung carcinoid tumours are rare neoplasms with a favourable prognosis. Bronchoplasty can be a conservative treatment for typical carcinoid tumours and can be applied for patients with limited respiratory function. We report the case of a 34‐year‐old woman, with a polypoid tumour located at the distal right main bronchus. Bronchial biopsy showed a typical carcinoid tumour. After resection of the tumour in the right main bronchus, bronchoplasty was performed by end‐to‐end anastomosis of the remaining right main bronchus, right upper lobar bronchus, and the upper bronchus intermedius. Bronchoscopy showed a good quality anastomosis with slightly reduced endoluminal calibre only. The post‐operative period was uneventful and the patient was discharged at the seventh day. One year later, no complications occurred and the patient is still being followed up regularly., In this article, we try to demonstrate the possibility of creating a "neo‐spur" without lobectomy to treat an intra‐bronchial typical carcinoid tumor.

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

Background: Hydatid cyst is an endemic disease that is common in the Mediterranean countries .Extra pulmonary intrathoracic localization of the cysts such as thoracic wall involving ribs, muscles, and vertebrae is very rare Methods: We retrospectively reviewed the records of 26 patients managed between 2000 and 2020 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana – Tunisia. Results: There were 9 woman and 17 men, with a mean age of 41 years (18-76).The most common signs were chest pain (12 cases), neurological deficit (5 cases) ,cough and dyspnea (3 cases). Parietal swelling was reported in 10 cases and 1 patient was asymptomatic. Chest X-ray showed an homogeneous opacity (6 cases), bone destruction (4 cases) and was normal in 5 cases. The cysts mostly were located at ribs (16 cases) and ribs with vertebrae (13 cases). Other parts of chest wall were involved like muscles and sub-cutaneous tissue in 1 case in the sternum in 2 cases. CT scan and MRI often revealed the diagnosis .The cyst was mimicking tumor in 1 case.15 patients underwent costal resection; 7 underwent a costovertebral resection. Other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (2 cases).the postoperative course was uneventful in 22 cases .reported complications were paraplegia in 1 case , ARDS and death in 1 case and severe sepsis in 2 cases. Albendazole was given for most cases. Conclusion: Current imaging investigations make diagnosis of chest wall hydatidosis easier. Radical surgery combined with antihelminthic therapy is the best treatment. Prevention is necessary.

Method: Hydatid disease is a worldwide health problem. Children are frequently infested by the cyst in endemic countries. Surgery is the treatment of choice. Method: This is a retrospective analytic and descriptive study of the morbi-mortality of pulmonary hydatid cyst for 75 children operated in our department between january 2010 and september 2019 . Method: During the study period, 700 adults and 75 children were operated for hydatid cyst. There were 28 girls and 47 boys. The average age was 11 years. The cyst was localised in the right lung in 27 cases , in the left lung in 47 cases, and in both sides in one case. 42 children had a complicated cyst and 33 had a non complicated one. 67 children had cystectomy and capitonnage. Only 7 children had a lobectomy, and just one had a segmentectomy. Videoassisted thoracic surgery was performed in 24 cases. There were 3 cases of post operative complications consisting on pneumothorax, fever and hematoma. There were 41 cases of post operative complications for the 700 adults operated in the same period. There is no significant difference of morbi mortality between children and adult (p=0.3). We didn’t found a correlation between the morbidity and the nature of the cyst complicated versus none complicated (p=0.6). We also studied the morbidity depending on the surgical treatment (lobectomy and segmentectomy vs cystectomy ) but there is no significant difference( p=0.2). Method: Surgery remains the only effective treatment in pulmonary hydatid cyst even in childhood. Morbi-mortality is low especially with the development of minimally invasive techniques. However, prophylactic measures are essential to interrupt the parasite’s life cycle.

Introduction La tuberculose de la paroi thoracique est une forme rare et inhabituelle de la tuberculose extrapulmonaire. Elle peut se presenter sous forme d’abces froid ou de masse pseudo-tumorale. Elle pose un probleme de diagnostic differentiel avec les tumeurs parietales et les autres atteintes infectieuses. La chirurgie et le traitement antituberculeux sont les piliers du traitement. Methodes Nous rapportons 15 cas de tuberculose parietale thoracique chez des patients immunocompetents, operes au service de chirurgie thoracique et cardiovasculaire d’Abderrahmane Mami a Ariana entre janvier 2000 et decembre 2019. Resultats Il s’agissait de 15 patients, de sex-ratio a 1,8. L’âge moyen etait de 47 ans (30 a 80 ans). La notion de tuberculose pulmonaire a ete trouvee dans un cas comme antecedents. Le debut de la maladie a ete insidieux dans la majorite des cas, marque par la constatation d’une tumefaction parietale thoracique, dont la taille de l’abces variait de 2 a 2,5 cm, de consistance molle et douloureuse. La lesion etait fistulisee a la peau dans 40 % des cas et evoluant dans un contexte d’impregnation tuberculeuse. La fievre etait absente dans tous les cas. Le bilan inflammatoire etait positif dans 35 % des cas. A l’imagerie, il s’agissait d’une collection sous-cutanee avec grignotement osseux en regard sans extension endothoracique dans tous les cas. Des abces froid multiples ont ete observes dans 3 cas. Tous les patients ont ete operes a visee diagnostique et therapeutique. Tous les patients ont eu une mise a plat de l’abces froid avec biopsie. Le traitement antituberculeux a ete administre chez tous les malades a j1 postoperatoire. Les suites operatoires ont ete simples avec bonne evolution clinique et radiologique chez tous les malades. La confirmation diagnostique etait essentiellement histologique. Tous les patients etaient mis sous traitement anti-bacillaire, avec une bonne evolution radioclinique pendant un recul qui etait en moyen de 34 mois, sans aucune recidive. Conclusion Malgre la frequence de la tuberculose dans notre paye, les abces froids tuberculeux representent une forme rare de tuberculose extrapulmonaire. L’evolution reste favorable sous traitement precoce et bien conduit. La recherche de localisations tuberculeuses extrathoraciques et thoraciques est necessaire car elles conditionnent les modalites therapeutiques.

Introduction Les pneumonectomies pour des lesions benignes sont plus rares que celles indiquees pour des lesions cancereuses mais semblent avoir une morbi-mortalite plus importante. Methodes Il s’agit d’une etude retrospective comparative portant sur 117 patients qui ont eu une pneumonectomie pour des lesions benignes (groupe A) versus (vs) 424 patients qui ont eu une pneumonectomie pour des lesions neoplasiques (groupe B) entre 1989 et 2018 operes au service de chirurgie thoracique et cardiovasculaire de l’hopital Abderrahmene Mami de l’Ariana. Resultats Durant la periode d’etude, 541 pneumonectomies ont ete faites dont 117 (21,62 %) ont ete indiquees pour des lesions benignes. Les indications de pneumonectomie pour le groupe A etaient : des dilatations de bronches dans 67 cas, des lesions de tuberculose dans 17 cas, un abces pulmonaire dans 5 cas, l’actinomycose dans un cas, un aspergillome dans 9 cas, une atelectasie post-traumatique dans 3 cas, un blastome pulmonaire dans un cas, une embolie hydatique dans un cas, un kyste hydatique complique dans un cas, un emphyseme bulleux dans un cas, un hamartochondrome dans un cas, un kyste bronchogenique dans un cas, la maladie de Castelman dans un cas, la mucormycose dans un cas, des malformations vasculaires dans 4 cas, deux cas de tumeur inflammatoire et une hypoplasie pulmonaire dans un cas. Le cote gauche etait predominant (n = 73). L’âge moyen des patients etait de 38,53 ans pour le groupe A vs 58,46 ans pour le groupe B, le sex-ratio pour le groupe A etait de 1,38 (49 femmes et 68 hommes) vs 7,28 pour le groupe B. Le taux de complications postoperatoires etaient respectivement de 13,63 % (n = 16) pour les patients operes de lesion benigne, et 12,02 % pour les indications neoplasiques (p = 0,06). La mortalite postoperatoire intra-hospitaliere etait respectivement de 7,27 % (n = 8) pour le groupe A vs 3,06 % (n = 13) pour le groupe B. Dans les deux groupes les complications etaient essentiellement respiratoires et infectieuses. Conclusion La pneumonectomie pour lesion benigne, consideree comme traitement de dernier recours avec des indications tres limitees, est correlee a un taux de morbi-mortalite postoperatoire plus eleve que pour les indications neoplasiques.

Introduction L’inhalation accidentelle de corps etranger (CE) est frequente chez l’enfant et exceptionnelle chez l’adulte. Elle represente une urgence respiratoire pouvant mettre en jeu le pronostic vital. L’extraction de CE est realisee grâce a la fibroscopie bronchique ou a la bronchoscopie rigide. La chirurgie s’impose en cas d’echec d’extraction endoscopique. Methodes Nous rapportons une etude retrospective realisee sur une periode de 25 ans (entre janvier 1994 et decembre 2019) concernant 45 cas de CE endobronchiques pris en charge au service de chirurgie thoracique et cardiovasculaire de l’Ariana. Resultats Nous avons repertorie 45 dossiers de patients admis pour corps etrangers tracheobronchiques. Il s’agissait de 14 hommes et 31 femmes dont l’âge moyen etait de 13 ans. Le delai de consultation etait variable. Le siege du CE etait a droite dans 30 cas. Sur le plan clinique, la toux etait retrouvee chez tous les patients. Le syndrome de penetration etait le maitre symptome revelateur, retrouve dans 31 cas, suivi des infections respiratoires a repetition retrouves chez 13 cas. L’extraction du CE a ete realisee par bronchoscopie avec succes dans 19 cas. Le recours a la chirurgie a ete observe dans 26 cas. Seize patients ont eu une lobectomie devant des lesions de dilatation de bronche secondaires, 8 patients ont eu une extraction par bronchotomie et 2 ont eu une resection parenchymateuse atypique emportant le CE (en wedge). La voie d’abord etait une VATS dans 3 cas et une thoracotomie posterolaterale dans 23 cas. La nature du CE etait variable mais restait largement dominee par les epingles a foulards surtout chez les jeunes filles dans 78 % des cas et le CE alimentaire type cacahouete retrouve dans 4 % des cas. Les suites operatoires etaient simples dans 97 %. Aucune mortalite perioperatoire n’a ete relevee. Conclusion Les corps etrangers tracheobronchiques sont frequents chez les enfants. Ils peuvent passer inapercus et se manifester par des infections bronchopulmonaires resistantes a tout traitement. La chirurgie des corps etrangers intrabronchiques ne doit etre une alternative therapeutique qu’apres echec de l’endoscopie bronchique. Les mesures preventives surtout chez l’enfant restent le meilleur traitement.

Introduction Les kystes pleuropericardiques representent 7 % de l’ensemble des tumeurs du mediastin. Il s’agit d’une tumeur embryonnaire benigne. Ils font partie des kystes malformatifs dont l’origine est une malformation du cloisonnement cœlomique. Methodes Nous rapportons une serie retrospective des patients qui ont ete operes pour kyste pleuropericardique entre janvier 2000 et decembre 2019 au service de chirurgie thoracique et cardiovasculaire de l’hopital Abderrahmen Mami de l’Ariana. Resultats Quinze patients ont ete operes durant la periode d’etude. Ces patients etaient repartis en neuf femmes et six hommes avec un âge moyen de 50 ans. La decouverte etait fortuite dans la majorite des cas. Le cote droit etait predominant : 11 cas. L’abord a ete une mini-thoracotomie video-assistee (VATS) dans huit cas, une video-thoracoscopie exclusive (VTS) dans six cas et une thoracotomie posterolaterale dans un cas. Le geste consistait en une kystectomie. Les suites operatoires etaient simples pour tous les patients avec une mortalite nulle. Aucun cas de recidive n’a ete collige. Conclusion Les kystes pleuropericardiques sont rares et souvent asymptomatiques. La chirurgie, par abord mini-invasif de preference, permet de traiter la lesion au prix d’une morbidite minimale et d’un sejour postoperatoire court.

Background: Uncontrollable bleeding during thoracic surgery has been a challenging problem faced by surgeons. The aim of this study was to clarify the usefulness of pleural packing as a good alternative to control hemorrhage and to deduce the common point between those patients.Methods: This was a retrospective case series study of eight patients who underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and shock which required intrathoracic packing from January 2014 to December 2019.Results: During the study period, eight patients underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and needed packing. Successful hemostasis was achieved in all cases after pleural packing. The mean age was 58.5 years and six patients were males. The common point was the history of pulmonary tuberculosis which was with invasive pulmonary aspergillosis for two patients. Incision was a posterolateral thoracotomy in all cases and six patients required pulmonary resection (five lobectomy and one bilobectomy), one patient required decortication, and one had tumorectomy of a paragonglioma located in the Barety’s space. The unpacking took place right after 48 hours. An arrest of the bleeding was noticed in all the remaining patients. The mean time of the mechanical ventilation was 11 days. Complications included atelectasis and infectious pneumonitis. We noted one case of death.Conclusions: Intrathoracic packing may be an effective and feasible technique in managing uncontrollable post-operative hemorrhage when the life of patients is in danger. This technique should always be considered for patients with tuberculosis history.

Introduction : dans les pays du Maghreb, l’hemoptysie est le plus souvent secondaire a une cause infectieuse, contrairement aux pays occidentaux (ou l’origine neoplasique est predominante). On s’est propose d’etudier les particularites de l’hemoptysie d’origine hydatique et d’evaluer sa prise en charge. Methodes : il s’agit d’une etude retrospective, regroupant tous les patients pris en charge pour hemoptysie d’origine hydatique dans notre departement entre Janvier 2005 et Decembre 2015. Resultats : l’hemoptysie a ete le signe revelateur de l’hydatidose pulmonaire chez 46 patients repartis en 24 hommes et 22 femmes. L’âge moyen etait de 26ans+/-15ans (5-70ans). Le delai moyen de prise en charge a ete de 3 mois (1jour et 12mois). Cliniquement, l’hemoptysie etait isolee chez 34 patients. Le kyste a ete bilateral dans 6.5% des cas avec un nombre moyen de 1.3+/-0.7 (1-4). Le kyste etait radiologiquement complique chez 67% des patients. L’hemoptysie a ete evaluee de moyenne a grande abondance chez 13 patients. La chirurgie a ete indiquee en urgence pour 7 patients. La fibroscopie bronchique a ete faite en pre-operatoire chez 11% des patients, et une embolisation a ete tentee pour deux patients avec echec. La thoracotomie classique a ete la voie d’abord preconisee chez 94% des cas. L’origine du saignement a ete toujours une branche arterielle ou veineuse erodee par le kyste. L’hemostase a ete assuree par suture elective (90%), par resection atypique (6%), ou par une resection reglee (4%). Les suites post-operatoires ont ete compliquees dans 13% des cas: empyeme (4.5%), bullage prolonge (4.5%), hemorragie (2%) et atelectasie (2%). Deux recidives (4%) ont ete notees. La mortalite hospitaliere etait nulle dans notre serie. Conclusion : l’hemoptysie en cas d’hydatidose pulmonaire ne constitue pas en elle-meme une indication a une resection reglee. Le bon traitement du kyste, ainsi que la cavite residuelle, constituent le traitement de reference, permettant en meme temps dans la plupart des cas de juguler l’hemoptysie.

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.

Background: Substernal goiters are usually classified as secondary or primary intrathoracic goiters. Primary ones result from an abnormal embryologic migration of the thyroid and represents less than 1% of all goiters. Secondary substernal goiters develop from the descent of the thyroid into the mediastinum and represents 98-99% of goiters.Methods: This was a retrospective study which discuss the symptoms, the diagnosis and the treatment of 7 primary intrathoracic goiters.Results: Goiter was located in the anterior mediastinum in 5 cases, in the posterior mediastinum in 1 case and in the medium mediastinum in 1 case. The mass was located on the right in 5 cases cervical approach was performed in 3 cases. Two patients required a transthoracic approach, 1 required sternotomy and in 1 case video-thoracic surgery was sufficient. Only one patient had postoperative complication which was secondary pneumothorax. All tumors were benign.Conclusions: Mediastinal ectopic goitre is rare. However it should be discussed among the different etiologies of mediastinal masses.