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Introduction L’evolution de la tuberculose pulmonaire (TBC) est souvent favorable avec un traitement bien conduit. Un retard de negativation des bacilloscopies au-dela de 2 mois chez les patients tuberculeux sous traitement est responsable d’une prolongation de la periode de contage et peut modifier l’evolution de la maladie. Methodes Il s’agit d’une etude retrospective portant sur 60 dossiers de patients ayant une TBC confirmee sous traitement durant la periode 2017 et 2018. Les patients etaient divises en 2 groupes : le premier groupe (G1) : patients presentant un retard de negativation a 2 mois de traitement et le deuxieme groupe (G2) les patients n’ayant pas un retard de negativation. Le but etait d’analyser les particularites cliniques et radiologiques des patients ayant un retard de negativation des bacilloscopies. Resultats Le delai de negativation etait en moyenne de 35,6 jours. Quatorze patients (23 %) ont presente un retard de negativation a 2 mois de traitement. Le tabagisme etait plus frequent dans le G1 (98 % versus 81 %) avec une intoxication tabagique moyenne de 22 paquets-annee dans le G1 versus 18 paquets-annee dans le G2. L’âge moyen etait plus avance dans le groupe G1 avec une moyenne (62,35 ans versus 43,45 ans ; p = 0,02). Le retard diagnostique etait plus frequemment rapporte dans le G1 avec un delai de consultation moyen de (75,69 jours dans le G1 vs 33,6 jours dans le G2). Les comorbidites etaient plus frequentes dans le G1 (21,5 vs 16 %) mais sans difference significative. Une atteinte radiologique etendue et bilaterale etait plus observee dans le G1 (9 % vs 4 % ; p = 0,005). Une mauvaise observance therapeutique etait plus frequemment retrouvee dans le G1 (34,2 % versus 26,5 % ; p = 0,067). Par ailleurs, un antibiogramme a ete pratique pour tous les patients qui n’a pas montre une resistance aux antituberculeux. Conclusion Un retard de negativation est un facteur important dans le pronostic de la tuberculose pulmonaire. L’âge avance, le terrain, les antecedents pathologiques, la mauvaise observance therapeutique ainsi que le degre d’extension des lesions initiales etaient correlees a un risque important de retard de negativation.

Introduction La tuberculose reste l’une des premieres causes de mortalite par maladies infectieuses. Sa forme pulmonaire est frequente dans notre pays. Plusieurs etudes s’interessent a l’impact de la consommation de la cigarette sur cette maladie toutefois peu d’etudes se sont interessees aux patients tuberculeux fumeurs de narguile bien que celle-ci est de plus en plus repandue de par le monde. Le but de notre etude est de rechercher les particularites cliniques, bacteriologiques, radiologiques et evolutives de la tuberculose pulmonaire chez les fumeurs de narguile. Methodes Nous avons mene une etude retrospective sur deux ans, 70 patients, tous tabagiques, ont ete colliges ayant une tuberculose pulmonaire confirmee et suivie sur au moins un an. Nous avons exclu 20 patients n’ayant pas totalise le traitement ou decede avant la fin du traitement. Deux groupes ont ete compares : patients fumeurs de narguile (N1 = 14) et patients non-fumeurs de narguile (N2 = 36). Resultats Tous sont de sexe masculin. L’âge moyen des patients de N1 etait de 30,5 ± 10,2 ans vs 42,5 ± 14,2 ans, (p = 0,086) avec un niveau socioeconomique plus bas (N1 = 71,4 % vs N2 = 41,7 %, p = 0,05). L’intensite moyenne de l’intoxication tabagique etait de 14,9 ± 12,4 PA pour le N1 vs 25,7 ± 29,0 PA (p = 0,18). La consommation de cannabis et de drogues dures etait respectivement de N1 = 57,1 % vs N2 = 2,8 %, (p 0,05). Les patients du groupe N1 avaient plus d’intolerance au traitement combine (21,4 % vs 8,3 %, p = 0,2). Des reactions allergiques cutanees ont ete notees dans 14,3 % vs 0 % ; p = 0,006. Le retard de negativation etait note dans 21,4 % dans le groupe N1 vs 44,4 %, p = 0,118. Aucun cas de TBC-MDR n’a ete note dans les 2 groupes. Conclusion Le narguile pourrait influencer la presentation radiologique et la tolerance au traitement des patients tuberculeux. Des etudes supplementaires sont necessaires pour mieux preciser l’effet du narguile chez cette population.

Introduction Bien qu’elle soit indispensable, la bronchoscopie rigide a ete longtemps delaissee au profit de l’endoscopie souple. Cette technique n’est redevenue disponible dans le secteur public tunisien que depuis quelques annees. Le but de notre travail etait d’evaluer cette nouvelle activite d’endoscopie interventionnelle. Methodes Il s’agit d’une etude retrospective descriptive incluant tous les patients qui ont subi une bronchoscopie rigide, pris en charge dans le service de pneumologie et d’endoscopie interventionnelle (pavillon 2) de l’hopital A.-Mami de l’Ariana. Resultats L’activite a demarre en janvier 2016. A ce jour, nous avons effectue 64 bronchoscopies rigides pour 41 patients adultes. La bronchoscopie rigide etait indiquee pour une extraction de corps etranger chez 3 patients et pour une desobstruction de stenose tracheale acquise dans tous les autres cas. Tous les patients presentant une stenose tracheale ont eu une desobstruction mecanique dont 7 etaient laser assistee et 7 avec mise en place d’une prothese endotracheale. Nous ne rapportons aucune complication au decours de l’intervention. Un echec a ete note dans 2 cas (3 %) a cause d’une difficulte d’intubation dans 1 cas et un corps etranger inaccessible dans un autre cas. L’evolution immediate etait favorable dans tous les cas. Toutefois, 11 patients ont recidive leur stenose (29 %), necessitant un complement de traitement par laser dans 2 cas, la mise en place d’une prothese dans 3 cas et une resection-anastomose dans 6 cas. Conclusion L’endoscopie interventionnelle est un moyen therapeutique indispensable dans la prise en charge de nos patients. Elle permet, dans plusieurs cas, d’eviter une tracheotomie inutile ou une chirurgie lourde et surtout constitue dans certains cas le seul moyen therapeutique qui permet de preserver le pronostic vital du patient.

Introduction Le cancer bronchopulmonaire (KBP) est le plus souvent diagnostique a un stade avance ou la chirurgie curative n’a plus d’indication. Notre etude a pour objectif de determiner les facteurs de recidives chez des patients (P) operes pour KBP et ayant eu une chimiotherapie (CT) adjuvante. Methodes C’est une etude retrospective de fevrier 2009 a decembre 2018. Parmi les 543 P hospitalises pour KBP, seuls 21 ont beneficie d’une chirurgie curative. Tous les KBP ont ete classes selon la 8e edition de la classification TNM. Resultats L’âge moyen des patients etait de 60,86 ans avec un ecart type de 8,39 ans. Tous de sexe masculin vu le mode de recrutement de notre service et tous tabagiques (moyenne de 51,62 PA). La chirurgie etait a but diagnostique et curatif dans 66,7 % des cas. Le stade IIb etait le plus frequent (33,3 %), suivi du stade IIIb (19 %). Le delai moyen d’acces a la chirurgie etait de 43 jours. Une lobectomie avec curage ganglionnaire a ete faite dans 66,6 % des cas, une lobectomie elargie a la paroi ou au pericarde dans 23,8 % des cas, une pneumonectomie avec curage ganglionnaire dans 4,7 % des cas, et une resection wedge dans 4,7 % des cas. Il s’agit d’adenocarcinomes, de carcinomes epidermoides ou de carcinomes adenosquameux dans respectivement 47,6 %, 42,9 % et 4,8 % des cas. La taille tumorale moyenne etait de 5,1 cm. Les recoupes etaient saines dans 100 % des cas. La presence d’emboles vasculaires ou lymphatiques a ete notee dans respectivement 3 et 1 cas. L’atteinte pleurale a ete notee dans 8 cas. La CT adjuvante a ete indiquee chez 81 % des patients (17 cas). Parmi ces derniers, elle n’a pas ete realisee chez 3 patients pour depassement de delai. Le nombre de cycles moyen etait de 3,29. Une CT dans un delai inferieur a 8 semaines (S) a ete realisee dans 51,7 % des cas (G1 = 8P) avec un delai moyen de 5,96 S, et le reste des patients (G2 = 6P) apres 8 S (delai moyen de 11,66 S). Une recidive locoregionale a ete notee dans 38,1 % des cas. (60 % : G1 versus 40 % : G2). Le taux de recidive etait plus important pour les tumeurs pN- (85,7 % versus 14,28 %). Cinquante-sept pour cent des patients sont encore en vie avec une survie moyenne de 32,71 mois. Conclusion Dans notre etude, le taux de recidive etait plus important pour les patients ayant eu une CT adjuvante dans un delai inferieur a 8 semaines et pour ceux ayant un pN-, ce qui est en discordance avec les donnees de la litterature. L’etude des autres facteurs est necessaire sur une population plus large pour mieux preciser tous les facteurs intervenants.

Resume Objectifs Evaluer les resultats de l’embolisation arterielle bronchique (EAB), a court, a moyen et a long terme et identifier les facteurs favorisant la recidive de l’hemoptysie. Patients et methodes Il s’agit d’une etude retrospective, de janvier 2001 a juin 2010, comportant 53 patients consecutifs ayant eu une EAB. L’âge moyen etait de 53,8 ans, Il s’agissait de 15 femmes (28,30 %) et de 38 hommes (71,69 %). Resultats Les etiologies de l’hemoptysie etaient dominees par les sequelles de tuberculose pulmonaire : 18 cas (33,96 %), les dilatations de bronches : 12 cas (22,64 %) et l’aspergillome : cinq cas (9,43 %). L’arteriographie bronchique a montre des signes d’hypervascularisation bronchiques dans 92,45 % des cas. Quarante-six patients ont eu une premiere embolisation (86,79 %) avec une efficacite immediate dans 84,90 % des cas (n = 45), et a plus de trois ans dans 60,08 % des cas. Une recidive de l’hemoptysie a ete notee a court ( 30 jours et trois ans) etait correle a l’âge. La survie sans recidive etait statistiquement meilleure quand l’âge etait inferieur a 60 ans (p = 0,0041). Conclusion L’EAB est un moyen therapeutique efficace. L’aspergillome represente le facteur de risque majeur a l’origine des recidives hemoptoiques. Une embolisation repetee peut etre proposee pour ces patients.

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.

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.

Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust.A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids.Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

Pleural solitary fibrous tumour (PSFT) is a rare, usually benign tumour, with unpredictable behaviour.Five cases of PSFT were diagnosed in our department over a 12-year period from January 1999 to December 2010. Clinical, radiological, histological, therapeutic and follow-up information were provided in all cases.Our series comprised four men and one woman. The mean age of the patients at presentation was 55 years. All patients were symptomatic. Radiologic investigations showed a pleural lesion with a mean size of 10.6cm ranging from 3 to 17cm. Histologic diagnosis was made from resected parietal pleura in three cases and visceral pleura in two cases. The histologic features were suggestive of malignancy in two cases and benign in three cases. Immunohistochemical study showed that the tumour cells expressed vimentin, CD34, CD99 and Bcl2. Complete resection was obtained in all patients. The evolution was marked in the two patients with malignant PSFT by the recurrence of the tumour after 6 and 21 months respectively. Both died from the condition. The three patients with a benign form are disease-free after 3, 11 and 2 and half years of follow-up.PSFT is rare tumour, the diagnosis of which is based on histologic investigations. These tumours require long-term monitoring due to the possibility of local recurrence and malignant transformation.

Acute anaphylaxis due to chicken meat is very rare; only a few cases have been reported in the literature. We report the case of a 13-year-old girl, with a past history of allergic urticaria due to eggs, who presented immediately after ingestion of lightly grilled chicken meat with facial edema, dysphonia, acute dyspnoea and a feeling of suffocation. A few months later, the patient developed asthma in the vicinity of poultry and after contact with chicken feathers.

Tuberculosis is still endemic in Tunisia. Even though recurrent TB (RT) is rare, there is an increased risk of resistance. The purpose of this study is to investigate predictors of RT.This was a case controlled retrospective study, comparing two groups of patients with confirmed pulmonary tuberculosis: a relapse group (GR) of 64 patients with RT and a control group (GT) of 105 patients.Between September 1995 and December 2007, the incidence of RT was 9.48%. All the patients were male. There was no difference in the average age of the two groups. A smoking history of greater than 20 pack-years was more common in the GR (44.89% versus 21.4%, P=0.055). No difference was found regarding the history and clinical signs except that chest pain and dyspnoea were more frequent in the GR. A low haemoglobin was more common in the GR (11.33 ± 1.57g/dL versus 12.41 ± 1.66g/dL, P=0.008). The tuberculin skin test was negative in 73.7% of GR versus 31.1% of GT (P=0.001). Adverse liver reactions are more frequent in the GR (27.3% versus 8.6%, P0.05). Discontinuation of TB treatment was more common in the GR (36.7% versus 3.8%, P0.001). The achievement of sputum negativity was delayed in the GR (46.32 ± 54.01 versus 9.35 ± 11.84 days, P0.001). Despite this, we have noted no significant difference in drug resistance. In multivariate analysis, hepatic cytolysis and a negative tuberculin skin test were independent predictive factors for RT.All tuberculous patients should have a carefully adapted treatment regimen, particularly the presence of factors predictive for recurrence.

Tuberculosis (TB) is a greatest public health problem of the world. This work aims to study the antituberculous treatment and the evolution of the patients with recurrent tuberculosis.The study is a retrospective study on 64 patients with recidivant pulmonary TB: A1 group: at the first TB attack; A2 group: at the time of recidivant TB, and 105 controls patients with confirmed TB without recidive.Multidrug-resistant TB is more frequent with recidivant TB (21.1% vs 3%, P0.05) and also extensively drug-resistant. Antituberculous treatment duration in group A1, A2 and T was respectively 8.63 months, 9.79 months, and 7.08 months. Antituberculous drug complications were more frequent in group A2 compared to group T (76.1% vs 41.2%; P0.001).All tuberculous patients, specially recidivant TB, should benefit of particular care and drug protocol adaptation.

The study of pain in elderly patients with a primary lung cancer (PLC) deserves special attention particularly because this symptom is frequently associated with the condition and influences the management and prognosis. To study the characteristics of pain due to PLC in the elderly, we prospectively evaluated pain in all patients aged over 65 years admitted for PLC. Thirty-nine elderly patients were enrolled in 15 months (62% of all PLC). The average age was 72 years. The cancer was advanced NSCLC in most cases. Pain was present in 74.3%. It was significantly less common among those over 75 years (50% versus 85.1%; P0.05). The pain, mild in most cases, worsened during follow-up in 55.5%. The last mean visual analogue scale score was significantly lower than the first (1.3 versus 3.6; P=0.001). The pain treatment required was based on level I in 20.6%, level II in 48.2% and level III in 31% of cases. Pain management in the elderly should be early, adequate and continued in order to preserve to a maximum the quality of life of these patients with PLC.

Costal primary tumors are rare and dominated by malignant tumors. Haemangioma of the bone represents only 1% of bone tumors. Costal localization accounts only for 1% of the cases and only about fifty cases have been reported in the literature.The authors aim to describe a rare costal tumor, its histological features and the main differential diagnoses.The authors describe the case of a 46-year-old woman who presented with chest pain. Radiological findings did not permit a malignant tumor to be ruled out and the treatment consisted of a resection of the posterior arch of the rib. Microscopic examination concluded that the patient had a costal haemangioma and the patient didn't present any recurrence after a six-year follow-up.The costal haemangioma is a very rare tumor with a debated etiology. Some radiological features are specific such as the "soap bubble" or "honeycomb" aspect. However, the basis for diagnosis remains microscopic examination. These tumors have a good prognosis and no cases of recurrence have been reported following complete resection.

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.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.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.The imaging features of mediastinal amyloidosis are non-specific. Pseudotumoral involvement of mediastinal nodes associated with pulmonary amyloidosis accelerates the degree of airway obstruction.

Erasmus' syndrome involves the association of systemic scleroderma (SS) and exposure to silica. Silicosis may precede the SS but the latter may be the presentation, in which case a history of exposure to silica should be sought as part of the diagnosis.A 46-year-old man with history of pulmonary tuberculosis presented with dyspnoea and dysphagea. Clinical examination revealed thickening of the facial skin with a pointed nose, erythema and telangiectasia, Raynaud's syndrome and sclerodactyly. A thoracic CT scan revealed bilateral, fibrotic, pseudo-tumoural masses. Antinuclear antibodies, anti-topoisomerase 1 and antihistone were positive.The clinical presentation of Erasmus' syndrome associating systemic scleroderma and pulmonary pseudo-tumours may pose a problem of differential diagnosis from lung cancer. This condition requires regular clinical and radiological monitoring, particularly as both scleroderma and silicosis increase the risk of lung cancer.

Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options.A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia.52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism.Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.

In thoracic oncology, no tumor marker has yet shown sufficient sensitivity nor specificity to be usefull for lung cancer diagnosis. However, in some cases, monitoring of tumor marker blood levels provides useful evaluation of response to specific treatment and assessment of infracfinical tumor progression.To determine the value of umor markers in pulmonary tuberculosis.A prospective study was conducted in our department during 2 years 2005 through 2007. We included 40 men who presented confirmed pulmonary tuberculosis. Before starting antituberculous chemotherapy, serum assays were practiced for the following tumor markers: NSE, CA125, ACE and Cyfra 21.1.Mean age was 37.12 years (17-81). The levels of NSE were high in 91.66% of cases with an average value of 29.22 microg/l (2.24 X normal). This highest sensitivity was superior to those of other tumor markers: 55.55% for CA125, 28.94% for ACE and 7.6% for Cyfra 21.1. Analysis of the levels of NSE according to age, tobacco consumption, delay of consultation, type of the pulmonary lesions and negativation delay in smear did not show any significant difference, whereas levels of CA125 were higher in bilateral lesions (P = 0.05).The highest sensitivity of the NSE in pulmonary tuberculosis, with no neoplastic pathology could be interesting for diagnosis of smear negative tuberculosis, with small amounts of bacilli.

Pseudotumour is a rare presentation of bronchopulmonary tuberculosis, occurring in immunocompetent patients, which simulates lung cancer and may thus cause diagnostic difficulty. To assess the frequency and clinical features of tuberculous pseudotumour in immunocompetent patients, we analyzed all cases of pulmonary tuberculosis hospitalized in our department. Tuberculous pseudotumour was defined by the presence of a bronchial or pulmonary lesion suggestive of lung cancer. Over a period of 11 years, 12 cases of tuberculous pseudotumour were collected among 341 cases of pulmonary tuberculosis (3.5%). Mean age was 45 years. All patients were smokers. Symptoms were not specific and were dominated by cough and chest pain. Radiological investigations showed consolidation in five cases and a mass lesion in five cases. Fibreoptic bronchoscopy visualized a tumour in four cases and stenosing bronchial wall infiltration in one case. Mean delay to diagnosis was 47 days. The confirmation of tuberculosis was bacteriologic in only three cases but histological in the others (four bronchial biopsies, two transbronchial biopsies, one pleural biopsy, four surgical specimen). The positive diagnosis of tuberculous pseudotumour is difficult because the clinical and radiological presentation may closely mimic lung cancer, especially as the cases are usually smear negative, leading to a very late diagnosis.

Drug-induced muscle disorders are now well known and vary from a simple isolated increase in muscle enzymes to severe drug-induced myopathy. The list of drugs inducing myopathy is very long and continues to grow. The onset of muscle disorders under isoniazid often falls within a drug-induced neuropathy or a drug-induced lupus. However, the occurrence of isolated isoniazid-induced drug myopathy without neuropathy is an extremely rare condition especially with non-toxic doses. The authors report the case of a 28-year-old man, without a previous medical history, hospitalized for pulmonary tuberculosis. After initiating tuberculosis treatment for five days, he presented muscle pain, fasciculation and weakness initially involving the lower left limb that quickly propagated to all four limbs. The physical examination noted a left ankle flush, a swollen left calf and fasciculation of both calves while the neurological examination was normal. The CPK was normal. Electromyography confirmed the myopathy without neuropathic findings. Isoniazid withdrawal was marked by the rapid disappearance of the symptoms. The reintroduction of a half-dose of isoniazid only induced a few transitional muscular fasciculations. The onset of the symptoms under tuberculosis treatment, the absence of later muscle disorders, the absence of any other cause of myopathy and the total disappearance of the symptoms after isoniazid withdrawal confirmed the diagnosis of isoniazid-induced myopathy.

The authors report the case of a 68-year-old man complaining of haemoptysis and breathlessness. Bronchoscopy revealed a budding formation in tracheal bifurcation. Multiple biopsies were performed and concluded as to AL type amyloidosis. Tracheobronchial amyloidosis is an uncommon localised form of amyloidosis that can simulate lung cancer.

Inflammatory pseudotumor of the lung is an uncommon nonneoplastic tumor of unknown origin. It can mimic lung carcinoma. We report a 65-year-old man who presented with productive cough, weight loss, and a heterogeneous right apical lung condensation. This clinical and radiographic presentation suggested a malignant lung tumor. Surgery was performed and the histological examination of the surgical specimen concluded to an inflammatory pseudotumor. A pneumonectomy was performed because of the tumor extension towards the lower lobe and the mediastinum. No recurrence was observed after a 2-year follow-up. Surgery is essential to confirm the diagnosis of inflammatory pseudotumor. Complete resection is the only guarantee to prevent recurrence.

Hemothorax is generally secondary to trauma, invasive thoracic surgery or specific lung of pleural disease. Hemothorax secondary to aortic dissection is rare. We report a case in a 69-year-old man with a history of smoking and hypertension. The patient was referred for exploration of a left pleural opacity with mediastinal widening. Pleural puncture produced a hemorrhagic fluid. The thoracic scan led to the diagnosis of Stanford type B aortic dissection. The patient was given antihypertensive treatment and now has a sixteen month follow-up. Aortic dissection can give rise to hemothorax, especially in a hypertensive subject with an anomalous aortic arch or mediastinal widening on the chest X-ray. Computed tomography generally gives the diagnosis. Treatment may be medical or surgical, depending on the site of the lesion and the severity of the clinical presentation. Aortic dissection is a cause of hemothorax, particularly in patients with favorable conditions or a suggestive radiological anomaly.

Solitary fibrous tumours of the pleura are usually benign. However, malignancy is observed in 13% of the cases. The authors report two cases of 27 and 69 year-old patients, presenting chest pain and dyspnoea. The roentgenograms and computed tomography scanning revealed a pleural tumour in both cases. The patients underwent complete resections of these tumours. The immunohistochemical study confirmed the diagnosis of malignant solitary pleural fibroma. The patients succumbed to their disease secondary to local recurrences. Histopathology is very helpful in the diagnosis of malignant pleural fibroma. Surgery and long-term follow-up are mandatory.

Pulmonary hydatid cyst is exceptional in our country. The diagnosis is generally established on the basis of imaging. Surgical treatment is indicated in most patients. We report a case of pulmonary hydatid cyst in a 74-year-old smoker (11 package-years) who presented cough with mucopurulent expectoration and occasional hemoptysis. The chest x-ray demonstrated a poorly delimited heterogeneous opacity in the upper third of the left lung which persisted after antibiotic therapy. Bronchial fibroscopy revealed a hydatid membrane in the left superior bronchus which was totally removed by aspiration. A control radiography after the fibroscopy demonstrated a clear regression of the opacity. A thoracic CT-scan was performed and revealed a residual cavity in the left upper lobe with bronchial dilatation. The indication for surgery was not retained. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event. Our exceptional case illustrates an atypical radiological presentation and the use of "therapeutic" fibroscopy.

Hydatid pulmonary embolism is a rare condition. Diagnosis is difficult and there is no consensus on treatment. Prognosis is generally poor. We conducted a retrospective analysis of patients hospitalized between 1994 and 2002 who had a diagnosis of hydatid pulmonary embolism. Seven cases were identified. All patients had a cyst which spontaneously ruptured into the bloodstream. All patients were symptomatic. Chest x-ray revealed images of metastatic pulmonary echinococciasis in all patients. Thoracic CT and/or angioscan provided the diagnosis in five patients. In one, the diagnosis was established with pulmonary angiography. For one other, the diagnosis was established at the pathology examination of the surgical specimen. Searching for the primary localization of the hydatid disease revealed hepatic cysts in all patients, associated in one with a cyst in the right atrium. The cardiac cyst was not operated and all hepatic cysts were removed. Embolectomy was performed in one patient. Medical treatment with albendazole was given in five patients. The clinical course was marked by death in two patients, due to abundant hemoptysia. The five other patients are followed regularly and were doing well at six months to five years. The diagnosis of hydatid pulmonary embolisms is basically obtained with imaging. Treatment is surgical resection of the embologenic focus then embolectomy. The role of medical treatment is not clearly defined. The short- and mid-term prognosis is generally poor.

Misdiagnosed and complicated diaphragmatic hernia can lead to diagnostical and therapeutical difficulties.A strangulated post-traumatic diaphragmatic hernia in a 53 years old woman was at the origin of whole hemithoracic hydroaeric opacity. The hernia diagnosis based on digestive opacification and thoraco-phreno-abdominal ultrasonography. Emergent intervention is critical and allowed aetiologic and lesional assessment.After thoracic traumatism, it's necessary to carry on observation and realize, in front of any suspicion, radiological investigations especially modern imaging.

Aspergilloma is the most common form of pulmonary aspergillosis, generally developing pre-existing lung cavities. Fiberoptic bronchoscopy is required in case of hemoptysis. We report the case of a 74-year-old man with pulmonary aspergilloma where fiberoptic bronchoscopy visualized mycetoma and cavitation. Visualization and biopsy of the fungus ball during fiberoptic bronchoscopy is rare.

PurposeTo assess the short, medium and long-term results of bronchial artery embolisation (BAE) and identify the factors favouring the recurrence of haemoptysis.Patients and methodsThis is a retrospective study, between January 2001 and June 2010, comprising 53 consecutive patients with BAE. The mean age was 53.8 years. There were 15 women (28.30%) and 38 men (71.69%).ResultsThe aetiologies of haemoptysis were dominated by the residual signs of pulmonary tuberculosis: 18 cases (33.96%), bronchial dilations: 12 cases (22.64%) and aspergilloma: five cases (9.43%). The bronchial arteriography showed signs of bronchial hypervascularisation in 92.45% of the cases. Forty-six patients had a first embolisation (86.79%) with immediate efficacy in 84.90% of the cases (n=45). This efficacy was noted after more than 3 years in 60.08% of the cases. Short (< 30 days) and medium-term (> 30 days and < 3 years) recurrence of haemoptysis were noted in 17.39% and 8.69% of the cases respectively. A statistically significant correlation between aspergilloma and the immediate recurrence was found (P=0.013). The risk of medium and long-term recurrence (> 3 years) was correlated with age. The survival without recurrence was statistically higher when the age was less than 60 years (P=0.0041).ConclusionBAE is an effective treatment. Aspergilloma is a major risk factor in the recurrence of haemoptysis. Repeated embolisation may be proposed for these patients.