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A wide variety of infections can affect the chest wall including pyogenic, tuberculous, fungal, and some other unusual infections. These potentially life-threatening disorders are frequent especially among immunocompromised patients but often misdiagnosed by physical examination and radiographs. The purpose of this article is to describe the clinical and imaging features of these different chest wall infections according to the different imaging modalities with emphasis on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The outcome of chest wall infection depends on early diagnosis, severity of the immunosuppression, offending organism, and extent of infection. Because clinical findings and laboratory tests may be not contributive in immunocompromised patients, imaging plays an important role in the early detection and precise assessment of the disease. US, CT, and MRI are all useful: bone destruction is more accurately detected with CT whereas soft tissue involvement are better visualized with US and MRI. CT and US are also used to guide percutaneous biopsy and drainage procedures. MR images are helpful in pre-operative planning of extensive chest wall infections.

Purpose: To describe the CT findings of ruptured pulmonary hydatid cyst (HC) and to establish a progressive CT staging., Patients and Methods: CT scans of 41 patients with pulmonary hydatid cyst complicated by rupture in the bronchi were retrospectively reviewed. We also reviewed the findings in the literature on the rupture of pulmonary hydatid cysts and the Lewall and McCorkell classification and proposed a more detailed staging related to the progression of HC. The Lewall and McCorkell communicating rupture is manifested by a tear of the endocyst with a discharge of the cyst's contents via the bronchioles that were incorporated in the pericyst: -Stage I: signet ring sign; -State II: crescent sign and inverse crescent sign; -Stage III: air bubble sign and honeycomb; Stage IV: air-water level, double arch sin, water lily sign, serpiginous aspect, regular air-water level; -Stage V: dry cyst sign, ball of wool aspect, small bell image, pseudotumoral aspect; -Stage VI: sequela image, residual cavity, and cicatricial image., Results: Seventy-three complicated pulmonary hydatid cysts were included in the analysis and were distributed as follows: stage I (16%), stage II (12.7%), stage III (42.8%), stage IV, double arch sign (2.7%), water lily sign (10%), serpiginous aspect (8.2%), regular air-water level (5.4%), stage V, ball of wool aspect (6.8%), small bell image (15%), pseudotumoral aspect (4%), stage VI, residual cavity (4%) and cicatricial image (2.7%)., Conclusion: Our staging offers more details than the Lewall and McCorkell general classification. Moreover, this staging takes into consideration both the natural evolution of the HC and the particularities of the pulmonary location.

Purpose: The objective of this study was to describe the different radiological features of the hydatid cyst of the mediastinum., Materials and Methods: We conducted a retrospective study on 14 patients (seven women, seven men), diagnosed with mediastinal hydatid cyst, aged 13-67 years (mean, 48 years) over a period of 16 years in our hospital where 71 cases of hydatid disease are annually diagnosed. The patients were explored by chest radiography (n=14), chest ultrasonography (n=10), abdomen ultrasonography (n=14), computed tomography (CT scan) (n=13), and magnetic resonance imaging (MRI) (n=8)., Results: The chest x-ray showed an opacity of the anterior (n=11), middle (n=1), and posterior (n=1) mediastinum. The thoracic ultrasound confirmed the liquid nature of the mass with a multivesicular aspect (n=9). CT and thoracic MRI made it possible to precisely locate the mediastinal compartment involved and study the relationship to adjacent structures. A purely mediastinal location was found in only six cases. In the remaining cases, it was associated with hepatic (n=7) and pleural (n=1) locations., Conclusion: Hydatid cysts of the mediastinum are very uncommon. Diagnosis can be made by chest sonography. CT scan is the main tool for diagnosis and the study of possible extension. Our study showed a more frequent location to the anterior mediastinum.

Pulmonary tuberculosis may at times simulate lung carcinoma on bronchoscopic examination or imaging studies. Diagnosis can be delayed and lead to surgical resection. Based on a review of 25 cases, the different CT features are reviewed.

Thoracic involvement of Behcet's disease is unusual but serious. It is related to the well known vascular tropism of the disease. It may involve the superior vena cava, pulmonary arteries, aorta and subclavian vessels. Imaging is useful for diagnosis and assess the degree of thoracic involvement. CT scan and MRI are obviously more accurate than angiography. The spectrum of thoracic manifestations of the disease is presented based on a review of 22 cases.

Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithorax. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed preoperatively in 30 of the 40 cases. Posterolateral thoracotomy was performed in all patients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed 15 lobectomies, 10 wedge resections, 16 decortications, and in one patient simple drainage of a voluminous pleuropulmonary and hepatic purulent hydatic collection. The postoperative course was uneventful in 26 cases, but 14 patients had complications, from which 3 patients died. The therapeutic approach depends on ultrasonographic findings. We believe ultrasonography to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and is sufficient if the biliary tract is safe. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.

Background: The right ventricle is an exceptional localization for hydatic cysts. There is a risk of hydatic embolism and chronic or acute cor pulmonale., Case Report: A 63-year-old-man with an uneventful history was hospitalized for dry cough, exercise-induced dyspnea and bloody expectorations which had developed over the previous year. Multiple and bilateral opacities were visualized on the standard chest x-ray and the right border of the heart showed a bulge in the middle portion. Signs of right-sided hypertrophy were seen on the ECG. Imaging findings led to the diagnosis of multiple organ hydatiasis involving the lung, the liver the mediastinum and a ruptured hydatic cyst in the right ventricle. The cavogram revealed defect images in the superior vena cave and the pulmonary angiogram confirmed the diagnosis of hydatic embolism. Medical treatment was given but the patient died 8 months after diagnosis., Discussion: Hydatic pulmonary embolism generally occurs after rupture of a hydatic cyst in the right ventricle or due to venous migration of daughter vesicles to the right heart then the pulmonary artery. Clinical manifestations are not specific although hemoptisy is the most frequent sign. Positive diagnosis, guided by echocardiographic findings, is based on the pulmonary arteriogram. Prognosis is particularly poor and depends of the patient's general status as well as the number and size of the embolized vessels. Survival rate is poor. Open heart surgery is indicated in localized forms.