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Plexiform neurofibromas are rare benign tumors developed from peripheral nervous system often associated with neurofibromatosis type 1. We report the case of multifocal plexiform neurofibromas in a 2-year-old child with cervical mass obstructing the trachea causing respiratory distress. A cervical ultrasound examination was performed followed by enhanced CT and MRI. Imaging revealed an expansive cervical mass extended from the base of the skull to the mediastinum associated with similar pelvic and sacral foraminal masses. The target like MRI aspect on T2-weighted images was suggestive of the neural origin. Biopsy under ultrasound control confirmed the diagnosis of plexiform neurofibroma.

Resistant tuberculosis is a topical subject given the difficulties of its management.To evaluate the role of imaging in the diagnosis and follow-up of multidrug-resistant tuberculosis (MDR-TB).Retrospective study of MDR-TB cases followed in Hall C of Abderrahmane Mami Hospital (2010 to 2016).Forty four patients included. The average age was 33 (15-58). The sex ratio was 1.7. Chest radiographs at the start of treatment showed lesions dominated by nodules (n = 39) and cavities (n = 36). The parenchymal lesions were bilateral (n = 32), associated pleural (n = 4) and mediastinal lesions (n = 7). During treatment, radiological improvement dominated during the first 7 months of treatment. Computed tomography was performed as part of the preoperative assessment of MDR-TB (n = 2), lung cancer extension assessment (n = 1) and etiological assessment of haemoptysis. It allowed to refute a suspected pulmonary embolism (n = 1) and to drain a pleural effusion. Parenchymal lesions on CT were dominated by nodules (n = 8) and cavities (n = 6). Mediastinal nodes (n = 4) and pleural effusions (n = 3) were noted. Ultrasonography showed pleural effusion with pleural thickening (n = 2) and permits its ponction.Imaging is a key element in the diagnostic approach to tuberculosis. It permits to evaluate tuberculous lesions and to detect tuberculous complications. It helps to guide the therapeutic management and evaluate its effectiveness.

A correct understanding of the true costs of a procedure is necessary to make informed decisions in cost-effectiveness analyses. The actual comprehensive costs of performing CT guided biopsy of lung lesions (CTGLB) were analyzed. Methods: Costs included labor, equipment, administration, facility establishment and maintenance, overhead, and consumable supplies. Cost identification was performed with use of an hourly rate that reflected the labor cost of CTGLB. The costs of the consumable supplies used during the procedure were calculated. From august to December 2018, 65 CTGLB were studied in 61 consecutive patients to determine mean procedure duration and supplies consumption. Variable costs include consumable supplies and salaries of the personnel involved in the procedures. Fixed direct costs include the purchase, depreciation, maintenance, and repair costs of the CT scanner and other related equipment. The indirect costs which include transfer and overhead costs were not calculated due to the absence of an analytical accounting of the hospital. Costs were calculated in Tunisian Dinars (TND) then converted into dollars: 1$=3TND Results: the average duration of the procedure was estimated at 30 minutes. Total inclusive direct cost of labor was 8 $ per procedure (Radiologist, resident, Radiology nurse, Technologist). Average cost by procedure, including consumable supplies was 45 $ . Fixed direct cost was 33 $ per CTGLB (depreciation 18$, maintenance and repair costs 10$). The average direct cost of a CTGLB was 86 $. Conclusion: The average direct cost of CTGLB was established, showing that the cost remains very low under our skies. This is due mostly to underpayment of hospital medical staff in our country

Background: Bronchogenic cysts (BC) result from a congenital abnormality in the development of the tracheobronchial tree. BC remain asymptomatic for a long time and the occurrence of clinical signs points towards complication. The aim of our study was to assess the clinical and therapeutic characteristics of BC discovered in adulthood. Methods: We retrospectively reviewed the records of 106 patients managed between 1985 and 2018 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia. Results: There were 47 women and 59 men, with a mean age of 42 years [18-83 years]. The most common signs were chest pain (51 cases), cough (44 cases) and dyspnea (31 cases). Dysphagia was reported in 3 cases, dysphonia in 1 case and 11 patients were asymptomatic. Chest X-ray showed a homogeneous opacity (37 cases), an air-fluid level (23 cases), a suspicious opacity (14 cases) and was normal in 16 cases. Fiberoptic bronchoscopy showed: inflammation (26 cases), signs of extrinsic bronchial compression (8 cases) and an endobronchial bud (3 cases). CT-scan revealed 67 intra-parenchymal BC and 37 mediastinal BC, mainly at the subcarinal level (28 cases). All patients were operated. The most common surgical approach was thoracotomy (82 cases). Cystectomy was total in 68 cases and subtotal in 13 cases. Lobectomy was required in 23 cases and segmentectomy in 2 cases. The postoperative course was uneventful in 102 cases (96.2%). Reported complications were pulmonary infection and pneumothorax. Conclusion: Because of the risk of complications, which make surgical management more difficult, surgical resection of BC is recommended, whatever the age of discovery.

Background: Liver Hydatid cyst with intrathoracic rupture is a rare complication, which may be life-threatening. Currently there is a lack of consensus about the best way of management. The aim of our study was to assess the characteristics and outcomes of patients presenting with liver hydatid cyst ruptured into the thorax and managed through a thoracic approach. Methods: The records of 113 patients managed between 1994 and 2018, in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia, were retrospectively analyzed. Results: There were 64 women and 49 men. The mean age was 48 years [13-86 years]. Reported signs were: chest pain in 68 cases (60.1%), fever in 49 cases (43.3%), dyspnea in 41 cases (36.2%), cough in 30 cases (26.5%), or pain in the right upper quadrant of the abdomen in 5 cases (4.4%), and 21 patients (18.5%) were admitted in emergency. The cysts were assessed with abdominal ultrasonography, CT-scan or both. Surgery was performed in 106 cases. The main procedure was cystectomy through thoraco-phrenotomy and ‘Lagrot’ on the liver in 57 cases (53.7%). Lung resections were performed in 17 cases: segmentectomy (2 cases), bilobectomy (2 cases), lobectomy (12 cases) and right pneumonectomy (1 case). Twenty three patients had a decortication. Mortality rate was 2.6% and morbidity rate was 23.5%. Conclusion: Intrathoracic rupture of liver hydatid cyst may be managed through an abdominal or a thoracic approach. The thoracic approach should be preferred whenever the lung or the pleura are involved. In some cases, a combined thoracic and abdominal approach should be considered in order to prevent recurrences.

Resume Objectifs Evaluer les donnees recentes de la litterature concernant les indications therapeutiques dans les cancers du rein localement avances et/ou metastatiques et analyser le benefice des therapies ciblees depuis leur adjonction dans l’arsenal de traitement. Methode Nous avons effectue une revue de la litterature en utilisant les mots-cles suivants, Renal Cell Carcinoma, Target Therapy, Surgery, Metastases, RECIST sur le moteur de recherche Pubmed pour rechercher des articles indexes entre les annees 1999 et 2014. Nous avons retenu les donnees des grandes etudes cliniques des differentes therapies ciblees dont nous avons fait la synthese et rapportons les recommandations actuelles d’utilisation pratique dans les cancers du rein a cellules claires (CRCC) localement avances et/ou metastatiques (LA/M). Resultats Les essais randomises recents de grande taille ont demontre l’efficacite des differentes therapies ciblees dans la prise en charge des CRCC en termes de survie sans progression. Conclusion L’unification et pratiquement « mondialisation » des protocoles doit beaucoup aux propositions therapeutiques, issues des resultats des differentes essais prospectifs et basees sur un niveau d’evidence eleve.

To analyze the medical literature concerning the results of the international randomized muticentric trials concerning therapeutic innovations, mainly targeted therapies in locally advanced and or metastatic renal cell cancer and to evaluate the benefit of these TT.We performed a review of publications that concerned this topic published from 2000 to 2014.They concerned the large randomized trials have showed a benefit of the targeted therapies in the treatment of clear cell carcinomas in terms of progression-free survival.Advances in molecular biology have allowed the development of these targeted therapies that have all proved their role in the treatment of metastatic renal cell carcinoma.

Pulmonary actinomycosis is a rare bacteriological disease, caracterized by local suppuration and an extensive fibroinflammatory process, with a possible pseudotumoral outcome.To report a new observation of a pulmonary actinomycosis.A 52-year-old patient, smoker, admitted in our department for infectious pneumopathy complicated by purulent pleurisy. Clinical and radiological findings were not contributive.Fiberoptic had evocate the diagnosis of bronchopulmonary cancer. Evolution had been marqued by abondant hemoptysia indicating right low lobectomie. The diagnosis of actinomycosis was obtained by the pathology of the surgical resection.Diagnosis of pulmonary actinomycosis can be difficult because it can mimic the presentation of lung carcinoma.If the diagnosis is no late established, and if the patient is correctely treated medically, the prognosis still excellent.

Vena cava superior syndrome results of an obstruction of superior vein cava(SVC)and/or brachiocaphalic venous troncs by extrinsic compression and/or by tumoral or cruoric thrombosis. The bronchopulmonary cancer represents the most frequent aetiology.The aim of this study is to establish clinical, radiological, evolutive profiles and modalities of treatment of neoplasic vena cava superior syndrome independently of its histological type.It is a retrospective study about 20 patients presenting vena cava superior syndrome complicating primary bronchopulmonary cancer, hospitalised between January 2000 and December 2007 in Ibn Nafiss department in Abderrahmen Mami hospital.All patients were males with an average of 57,8 years. Vena cava superior syndrome had revealed cancer in 60% of cases. It was metachrone in 40% of the patients. The most frequent histological type was small cell lung cancer. Treatment was proceeded in 2 steps, symptomatic and etiologic for the bronchopulmonary cancer.The bronchopulmonary cancer is the most frequent aetiology of vena cava superior syndrome. Its treatment is actually well codified.

Ewing Sarcoma is considered as primitive neuro ectodermic tumor. It's the most frequent osseous tumor in children and adolescent. It was localised frequently at long osseous and pelvis, however, it can be arising from the rib.this article aimed to show that Ewing sarcome could arise twely from thorax.We report the case of 15-year-old girl, admitted in our hospital because of left scapular pain with important weight loss. Chest X ray showed dense left latero tracheal opacity with mediastinal limits. Bronchofiberoscopy was performed and it showed no abnormalities. Thoracic CT scan and MRI noted left posteroir expansif mediastinal process infiltrating D2, D3 and homolateral conjugation's canal. This process was associated at vertebral metastasis in D1, D4 and D8.Rapid clinical aggravation, with installation for medullar compression was noted. The patient had benefit for three cures of decompress radiotherapy and treated by laminectomy of dorsal vertebras in neurosurgery department. Morphologic aspects and immunohistochimical study for the operator piece concluded at Ewing sarcoma of the children considered as primitive neuro ectodermic tumor. Six cures of chemotherapy had been prescribed with well recuperation of the motor failure. She still on life since 7 months.Even rare, thoracic localisation of Ewing sarcoma in not exceptional, it is necessary to evocate it in front of mediastinal mass.

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.

Spine is the most frequent location of bone tuberculosis, which can seldom be revealed by thoracic manifestations.In a seven-years retrospective study, we reported radioclinical manifestations revealing Pott's disease, methods of diagnosis and the treatment outcome.Five non immunocompromised female patients were hospitalized between 1997 and 2003 in Clinical Department of Pulmonary Diseases in Abderrahmane Mami Hospital Ariana Tunisia, for thoracic manifestations that led to the diagnosis of Pott's disease, which represents 4.2% of extrapulmonary tuberculosis and 1.3% of all cases of tuberculosis cared for in the same period. The median age was 48.6 years. The disease was revealed by a paramediastinal radiographic shadow infiltrating the contiguous left lung in one case, abscesses of chest wall in two cases. Another patient was hospitalized for a tuberculous empyema. The last case had a diffuse miliary shadow in both lungs. All patients complained from thoracic or respiratory problems and constitutional symptoms, that evolved for an average of 5.6 months. Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine identified monolevel spondylitis in two cases and multilevel disease in three cases. Diagnosis of tuberculous infection was confirmed in only one case by CT-guided biopsy of a perivertebral abscess, it was retained in three cases by bacteriological and or histopathological exams obtained from extra-vertebral lesions, and presumed in the fifth on a favorable treatment outcome. All patients had at least one extra-vertebral location of tuberculosis. Four patients were treated successfully with antituberculosis chemotherapy, prescribed for 18 to 22 months. Relapse occurred only in one patient, who received 12 months of treatment.Pott's disease can be observed in non immunocompromised patients. In the Lung Diseases Department, it is often revealed by thoracic manifestations and associated to pulmonary lesions, which makes the formal diagnosis easy. Here, vertebral tuberculosis does not have anatomical specificities; nevertheless, the multilevel forms are relatively frequent. It constitutes an index of bacillus dissemination, requiring the search for other extra-vertebral locations.

Bronchial lesion is a rare site for tuberculosis. It can mimic lung cancer especially when sputum- smear is negative, and this be a cause of a delay in diagnosis, that can be made later on by a culture of Koch bacillus or after a bronchial biopsy. Through these 4 cases reports, the authors recall the ethiopathogenic hypotheses of this lesion and review the radiologic, clinical and prognostic features of these unusual forms of TB.