[Frequency of chest X-ray suggestive of SARS-CoV-2 involvement from March to May 2020 in the population of an urban health area]

OBJECTIVE

Know the number and percentage of chest X-rays (CXR) referred to a Primary Care Imaging Center and Primary Care Emergency Center to rule out lung involvement due to SARS-CoV-2 from March 16 to May 15, 2020, in an urban health area of about 400,000 reference population inhabitants. To determine the percentage of cases suggestive of pulmonary involvement due to SARS-CoV-2 CXR and the percentage of cases without pulmonary involvement of the total CXR derived in the reference population from March 16 to May 15, 2020.

MATERIAL AND METHODS

Design observational descriptive study. The radiological criteria to classify probable pulmonary infection by SARS-CoV-2 (RxT[+]) are: 1) focal opacity; 2) faint focal opacity; 3) faint diffuse increase in density; 4) focal or diffuse interstitial pattern, and 5) focal or diffuse interstitial alveolus pattern.

RESULTS AND CONCLUSIONS

Maintain CXR as a useful screening method in the middle stages of the disease, when CXR is more sensitive to detect lung involvement due to SARS-CoV-2. Our graph of affectation by SARS-CoV-2 does not present assessable differences with the expected curve in an epidemic.

[Chest wall tuberculosis: report of 3 cases]

Despite the dramatic decline in the incidence of tuberculosis during the last decades, the disease remains a significant public health problem especially in developing countries. Chest wall tuberculosis is a very rare location. Clinically, it can present as a pyogenic abscess or soft tumor, making diagnosis difficult, particularly in the absence of warning signs. Optimal therapeutic management is controversial. Medical treatment alone in often insufficient and must be associated with a surgical excision or debridement.

[Pediatric Ewing sarcoma of the rib: role of neoadjuvant chemotherapy in tumoral shrinking and sterilization. A case report]

Ewing sarcoma is a rare tumor, which represents, nevertheless, the most common primary chest wall tumor in children. The management and prognosis of these tumors have markedly improved with the use of multimodal therapy including adjuvant chemotherapy, surgery and/or irradiation. A good response to chemotherapy often avoids the need for extensive local treatment without sacrificing local control or long-term survival. Here, we report a new case of a bulky rib Ewing sarcoma, well managed by neoadjuvant chemotherapy resulting in significantly tumor shrinking that allowed complete resection. At the histological examination of the specimen, there was only inflammatory and fibrosis tissues without viable tumoral tissue.

[Pulmonary decortication: value of lung function recovery]

PURPOSE

Based on the experience in the thoracic surgery unit at Hôpital Militaire d'Instruction Mohammed-V in Rabat, this study analyses the indications as well as the results of pulmonary decortication.

MATERIALS AND METHODS

Twenty-five cases of pulmonary decortication were examined over a period of 5 years ranging from January 2002 to December 2006. The aetiology of chronic pyothorax was dominated by non tubercular causes. The clinical symptomatology mainly involved fever and dyspnoea (48% and 44% respectively). Pachypleuritis, collapse of the lung and pleural effusion account for most of the lesions found on the thoracic imaging. Surgery was indicated after failure in the medical treatment after four months on the average.

RESULTS

The respiratory function was assessed in 20 patients three months after the intervention. The improvement in the spirometry was good in 85% of the cases (n=17), was not highly satisfactory in 10% of the cases (n=2) and a deterioration was noted in 5% of the cases (n=1). This unfavourable evolution was correlated with the tubercular aetiology and the poor state of the pulmonary parenchyma.

CONCLUSION

Non tubercular causes, early diagnosis and absence of parenchymatous lesion seem to be predictive factors of good results after decortication.

[The surgical extraction of foreign bodies after the inhalation of a scarf pin: two cases]

The inhalation of a foreign body (FB) is rare in the adult although more common in the child. The type of FB varies greatly according to the dietary and educational habits of the populations studied. In Morocco, metal FB are common, especially the pins used to attach scarves. These pins migrate easily and wedge at a distance making them difficult to extract by endoscopy, thereby resulting in thoracotomy. The authors present two cases of the inhalation of a pin held in the mouth during a sudden emotion. Since the clinical symptomatology is inconspicuous, thoracic imaging is used to locate the FB. After a failure to extract it by rigid bronchoscopy combined with flexible bronchoscopy, the two patients underwent surgery. The sequellae were simple. Prevention in both the child and in the adult are the best way to avoid this incident that may have dramatic results.

[Primary leiomyosarcoma of visceral mediastinum]

Primary leiomyosarcoma of the thorax is a rare malignant mesenchymatous tumour. Most of those tumours occurring in the mediastinum arise from the oesophagus and great vessels, whereas an appearance in the soft tissue of the mediastinum is extremely rare. The rare incidence of this tumour and its slow growth reflect the difficulties in differential diagnosis according to their histopathology and location. The most common treatment is surgical resection. The authors describe a case of a leiomyosarcoma arising from soft tissue of the mediastinum and present a review of the literature.

[Pulmonary actinomycosis in a child]

Pulmonary actinomycosis is a rare bacteriological disease, characterized by local suppuration and an extensive fibro-inflammatory process, with a possible pseudotumoral outcome. We report on a case in a 15-year-old boy, admitted in our department for prolonged pleuropneumopathy. Clinical and radiological findings were not contributive. The diagnosis of actinomycosis was obtained by pathology after surgical resection. This disease can mimic on lung X-rays a number of disorders, such as pulmonary tuberculoma, invasive tuberculosis or lung carcinoma. Pleuropulmonary actinomycosis is a rare intrathoracic infection during childhood, of which poor outcome and tough diagnosis lead usually to a surgical attitude given a picture of recurrent pulmonary abnormality. When the diagnosis is established, the treatment is medical.

[Thyroid tuberculosis]

Thyroid is a rare localization of tuberculosis, and should be considered in the diagnosis of nodular lesion of the thyroid gland except for the complicated forms with collection in which the fine needle aspiration showed the acid fast bacilli on Ziehl-Neelson stain (Koch bacilli) and/or granulomatous inflammation with caseation necrosis. We report the case of a 70 year-old woman referred to the hospital with a diagnosis of endothoracic goiter without clinical signs of tuberculosis. The diagnosis was established after total thyroidectomy and histological exam. Six-month treatment with three antituberculous drugs was administered with a good outcome.

[Extra-pulmonary thoracic hydatid cysts]

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.

[Sequestration of the posterobasal segment of the right lower pulmonary lobe]

Pulmonary sequestration is a rare congenital malformation that receives its blood supply from a systemic artery. We report a case of pulmonary sequestration treated by ligature of the anomalous artery without pulmonary resection. Pulmonary sequestration must be treated surgically before the occurrence of severe complications.

[Surgical treatment of pulmonary hydatid cysts in childhood]

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.

[An unusual diagnosis of post-traumatic hemothorax]

We report the case of malignant pleural mesothelioma revealed by a post-traumatic hemothorax.