Single Pulmonary Nodule Management: Experience of a Moroccan Center about 24 Patients

Introduction: The management of single pulmonary nodule remains difficult, since it is of multiple etiologies. The endemicity of tuberculosis and hydatidosis in our context makes the etiological orientation even more difficult. Materials and Methods: This is a retrospective study, involving 24 patients, all operated on for a single pulmonary nodule in the department of thoracic surgery of CHU Hassan II of Fez over a period of 8 years. Results: There were 15 men and 9 women, with an average age of 51 years. 45.4% of patients had a history of known neoplasia. Discovery was fortuitous in 54% of cases. The radiologic diagnosis based on thoracic computed tomography had objectified an isolated nodule in all the patients with a right localization in 71% of the cases It was a solid pulmonary nodule in 91.5% of cases, and a frosted glass appearance in 8.5%. Bronchial fibroscopy was contributory in one case which was a carcinoid tumor. The approach was a conservative postero-lateral thoracotomy in 22 patients. The gesture was atypical resection in 67%, and lobectomy in 24.5% of cases, in the context of centrilobular nodules. The etiologies were dominated by pulmonary metastases in 29% of cases, pulmonary tuberculosis in 21% of cases. The postoperative course was simple in all patients. Conclusion: The pathological antecedents and the characteristics of the nodule on the imaging are essential elements allowing an etiological orientation. However, the pathological study remains the only method to confirm the diagnosis.

Surgical Management of Pyothorax: A Series of 172 Cases

Introduction: The pyothorax or thoracic empyema is defined by the presence between the two pleural layers of a purulent liquid, or a non-purulent liquid, but with bacteriological or biochemical characteristics testifying to a microbial invasion. The use of early medical treatment prevents the passage to pleural encystment, whose management remains surgical. Material and Methods: Our study was performed retrospectively, in the department of thoracic surgery of CHU Hassan II of Fez, between 2010 and 2016, involving 172 patients operated for pyothorax. Results: Among the 172 patients included in our study, there were 110 men and 67 women. The average age was 32.11 years old. The clinical picture was dominated by pleural syndrome in 56% of cases, signs of tuberculous impregnation in 44.1% of cases. Preoperative preparation with thoracic drainage, bi-antibiotic therapy and respiratory physiotherapy was performed in 90% of cases. The attack was right in 55.8% of cases and left in 44.1%. A chest CT scan performed in all patients showed pachypleuritis in all cases. The tuberculous pyothorax accounted for 54% of cases, those by intra pleural rupture of a pulmonary hydatid cyst in 10.4%, para-pneumonic origin in 5.2% and post-traumatic in 4.06%. The origin was undetermined in 26.16%. A conservative posterolateral thoracotomy was performed in all our patients. The pulmonary release was done through the extrapleural plane in 94% of cases, and pleuropulmonary decortication performed in all cases. Atypical resection was associated in 4.3% of cases and peri-cytectomy in 13.9% of cases. Operative follow-up was simple in 79.6% of cases. The main postoperative complications were a prolonged aerial leak in 16.7%, atelectasis in 4.5%, a wall infection in 6.5%, a hemothorax refrained in 3.2% of cases. The average follow-up was 2.5 years. Conclusion:?Tuberculosis remains the most common etiology of pyothorax in our setting. Early management plays an important role in reducing the morbidity and mortality of this pathology. However, surgery remains the only effective treatment at the pleural encystment stage.

About 2 Cases of Accidental Discovery of Broncholithiasis

Broncholithiasis is the presence of calcified material in the bronchial lumen. Bronchial fibroscopy and thoracic CT are the main paraclinical elements for diagnosis. However, most broncholithiasis is fortuitous discovery intraoperatively. The evolution may be marked by complications in the underlying lung, or fistulization in the mediastinal structures especially the esophagus. Early on, management can be simple monitoring or endoscopic extraction of broncholithiasis. Surgery remains the only option in case of complications. The authors report 2 cases of broncholithiasis, one of which was diagnosed radiologically and the other of incidental discovery during the surgical exploration of a lesion of the right lower lobe.

Cerebral Abscesses Revealing Pulmonary Arteriovenous Malformations

Pulmonary arteriovenous malformations （AVM） lung is defined by an abnormal communication between pulmonary artery（ies） and vein（s） responsible for a right-left shunt. Congenital forms are most common and usually associated with Rendu-Osler disease （ROD）. Inversely, 15-45% of patients with ROD present lung AVM Nowadays, embolization is preferred to surgical resection in the majority of cases. Except for certain cases where surgery is indicated. This paper shows the role of surgery in AVMs.