We report two observations of unusual mass in the posterior mediastinum: hemangioma, with differe... more We report two observations of unusual mass in the posterior mediastinum: hemangioma, with different imaging features. In one case, it was a sharply marginated mass of the paraspinal region with limited extension into the adjacent foramina. In the second case, it was a posterior mediastinal mass with a large intra-spinal extension. On CT, the two masses did not contain calcifications according to phleboliths. In CT and MRI, they showed moderate enhancement in the first case and intensive enhancement in the second case. On T2 weighted sequences, the two masses showed a very high signal. These imaging features are relatively unspecific but indicative to think about mediastinal hemangioma as important differential diagnosis. Therefore MRI is very important to give the clues for the diagnosis, even if neurogenic tumors are the most frequent masses in this location.
Cardiac myxomas are the most common benign tumours of the heart. In spite of their benign nature,... more Cardiac myxomas are the most common benign tumours of the heart. In spite of their benign nature, these tumours may induce metastasis or recurrences. Their diagnosis is challenging because of the lack of specific signs, and positive diagnosis is based on microscopic findings. We report a case series of 6 patients documented by radiologic and microscopic findings. In addition, one case was unique due to its location in the right atrium. Tumours were detected by trans-oesophageal ultra-sound examination in all cases. They were located in the left atrium in five cases and in the right side in one case. All patients underwent a successful surgical excision with en-bloc removal of the tumour. The outcome was fatal in one patient because of atrial arrhythmia.
L'intervention chirurgicale faite en urgence confirme le diagnostic et une desobstruction des... more L'intervention chirurgicale faite en urgence confirme le diagnostic et une desobstruction des troncs arteriels iliaque et femoraux de l'aorte est pratiquee. La thrombose en fait n'interesse pas les arteres renales. Les etiologies de thromboses de l'aorte chez l'enfant sont passees en revue et discutees ainsi que les differents moyens d'exploration. Une conduite a tenir est degagee
Indian Journal of Thoracic and Cardiovascular Surgery, 2017
Combined heart surgery and lung resection remains a controversial issue. The treatment of two maj... more Combined heart surgery and lung resection remains a controversial issue. The treatment of two major conditions in the same operative time may be attempted in certain cases. We report the case of a 68-year-old man who presented for dyspnea on exertion. The chest computerized tomography scan showed an infiltrating tumor which involved the right interlobar artery. A pneumonectomy was indicated and the preoperative echocardiography detected a calcified aortic valve with severe stenosis and significant pressure gradient. The patient had combined pneumonectomy and aortic valve replacement through median sternotomy and was discharged 18 days after surgery. Cardiac valve replacement is feasible in conjunction with pulmonary resection. However morbidity is increased in case of associated pneumonectomy.
19 e Congrès de pneumologie de langue française-Lille, 30 janvier-1 er février 2015 A173 survenue... more 19 e Congrès de pneumologie de langue française-Lille, 30 janvier-1 er février 2015 A173 survenue de complications à type de : infection de cavité résiduelle (2 cas), embolie hydatique (1 cas) et récidive de l'hydatidose pulmonaire (1 cas). L'HPM pose essentiellement un problème thérapeutique ce qui incite à souligner l'importance de la prévention de la maladie. Déclaration d'intérêts Les auteurs n'ont pas transmis de déclaration de conflits d'intérêts.
Background: Thymomas are rare tumors with a challenging management. After a review of the literat... more Background: Thymomas are rare tumors with a challenging management. After a review of the literature, we noticed the absence of a simplified decisional diagram. We aimed to present a scheme for the management of these tumors based on the experience of a Tunisian multi-disciplinary team and a review of the literature. We report a retrospective study 100 thymomas diagnosed between 1994 and 2011. We also performed an exhaustive PubMed research using the keywords: Thymoma, prognosis, management. We noticed, that the most famous studies were reported in the 1990s with most of them being a review of the literature. The proposed decisional diagram is quite similar to the National Comprehensive Cancer Network (NCCN) guidelines with some particularities. These particularities consist in the recommendation of an initial surgical resection even in advances disease (stages IIIb or IVa) and the association of a radiation therapy in R1 or R2 stages I, II, and IIIa thymomas. This study highlights the necessity of further research performed in the field of thymoma in order to answer the unresolved question. This work seems to be necessary and helpful in daily practice of thoracic surgeons and clinicians.
From january 1984 to december 1999 we operate in our institution, 465 patients affected by lung c... more From january 1984 to december 1999 we operate in our institution, 465 patients affected by lung cancer. In the early post-operative period we observe two arterial peripheral embolic events. Treatment consist in surgical embolectomy by Fogarty probe under femoral way. We don't observe post-operative complications or any functional sequelae. For the two patients tumoral character of the embolism was confirmed this work confirm the need of pre-operative precautions to avoid this complication that way be severe when in diagnosed or treated lately.
We report a case of pleiomorphous pulmonary rhabdomyosarcoma observed in a 64-year-old patient wi... more We report a case of pleiomorphous pulmonary rhabdomyosarcoma observed in a 64-year-old patient with no history of soft tissue tumor. The tumor was found extending into the right lower and middle lobes. The intra-parenchymatous extension protruded into the middle lobular bronchus and was prolonged by a 4 cm polyp. The polyp extended up to the carina and reached the contralateral common bronchus. Outcome was fatal after surgery performed in an emergency setting due to asphyxia. Explorations could not be continued to determine the primary or secondary nature of the tumor. An intraparenchymatous endobronchial localization is uncommon. Primary rhabdomyosarcoma is generally a purely intra-parenchymatous tumor. The endobronchial localization has been described before but is very exceptional. This localization would also be exceptional for secondary rhabdomyosarcoma mimicking a primary malignant tumor. The histology study revealed an undifferentiated pleiomorphous tumor. Immunohistochemistr...
Presse médicale (Paris, France : 1983), Jan 4, 1999
Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominate... more Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominates, accounting for 40% of all cases of malignant costal tumors. Four patients (3 women, 1 man, mean age 28.2 years) were hospitalized for costal chondrosarcoma. Pain and tumefaction dominated the clinical presentation. Calcifications suggested the diagnosis in 3 cases. Curative surgery was performed in all cases. Postoperative radiotherapy was unable to improve prognosis in 2 patients. Chondrosarcoma of the ribs is characterized by a strong potential for invasive extension. Diagnosis is suspected on the basis of imaging findings and confirmed at pathology. Surgery is required. Chemotherapy and radiotherapy do not improve prognosis significantly.
We report two observations of unusual mass in the posterior mediastinum: hemangioma, with differe... more We report two observations of unusual mass in the posterior mediastinum: hemangioma, with different imaging features. In one case, it was a sharply marginated mass of the paraspinal region with limited extension into the adjacent foramina. In the second case, it was a posterior mediastinal mass with a large intra-spinal extension. On CT, the two masses did not contain calcifications according to phleboliths. In CT and MRI, they showed moderate enhancement in the first case and intensive enhancement in the second case. On T2 weighted sequences, the two masses showed a very high signal. These imaging features are relatively unspecific but indicative to think about mediastinal hemangioma as important differential diagnosis. Therefore MRI is very important to give the clues for the diagnosis, even if neurogenic tumors are the most frequent masses in this location.
Cardiac myxomas are the most common benign tumours of the heart. In spite of their benign nature,... more Cardiac myxomas are the most common benign tumours of the heart. In spite of their benign nature, these tumours may induce metastasis or recurrences. Their diagnosis is challenging because of the lack of specific signs, and positive diagnosis is based on microscopic findings. We report a case series of 6 patients documented by radiologic and microscopic findings. In addition, one case was unique due to its location in the right atrium. Tumours were detected by trans-oesophageal ultra-sound examination in all cases. They were located in the left atrium in five cases and in the right side in one case. All patients underwent a successful surgical excision with en-bloc removal of the tumour. The outcome was fatal in one patient because of atrial arrhythmia.
L'intervention chirurgicale faite en urgence confirme le diagnostic et une desobstruction des... more L'intervention chirurgicale faite en urgence confirme le diagnostic et une desobstruction des troncs arteriels iliaque et femoraux de l'aorte est pratiquee. La thrombose en fait n'interesse pas les arteres renales. Les etiologies de thromboses de l'aorte chez l'enfant sont passees en revue et discutees ainsi que les differents moyens d'exploration. Une conduite a tenir est degagee
Indian Journal of Thoracic and Cardiovascular Surgery, 2017
Combined heart surgery and lung resection remains a controversial issue. The treatment of two maj... more Combined heart surgery and lung resection remains a controversial issue. The treatment of two major conditions in the same operative time may be attempted in certain cases. We report the case of a 68-year-old man who presented for dyspnea on exertion. The chest computerized tomography scan showed an infiltrating tumor which involved the right interlobar artery. A pneumonectomy was indicated and the preoperative echocardiography detected a calcified aortic valve with severe stenosis and significant pressure gradient. The patient had combined pneumonectomy and aortic valve replacement through median sternotomy and was discharged 18 days after surgery. Cardiac valve replacement is feasible in conjunction with pulmonary resection. However morbidity is increased in case of associated pneumonectomy.
19 e Congrès de pneumologie de langue française-Lille, 30 janvier-1 er février 2015 A173 survenue... more 19 e Congrès de pneumologie de langue française-Lille, 30 janvier-1 er février 2015 A173 survenue de complications à type de : infection de cavité résiduelle (2 cas), embolie hydatique (1 cas) et récidive de l'hydatidose pulmonaire (1 cas). L'HPM pose essentiellement un problème thérapeutique ce qui incite à souligner l'importance de la prévention de la maladie. Déclaration d'intérêts Les auteurs n'ont pas transmis de déclaration de conflits d'intérêts.
Background: Thymomas are rare tumors with a challenging management. After a review of the literat... more Background: Thymomas are rare tumors with a challenging management. After a review of the literature, we noticed the absence of a simplified decisional diagram. We aimed to present a scheme for the management of these tumors based on the experience of a Tunisian multi-disciplinary team and a review of the literature. We report a retrospective study 100 thymomas diagnosed between 1994 and 2011. We also performed an exhaustive PubMed research using the keywords: Thymoma, prognosis, management. We noticed, that the most famous studies were reported in the 1990s with most of them being a review of the literature. The proposed decisional diagram is quite similar to the National Comprehensive Cancer Network (NCCN) guidelines with some particularities. These particularities consist in the recommendation of an initial surgical resection even in advances disease (stages IIIb or IVa) and the association of a radiation therapy in R1 or R2 stages I, II, and IIIa thymomas. This study highlights the necessity of further research performed in the field of thymoma in order to answer the unresolved question. This work seems to be necessary and helpful in daily practice of thoracic surgeons and clinicians.
From january 1984 to december 1999 we operate in our institution, 465 patients affected by lung c... more From january 1984 to december 1999 we operate in our institution, 465 patients affected by lung cancer. In the early post-operative period we observe two arterial peripheral embolic events. Treatment consist in surgical embolectomy by Fogarty probe under femoral way. We don't observe post-operative complications or any functional sequelae. For the two patients tumoral character of the embolism was confirmed this work confirm the need of pre-operative precautions to avoid this complication that way be severe when in diagnosed or treated lately.
We report a case of pleiomorphous pulmonary rhabdomyosarcoma observed in a 64-year-old patient wi... more We report a case of pleiomorphous pulmonary rhabdomyosarcoma observed in a 64-year-old patient with no history of soft tissue tumor. The tumor was found extending into the right lower and middle lobes. The intra-parenchymatous extension protruded into the middle lobular bronchus and was prolonged by a 4 cm polyp. The polyp extended up to the carina and reached the contralateral common bronchus. Outcome was fatal after surgery performed in an emergency setting due to asphyxia. Explorations could not be continued to determine the primary or secondary nature of the tumor. An intraparenchymatous endobronchial localization is uncommon. Primary rhabdomyosarcoma is generally a purely intra-parenchymatous tumor. The endobronchial localization has been described before but is very exceptional. This localization would also be exceptional for secondary rhabdomyosarcoma mimicking a primary malignant tumor. The histology study revealed an undifferentiated pleiomorphous tumor. Immunohistochemistr...
Presse médicale (Paris, France : 1983), Jan 4, 1999
Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominate... more Tumors of the rib cage are uncommon and malignant in 29% of the cases. Chondrosarcoma predominates, accounting for 40% of all cases of malignant costal tumors. Four patients (3 women, 1 man, mean age 28.2 years) were hospitalized for costal chondrosarcoma. Pain and tumefaction dominated the clinical presentation. Calcifications suggested the diagnosis in 3 cases. Curative surgery was performed in all cases. Postoperative radiotherapy was unable to improve prognosis in 2 patients. Chondrosarcoma of the ribs is characterized by a strong potential for invasive extension. Diagnosis is suspected on the basis of imaging findings and confirmed at pathology. Surgery is required. Chemotherapy and radiotherapy do not improve prognosis significantly.
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Papers by T. Kilani