Background. Persistent left superior vena cava (PLSVC) is a rare anomaly of the thoracic venous system. Case Report. We present a case of a patient with isolated asymptomatic PLSVC, who was diagnosed because of dyspnea revealing an associated asthma. An 18-year-old male patient complained of paroxystic sibilant dyspnea. He did not have any anomaly in physical examination. The chest X-ray revealed cardiomegaly with a widening of lower mediastinum. The electrocardiogram does not show any anomaly. Echocardiography showed the PLSVC. The thoracic contrast computed tomography of the chest showed ecstasies of the right cardiac cavities and a double superior vena cava. The patient did not have similar family cases. Respiratory functional explorations led to the diagnosis of an associated asthma. Currently, he is followed up periodically. Asthma was improved with inhaled corticosteroid treatment. Conclusion. PLSVC is rare but can have important clinical implications. Associated severe cardiac malformations must be systematically sought.
La blastomycose est une maladie fongique rare en Afrique, due souvent à l’inhalation de « Blastomyces dermatitidis ». La forme pulmonaire est la manifestation clinique la plus fréquente, pouvant aller de la forme asymptomatique jusqu’à la forme rapidement mortelle. Nous rapportons l’observation d’un patient tunisien âgé de 35 ans sans antécédents médicaux, hospitalisé pour une toux chronique, des douleurs basithoraciques bilatérales, fièvre et un amaigrissement. L’examen clinique a objectivé la fièvre ainsi qu’une tuméfaction sous cutanée para-vertébrale gauche en regard de la dixième vertèbre thoracique (T10). L’imagerie thoracique a objectivé des opacités alvéolaires et nodulaires bilatérales excavées par endroit. La recherche de bacille de Koch (BK) dans les expectorations était négative à l’examen direct et à la culture. La fibroscopie bronchique était normale. L’étude anatomopathologique de la biopsie de la masse dorsale a conclu à une blastomycose et le diagnostic a été confirmé par le résultat des cultures des fragments biopsiques de la masse sus décrite. Un traitement antifongique à base d’itraconazole a été instauré avec une amélioration clinique et radiologique. Ce cas illustre la difficulté diagnostique que peut poser la blastomycose, notamment, avec la tuberculose dans notre pays, d’où le retard thérapeutique.
Typical carcinoid tumors of the lungs carry an excellent prognosis after complete surgical excision. However, recurrence of these cancers remains poorly described in the literature and may occur many years after surgery.
We report a case of carcinoid tumor of the lung. Clinical presentation and follow-up were uneventful.
The 55 years old patient had got a surgical removal of a huge typical carcinoid tumor of the left lung. A left pneumonectomy with a mediastinal lymph node resection were performed. Thirteen years later, paraneoplastic acromegaly revealed a pulmonary and extrapulmonary recurrence of the tumor. We prescribed a chemotherapy regimen including Cisplatin and Etoposide.
Endocrine paraneoplastic syndromes are related to mutations in specifically known genes. Several mutations may become a promising therapeutic target in the future. In the case of neuro-endocrine pulmonary tumors, authors described BCOR gene mutation as an oncogenic development inducer and an eventual generator of ectopic tumoral secretions.
The more we get familiar with carcinoid tumor mutations, the closer we get to targeted therapy for non-resectable tumors.
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