Tarek Kilani

Bio: Tarek Kilani is an academic researcher from Tunis University. The author has contributed to research in topics: Rib cage & Chondrosarcoma. The author has an hindex of 13, co-authored 106 publications receiving 632 citations.

Hydatid disease of the liver with thoracic involvement.

Abstract: Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic disease in Mediterranean countries. The most frequent anatomic locations are liver and lung. Intrathoracic rupture of hydatid cysts situated in the hepatic dome is a serious complication resulting in damage to the pleura, pulmonary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithorax. Hepatic and thoracic ultrasonography was performed in all cases. The diagnosis of intrathoracic rupture of a liver cyst was confirmed preoperatively in 30 of the 40 cases. Posterolateral thoracotomy was performed in all patients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed 15 lobectomies, 10 wedge resections, 16 decortications, and in one patient simple drainage of a voluminous pleuropulmonary and hepatic purulent hydatic collection. The postoperative course was uneventful in 26 cases, but 14 patients had complications, from which 3 patients died. The therapeutic approach depends on ultrasonographic findings. We believe ultrasonography to be the best examination for assessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and is sufficient if the biliary tract is safe. An abdominal approach is necessary when biliary duct drainage is required, and it may be sufficient in cases of direct rupture into the bronchi.

Pulmonary hydatid and other lung parasitic infections

Abstract: The lung may be infested by a great number of parasites. Hydatidosis is the most frequent parasitic lung disease. Diagnosis of lung hydatidosis is usually easy on chest radiography, ultrasonography, and CT scan, and immunodiagnosis may help in dubious cases. Surgery is necessary in most cases, but it must be conservative. Complex forms, such as disseminated disease and secondary lung hydatidosis (metastatic or bronchogenic) are difficult to treat and may be considered malignant. Medical treatment may be helpful in complex forms, in poor surgical risk patients, and in cases of preoperative spillage of hydatic fluid. Prevention programs are necessary in endemic areas, and research must be directed toward vaccination against the parasite. Other parasitic diseases are reported less frequently in the literature, and the majority of published articles are either case reports or only report a small number of cases. Clinical presentation is variable according to the great variety of parasites that may involve the lungs.

Imaging of thoracic textiloma

Abstract: Objective: Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. Methods: Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magneticresonanceimaging(MRI).Results:Inpatientswithahistoryofabdominalsurgery,theforeignbodywaslocatedintheparenchymaofthe right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textilomainthreeof thefivepatientsbydemonstratinga non-calcifiedhyperechoicmasswithacousticshadow.At CT, thegossypiboma wasa lowattenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. Conclusions:The CTaspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CTsigns helps to have a preoperative diagnosis. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Hydatid disease from head to toe.

Abstract: Hydatid disease (HD) is a unique parasitic disease that is endemic in many parts of the world. HD can occur almost anywhere in the body and demonstrates a variety of imaging features that vary according to growth stage, associated complications, and affected tissue. Radiologic findings range from purely cystic lesions to a completely solid appearance. Calcification is more common in HD of the liver, spleen, and kidney. HD can become quite large in compressible organs. Hydatid cysts (HCs) can be solitary or multiple. Chest radiography, ultrasonography (US), computed tomography (CT), magnetic resonance (MR) imaging, and even urography can depict HCs. The imaging method used depends on the involved organ and the growth stage of the cyst. US most clearly demonstrates the hydatid sands in purely cystic lesions, as well as floating membranes, daughter cysts, and vesicles. CT is best for detecting calcification and revealing the internal cystic structure posterior to calcification. MR imaging is especially helpful in detecting HCs of the central nervous system. Radiologic and serologic findings can generally help establish the diagnosis of HD, but an HC in an unusual location with atypical imaging findings may complicate the differential diagnosis. Nevertheless, familiarity with imaging findings, especially in patients living in endemic regions, is advantageous in this context.

Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology.

Abstract: Congenital anomalies of the chest are an important cause of morbidity in infants, children, and even adults. The evaluation of affected patients frequently requires multiple imaging modalities to d...

The solitary pulmonary nodule.

Abstract: This study is a clinical pathological correlation based on 887 resected pulmonary masses. Because of the nature of the study and the source of the material there is a certain amount of selection. The patients were all males, and they had all been healthy enough to have been inducted into the armed services. Only 16 of 887 had significant other pulmonary disease. While the author draws few conclusions, the monograph itself asserts some very forceful points: second primary malignancies can and do occur and may present as pulmonary nodules; pulmonary granulomas can occur in patients with history of malignancy elsewhere; benign tumors of the lung can occur in patients who have had a previous malignancy; preoperative examination with bronchoscopy, cytologic study of the sputum, and scalene node biopsy offer a very low yield of positive diagnoses in pulmonary nodules; size cannot be used as a criterion for determining malignancy; tuberculosis