Peripherally inserted central catheter placement in patients with coagulation disorders: A retrospective analysis.

OBJECTIVE: To assess the safety of peripherally inserted central venous catheter (PICC) placement in patients with altered and uncorrected coagulation parameters or receiving antiplatelet therapy. MATERIALS AND METHODS: Medical charts of all patients with major primary and secondary hemostasis disorders, combined hemostasis disorders or on antiplatelet therapy and who had undergone non-tunneled PICC placement from December 2009 to December 2013, were retrospectively reviewed. A hemostatic disorder was defined as a platelet count (PC)≤50×10(9)/L, an international normalized ratio (INR) ≥ 2, or an activated partial thromboplastin time (aPTT)≥66s, alone or in combination. Underlying hemostasis disorders were not corrected and antiplatelet therapy was not interrupted before PICC placement in any patient. 4, and 5-Fr single and dual lumen PICCs were used. RESULTS: A total of 378 PICCs were placed in 271 patients (180 men and 91 women; mean age=62±13.4years; range, 18-93 years)) with coagulation disorders. Eighty-nine (23%) PICCs were placed in patients who were receiving antiplatelet therapy (aspirin, clopidogrel, rivaroxaban). Thrombocytopenia was noted in 269PICC placements (71%). Among these patients, 23 had disseminated intravascular coagulation. Prolonged INR and aPTT were observed in 42 procedures (11.1%). PICC placement was achieved in all patients, with a mean number of 1.14 attempts. Peripheral venous access was obtained through the basilic and the brachial vein respectively in 295 (79.1%) and 83 (20.9%) of patients. The placements were performed by residents and fellows in 108 (28.5%) and 270 (71.5%) procedures, respectively. No early or late complications were reported after any procedure. No accidental puncture of the brachial artery occurred. CONCLUSION: In patients with severe primary and secondary hemostasis disorders, combined hemostasis disorders or on antiplatelet therapy, PICC placement is a feasible and safe procedure and does not require correction of coagulation parameters or discontinuation of antiplatelet therapy.

MRI assessment of local acute radiation syndrome.

OBJECTIVES: To describe local acute radiation syndrome and its radiological imaging characteristics. METHODS: We performed a retrospective study of patients who had suffered skin and deeper radiation damage who were investigated by magnetic resonance imaging (MRI). We compared the clinical findings, C-reactive protein (CRP) levels and MRI results. RESULTS: A total of 22 MRI examinations were performed between 2005 and 2010 in 7 patients; 6 patients had increased CRP levels and MRI abnormalities. They were treated by surgery and local cellular therapy. One patient had no CRP or MRI abnormalities, and had a spontaneous good outcome. Eighteen abnormal MR examinations demonstrated high STIR signal and/or abnormal enhancement in the dermis and muscle tissues. Three MRI examinations demonstrated skeletal abnormalities, consistent with radionecrosis. The four normal MRI examinations were associated only with minor clinical manifestations such as pain and pigmentation disorders. CONCLUSION: MRI seems to be a useful and promising imaging investigation in radiation burns management i.e. initial lesion evaluation, treatment evaluation and complication diagnosis. MRI findings correlated perfectly with clinical stage and no false negative examinations were obtained. In particular, the association between normal MRI and low CRP level seems to be related to good outcome without specific treatment. KEY POINTS: Local acute radiation syndrome (radioepidermitis) mainly affects the skin and superficial tissues. MRI findings correspond with clinical stage (with a strong negative predictive value). MRI outperformed X-ray examination for the diagnosis of bone radionecrosis. Diffusion-weighted imaging shows low ADC in bone and soft tissue necrosis. Perfusion sequence allows assessment of tissue microcirculation impairment.

Gadolinium enhancement in brain magnetic resonance imaging in progressive multifocal leukoencephalopathy after natalizumab monotherapy: is it really atypical?

Progressive multifocal leukoencephalopathy (PML) generally occurs in patients with impaired cellular immunity. Monoclonal antibodies also predispose the patient to PML as they depress the immune system. PML was classically characterized by a lack of inflammation and absence of gadolinium enhancement. However, gadolinium enhancement of PML lesions was first described in HIV-positive patients under therapy. We present a case of gadolinium enhanced PML lesions occuring after natalizumab monotherapy of a relapsing multiple sclerosis. Radiologists must be aware of this particular feature, as confirmation of the diagnostic of PML becomes more challenging. Namely, distinction between starting PML and multiple sclerosis enhanced additional active lesion is difficult and diagnosis must be established by combined analysis of full clinical evolution, brain MRI scans, and polymerase chain reaction of cerebrospinal fluid.

[Periprocedural management of hemostasis risk in interventional radiology]. / Prise en charge du risque hémostatique au cours des actes de radiologie interventionnelle.

Given the increasing demand for interventional image-guided procedures, radiologists are increasingly sollicited by clinicians to participate in the management of patients prior to and after the interventional procedure, especially with regards to hemostasis. Therefore, radiologists should be familiar with the risk of procedure related hemorrhage. Based on consensus guidelines published by the Society of Interventional Radiology (SIR), the risk of hemorrhage for each interventional procedure will be classified. Recommendations for preprocedure testing based on the type of procedure planned will be reviewed. Finally, limitations of hemostasis parameters will be discussed along with management of anticoagulants and antiplatelet agents before the procedure.

[Catamenial pneumothorax with diaphragmatic lacerations]. / Brèches diaphragmatiques majeures au cours d'un pneumothorax cataménial.

The authors describe a case of catamenial pneumothorax with diaphragmatic lacerations and partial liver herniation. It's a rare presentation of catamenial pneunmothorax. We analyse the diagnostic and surgical therapeutic.

[Rhinocerebral infections in immunosuppressed patients with hematological disorders]. / Infections rhinocérébrales chez l'immunodéprimé en hématologie.

Invasive rhinosinusitis, occurring almost exclusively in immunosuppressed patients, is defined by the presence of local inflammation with vascular and osseous necrosis with extensive soft tissue extension. Imaging and bacteriological and even histological (mycelial filaments) criteria have been established. Because it can evolve to death in patients with hematological disorders, accurate diagnosis is important but difficult to achieve due to the non-specific nature of signs and symptoms. Imaging plays an important role with CT of the paranasal sinuses and MR imaging of the brain for early diagnosis and treatment in order to improve prognosis. We will present the imaging features of three cases of rhinocerebral infections, with two cases of fungal infection and one case of invasive bacterial sinus infection.

[An unusual MRI observation of neurosarcoidosis]. / A propos d'une observation singulière de neurosarcoïdose.

Sarcoidosis is a multisystemic granulomatous disease, characterized by the formation of an inflammatory lesion, the noncaseating giant-cell granuloma. Neurosarcoidosis represents only 5% of cases, but this figure is probably an underestimation. Diagnosis is difficult because of its clinical and radiological polymorphism. Magnetic resonance imaging (MRI) represents the "gold standard" of central nervous system exploration. We report here on an atypical example of primary neurosarcoidosis, according to MRI semiology, with preferential involvement of the Virchow-Robin perivascular spaces.

[A rare cause of epigastric pain: isolated spontaneous dissection of the celiac artery, a case report]. / Une cause rare de douleur épigastrique: la dissection spontanée isolée du tronc coeliaque, à propos d'un cas.

Spontaneous dissection of visceral arteries, and more particularly of the celiac artery, is a rare event. We report an exceptional case of an isolated spontaneous dissection of the celiac artery which occurred in a 53-year-old man seen in an emergency setting for suspected acute pancreatitis. Computed tomography enabled the diagnosis, revealing spontaneous isolated dissection of the celiac artery, associated with a small aneurysmal dilatation of the artery. Based on a review of the literature and this clinical experience, we recall the contribution of computed tomography and 3D reconstructions to the diagnosis, the therapeutic strategy and the follow-up of spontaneous dissection of visceral arteries.

[Carotido-cavernous fistula after traumatic brain injury: an unusual vascular complication]. / Fistule carotidocaverneuse post-traumatique : une complication vasculaire inhabituelle.

The authors reported the case of a young man who suffered a cranial traumatism and showed neurological, ophthalmic and orbital signs with orbital bruit, cranial nerve palsy and chemosis while he was in the intensive care unit. Further examinations of imagery made it possible to highlight a high-flow carotid-cavernous fistula which was the origin of these symptoms and which was successfully treated by endovascular way. The aim of this article is to remind the reader of the characteristics of this pathology, in terms of epidemiology, physiopathology, clinical and paraclinical presentation, and therapeutic care.

[Asymptomatic pulmonary embolism and venous thrombosis of the lower limbs. Study with spiral x-ray computed tomography]. / Embolie pulmonaire asymptomatique et thrombose veineuse des membres inférieurs. Etude par tomodensitométrie hélicoïdale.

AIM: Spiral Computed Tomography (CT) allows diagnosis and follow-up in pulmonary embolism (PE). MATERIAL AND METHOD: We studied prospectively with spiral CT 21 patients to evaluate the frequency and the extent of asymptomatic PE in the patients with lower limbs venous thrombosis and no pulmonary symptomatology. RESULTS: We observed a asymptomatic PE in 8/21 cases (34%). Extensive pulmonary thrombosis could be observed despite normal presentation. There was no association between the localization of PE topography and, the extent of the lower limb venous thrombosis extent. CONCLUSION: This study shows about the capability for CT to evaluate PE severity and clinical underestimation PE occurrence.

[X-ray findings in pulmonary tuberculosis in children and its complications]. / Les données de la radiologie dans la tuberculose pulmonaire de l'enfant et ses complications.

Pulmonary tuberculosis is still a common disease in children, especially those of immigrant families. Prevention and diagnosis rest on the plain chest film which should remain the first step of the work-up. Apart from cerebromeningeal complication, CT scan is also useful for evaluating chest lesions including mediastinal lymphadenopathies and lung parenchyma involvement. CT scan combined with endoscopy ensures detection of complications including bronchogenic dissemination. With a few cases as illustrations, the role of roentgenographic investigations in the management of pediatric tuberculosis is outlined.

[Contribution of scanner in the diagnosis of intestinal infarction]. / Apport du scanner au diagnostic d'infarctus intestinal. A propos de deux observations.

The clinical expression of arterial mesenteric infarction is not always acute and typical. In venous thrombosis, clinical signs of aggravation occur after a long development. So, clinical pictures of bowel infarction use not be suggestive. For these patients, US performances are sometimes subject to doubt and deceptive. Therefore, CT findings are of the highest importance. In two cases, the authors remind us the CT characterization of vascular and intestinal abnormalities.