Tubular duplication of the esophagus. Contribution of magnetic resonance imaging in anatomical analysis before surgery.

The authors report a tubular duplication of the thoracic esophagus in a 17-year-old male. This anomaly, rare in the adult, can be explained either by a failure of esotracheal compartmentalisation, or a notochordodysraphy or more probably by an error during vacuolisation of the esophagus. The anatomical characteristics of the duplication were clearly seen on MRI. This investigation showed the intramural duplication, with only a thin barrier without muscle, between the esophageal lumen and the duplication channel: two communications were present between the esophageal lumen and the duplication. The esophagus was accessed by right thoracotomy. The close contact between the duplication and the esophagus did not allow them to be separated. A subtotal esophagectomy was necessary, with digestive continuity being restored by coloplasty after a left cervicotomy and a laparotomy. The anatomy seen on the MRI should have predicted that an esophagectomy was necessary and that a thoracotomy could have been avoided by performing the procedure with a closed thorax.

[The contribution of imagery in the early diagnosis of Fournier's gangrene]. / Apport de l'imagerie dans le diagnostic précoce de la gangrène de Fournier.

Scrotal ultrasonography, completed by MRI, allowed the early diagnosis of a case of Fournier's gangrene, before the appearance of subcutaneous crepitation allowing rapid treatment adapted to the extent of necrosis. Ultrasonography is recommended in the assessment of inflammatory disease of the scrotum and/or perineum. MRI is able to refine the ultrasonographic data, and define the extent of gangrene as well as its starting point.

[Orbital lymphangioma: a clinical and radiological entity. Apropos of a case]. / Le lymphangiome orbitaire: une entité clinique et radiologique. A propos d'une observation.

We reported on the case of a seven years-old boy suffering from an acute unilateral proptosis. Diagnosis of orbital lymphangioma was made with Magnetic Resonance Imaging (MRI) showing an intra-tumoral hemorrhage in a vascular tumor unrelated to general circulation. Authors underlined the interest of MRI due to its unique ability to characterize hemorrhage with hemodynamic isolation and to plan therapeutic approach. Even controversial, conservative management remained the best choice but surgery should be considered if vision is threatened.

[Emergency lung resections for invasive aspergillosis in neutropenic patients]. / Résections pulmonaires en urgence pour aspergillose invasive chez des patients neutropéniques.

Mortality due to Invasive Pulmonary Aspergillosis (IPA) remains high in neutropenic patients due to pulmonary haemorrhage. The aim of this study was to evaluate the emergency surgical management of IPA. Seven neutropenic patients, with a mean age of 47 years (range: 30-64) (4 women and 3 men) were treated for (6 cases) acute leukaemia one Myeloma (1 case). Presumptive diagnosis of IPA was based on: Halo sign (n = 6) or air-crescent sign (n = 1) on CT scan, positive serology (n = 4), positive antigenemia (n = 3) and positive broncho-alveolar lavage (n = 1). In 2 cases, IPA diagnosis was only based on CT scan. In all cases, aspergillosis lesions were located near the left (n = 5) or right (n = 2) pulmonary artery. The type of pulmonary resection was: left superior lobectomy in 3 cases, left superior lobectomy and Fowler's segmentectomy in 1 case, Left inferior lobectomy in 1 case, right superior lobectomy in 1 case and middle lobectomy and paracardiac segmentectomy. Sleeve resection of the pulmonary artery was performed in two patients. There were no deaths or major postoperative complications. Mean hospital stay after surgery was 12 days (rang: 8-19). Histological examination confirmed the diagnosis of IPA. CT is essential to determine the optimal timing for surgery.

[Primary sarcoma of the pulmonary artery]. / Sarcome primitif de l'artère pulmonaire.

On the basis of one personal case of leiomyosarcoma, the various anatomicoclinical features of sarcomas of the pulmonary artery are summed up. They most often produce a picture of severe pulmonary embolism that is resistant to all treatments; the lesion most often is a hilar mass without any associated bronchoscopic abnormality. Angiograms are not always easily interpreted, and the modern imaging techniques (ultrasound, computed tomography, and above all MRI) can best lead to the preoperative diagnosis, although this lesion is unfrequent.

[Plastic coating in the surgical treatment of intracranial aneurysms. Late results of twenty cases (author's transl)]. / L'enrobage par matière plastique : complément important de la chirurgie actuelle des anévrysmes des artères cérébrales suites éloignées d'une série opératoire de 20 cas.

The authors reported the late results of a serie of fifteen intracranial aneurysm treated by plastic coating. These fifteen patients belong to a group of twenty cases operated with this technic. Four patients were pre-operatively in stade V. One patient died massive pre-frontal infract probably to retractor. In the same period, seventy-two others patients were operated for intracranial aneurysm by usual clip. The fifteen patients with plastic coating have been from two years to seven years observed. One case of minor epilepsy, one case of meningitis good imprevoded were noted. In this serie, no relapsing meningeal hemorrhage, is noted.