[Amebic liver abscess and late recurrence with no travel in an endemic area]. / Abcès amibien hépatique avec récidive tardive en l'absence de séjour récent en zone d'endémie.

Amebic liver abscess is the main complication of amebic dysentery. Recurrences after treatment and apparent healing are very uncommon. The purpose of this report is to describe the case of a patient with a very late relapse of an amebic liver abscess, 10 years after the first episode. This recurrence seems due to an incomplete initial treatment. This case illustrates the reason for and importance of complying with the current therapeutic strategy: nitroimidazole followed by a luminal agent to eradicate intestinal amebic colonization.

[MR spectroscopy of the prostate with external surface coils: clinical feasibility]. / Spectro-IRM de prostate avec antennes externes: faisabilité en pratique clinique?

PURPOSE: To determine the clinical feasibility of MR spectroscopy (MRS) of prostate cancer using external multi-channel surface coils at 1.5T. Materials and methods. Retrospective study of 31 patients with prostate cancer who underwent MRS as part of the staging work-up prior to radical prostatectomy. The ratio of the three main metabolites ([choline + creatine]/citrate) were measured along with spectral analysis of different regions of interest (ROI) placed in areas of normal tissue and cancer using the surgical specimen as the standard of reference. RESULTS: One hundred and eighty-three voxels were analyzed. Qualitative visual analysis identified pathological spectra in 88.5% of cancer ROI, 11.7% of normal transitional zone ROI and 1.6% of normal peripheral zone ROI. The ratios of normal prostate tissue were significantly more elevated (p<0.0001) in the transition zone (0.41 +/- 0.24) than in the peripheral zone (0.22 +/- 0.36). Tumor containing voxels had significantly higher ratios (2.84 +/- 2.74) than normal tissue containing voxels of the transition zone (p<0.0001) and peripheral zone (p<0.0001). CONCLUSION: Prostate MRS using external surface coils appears routinely feasible at 1.5T, even though it presents some limitations.

[Results of fine-needle aspiration cytology (FNAC) in the diagnosis of indeterminate solid renal tumours]. / Résultats de l'aspiration cytologique à l'aiguille fine dans le diagnostic des tumeurs solides du rein de nature indéterminée.

OBJECTIVE: To evaluate the accuracy of fine-needle aspiration cytology for the diagnosis of imaging indeterminate solid renal tumours. MATERIALS AND METHODS: From February 2003 to February 2009, 60 cytoaspirations have been performed to 20 female and 40 male patients (average age: 62.0+/-14.2 years) with an indeterminate solid renal mass by imaging. The average tumour size was 3.4+/-2.8 cm. The cytoaspiration was performed through a 22 Gauge needle under CT (n=39) or US (n=21) guidance. Papanicolaou staining was used. All slides were examined by one experienced cytologist without any clinicoradiological information. The results were given as malignant, benign, suspect or non significant. A classification of subtypes of renal cancer might be added by the cytologist. RESULTS: Twenty-one cytoaspirations (35%) were non significant while 39 (65%) showed cells of interest. Among these 39 cellular cytoaspirations, the specificity for malignancy or benignity was 89.7%. The proportion of non-significant samples was the same in tumors lesser than 2 cm (38.4%) as in tumors 2-4 cm (38.8%) (p=1.000, Fisher's exact test). Subtype identification was only reliable for clear cell carcinomas. No complication was observed. CONCLUSION: The fine-needle aspiration cytology is an auxiliary technique for the diagnosis of indeterminate solid renal tumours. This simple and mini-invasive technique had a high specificity but a low sensitivity in our experience. Fine-needle aspiration is complementary to core biopsy which remains the gold standard of percutaneous sampling.

[Real-time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study]. / Echographie de contraste temps réel dans la prise en charge diagnostique des lésions nodulaires hépatiques: évaluation des performances diagnostiques et de l'impact économique sur une étude multicentrique française.

The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

[Mediastinal and abdominal lymphoedema: consequence of massive pulmonary embolism with shock?]. / Lymphoedème médiastinal et abdominal: conséquence d'une embolie pulmonaire massive avec choc?

We report a case of severe pulmonary embolism diagnosed using spiral CT-scan in a patient admitted for shock associated with acute abdominal symptoms. Intraluminal clots images were visualized associated with an infiltration of mediastinal fat. Abdominal CT showed infiltration of the hepatobiliary hilum. After thrombolysis, the clinical thoracic and abdominal symptoms improved. A CT-scan at the 48(th) hour showed that the thoracic and abdominal features had disappeared. We emphasize the misleading aspect of the CT-scan images and we speculated that this infiltration could reflect the abdominal and mediastinal lymphoedema.

[Bile duct papillomatosis: unrecognized preoperative diagnosis]. / La papillomatose des voies biliaires: un diagnostic préopératoire méconnu.

The diffuse biliary or pancreatic papillomatosis is a rare pathology. Reported cases in the literature underscore the difficulties of preoperative diagnosis of these lesions, their extensive nature, their tendency to relapse, and their malignant potential. The case that we report differs by the isolated involvement of the biliary tract and by the increasing role of imaging (MRCP) for diagnosis and follow-up.

[Imaging of intraductal papillary mucinous tumor of the pancreas: literature review]. / Imagerie des tumeurs intracanalaires papillaires mucineuses du pancréas: revue de la littérature.

Intraductal papillary-mucinous tumor (IPMT) is defined as a syndrome consisting of dilatation of the main pancreatic duct and/or branch ducts associated with mucin overproduction. The purpose was to evaluate the usefulness of different imaging techniques (CT, EUS, ERCP) for determination of tumor invasion and pancreatic extension. Diagnosis often is delayed because it is confused with chronic pancreatitis or cystic neoplasms of the pancreas. It is difficult to rule out invasive malignancy. MRCP can be an essential imaging modality because it is a non-invasive technique. Intraductal ultrasound or pancreatoscopy could become in the future an additional useful preoperative procedure. A high frequency of invasive carcinoma in patients operated for pancreatic IPMT is observed. Surgical resection should be extended until a normal tissue margin is encountered.

[Right atrial angiosarcoma and MRI: a case report]. / Angiosarcome de l'oreillette droite et IRM: à propos d'un cas.

The authors report a case of right atrial angiosarcoma in a 29 year old man presenting with massive pericardial effusion. This case illustrates the value of MRI in the preoperative evaluation, providing accurate information about the site and extension of the tumor, and even about the malignant nature of the lesion. Multiplanar transesophageal echocardiography did not provide any additional information in this case.

Contribution of ultrasonography and cholescintigraphy to the diagnosis of acute acalculous cholecystitis in intensive care unit patients.

OBJECTIVES: To assess the respective value of ultrasonography (US) and morphine cholescintigraphy (MC) in the diagnosis of acute acalculous cholecystitis (AAC). DESIGN AND SETTING: Prospective study in an intensive care unit of a university hospital. PATIENTS AND INTERVENTION: Twenty-eight patients with clinically and biologically suspected of AAC. US was performed at the bedside and less than 12 h later MC. US was considered positive if three major criteria were present: wall thickness greater than 4 mm, hydrops, sludge; MC results were regarded as positive if the gallbladder could not be visualized. These latter patients underwent cholecystectomy and the diagnosis of AAC was confirmed through histopathological study. MEASUREMENTS AND MAIN RESULTS: Sensitivity of US and MC, respectively, was 50% and 67%, specificity 94% and 100%, positive predictive value 86% and 100%, negative predictive value 71% and 80%, and accuracy 75% and 86%. The correlation between US and MC findings was 71%, with chi = 0.31. By Bayesian analysis the probability of disease if the MC finding was positive was 100% regardless of US results. A positive US finding was associated with a 86% probability of disease, but with a probability of only 66% in case of negative MC results. MC is thus superior to US for confirming AAC in selected critically ill patients. Nevertheless, US is an easy, noninvasive, and effective method of bedside screening. The combination of the two imaging tests improves diagnostic accuracy and reduces false-positive and false-negative rates. Poor agreement between the two tests leads to better diagnostic complementarity.

Contribution of cholescintigraphy to the early diagnosis of acute acalculous cholecystitis in intensive-care-unit patients.

Thirty-two intensive care unit patients (78% on long-term total parenteral nutrition) suspected of having acute acalculous cholecystitis (AAC) were studied prospectively. All of these patients underwent abdominal ultrasonography and cholescintigraphy with technetium-99m mebrofenin. Morphine sulphate (0.04 mg/kg) was administered only if the gallbladder was not visualised after 1 h (16 patients). The final diagnosis was reached after clinical improvement, or upon the discovery of another aetiology for the symptoms presented, or on the basis of histopathology following cholecystectomy (when this was performed). We analysed the contribution of individual cholescintigraphic findings (I: non-visualisation of the gallbladder during the first 60 min of the examination; II: persistent non-visualisation of the gallbladder 30 min following morphine administration; III: non-visualisation of the small bowel for at least 90 min) and their various combinations. We obtained a sensitivity of 79% and a specificity rate 100% using the interpretative criteria "I and II or III". Excluding obstructive syndrome ("I and II"), the sensitivity and specificity figures were 70% and 100% respectively (28 patients). We had no false-positive results in our patient population. Cholescintigraphy was found to complement ultrasonography, which had either good sensitivity (93%) and poor specificity (17%), when at least two of the three major signs were present (sludge, thickened wall, gallbladder distension), or poor sensitivity (36%) and good specificity (89%) when all three signs were present. We conclude that cholescintigraphy is a useful tool for early diagnosis of AAC in critically ill patients, in whom ultrasonography alone does not provide enough information to permit a sufficiently early decision regarding the use of surgery.

Role of oral contraceptives in the growth of a multilobular adenoma associated with a hepatocellular carcinoma in a young woman.

BACKGROUND: The occurrence of hepatocellular neoplasms is frequently reported in young females. The role of oral contraceptives in the development of these tumors is considered. METHODS: A 14-cm tumor was diagnosed in a 24-year-old female who had been taking the contraceptive pill for the last 3 years. Numerous blocks of this lesion were histologically and immunohistochemically analyzed. Some fragments of the lesion were snap-frozen in order to search for sex hormonal receptors and hepatitis B and C virus. RESULTS: On histological examination, the tumor was found to be a hepatocellular, multilobular adenoma with small foci of hepatocellular carcinoma. Neither hepatitis B virus nor hepatitis C virus was found in serum or in the tumor. Nuclear estrogen receptors and progesterone receptors were detected by immunohistochemical analysis in both the adenoma and the carcinoma, but only progesterone receptors were detected by a radio-ligand binding assay in the tumor. CONCLUSION: This finding suggests that the contraceptive pill may stimulate the growth of hepatocellular, multilobular adenomas through the binding of hormonal compounds to their specific receptors within tumoral cells.

Prospective flow cytometric DNA analysis of hepatocellular carcinoma specimens collected by ultrasound-guided fine needle aspiration.

BACKGROUND: The survival of 52 patients with hepatocellular carcinoma (HCC) seen during the last 4 years was analyzed prospectively on the basis of disease stage and nuclear DNA content. METHODS: Ploidy was measured by flow cytometry (FCM). Cells for cytologic diagnosis and FCM were collected by ultrasound-guided fine needle aspiration. RESULTS: DNA aneuploidy, which was detected in 62% of the patients, did not correlate with clinicopathologic features, except in the sonographic aspect (P = 0.03). However, ploidy correlated significantly with survival; the survival times for patients with an aneuploid DNA index were significantly shorter than for those with a diploid index (P = 0.02). In a Cox multivariate analysis, DNA content was prognostically significant, as were the grade of cirrhosis severity and the echographic aspect. CONCLUSIONS: In addition to the clinicopathologic features observed, FCM DNA analysis of ultrasound-guided fine needle aspirates from HCC is a simple and valid method for estimating a prognosis of these patients.

[An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses]. / Une complication exceptionnelle de la sigmoïdite diverticulaire perforée: l'aéroportie avec abcès miliaires du foie.

A patient presented with gas in the portal vein and miliary liver abscesses due to perforation of a sigmoid diverticulitis abscess. The outcome was favorable after surgical treatment. Gas in the portal vein, a sign of extreme seriousness, is generally the result of intestinal necrosis from ileo-mesenteric artery infarction, responsible for more than 75% of deaths. Diagnosis of this exceptional complication, suggested from a straight abdominal film, was confirmed by hepatic ultrasound and scan imaging. Urgent surgical intervention can hopefully, as in the present case, result in the patient's survival.