[Peritoneal parasitic teratoma and chemical dermoid peritonitis]. / Tératomes parasitiques péritonéaux et péritonites chimiques dermoïdes.

Chemical peritonitis occurs following intraperitoneal rupture of a mature ovarian dermoid. Rupture may be acute and spontaneous, typically during pregnancy, or iatrogenic. Low grade ruptures lead to parasitic peritoneal dermoid cysts, usually involving the greater omentum, cul-de-sac of Douglas and perihepatic region. Radiologists should be familiar with their appearance to correctly diagnose the condition and not mistake the disease for peritoneal carcinomatosis.

[Puerperal thrombophlebitis of the ovarian vein revealed by renal colic]. / Thrombophlébite puerpérale de la veine ovarienne révélée par une colique néphrétique.

The authors report the clinical case of a young woman with thrombophlebitis of the right ovarian vein following delivery by caesarean section, initially presenting in the form of renal colic. In the light of a review of the literature, they recall the pathophysiological mechanisms of ovarian thrombophlebitis and the various features observed on imaging examinations. The most frequent clinical features are also described. The authors emphasize the potential, but rare severity of this disease, characterized by the risk of pulmonary embolism, and its treatment, which is usually medical.

[Percutaneous treatment of superior vena cava obstruction]. / Désobstruction par voie percutanée de la veine cave supérieure.

Endovascular therapies represent the most efficient treatment of benign or malignant obstructions of the superior vena cava. The indication of stenting in case of malignant obstruction depends on the severity of the superior vena cava syndrome, the histological type of the tumor, and the response to radiotherapy and chemotherapy. Restoration of the superior vena cava patency is obtained in more than 90% of cases, with persistent good mid and long term results. Complications are rare, especially after early treatment. Stenting of benign obstructions, especially in patients who undergo hemodialysis, allows to restore venous accesses. However, indication of treatment may be discussed because the initial and late patencies are lower than in malignant obstructions.

[Puerperal thrombophlebitis and the ovarian vein with extension to the inferior vena cava]. / Thrombophlébite puerpérale de la veine ovarienne avec extension cave inférieure: aspects en échographie, TDM et IRM.

PURPOSE: To assess US, CT and MR findings in women having puerperal ovarian vein thrombosis with clot protrusion into the inferior vena cava. PATIENTS, MATERIAL AND METHODS: We retrospectively reviewed the duplex US (n = 9), CT (n = 5) and MR (n = 5) examinations of 9 patients with 8 right ovarian vein thrombosis, and one left ovarian vein thrombosis. RESULTS: US findings allowed for the diagnosis of ovarian vein thrombosis in all patients in showing enlarged tubular echogenic thrombus within the retroperitoneum with clot protrusion in the IVC in all cases. CT scan and MRI demonstrated ovarian vein thrombosis in all the cases in which it was performed but failed to show a mobile thrombus within the IVC in one patient. CONCLUSION: Duplex US is a reliable technique to show puerperal ovarian vein thrombosis and its extension to the IVC. CT scan and MR imaging can be used to precise the extension to the IVC.

[CT x-ray evaluation of abdominal and pelvic veins in patients suspected of acute pulmonary embolism with negative Doppler sonography]. / Evaluation TDM des veines abdominales et pelviennes chez les patients suspects d'embolie pulmonaire aiguë avec une échographie Doppler négative.

PURPOSE: To address prospectively the potential of CT of the abdomen and pelvis to demonstrate deep vein thrombosis in patients suspected of acute pulmonary embolism and investigated with helical CT of the pulmonary arteries. MATERIAL AND METHODS: 197 patients presenting non-diagnostic scintigraphy and negative Doppler US of lower limbs and IVC were included. They had helical CT of the pulmonary arteries (5mm collimation, 1:1 pitch, reconstruction every 2.5 mm, injection of 120 mL of contrast media at a rate of 3 mL/sec). Ninety seconds after the end of the thoracic acquisition, abdominal and pelvic CT were acquired (7 mm collimation every 12 mm). RESULTS: 3 (1.5%) of 197 patients had an unknown thrombosis of the caval system (renal vein, ovarian vein, lilac veins). A fourth patient had an unknown thrombosis of the mesenteric vein. All these patients had a pulmonary embolism (4/40). None of the 157 patients without pulmonary embolism at helical CT showed deep venous thrombosis. CONCLUSION: In our study, CT of the abdomen and pelvis disclosed an unknown thrombosis of a deep vein of the abdomen and pelvis that can explain the pulmonary embolism in 7.5% of patients.

[Does a universal strategy of acute pulmonary embolism diagnosis exist today?]. / Existe-t-il aujourd'hui une stratégie universelle de diagnostic de l'embolie pulmonaire aiguë?

In this review, we demonstrate that there is no universal diagnostic strategy for non-severe acute pulmonary embolism. The first part of the article is devoted to the concept of thromboembolic disease: its frequency, severity and diagnostic difficulties. The second part analyzes the tools used for diagnosis of pulmonary angiography, noninvasive venous studies, and helical CT angiography. The last part discusses current diagnostic algorithms for pulmonary embolism and the changes that may be introduced by the use of helical CT in clinical practice. The potential for MR imaging id discussed.

Portal vein thrombosis following splenectomy for hematologic disease: prospective study with Doppler color flow imaging.

We report the results of a prospective series of 60 consecutive splenectomies for hematologic disorders performed between February 1995 and May 1996. The portal venous flow of all the patients (34 men and 26 women with a mean age of 54.1 years) was systematically studied before and after intervention with Doppler color imaging (on the day before the intervention and on the 7th and 30th postoperative days). The objective of this study were to determine the real frequency of asymptomatic portal or splenic venous thrombosis (PSVT) after hematologic splenectomy. The intervention began with exteriorization of the spleen and the tail of the pancreas; ligation of the splenic vein was performed close to its junction with the inferior mesenteric vein. Twenty-three complications (38.3%) were noted with three deaths (5%). One symptomatic PSVT (1.6%) and three asymptomatic PSVTs (6.7%) were diagnosed and treated with no deaths. Three risk factors of PSVT, recognized by all the authors, were present in these four cases: large splenomegaly, thrombocytosis, or myeloproliferative disorder. The systematic ultrasonographic (US) examinations increased the frequency of diagnosis of PSVT sevenfold during the perioperative period. Patients with marked splenomegaly associated with lymphoma, chronic lymphocytic leukemia, or myeloid metaplasia probably require systematic US monitoring during follow-up, but this must be determined by further study.

Initial isolated Takayasu's arteritis of the right pulmonary artery: MR appearance.

Takayasu's arteritis involves the pulmonary artery tree in more than 50% of the cases. Initial isolated involvement of the pulmonary artery by Takayasu's arteritis, however, is very rare. We report the case of a 34-year-old white woman who presented a clinical and radiographic pattern that mimicked an acute pulmonary embolism with pulmonary infarction. Pulmonary angiography showed stenosis lesions and occlusion of the right pulmonary artery tree. Magnetic resonance imaging demonstrated thickening of the pulmonary artery wall leading to the correct diagnosis.

[Left ventricular insertion of a permanent pacemaker (radiographic aspect)]. / Insertion ventriculaire gauche d'une sonde de stimulation cardiaque définitive (aspect radiographique)

We report a case of inadvertent transarterial permanent pacing of the left ventricule that was not diagnosed on routine chest radiography or ECG. The malposition was diagnosed because of the rupture of the mitral valve cordage 2 months after pacemaker implantation. We emphasize the radiographic appearance of this rare malposition.

[Progress in tomodensitometry. Applications in cancerology]. / Progrès en tomodensitométrie. Applications en cancérologie.

Since 1992, spiral CT scanners replace conventional CT units in radiology departments. In the first part of this paper, we present some technical considerations concerning spiral CT (continuous rotation and emission of the source-detector; continuous translation of the patient at a constant rate through the gantry), as well as advantages and limitations of volumic acquisition. The main advantages can be summerized as: reduction of the acquisition time, optimization of contrast enhancement with intravenous opacification, and post processing allowing retrospective creation of overlapping images, multiplanar reconstructions, and 3-D reconstructions. Spiral CT improves lesions detection and characterization. Disadvantages are due to contrast media injection and radiation exposure. Then we describe clinical applications in the carcinologic field concerning pharyngo-laryngeal tumors, bronchogenic carcinoma, mediastinal tumors, pulmonary nodules, sub-diaphragmatic tumors. However, tumors of brain, spine, bone, and soft tissue are better explorated with MRI. Authors conclude on the future improvements of spiral CT.

[Diagnosis of broncholithiasis. Role of high resolution tomodensitometry]. / Diagnostic de la broncholithiase. Rôle de la tomodensitométrie haute résolution.

PURPOSE: to evaluate high resolution computed tomography (HRCT) in the diagnosis of broncholithiasis. PATIENTS AND METHODS: 10 patients with broncholithiasis underwent chest X ray, fiberoptic bronchoscopy (FOB), CT and HRCT. RESULTS: in 9 cases, chest X rays were abnormal but the diagnosis of broncholithiasis can't never be affirmed. In 9 cases, FOB was abnormal: broncholith were identified in only 2 cases; the other diagnosis were tumor like stenosis (n = 3), inflammatory stenosis (n = 3), extrinsic compression (n = 1). On conventional CT scan, broncholithiasis was suspected in 8 patients but because of volume averaging the relationship between calcified lymph nodes and bronchial tree was difficult to determine exactly. Only HRCT sections, sometimes tilted in the axis of the middle lobar bronchus, can affirm the endobronchial or peribronchial location of calcified lymph nodes in all patients. CONCLUSION: conventional CT scan can suggest the presence of broncholithiasis but HRCT sections are need to affirm the diagnosis.

[Intrathoracic hydatid cyst. Contribution of tomodensitometry. Apropos of 25 cases]. / Hydatidose intrathoracique. Apport de la tomodensitométrie. A propos de 25 observations.

Twenty-five cases of thoracic hydatic disease, studied by CT since 1982, are reviewed. Fifteen patients were Maghrebin, 10 were native. The lungs were interested 22 times, the mediastinum 3 times and the heart only once. Complications of hydatic disease were present 8 times. We compare contribution of CT to the other diagnosis criterious. Our results show the accuracy of CT for the diagnosis of non complicated cyst and the lack of specificity for complicated cysts.

[How can the extension of lung cancer to the osteo-muscular wall of the diaphragm, the pleura and the apex be assessed radiologically?]. / Comment évaluer radiologiquement l'extension des cancers pulmonaires à la paroi ostéo-musculaire, au diaphragme, à la plèvre et à l'apex?

The merits of evaluating the parietal extension of lung cancers is emphasized by the new TNM classification. CT and MRI have added to the conventional radiological techniques. The authors successively analyze the contribution of these techniques to the assessment of extension of lung cancers to the wall, including the costal and phrenic compartments, to the pleura and to the apex. Lung radiographs show obvious lesions, such as extensive costal lysis and major pleural extensions. Computed tomography has better sensitivity and specificity than lung radiographs to establish pleuroparietal involvement; it is best performed in the inclined plane of the ribs and in the high-resolution mode. The presence of costal lysis means parietal involvement, while the integrity of the pleura can be established if the lesion remains at a distance from the wall. The persistence of an extrapleural fatty rim between the tumor and the wall allows ruling out parietal extension. MRI provides accurate details in case of doubtful CT findings for the extension to the costovertebral groove, to the intervertebral foramina, to the peridural space and to the diaphragm. Its major asset is to assess the vertebral, vascular and nervous extension of cancers of the apex pulmonis.

[Diffuse infiltrative lung diseases: histological support of elementary lesions observed on tomodensitometry]. / Pneumopathies infiltratives diffuses: support histologique des lésions élémentaires observées en tomodensitométrie.

High resolution computed tomography (TDM-HR) is now the technique of choice in the diagnosis and management of diffuse infiltrative lung disease (PID). After a brief review of the technique the authors describe the normal appearance; anatomical observations and the in vivo findings have shown that TDM-HR allow for the exploration of details of structure down to the second pulmonary lobule. Thus, through the alterations that are transmitted in the lobular area, and from its contents and its limits, PID has led to the elaboration of a new semeiology. The authors review the basic computed tomographic images and correlate these in each case with the histological evidence. The spatial distribution and the time sequence of the elementary images are the two other terms in the diagnostic equation of PID. The spatial distribution of several elementary images presents in TDM-HR a superior aetiological pointer to that which is furnished by thoracic radiographs; and the time sequence may furnish a useful indication as to the progress of the treated disease. Sarcoidosis, histiocytosis X, idiopathic interstitial fibrosis and lymphangitis carcinomatosis would serve as examples. Nevertheless, the authors point out that it would be dangerous during the period of evaluation to prematurely extend to all cases of PID conclusions which are only possible to make at present in a restricted number of disorders.

[Primary liposarcoma of the mediastinum: contribution of MRI to the diagnosis. Apropos of a case]. / Liposarcome primitif du médiastin: apport de l'IRM au diagnostic. A propos d'un cas.

An exceptional case of liposarcoma arising in posterior mediastinum is reported in a young woman. CT fails in diagnosis because no area of fatty density was found. MR features were suggestive of this etiology.

[The role of new medical imaging technics (TDM and MRI) in the diagnostic strategies of superior vena cava syndrome]. / Place des nouvelles techniques d'imagerie médicale (TDM et IRM) dans la stratégie diagnostique du syndrome de la veine cave supérieure.

Superior vena caval syndrome (VCS), is easily recognised in the advanced case, however in the early case without clinical signs its detection is much less easy. New techniques of medical imagery such as IRM and above all computer tomography (TDM) have shown an increasing place in the daily clinical practice of the respiratory physician; these enable an early diagnosis to be made and a work up of the aetiology of the syndrome of VCS. With TDM the obstruction of the VCS appears the sign of direct obstruction (thrombosis or extrinsic compression) and of a collateral venous circulation deriving some anastomoses from the brachio-cephalic venous trunk (TVBC) and the azygos system, the VCS and the inferior vena cava (VCI), the two TVBC at the junction of the median line principally by the suprasternal network and finally these portal systemics, by the veins from the anterior wall of the trunk and the accessory portal veins of the round ligament. IRM introduced more recently enables a direct vision of the causal lesion endo or extra luminally, enabling an early detection of the syndrome by showing signs of a slow down of the venous flow. But the detection of a collateral circulation seems more difficult to demonstrate by this method.