Osteoblastic osteitis of the maxillary sinus.

Osteoblastic osteitis is a rare kind of bone infection typified by a proliferative reaction of the periosteum and by exuberant bone formation. In the maxillary sinus, it occurs as a consequence of chronic or recurrent sinusitis. It usually manifests with a vague facial discomfort, followed by complications in the deep facial spaces or fossae. The diagnosis is a radiological one. Eradication of this bone infection necessitates removal of the precipitating condition as well as the long-term administration of appropriate anti-biotics. In the case of a deep facial fossae abscess, drainage is mandatory.

Congenital unilateral hydrocephalus--CT findings.

Congenital unilateral hydrocephalus is extremely uncommon with 18 cases previously reported in the English literature. Two additional newborns with unilateral hydrocephalus are presented. The second baby also presented a mega cisterna magna. This unusual association between Dandy-Walker variant and unilateral hydrocephalus has not been previously reported. Following ventriculo-peritoneal shunt, the babies had a normal cognitive neurodevelopment. The role of cranial computed tomography (CT) in diagnosis and follow-up is emphasized.

Vertebral pneumatocyst. A case report.

STUDY DESIGN: This study illustrates intraosseous pneumatocyst of the vertebral body, a benign lesion. OBJECTIVES: To review the incidence and location of this benign lesion during a 1-year period. SUMMARY OF BACKGROUND DATA: Intraosseous pneumatocyst is a rare benign condition, commonly seen in iliac bone or sacrum. The etiology of this entity is unclear. Other locations of these lesions are very rare, and only a few isolated cases are reported in the literature. METHODS: In the last year (1994-1995), vertebral pneumatocyst was incidentally found in four patients who underwent computed tomography examination for presumptive discal lesion. Axial computed tomography with 2- and 4-mm slice thickness was performed. RESULTS: The typical computed tomography patterns of intraosseous pneumatocyst involving the cervical, dorsal, or lumbar spine were found. The bony structure and joints were normal. To the best of our knowledge, intraosseous pneumatocyst located in the spinal process has not been reported. CONCLUSIONS: Intraosseous pneumatocyst is a benign lesion. Biopsy and follow-up are unnecessary.

Unusual pseudoaneurysm of Dacron femoro-popliteal graft shaft. A case report.

An unusual case of pseudoaneurysm in the mid segment of a Dacron femoro-popliteal graft is reported. The radiological diagnosis was based on computed tomography which correlated well with the surgical findings. A manufacturing defect seems to be the most likely cause of this pseudoaneurysm.

Pseudoaneurysm of the internal carotid artery secondary to tonsillectomy.

A case of pseudoaneurysm of the cervical internal carotid artery secondary to tonsillectomy is presented and the pathogenesis of this vascular abnormality is discussed. Due to morphologic and inflammatory changes in the lateral pharyngeal wall, the entrapment aneurysm was maintained. The internal carotid artery was initially occluded above the carotid bifurcation. The transcatheter occlusion of the distal stump of this vessel, by steel coils, replaced a mutilating approach for exposure and ligation near the base of the skull.

Fine needle aspiration cytology and immunocytochemistry in a case of intrathoracic thyroid goiter.

Fine needle aspiration (FNA) was performed in the case of a patient with an anterior mediastinal mass. Examination of the smears revealed individual and groups of benign nondiagnostic cells. Surgical removal and histologic examination indicated that the mass was a true intrathoracic thyroid goiter. Subsequent immunocytochemical studies on the FNA smears showed thyroglobulin in the cytoplasm of the aspirated cells. The cytologic findings are presented; while not diagnostic of a thyroidal origin in this case, they serve as a reminder of the wide range of cytologic appearances of colloid nodules and goiters. This case will hopefully heighten the awareness of cytologists and other physicians to the consideration of the possibility of intrathoracic goiter in the differential diagnosis of mediastinal lesions seen in fine needle aspirates.

Bilateral idiopathic chondrolysis of the hip: a case report.

A case of bilateral idiopathic chondrolysis of the hip is presented. Chondrolysis is a process characterized by progressive necrosis of the hyaline cartilage of the acetabulum and femoral head, resulting in secondary joint space narrowing and stiffness. A 14-year-old boy was followed during a 2-year period, and the diagnostic values of the different imaging methods (radiography, magnetic resonance imaging [MRI], and bone scintigraphy) were evaluated. Scintigraphic evidence of marked periarticular uptake and premature fusion of the epiphysis of the greater trochanter was a reliable indicator of chondrolysis. Furthermore, the bone scan could precede other imaging methods (radiography and MRI) in the diagnosis of the progression of the pathologic process, status of the remodeling activity, and early involvement of an opposite joint. Given the high sensitivity of bone scans and the high specificity of radiographic and MRI examinations in the diagnosis of acute chondrolysis of the hip, all three methods are valuable and should be used as complementary diagnostic tools.

Unilateral acute renal cortical necrosis: correlative imaging.

Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis of the renal cortex and sparing of the medulla. Little information on the imaging presentation of bilateral acute renal cortical necrosis is available. The enhanced CT appearance is pathognomonic and diagnostic. The unilateral presentation of acute cortical necrosis is extremely rare, and no imaging methods have been described. The authors chose to apply scintigraphic evaluation to this unique condition complementary to CT to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of some tubular function and clear delineation of the shrunken kidney was found. Conversely, in the DTPA study the kidney was not visualized. A DMSA scan was performed for assessment of viability of the renal cortex and showed a photopenic halo around the small area of the viable cortex of the upper pole. The halo sign represents a cortical loss. The visualization of the upper pole as evidence of cortical viability as a consequence of collateral blood flow from capsular vessels was seen on angiography. Radiographic and scintigraphic correlation of this rare condition may be an effective means to confirm the diagnosis and to establish the extent of involvement. However, contrast CT remains the preferred method in the diagnosis of acute cortical necrosis.

Adrenal cysts: diagnosis and therapeutic approach.

We report nine cases of adrenal cysts, treated in our hospital, between 1980 and 1990. The majority of the cases (5/9) were incidental findings on US and CT examinations. We operated on 4/9 cases because of their symptomatology or their size. Four other cases were managed conservatively; one last case was treated by percutaneous drainage under CT. In our series, 1/9 (11%) was a malignant cyst. The follow-up shows excellent results in the benign cases and 40 months' survival in the malignant case, until today.

C.T. demonstration of metastatic anaerobic orbital abscess.

Orbital abscess of rhinosinogenic origin may develop, either by contiguous spread of the infection or by a thrombophlebitic process. While destruction of the bony walls of the paranasal sinus occurs in propagation of the infection by tissue continuity, haematogenous spread may take place through intact bone. Computed tomography demonstrates the status of the bony partitions shared by the orbit and paranasal sinuses, and the source of the orbital sepsis, thereby influencing the therapeutic approach.

[Epidural extraskeletal Ewing's sarcoma: the tenth case]. / Sarcome d'Ewing extra-osseux épidural: le dixième cas.

The 10th case of a primary epidural extraskeletal Ewing's sarcoma is presented. The treatment and the relevant literature are reviewed.

Perinephric inflammatory process following extracorporeal shock wave lithotripsy.

A patient with large branched staghorn calculi was treated with ESWL. She suffered from recurrent urinary tract infections. Following ESWL she developed a perinephric abscess, which necessitated percutaneous drainage. The clinical course is described and a possible pathogenesis of perinephric abscess following ESWL is suggested.

Post-herniorrhaphy paravesical granuloma simulating pelvic metastasis in a patient with bladder cancer.

We describe a rare case of bladder cancer associated with paravesical post-herniorrhaphy foreign body granuloma with abscess formation which simulated a lymph node metastasis. Management of this particular case is discussed and the literature is reviewed.

[Cystadenocarcinoma with peritoneal involvement (pseudomyxoma peritonei). Is surgical resection alone sufficient?]. / Cystadénocarcinome avec atteinte péritonéale (pseudomyxome péritonéal). L'exérèse chirurgicale seule est-elle suffisante?

We present our experience of 10 cases of pseudomyxoma peritonei treated in our regional hospital between 1978 and 1992. We note the rarity of this disease; the catastrophic macroscopic appearance may mislead the in experienced surgeon. Preoperative diagnosis is usually easy when confronted with a mass in an ascitic abdomen, with the help of ultrasonography and CT-scan, and above all after abdominal puncture which produces pathognomonic gelatinous fluid. Most cases are derived from the ovary and appendix. Treatment is surgical and aggressive; we adopt the protocol proposed by Sugarbaker which combines repeated surgery and local and systemic chemotherapy. The relatively good survival, even in the malignant cases, seems to be improved by this treatment.

[Complete traumatic dislocation of the cervical spine without permanent neurologic sequelae]. / Dislocation traumatique complète de la colonne cervicale sans séquelle neurologique permanente.

The authors present their experience with an unusual case of fracture of the lower cervical spine with complete dislocation at C6-C7 level, in a young man involved in a car accident. An initial unilateral root deficit progressed shortly after admission to hospital, to a classical Brown-Sequard' syndrome. The development of a partial cord lesion in spite of the severe dislocation of the spine, could be attributed to the simultaneous "traumatic laminotomy" and the enlargement of the neural canal at the level of the vertebral sliding, that occurred as a result of bilateral fracture of the posterior arc of the 6th cervical vertebra and its separation from the anteriorly displaced vertebral body. Our management consisted in cortico-therapy and early skeletal traction with prolonged immobilization of the cervical column. The closed, rapid reduction of the dislocation under neurologic and radiologic monitoring was followed by successful alignment of the neural canal at 48 hours after injury, with progressive neurologic recovery and by "auto-fusion" of the fractured bones with subsequent, stable and long-lasting consolidation.

[Chronic tophaceous gout].

A 51-year-old immigrant from the Caucasus had had chronic tophaceous gout for over 20 years, but had never been treated with anti-hyperuricemic drugs. He had developed large, multiple tophi in many locations, including both ankles and feet. The enormous size and unique location of the tophi caused considerable pain, and difficulty in standing and on walking. Since surgical removal of the tophi was refused by the patient, a course of allopurinol, 300 mg/day, was begun.