[Testicular nodules of infertile men and contrast enhanced ultrasonography: preliminary study]. / Nodules testiculaires de l'homme infertile et échographie de contraste: étude préliminaire.

INTRODUCTION: The incidence of testicular nodules discovered during infertility evaluation is increasing. These nodules are suspicious of malignancy. There is no paraclinical examination which allows histological orientation to these nodules. The recommendations propose priority treatment by total orchidectomy. PATIENTS AND METHODS: Through a retrospective cohort study of infertile patients, our goal is to study the enhancement of testicular nodules after injection of ultrasound contrast. The secondary objective is to determine whether CEUS may argue in favor of conservative treatment. From june 2010 to march 2013, 24 patients had underwent ultrasound contrast study of abnormal testicular parenchyma detected prior to infertility evaluation carried ultrasound. The characteristics of ultrasound enhancement were correlated with the pathological findings of surgical patients and proposed treatments (surgery or surveillance). RESULTS: Fifteen patients were followed up, 9 were operated (7 partial orchidectomies, 2 total orchidectomies). Histological analysis found four Leydig cell tumors, 2 Sertoli cell tumors and 3 seminomas. No adverse changes were noted during the follow-up. This study showed a typical semiology of early, intense and homogeneous enhancement with a phenomenon of wash in 100% of Leydig cell tumors. All Leydig cell tumors have been treated by partial orchidectomy. Seminomas have intense enhancement in 100% of cases. There was a phenomenon of wash in 2 out of 3 cases. When a wash in was described, it was always described as heterogeneous. All seminomas were finally treated by total orchidectomy. The sensitivity and positive predictive value of ultrasound intense enhancement for the diagnosis of testicular cancer was 89% (Se) and 80% (PPV). CONCLUSION: There is a semiology of ultrasound enhancement of testicular nodules with features that can guide in favor of a malignant tumor, seminoma or Leydig cell tumor. If a prospective study was undertaken, these arrangements could guide us to treatments promoting preservation of the testicular parenchyma.

Therapeutic embolization of a thoracoacromial artery perforated by placement of a deep venous catheter.

An 82-year-old man presented with massive external bleeding from the puncture site after placement of a deep venous catheter in the right subclavian vein. Emergent angiography revealed contrast extravasation along the central venous catheter tract due to perforation of the right thoracoacromial artery. Superselective catheterization of the bleeding artery followed by microparticle embolization definitively stopped the hemorrhage. During follow-up no recurrence of external bleeding was noted. Percutaneous embolization using microparticles is an effective tool to definitively treat iatrogenic arterial hemorrhage as a complication of deep venous catheter placement.

Radiolucent chest lesions in a neonate due to congenital cystic adenomatoid malformation.

A localized radiolucent cystic lesion in the left lower lobe with shift of the mediastinum to the opposite side in a neonate is shown on chest X-ray and CT. Findings on conventional X-ray and particularly on CT are very suggestive for congenital cystic adenomatoid malformation type 1. Histology after lobectomy confirmed the diagnosis.