Echography in hepatic angiomas.

All US patterns can be observed in hepatic angiomas; if the lesion is less than 3 cm, however, the echostructure is often hyperechoic and homogeneous.

Ultrasonography of hepatic cavernous haemangiomas.

Cavernous haemangiomas, the most frequent benign tumours of the liver, are discussed by the authors in connection with 50 personal cases and surveillance of 35 solitary hyperechoic nodules less than 3 cm diam. without clinical or biological abnormalities. All the diagnostic images are reviewed but attention is focussed on ultrasound. All US patterns may be observed, but if the lesion is less than 3 cm, the echostructure is often hyperechoic and homogeneous. In view of their asymptomatic nature and the absence of risk of evolution for these small hyperechoic lesions, it appears legitimate to propose surveillance merely by US if there are no clinical symptoms and if liver function tests are normal.

Comparison of ultrasonographic and histological findings for multinodular lesions of the salivary glands.

Fifteen cases of multinodular lesions of the salivary glands are presented. All nodules were hypoechoic, the largest measuring over 5 mm. The various etiologies represented included: 8 non-Hodgkin's lymphomas, 5 metastases of cancer of the tongue, 1 sarcoidosis limited to the submaxillary gland, and 1 case of oncocytosis involving all four salivary glands. After discussing the rarity and the general characteristics of these lesions, the authors propose a diagnostic strategy following examination by ultrasound.

Ultrasound evaluation of common bile duct size in normal adult patients and following cholecystectomy. A report of 750 cases.

The authors present the findings of seven hundred and fifty adult patients without biliary tract disease for whom the internal diameter of the common bile duct was measured. Six hundred and seventy-three patients had no biliary tract disease whatever while seventy-seven had no clinical evidence of disease but had undergone cholecystectomy over one year ago. In our series, the mean diameter of the common bile duct in normal patients was 3.67 +/- 0.03 mm. Only 5.9% of normal patients were found to have a bile duct with a diameter greater than or equal to 5 mm. The frequency of this finding increased in patients over fifty years of age. The mean diameter of the common bile duct in the seventy-seven who had undergone cholecystectomy was 4.47 +/- 0.10 mm.

[Ultrasonic findings of parotid tumours in 40 patients]. / Séméiologie échographique des tumerus de la parotide. A propos de 40 observations.

Ultrasonic findings of 40 parotid tumours are presented in this paper. After a technical description proceeding they show the ultrasonic pattern of the three main types of parotid tumours: mixed tumours, adenolymphomas and carcinomas. The differential diagnosis between malignancy and non malignancy is carried out in 87,5% of cases. This rate of success is, according to literature data, similar to that of sialography. Since it is non invasive, the authors recommend sonography in the assessment of parotid tumours, rather than sialography.

[Echography in tumor pathology of uterus (author's transl)]. / L'échographie en pathologie tumorale de l'utérus.

Based on the study of 234 cases of uterine tumor pathology, the authors attempt to define the role and limits of echography. In the case of uterine cancers, the major role of echography concerns postoperative surveillance, except for cancers of the corpus uteri for which it allows exact measurement of the size of the uterus and thus the optimization of radiotherapy. Fibromas are easily detected by echography, but in the case of submucosal or subserosal forms this technique can give false negative (submucosal forms) or erroneous diagnosis of an ovarian tumor (subserosal fibroma). Only the tumoral forms of endometriosis uterina can be recognized using echography, generally showing up as small transsonic images; infiltrating forms cannot be visualized. Echographic diagnosis of uterine polyps is often difficult. Echography has become the foremost complementary procedure following clinical examination. However, a negative uterine echogram in the presence of warning signs and in particular menorrhagia systematically warrants obtention of a hysterography to detect a polyp, a submocusal fibroma, endometrial lesions or an infiltrating cancer of the corpus uteri.

[Echographic survey of hepatic metastases]. / Surveillance échographique des métastases hépatiques.

In a study covering 105 patients with hepatic metastases, all of whom underwent at least two echographies, the authors were able to make comparisons with the previous examination in 220 cases. Comparisons dealt with modifications in the echographic aspect (observed in 72 cases among the 220 comparisons), modification in volume and modifications in the number of metastases. In most cases, modification of the echostructure corresponded to a volumetric change. Three evolutionary parameters should be considered: the number of metastases, if there are no more than five; the diameter of the largest liver metastasis, unless it is over 7 cm, in which case it is also advisable to retain two other metastases of 5 cm or less: the size of the liver (left liver measured on the median line and right liver along the right mamillary line). This last parameter appears to be the only valid one when dealing with diffuse metastatic forms.

[Retroperitoneal neuroblastoma diagnosed in utero. Apropos of 1 case]. / Neuroblastome rétropéritonéal diagnostiqué in utero. A propos de 1 cas.

The authors present a rare case of a retroperitoneal neuroblastoma discovered during a routine pregnancy check in the 29th week of amenorrhea and showing up as a 1.4 cm dia. hyperechoic nodule. A follow-up sonogram, obtained one month later, showed the lesion had increased in size. Following birth, the diagnosis was confirmed during surgery. The overwhelming importance of early diagnosis of this tumor for a favorable prognosis points out the value of systematic examination of the suprarenal regions of the foetus in the course of the last U.S. examination during pregnancy.

[The liver masses in ultrasonography. Report on 400 cases (author's transl)]. / Les masses hépatiques en échographie. A propos de 400 cas.

On the basis of 400 cases of liver masses, the authors have drawn conclusions that can be used to orient etiological investigations: --one or more well demarcated transsonic formations always correspond to a cystic etiology: --a hyperechoic metastatic liver points towards a primary cancer of the digestive tract whereas a hypoechoic metastatic liver is only rarely caused by such a cancer. The authors also propose a strategy for the exploration and surveillance of isolated hyperechoic or transsonic nodules of no more than 3 cm.

[Exploration and surveillance of the retroperitoneal space by lymphography and ultrasonography in patients with non-Hodgkin's lymphomas (author's transl)]. / Exploration et surveillance du rétropéritoine au cours des lymphomes non-hodgkiniens par la lymphographie et l'échographie.

The authors propose to conduct, in a systematic manner, lymphography and ultrasonography examinations before treatment of 75 cases of non-Hodgkin's lymphoma. The latter investigation enables examination of the upper part of the retroperitoneal space, and the detection of coeliomesenteric adenopathies, or possible lesions in the liver, spleen, and kidneys. The surveillance of most patients during treatment is possible with ultrasonography, if marked lipiodol resorption has occurred. Though this procedure is easy to conduct in all radiological departments, it does not have the same sensitivity as lymphography associated with computed tomography.

[Cavernous hemangioma of the spleen]. / Hémangiome caverneux de la rate.

A cavernous hemangioma of spleen in a clinically asymptomatic patient presented in the form of a hyperechogenic mass on ultrasound imaging, becoming progressively hyperdense on the CT scan with contrast. This appearance, similar in all respects to that seen with cavernous hemangioma of liver, is rarely reported in the literature.

[High-definition real-time ultrasonic echography of tumors of the thyroid gland. Apropos of 379 surgically treated cases]. / Echographie ultrasonore en temps réel de haute définition des tumeurs du corps thyroïde. A propos de 379 cas opérés.

The authors present the results of a review of 379 cases of benign and malignant thyroid tumors examined by high frequency (7 MHz) ultrasound prior to surgery. Features of the 37 cases of cancer are described. Hyperechogenicity was almost always correlated with benign lesions (only 1 cancer out of 71 hyperechoic nodules). For 313 of the 342 cases of benign tumors a good correlation was found between sonograms and intraoperative examination of the two thyroid lobes. In the case of clinically evident polyadenomatous goiters, ultrasound is a highly accurate means of determining whether any zones of healthy tissue remain (sensitivity 104/110 cases, i. e. 93.7%). When a contralateral lobe is normal on sonograms, intraoperative examination only rarely reveals lesions (12/159 cases, including 2 false positives for surgical investigation). Due to the excellent concordance between ultrasound and intraoperative exploration, and the difficulties involved in anterior dissection, the results of sonograms can be used to decide on the surgical approach. Direct intraoperative surgical exploration of the lobe opposite a thyroid lesion appears unnecessary if the sonogram is normal (cases of non suspected occult thyroid cancer). Since intraoperative exploration can give false negatives, intraoperative ultrasound can be used in the rare cases where 1 or 2 deep micronodules have been detected by pre-surgery sonograms in the lobe contralateral to the main lesion.

[Congenital cysts of the liver in echography]. / Les kystes congénitaux du foie en échographie.

The authors present 150 cases of congenital biliary cystic pathologies of the liver: solitary congenital cyst (98 cases), multiple congenital cysts (40 cases), hepatic polycystosis (8 cases), and Caroli's disease (4 cases). The general characteristics of these congenital liver affections are reviewed, including discussion of their frequency, classification and potential for evolution. The problems raised by this type of pathology and the benefits of ultrasonography are emphasized.

[Venous relations in cervical adenopathy. Review of a series of 300 cases]. / Rapports veineux. des adénopathies cervicales. Revue d'une série de 300 cas.

Three hundred cases of cervical adenopathies were reviewed in connection with head and neck cancers (205 patients) and lymphoma (95 patients). Overall, physical examination failed to detect such adenopathies in 83 cases. The echostructure of the cervical node was less echoic than that of the muscles in 111 cases (58 cases of lymphoma, 53 cases of metastasis), more echoic than the muscles in 185 cases (35 cases of lymphoma, 150 cases of metastasis), and nucrotic in 4 cases (2 cases of lymphoma and 2 cases of metastasis). Jugular vein thrombosis was noted in 78 cases (75 cases of metastasis, 3 cases of lymphoma); jugular vein compression without thrombosis was observed in 65 cases (35 cases of metastasis, 30 cases of lymphoma). Before histologic proof is obtained, jugular thrombosis suggests a diagnosis of metastasis, regardless of node size. The presence of nodular intraparotid lesions (12 cases) suggests lymphoma. By contrast, neither node size nor echostructure suggest the etiology of cervical adenopathies.

[Imaging of anaplastic carcinoma of the thyroid gland]. / Imagerie des cancers anaplasiques de la thyroïde.

Sixteen cases of anaplasic thyroid carcinoma have been reviewed. In 13 cases out of 16, a diffuse invasion of one or both thyroid lobes and of the isthm associated with calcifications (50%) and necrosis (62%) was present. In 6 cases out of 8, CT Scan with contrast media injection has detected an extension into surrounding tissues. Twelve of the 16 patients presented cervical lymph nodes on the ultrasound examination and 4 of 8 patients presented mediastinal lymph nodes on the CT Scan. In 3 cases out of 16, the anaplasic carcinoma of the thyroid presented as a localized, hypoechoic nodule associated with a cervical lymph node in 1 case.

[Contribution and current limitations of computed tomography in the diagnosis of cavernous hemangioma of the liver]. / Apport et limites actuelles de la scanographie dans le diagnostic d'hémangiome caverneux du foie.

Based on findings for 30 patients, the authors assess the value of CT scans for the diagnosis of cavernous hemangiomas of the liver. Four images were retained, and were graded 0 (absence) or 1 (presence): hypodensity before injection of the contrast material, arteriolar halo after injection, progressive centripetal filling and late hyperdensity. A score of 3 or 4 after the CT scan allows diagnosis. Solitary lesions of at least 3 cm are correctly evaluated. When associated with other smaller lesions, or when smaller than 3 cm, CT scans are less helpful and arteriography is necessary. In all. CT scanning has four limiting parameters: lesion diameter, the number of images requiring exploration, the difficulty in obtaining exactly the same section in various sequences allowing effective scan analysis (thoraco-abdominal position of the liver) and problems specific to individual patients (poor circulation, iodine allergy or intolerance). These limiting factors explain the "wait-and-see" strategy suggested when confronted with solitary hyperechoic nodules smaller than 3 cm.