Small Bowel Obstruction Due to Enterolith in a Patient with Diffuse Jejuno-Ileal Diverticulosis.

We report an unusual case of small bowel obstruction caused by a large enterolith released from small bowel diverticulitis in a 81-year-old patient with occult massive Diffuse Jejuno-Ileal Diverticulosis (DJID). DJID is a rare condition whose symptoms are usually absent or non-specific. In most cases, the diagnosis of DJID is incidentally made or consecutive to secondary complications comprising obstruction, haemorrhage, diverticulitis and perforation. We shortly review the clinical and imaging features and complications of DJID.

Cystic adventitial disease of the popliteal vein: report of a case.

Cystic adventitial disease of the popliteal artery is a rare but classic cause of arterial insufficiency. We report a case in which the disease affected the popliteal vein, causing painless swelling of the left lower limb.

[Diagnostic ultrasonography of perforating foreign bodies of the digestive tract]. / Diagnostic échographique des corps étrangers perforants du tube digestif.

Perforations of the gastrointestinal tract by ingested foreign bodies such as chicken or fish bones are rare and may occur at any site from the oesophagus to the rectum; the diagnosis is often very uneasy with conventional radiography. For many years, sonography has been more frequently requested as the first modality for the evaluation of abdominal pathology, and in many cases allowed a correct diagnosis to be reached without further assessment. We report six cases of complicated foreign bodies very successfully and specifically diagnosed by sonography in six different sites of the gastrointestinal tract. Four of these cases were preliminary correctly suspected by CT but the shape, length and the probable nature of the body were always better appreciated by multiaxial real time sonography. The correct sonographic diagnosis and follow-up allowed a conservative treatment in three cases, avoiding surgical exploration. We recommend the systematic sonographic investigation of foreign bodies in close relation with the gastrointestinal tract in all atypical inflammatory processes or to perform sonography as a complement to CT.

[Hypoechogenic aspects of the ventral embryonic cephalic pancreas: a large prospective clinical study]. / L'aspect hypoéchogène du pancréas céphalique embryonnaire ventral: une large étude clinique prospective.

Global echogenicity of the normal pancreas increases essentially with lipomatous involution which is common with aging. However, the two embryologic different parts of the cephalic pancreas may present a different echogenicity: the "embryologic ventral" pancreas-posterior cephalic pancreas + uncinate process-is then hypoechoic because of less fatty involution. It is important to distinguish such normal variant from a pathological process. The clinical prevalence and morphologic characteristics of this normal variant have been prospectively studied in a large series of 446 patients including 275 females and 171 males. The study confirms the proportional increase of pancreatic echogenicity with age. The variant has a sharp female predominance: 27.5% of males vs 43.3% females, corresponding to a sex ratio of 1:1.52. Hypoechoic ventral embryologic cephalic pancreas is never encountered before the age of 25 and is most frequent in middle aged females with moderately echoic pancreas. There is not any difference in global cephalic pancreatic thickness between our positive group and a negative group of reference of 66 patients. These observations rather plead a genetic uneven fatty involution in positive cases instead of ventral pancreas atrophy in negative cases. The morphological and biometric characteristics of the hypoechoic embryologic ventral pancreas are rather stable. These are relatively independent from age, sex, and global pancreatic echogenicity.

[Lipoma of the filum terminale: a prospective tomodensitometry study]. / Le lipome du filum terminale: une étude TDM prospective.

A lipomatous aspect of the filum terminale is sometimes recognized in routine lumbosacral CT studies as a small (1 to 2 mm) tubular fatty hypodensity that lies posteriorly in the dural sac. To study the epidemiologic frequency and pathological significance, the authors prospectively reviewed the standard lumbosacral CT studies of a large series of 1033 adult patients suffering from mechanical problems. The lipomatous aspect was encountered in 39 of them (3.77%). The average size was about 1 mm and never exceeded 2 mm (92%) except for 3 cases. The commonest site was L4-L5 but the anomaly was more commonly seen at two levels. Despite the lack of histological proof, the authors consider the lesion benign and trite with two restrictions: the pediatric cases (not studied in their series) and the patients presenting a lipoma greater than 3 mm; for these two groups further investigations are recommended to exclude a tethered cord syndrome.

[Pelvic plexiform neurofibroma: typical aspects in CT]. / Le neurofibrome plexiforme pelvien: aspect typique en TDM.

Plexiform neurofibroma is a relatively uncommon but characteristic manifestation of neurofibromatosis. Two pelvic cases were found by CT in two young patients in whom it was the first fortuitous manifestation of the disease. The CT pattern, which seems to be in close relation with pathology, is described and illustrated. This pattern is so typical that there is no difficulty to establish the differential diagnosis. The question of sarcomatous transformation is more problematic by CT.

[Giant and bilateral renal angiomyolipomas]. / Angiomyolipomes rénaux géants et bilatéraux.

We describe the very pathognomonic CT aspects of giant renal angiomyolipomas fortuitously demonstrated in a young male with typical neurological and dermatological patterns of tuberous sclerosis. Angiomyolipomas are rare but 20 to 50% are associated with multiple sclerosis. The advent of CT has made the diagnosis much accurate and avoids unnecessary surgery especially for a single mass. The presence of fat intermixed with areas of other tissue density is very specific and practically excludes the diagnosis of renal carcinoma. Along with MRI, CT is a method of choice to delineate the sometimes very invading tumor. The symptoms of tuberous sclerosis are shortly reminded; the clinical presentation and complications of angiomyolipomas are briefly described.

[Strangulated intestinal Spigelian hernia]. / Strangulated intestinal Spigelian hernia.

Spigelian hernia, an uncommon hernia of the anterior abdominal wall, has serious complications in a high percentage of cases. The diagnosis is often difficult because the symptoms can be insidious or simulate those of more classical lower quadrant abdominal diseases. Furthermore, the clinical findings are often nonspecific. We report a case of Spigelian hernia complicated by acute strangulation diagnosed by ultrasound. The anatomic features and the physiopathology are reviewed and illustrated by another typical case diagnosed by CT. CT is superior to sonography in showing the defect of the abdominal wall, in identifying the contents of the hernial sac and in discovering abnormalities in other areas of the abdomen. Sonography also generally appears adequate in showing a parietal defect. We therefore recommend systematic ultrasonographic examination of the abdominal wall in all doubtful cases of undiagnosed abdominal pain with vague gastro-intestinal symptoms.

[The value of ultrasonography and computerized tomography in mandibular diseases: apropos of 2 cases of chronic fistulizing mandibular osteitis]. / Intérêt de l'échographie et de la tomodensitométrie en pathologie mandibulaire: à propos de deux cas d'ostéite mandibulaire chronique fistulisée.

Though US and CT are infrequently used for the detection of mandibular disease, both techniques definitely contributed to the detection and extension work-up of fistulizing chronic mandible osteitis in our 2 patients. US clearly visualizes the mandible margin and enables detection of abnormal foramina. CT is highly valuable for the visualization of the complex (flat and curved) structure of the mandibular body and the adjacent soft tissues. While routine intraoral radiography remains necessary and sufficient in easy pathological conditions, it appears from our experience that CT and US are of unique value in detecting complex or complicated mandibular disease, in particular when involving the surrounding soft tissues.

[Prostatic leiomyoma]. / Leiomyome prostatique.

Large leiomyomas of the prostate are rare tumors. The authors report the case of a 78-year-old patient with two large prostatic leiomyomas who presented with chronic obstructive urinary symptoms. The US and CT aspects are illustrated; the signs are not specific but rather suggest a benign process. The tumor, probably of embryologic origin, must be distinguished from neoplasms when presenting in association with the classical benign prostatic hypertrophy. The definite diagnosis is obtained histopathologically. Prognosis is good with no evidence of recurrent disease.

[Lumbar arachnoid cysts: 2 unusual cases]. / Kystes arachnoïdiens lombaires: deux cas inhabituels.

Two cases of arachnoid cyst in the lumbar region are described. One is intradural, acquired, and associated to severe arachnoiditis while the other is extradural in location and probably congenital. The interest of myelography, CT myelography, and MRI for the diagnosis is discussed.

[Computed tomographic diagnosis of biliary ileus]. / Diagnostic tomodensitometrique de l'ileus biliaire.

Rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in patients over the age of 65. While mortality has declined over the years, it remains high at 12-17 per cent. This is largely due to the insidious symptoms making the diagnosis difficult and to the aged patient population, with frequent comorbid medical conditions contributing to mortality. Much better than plain radiograph and probably easier than ultrasound, CT makes the correct diagnosis of the classical triad of Rigler: distended small bowel loops, pneumobilia and an ectopic calcified gallstone. We report two cases promptly and specifically diagnosed with CT. The second case was a very rare Bouveret's Syndrome, a gastric outlet obstruction caused by a gallstone. Patients were treated by a one time associated enterolithotomy and cholecystectomy. We recommend the early use of abdominal CT scanning for the investigation of clinical bowel obstruction in the elderly, where gallstone ileus is a more common condition.

[Pulmonary edema secondary to the intravenous administration of iodized contrast. A clinical case with high-resolution tomodensitometry studies]. / Oedème pulmonaire secondaire à l'administration de contraste iodé. Un cas clinique avec analyse tomodensitométrique en haute résolution.

Contrast media related reactions are numerous and of variable gravity. We report a case of pulmonary edema related to the intravenous administration of contrast media. Cardiogenic and non cardiogenic pulmonary edema are pathophysiologic possibilities. High resolution CT findings associate patchy ground glass areas and smooth thickening of subpleural septa, both rapidly disappearing.

[Presentation of an acute and painful giant, necrotic ileal leiomyoma]. / Présentation aiguë et douloureuse d'un leiomyome iléal géant et nécrotique.

We report on a case of giant necrotic ileal leiomyoma presenting uncommonly as a painful pelvic mass mimicking a sigmoid inflammatory process. The classical symptoms and clinical aspects of intestinal leiomyoma are briefly summarized. The CT and US aspects are described with peculiar attention to color Doppler which played an important role in the diagnosis of our patient.

[Late diagnosis of a traumatic pseudo-aneurysm of the subclavian artery]. / Diagnostic tardif d'un pseudoanévrysme traumatique de l'artère sous-clavière.

The authors report a rare case of subclavian pseudoaneurysm diagnosed six months after a left clavicular fracture. The leading symptoms were pain and claudication in the left arm related to peripheral embolization. The essential diagnosis was made by selective arteriography followed by arterio-CT. Peripheral embolization or brachial nerve compression are the most common presentations of subclavian pseudoaneurysms. To avoid such late complications, the authors emphasize the importance of the initial vascular examination of the shoulder after blunt trauma with or without clavicular fracture. Surgery is imperative and the use of autologous vein graft is the method of choice.