Atypical alveolar proteinosis.

Alveolar proteinosis is a rare pulmonary disease characterized by intra-alveolar accumulation of surfactant composed of lipoproteinaceous material, related to a lack of surfactant resorption by alveolar macrophages. Crazy paving pattern is characteristic, but not specific. The multinodular forms of this affection remain exceptional.

Colocolic tumoral intussusception in the adult: value of multi-slice spiral CT imaging.

Colocolic intussusception in the adult, caused by a tumoral process, is a rare clinical event. We have studied two adults clinically presenting with a mass in the right iliac fossa, which was produced in one case by a carcinoma involving the right colon and in the other case involving the sigmoid. Multi-slice spiral CT imaging showed the presence of a colocolic intussusception-the tumoral characteristics of the lesion eliminated the possibility of a lipoma-and it allowed a satisfactory presurgical evaluation of the pathological process.

Can low-dose computed tomographic scan of the spine replace conventional radiography? An evaluation based on imaging myelomas, bone metastases, and fractures from osteoporosis.

We evaluated and compared the radiological images of the spine of 111 patients affected by myeloma, bone metastases, and fractures secondary to osteoporosis demonstrated in low-dose computed tomographic (CT) scans and those demonstrated in conventional radiographic studies. From the analysis of the data obtained, it appears that the duration of the CT procedure is definitely shorter and that its diagnostic sensitivity is superior to that of conventional radiography. We should mention that the dose of radiation delivered by CT scanning does not constitute an unfavorable element in patients, usually elderly, for whom CT scanning was indicated.

Lipomas of the right colon: report on six cases.

We report six cases of lipomas of the right colon, of which one was affected by two lesions. Two cases presented with episodes of partial occlusion; the others did not present with particular symptoms. The diagnoses were based on imaging by computed tomography, which demonstrated an intraluminal formation of fatty density, not associated with tissual components or hypervascularization.

Lipomatous tumors of the adrenals--a report on 18 cases and review of the literature.

The lipomatous tumors of the adrenals are hormonally inactive lesions, often of a benign nature, such as myelolipomas, lipomas, angiomyolipomas, or mature teratomas, and are rarely malignant, such as liposarcomas. The importance of recognizing their characteristic radiological images, which would lead to their correct treatment, is fundamental since there has been an increase in the demonstration of this lesion, often detected incidentally. The various imaging procedures, although not allowing to formulate a histological diagnosis, nonetheless permit to determine the volume of the tumoral mass and their evolution. These two factors are of significant importance in the planning of the correct surgical procedure, while a third important factor is the proper evaluation of the symptoms presented by the patient. Regarding the treatment, on the basis of our own experience, which agrees with that of other authors, the surgical removal of any lesion greater than 5 cm is mandatory.

Subumbilical parietal cystic images.

We report three cases of women who came to our observation suffering from a feeling of heaviness in the pelvic floor. Ultrasonography showed, in all cases, a cystic formation, medially located under the umbilicus, suggesting the presence of a cyst of the urachus. Computed tomography and magnetic resonance imaging, however, thanks to a more definite topographic evaluation, allowed elimination of this diagnosis in two patients with history of previous abdominal surgery.

Torsion of a uterine leiomyoma: MRI features.

We report a case of a patient admitted to our hospital for acute pelvic pain. Ultrasounds and abdominal CT scan found a voluminous mass situated in the upper urinary bladder and contiguous to the uterus and to the ovaries. Magnetic resonance imaging identified a pedicle connecting the uterus to the mass which had an aspect of a necrobiotic leiomyoma. Laparoscopic surgery confirmed the diagnosis of acute torsion of a subserous uterine leiomyoma.

Thrombophlebitis of the hepatic veins: complication of a Klebsiella liver abscess.

Among the various causative agents of an abscess of the liver, Klebsiella is a frequent and well-known cause, and its imaging findings have been described in the past decades. We report two cases of this type of abscess, which were of interest because of associated findings indicating a subhepatic thrombophlebitis of the liver, a process which could have explained the development of a concomitant pulmonary infectious process.

Clinical follow-up of 50 patients treated by percutaneous lumbar discectomy.

A series of 50 patients presenting with lumbar discogenic disease, and treated by percutaneous discectomy using the Dekompressor system (Stryker, Kalamazoo, MI, USA), were followed for more than 6 months, by analyzing the evolution of the painful symptomatology with the visual analog scale (VAS) system. All patients had been under treatment with analgesic or anti-inflammatory agents. The intensity of the pain was measured 2, 7, 30, and 180 days after the percutaneous discectomy. An improvement in the painful symptomatology of less than 30%, observed in 11 cases and in 1 case of epidural pathology, was considered an unsuccessful result. A decrease of the pain of more than 70% was observed in 72% of cases, either with the end of the symptoms of pain as noted in 79.5% of patients or with a marked reduction of the medical treatments obtained in 21.5%. The results obtained were already almost definitive at the seventh day of follow-up, and further controls rarely demonstrated an improvement in the pain. The location of the herniated disc is a parameter which appears to be very important in the efficacy of percutaneous discectomy. We noted an improvement of more than 70% in 79% of the posterolateral foraminal or extraforaminal hernias, although these favorable results were observed only in 50% of the posteromedian hernias.

Shoulder distension arthrography in adhesive capsulitis.

Capsular retraction of the shoulder often occurs as a solitary pathological process; half of the cases are of primitive nature. In the past 10 years or more, distension of the shoulder joint has proven to be an efficient percutaneous treatment, and various techniques have been proposed. We report on our technique, which was performed on a series of 200 patients, and on the results observed in 27 patients with a precise evaluation of progressive changes in movements of the joint.

Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report.

Nineteen months after a Whipple procedure for pancreatic carcinoma, a 79-year-old woman developed recurrent tumoral strictures of the bile ducts and afferent Roux-en-Y limb with resultant jaundice, cholangitis, and liver abscess. Transhepatic abscess and biliary drainages were performed first. Afferent loop obstruction was too far from biliary anastomosis to be crossed via the transhepatic route. Percutaneous jejunostomy and stenting were performed to relieve the malignant afferent loop syndrome. After initial relief of symptoms, jaundice recurred in relation to peritoneal carcinomatosis progression and was treated with percutaneous jejunostomy drainage until patient's death. Therapeutic options of tumoral occlusion of afferent loops are reviewed.

Inguinal herniation of a bladder diverticulum.

The inguinal herniation of a bladder diverticulum is a rare entity. We report two cases and describe the findings observed by computed tomography, which allowed demonstration of the site and contents of the hernia.

Magnetic resonance cholangiography features of biliary abnormalities due to cavernous transformation of the portal vein.

BACKGROUND: The aim of this retrospective and monocentric study was to describe the magnetic resonance cholangiography (MRC) features of biliary abnormalities related to extrahepatic obstruction of the portal vein (EHOPV). METHODS: From September 2001 to May 2003, MRC was performed in 10 consecutive patients who had a portal thrombosis. RESULTS: Biliary ductal pathology was demonstrated via MRC in nine patients. It consisted of stenoses, ductal narrowing or irregularities involving the common bile duct for three patients with extrahepatic portal vein thrombosis discovered a mean of 1.5 years ago, or involving both right and left intrahepatic bile ducts and common bile duct for six patients with extrahepatic portal vein thrombosis discovered a mean of 16.2 years ago. Dilation of intrahepatic bile ducts was seen for seven patients, four of them having cholestasis. For three patients with symptomatic cholestasis, direct cholangiography (DC) was performed and showed the same findings as MRC which nevertheless overestimated the degree of bile duct stenosis. CONCLUSIONS: MRC seems to constitute an accurate tool to investigate noninvasively patients with portal biliopathy.

Peripheral neurogenic tumors: is the use of different types of imaging diagnostically useful?

We report a series of six benign peripheral neurogenic tumors (five schwannomas and one neurofibroma) studied by 3D ultrasonography (US) and magnetic resonance imaging (MRI). The findings demonstrated by US and MRI are variable, but usually permit the diagnosis of benign nervous tumor without prejudging the final histological diagnosis. MRI does not bring forward further complementary images to those observed at US, which is limited by its dependence on its operator. The use of 3D US will be sufficient for the diagnosis and preoperative evaluation of a lesion when it is possible to furnish the volumetric data and the tools necessary for data analysis in a single document (in a CD).

Atypical MRI features of a biliary cystadenoma revealed by jaundice.

We report on the case of a patient admitted for epigastric pain. An abdominal ultrasound revealed a voluminous cystic lesion of the left hepatic lobe. In magnetic resonance imaging, the mass had a liquid-liquid level that was spontaneously hyperintense on T(1)-weighted images and hypointense on T(2)-weighted images. Magnetic resonance cholangiography identified bilateral intrahepatic bile duct dilatation. A left hepatectomy finally revealed a mucinous cystadenoma with pseudo-ovarian stroma that had a pedunculated intraductal extension to the biliary convergence.

[Multiple focal nodular hyperplasia of the liver associated with congenital absence of the portal vein]. / Multiples hyperplasies nodulaires focales hépatiques associées à une agénésie congénitale de la veine porte.

We report the 32nd case of congenital absence of portal vein in an 18-year-old female adult associated with multiple focal nodular hyperplasia of the liver. The association of various hepatic tumors has been observed in half of the publications about congenital absence of portal vein. Hepatic tumors seem to result from systemic diversion of portal vein flow with a resultant increase of arterial flow causing important vascular and nutritif changes the liver and consequent parenchymal transformation.

Acquired complicated diverticulum of the ileum.

The complicated diverticula of the ileum are a rare cause of an acute abdomen. We report on a case in whom the CT imaging leads to the surgical removal of the ileocecal segment.

Posterior arthrodesis of the spine by percutaneous CT-guided application of screws: preliminary report.

We report our preliminary results obtained in five patients following a percutaneous posterior arthrodesis of the spine, executed under fluoroscopic control and CT guidance. To benefit from a mechanical fixation after an anterior osteosynthesis without the inconveniences of the classic posterior surgical intervention, we have adopted a procedure performed under local anesthesia and based on the intraarticular application of screws. The procedure is CT-guided, resulting in a perfect localization of the area involved, it is safe, and it is performed in a short time limiting, therefore, possible neurological, vascular, or visceral complications.

Burst fracture of the spine involving vertebrae presenting no other lesions: the role of vertebroplasty.

We report our experience on percutaneous vertebroplasty performed on five patients who presented with history of trauma to the spine and secondary burst fracture, but with stable fractures, and on whom the medical and orthopedical therapies had been unsuccessful in the relief of the intractable pain and in the treatment of their functional status. Four cases have benefitted from the intervention, with complete disappearance of the symptomatology in two and incomplete in the other two. In one case, the improvement in the persistent painful symptoms was of no significance. Controls by computed tomography (CT). Which were performed after 3 months showed a satisfactory consolidation of the fractured vertebrae.

Endoscopic treatment of vesicoureteral reflux--a 20-year follow-up.

Endoscopic reflux therapy has gained more and more popularity, and the use of this method is increasing. These imaging patterns (well known by pediatric radiologists) should be known by the general radiologist as the first young patients treated 20 years ago are now adults.