[Multiple ovarian fibromas in a patient with Gorlin syndrome: US and MR imaging features with pathological correlation]. / Fibromes ovariens multiples chez une patiente atteinte du syndrome de Gorlin.

We report a case of multiple ovarian fibromas in a 23 year old woman with Gorlin syndrome. We describe the US and MR imaging features with pathological correlation. The fibrous component of the tumors were hypoechoic and attenuating on US with corresponding T2W hypointensity whereas myxoid components were hypoechoic with increased through transmission on US with corresponding T2W hyperintensity.

[Imaging of acute pelvic pain in women]. / Imagerie de la douleur pelvienne aiguë

Acute pelvic pain in women is a routine situation in any emergency unit. The radiologist should know how to explore the patient with regards to the history and clinical findings. Ultrasonography is the primary and sometimes the only necessary imaging tool in the assessment of acute pelvic pain in women. MRI is the preferred technique in pregnant or young women. CT is more valuable for assessing nongynecologic disorders or post-partum and post-operative infections. This article reviews the contribution of each imaging technique in this clinical situation. Emphasis is put on the importance of age and clinical findings in the diagnostic strategy.

[Aspergillosis and sarcoidosis]. / Aspergillose et sarcoïdose.

INTRODUCTION: Diffuse fibrosing sarcoidosis represents an important predisposing factor for infection by Aspergillus sp. The clinical features and specific complications are illustrated by 3 case reports. BACKGROUND: Patients with chronic fibrosing sarcoidosis and cystic changes or cavitation in the upper lobes are the most prone to aspergillosis. Aspergilloma is the most common form and can be difficult to distinguish from chronic necrotising aspergillosis. Sarcoidosis with aspergillosis is associated with an increased incidence of respiratory failure and fatal haemoptysis. The 3 cases presented in this paper also illustrate the poor efficacy of oral antifungal drugs and bronchial embolisation. Surgery is often necessary but may be difficult on account of the extent of the lesions and poor respiratory function. VIEWPOINT: In the future the use of new drugs such as voriconazole and posaconazole may improve the prognosis of this complication. CONCLUSION: Aspergillosis represents a frequent complication of diffuse fibrosing sarcoidosis which warrants early detection and treatment on account of its poor prognosis.

Bacterial colonization status of cystic fibrosis children's toothbrushes: A pilot study.

BACKGROUND: Pseudomonas aeruginosa and Staphylococcus aureus toothbrush contamination in cystic fibrosis (CF) is unknown. This pilot study aimed to determine their prevalence and the potential involvement of toothbrushes in pulmonary infection. METHODS: Toothbrush bacteriological analysis for children aged 8-18 years was conducted on 27 CF patients, 15 healthy siblings, and 15 healthy children from the general population. RESULTS: S. aureus was detected on 22% of the patients' toothbrushes, and 13% of healthy children's toothbrushes and P. aeruginosa on 15% of patients' toothbrushes and 0-13% of healthy children's toothbrushes. There was no statistical correlation between pulmonary colonization and toothbrush contamination. P. aeruginosa genotyping showed two identical clones on the patients' toothbrushes and in their sputum, and between one patient's sputum and his sibling's toothbrush. CONCLUSION: S. aureus and P. aeruginosa can colonize CF patients' toothbrushes. The impact on pulmonary colonization remains unknown. Toothbrush decontamination methods need to consider these bacteria in CF patients.

Intrapulmonary haematoma complicating mechanical ventilation in patients with chronic obstructive pulmonary disease.

Intrapulmonary haematomas occurred during mechanical ventilation of two patients with advanced chronic obstructive pulmonary disease and bullous dystrophy. In both cases, the haematomas were revealed by blood-stained aspirates, a fall in haemoglobin level, and the appearance of radiological opacities. Haematoma occurrence in the area of a bulla which recently has rapidly increased in size, suggests that the haematoma is due to the rupture of stretched vessels embedded in the wall of the bulla.

Influence of medical speciality and experience on interpretation of helicoidal thoracic computed tomography in blunt chest trauma.

OBJECTIVE: To compare the quality of interpretation of chest helicoidal computed tomography (HCT) by physicians with different levels of experience and medical specialty. DESIGN: Prospective observational study. SETTING: Trauma critical care unit at a French university hospital (US equivalent: level 1). PATIENTS: HCT of 50 consecutive patients with blunt chest trauma were assessed by four groups of physicians [residents in anaesthesiology (n=5), residents in radiology (n=5), senior anaesthesiologists (n=5), and senior radiologists (n=5)]. Interpretation from each physician was compared with a grid obtained from an expert interpretation by a senior radiologist and a senior anaesthesiologist. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: No group of observers performed better than another in their interpretation of lung and parietal injuries on HCT. In contrast, senior radiologists were better than anaesthesiologists for the diagnosis of pneumomediastin. However, residents in radiology performed better than other physicians in detecting the presence of gastric and tracheal tubes. CONCLUSIONS: Compared with anaesthesiologists, senior radiologists seem more expert in the diagnosis of HCT mediastinal injuries whereas residents in radiology were better at detecting resuscitation materials in thoracic trauma patients. This article reinforces the usefulness of the interpretation of the HCT by a senior radiologist in the case of blunt chest trauma. This also reinforces the usefulness of an aspect team of radiologists and anaesthesiologists in the case of trauma. The logical usefulness of a systematic interpretation of the images should be borne in mind.

[Feasibility study of the Doppler exploration of the renal artery]. / Etude de faisabilité de l'exploration Doppler de l'artère rénale.

Using arteriography as a reference, the authors investigate the feasibility of pulsed doppler exploration of the normal or pathological renal arteries in 46 successive patients. The poor sensitivity of pulsed doppler, mainly due to the considerable anatomical variations of the renal pedicle, does not currently allow using this technique for the detection of renal arterial stenosis. When combined with angiography, pulsed doppler becomes a definite asset in therapeutic radiology to help in the choice of a treatment and in follow-up.

[Late empyema after pneumonectomy. Demonstration in x-ray computed tomography]. / Empyème tardif après pneumonectomie. Démonstration en tomodensitométrie.

The authors describe CT signs of a thoracic empyema, developed several years after a pneumonectomy. The disappearance of the concavity of post-pneumonectomy space in contact with mediastinum, associated to the absence of retraction of the hemithorax are the main signs of the diagnosis.

[MRI evaluation of placenta accreta treated by embolization. Apropos of a case. Review of the literature]. / Evaluation IRM d'un placenta accreta traité par embolisation. A propos d'un cas. Revue de la littérature.

Placenta accreta results from an abnormal attachment of the placenta to the uterine myometrium. The reported incidence in literature is variable, with an average of 1/7000 pregnancies. This condition is associated with a significant risk of bleeding at the time of delivery, usually requiring hysterectomy. Sonography associated with color Doppler is useful for diagnosis, but MRI can be used successfully to evaluate the degree of placental tissue invading into the myometrium, the serosa, and for follow-up after conservative management. To our knowledge, only two cases of placenta accreta evaluated with MR and six cases of placenta accreta treated by embolization have been reported in the literature. The authors report one case of placenta accreta treated successfully by embolization, and followed-up by MRI.

[Endometrial imaging]. / L'endomètre: quelle imagerie?

The diagnostic value of endovaginal sonography in benign or malignant endometrial pathology is high, increased by sonohysterography. Sonohysterography is useful in the diagnosis of endometrial thickness and to determine further investigations. MRI is accurate in the uterine adenomyosis diagnosis and is the imaging modality of choice for the preoperative endometrial cancer staging.

[Imaging of the endometrium]. / Imagerie de l'endomètre.

During genital activity, physiological and pathological modifications can be observed; Pre- and postmenopausal menometror-rhagia are the principle clinical signs of various endometrial pathologies: benign (polyp, atrophy or endometrial hypertrophy), malignant (cervical or endometrial carcinoma) or neighboring pathologies (myometrium or ovary). The value and methods of various imaging techniques (B-mode and Doppler abdominal and endovaginal ultrasonography, hysterosonography, computed tomography, MR imaging and hysteroscopy) are described together with symptomatological features permitting identification of the endometrial pathology.

[Which initial tests should be performed to evaluate meno-metrorrhagias? A comparison of hysterography, transvaginal sonohysterography and hysteroscopy]. / Quelle exploration réaliser de première intention face aux méno-métrorragies? A propos d'une série prospective comparant l'hystérographie, l'hystérosonographie et l'hystéroscopie.

OBJECTIVE: Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause. All patients underwent an hysterography and transvaginal sonohysterography, in random order, followed by an hysteroscopy with histological sample. The results were compared with the histo-pathological examination that was used for reference diagnosis. Statistical study of sensitivity, specificity and Positive and Negative Predictive Value (PPV-NPV) of each investigation; rate of agreement by the coefficient of Kappa. RESULTS: The hysterography offers a PPV of 83% and a NPV of 100%. The interpretation errors were associated with the simple mucous hypertrophy interpreted as "hyperplasy". The limits correspond to a contrast agent allergy. The sonohysterography had a VPP of 89% and a VPN of 100%. The false positive is due to the difficulties of distinguishing the clots from the polyps. The limits correspond to the difficulties of cervix catheterization (13%). As regards the hysteroscopy, the VPP was 81.5% and the VPN of 75%. The interpretation mistakes were associated with mucous hypertrophy and the hyperplasy. CONCLUSIONS: The most useful examination for abnormal uterine bleeding, in the first instance, is transvaginal sonography with saline instillation. A complement by Doppler study would probably make it possible to limit the false positives.

[Heart injury following closed thoracic injury]. / Plaie du coeur après un traumatisme fermé du thorax.

A 60-year-old man, was admitted in the emergency ward, following a motor vehicle accident. At the time of arrival his clinical state was stable. The initial investigations showed a moderate left haemopneumothorax and fractured ribs. After insertion of a thoracostomy tube into the left pleural cavity he had to undergo surgery for an open fracture of the left arm. Following induction of anaesthesia, a cardiovascular collapse occurred rapidly. An emergency thoracotomy was performed which showed a right ventricular perforation by a rib fragment. The authors discuss the role of possible changes in heart position produced by induction of general anaesthesia. Indeed the decrease in functional residual capacity following induction of anaesthesia with a cephalad diaphragmatic shift may have secondarily exposed the right ventricle to the bevel of a fractured rib.

[Interpretation of standard chest x-rays in thoracic trauma: influence of the experience of the interpreter]. / Interprétation des clichés thoraciques standard chez les traumatisés thoraciques: influence de l'expérience du lecteur.

OBJECTIVE: To compare the quality of interpretation of chest radiographs (CRs) by physicians of different levels of experience, with reference to data obtained from helicoidal computed tomography (HCT). STUDY DESIGN: Prospective observational study. MATERIAL: CRs of 50 thorax trauma patients as recent to HCTs as possible obtained within the 48 h following admission to the intensive therapy unit. METHOD: CRs were analyzed according to a grid by observers included in one of the four groups: residents in anaesthesiology (n = 6), residents in radiology (n = 3), senior anaesthesiologists (n = 5), and senior radiologists (n = 3). The inter-observer agreements, the specificity and sensibility of each group with reference to HCT, and their global performances were assessed. RESULTS: Inter-observer agreements were poor and sensitivities low in comparison to specificities. No group of observers performed better than another one. These data substantiate the low sensitivity of CRs in comparison to HCT and show that the quality of interpretation of CRs of thorax trauma patients is not influenced by physicians' experience.

[Analysis of chest radiographs of patients with thoracic trauma is not influenced by a grid nor by the experience of the reader]. / L'analyse du cliché thoracique chez le traumatisé n'est améliorée ni par une grille de lecture ni par l'expérience du lecteur.

OBJECTIVE: To evaluate the interest of a grid and the experience of the interpreter to interpretate the chest radiographs (CRs) of patients with thoracic trauma, the reference is the helicoidal computed tomography (HCT). STUDY DESIGN: Prospective observational study. MATERIAL: CRs and HCT of 50 thorax trauma patients. METHOD: CRs were analysed without a grid (L) and results were compared with those obtained in an anterior study with a grid (G). The interpreter were residents in anaesthesiology (DESAR; G: n = 6/L: n = 4), residents in radiology (DESR; G: n = 3/L: n = 5), senior anaesthesiologists (MAR; G: n = 5/L: n = 4), and senior radiologists (MR; G: n = 3/L: n = 5). The reference was the HCT. The lectors were compared. RESULTS: The interpretation of the CRs was neither influenced by the experience and the specialty of the lector nor by the use of a grid. Perhaps the formation is sufficient for the anaesthesiologists to evaluate the essential lesions in the trauma patient and treat them.

[Low grade pulmonary sarcoma preceding the discovery of a uterine primary]. / Sarcome pulmonaire de bas grade précédant la découverte d'un primitif utérin.

INTRODUCTION: Low grade pulmonary sarcomas are very rare tumours. We report the case of a low grade sarcoma of the lung occurring two years prior to the finding of a uterine primary. CASE REPORT: Complete surgical excision of a low grade pulmonary sarcoma was performed. The initial search for dissemination was negative. Two years later a follow-up scan discovered a uterine mass as well as a para-aortic shadow that proved to be the primary tumour (low grade uterine sarcoma) and a metastasis. CONCLUSION: This is the second case of a pulmonary metastasis discovered before a primary low grade uterine sarcoma. The first was found during the investigation of a pulmonary sarcoma. The main differential diagnosis to consider is metastatic leiomyosarcoma. In both cases their finding justifies the search for a uterine primary by immunohistochemical examination for oestrogen and progesterone receptors as well as pelvic ultrasound or even magnetic resonance imaging.

[Acute paraffin oil pneumopathies. Apropos of a case in a fire-eater]. / Les pneumopathies pétroliques aiguës. A propos d'un cas chez un cracheur de feu.

A case of acute paraffin oil-induced pneumonia due to accidental inhalation by a fire-eater of kerdane, a petroleum derivative is reported. The symptoms and course of respiratory manifestations of acute paraffin oil poisoning are reviewed. The physical properties of the petroleum derivative inhaled account for the pathogenesis of the pneumonia. Pulmonary lesions, usually fully reversible, result from the joint effects of an inflammatory phase with exudate and a proliferative phase.

[MR-galactography: a new way to explore nipple discharges]. / La galacto-IRM: une nouvelle méthode d'exploration des écoulements mamelonnaires.

Nipple discharge is a common breast complaint that justifies an etiologic check-up in order to identify and characterize the underlying intraductal lesion. The low sensitivity and specificity of the existing imaging exams led to the search of new, more efficient ways to explore nipple discharge. MR-Galactography is one of these emerging techniques. Recent literature tends to prove that MR-Galactography could be an interesting technique for localizing and characterizing lesions causing nipple discharge.