[Hypermobile snapping medial meniscus: features on flexion-extension MRI]. / Hypermobilité du ménisque médial avec ressaut: IRM en extension et en flexion.

We report 3 cases of snapping medial meniscus due to hypermobility confirmed on extension and flexion MR imaging. The anterior horn of the medial meniscus was anteriorly subluxed during extension with reduction during flexion. Analysis of our imaging data and a review of the literature confirm that this relates to hypermobile medial meniscus, an anatomical variant.

[Non traumatic high flow priapism: arterial embolization treatment]. / Priapisme à haut débit non traumatique: traitement par embolisation artérielle.

PURPOSE: To report cases of non traumatic high flow priapism treated by arterial embolization. MATERIAL AND METHODS: Six men presented with non traumatic high flow priapism, the diagnosis was based on colour Doppler ultrasound, cavernous blood gas analysis with arterial blood saturation levels and failed medical or surgical therapy. Four patients had sickle cell disease. The embolization was performed with Gelfoam and was unilateral in one case, bilateral in the other cases. RESULTS: Detumescence occurred in a few hours in all cases. One patient had recurrent priapism two years after and was treated by embolization. Transient erectile dysfunction was observed in five cases, permanent in one case. CONCLUSION: Arterial embolization is the treatment of choice in high flow priapism with low rate of permanent erectile dysfunction.

CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases.

OBJECTIVE: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. MATERIAL AND METHODS: Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. RESULTS: Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. CONCLUSION: This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.

[Extensive cerebral venous thrombosis resistant to heparin: local fibrinolysis with urokinase]. / Thrombose veineuse cérébrale étendue résistante à l'héparine: fibrinolyse locale par urokinase.

A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic treatment was then performed using transvenous catheterization and instillation of Urokinase (2.6 MU over 4 days). A near complete repermeabilization of the sinuses was obtained and the patient improved dramatically in a few days. The only adverse effect of Urokinase was hematuria. Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relatively safe procedure. This treatment should be considered in a patient with extensive dural sinus thrombosis which fails to respond to heparin treatment.

[Aneurysm of the pulmonary artery. X-ray computed tomographic and MRI aspects. A case report and review of the literature]. / Anévrysme de l'artère pulmonaire. Aspects TDM et IRM. A propos d'un cas et revue de la littérature.

A case of aneurysm of the pulmonary artery diagnosed by CT scan and MRI and confirmed by angiography is reported. The discussion considers the literature review.

[The double band sign: pleural tuberculosis in x-ray computed tomography]. / Signe de la double bande: tuberculose pleurale en tomodensitométrie.

We described on computed tomography, two cases of pleural tuberculosis with parietal pleural enhancement and thickening associated with another external high density line. We called this parietal pleural and extra pleural change, the "double band sign". After study of the regional anatomy, we think that this external line is the endothoracic fascia.

[Magnetic resonance imaging of the knee. 3 cases of pigmented villonodular synovitis]. / Imagerie par résonance magnétique du genou. 3 cas de synovite villonodulaire pigmentée.

Pigmented villonodular synovitis is a benign monoarticular synovial proliferative disorder. Three cases involving the knee are reported. MR signs are highly suggestive: --joint effusion (blood); --hypointense synovial proliferation (irregular infrapatellar fat pad sign; hemosiderin deposits); --no loss of joint space. Diagnosis by MR Imaging is early, accurate and atraumatic.

[CT-guided percutaneous treatment of inoperable pulmonary aspergilloma. Apropos of 42 cases]. / Traitement percutané radiologique des aspergillomes pulmonaires inopérables. A propos de 42 cas.

The authors report 42 cases of symptomatic pulmonary aspergilloma treated by intracavitary percutaneous injections of Amphotericine paste. These patients were not considered as operable. The aspergillomas complicated tuberculosis sequels and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection under CT guidance; the aim being to obtain complete filling of the cavity and creating an "anaerobic" environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other treatments (drugs and surgery).

[X-ray computed tomographic and radiographic aspects of thoracic actinomycosis]. / Aspects radiographiques et tomodensitométriques de l'actinomycose thoracique.

UNLABELLED: The aim of this study was to evaluate chest radiographs and computed tomography (CT) in patients with thoracic actinomycosis. MATERIAL AND METHOD: Chest radiographs and CT scans of 9 patients with proved thoracic actinomycosis were reviewed. CT scans were performed after intravenous contrast administration. RESULTS: Airspace consolidation was present in the upper lobes in 6 patients and in the lower lobes in 3. Cavitations not apparent on the radiographs were seen on CT s in 2 cases. Mediastinal lymphadenopathies were seen on CT s in 2 cases, in one the infection extended through the mediastinal pleura into the mediastinum. Pleural thickening adjacent to the airspace consolidation was identified in 6 cases. Chest wall invasion occurred in 4 cases with a wavy periostal reaction involving ribs adjacent to the site of parenchymal involvement in 3 cases. Extension into the abdomen through the diaphragm was seen in one case. DISCUSSION: In humans, actinomycosis involves the thorax in 15% of the cases. Thoracic and pulmonary parenchymal involvement is usually secondary to aspiration of colonized material from the oropharynx in patients with poor oral hygiene. There is a basilar predominance of the disease, but some studies have reported apical predominance. The pulmonary infection leads to an airspace consolidation mainly in the lung periphery. The infection may extend across fissures and through the pleura. Chest wall and bone invasion are not uncommon. A wavy periosteal reaction involving ribs is said to be highly suggestive of pulmonary actinomycosis. CONCLUSION: Thoracic actinomycosis is characterized by airspace consolidation with adjacent pleural thickening. Chest wall invasion with a wavy periosteal reaction is highly suggestive.

[X-ray computed tomographic tests in the diagnosis and treatment of amebic liver abscesses]. / Apport de l'examen tomodensitométrique pour le diagnostic et le traitement des abcès ambiens du foie.

PURPOSE: The aim of this study was to evaluate the CT findings of amebic liver abscesses and its usefulness for treatment. METHODS: CT was performed in 51 patients with proved amebic liver abscess. CT studies were made before and after contrast injection. RESULTS: Among the 98 abscesses, 66% occurred in the right lobe. 66% of the patients presented a solitary abscess. The diameters were found between 2 cms to 15 cms. The mean was 7 cms. An enhancing wall was present in 84%; the margins were festooned in 75%, smooth in the other cases; internal septations were noted in 57%. High density material within the abscess, before injection of contrast was seen in 50%. 30% of patients had focal intra-hepatic biliary dilatation, 27% right pleural effusion, 23% peri-hepatic fluid collection. One hepatic-colic fistula and one hepato-pulmonary fistula were not suspected on U.S. examination. Percutaneous aspiration was done in 31% of the patients, when the diameter of the abscesses were more than 10 cms or when they were seen in the left lobe or when fever or pain did not disappear after treatment. CONCLUSION: CT scan may be helpful in diagnosis of amebic liver abscess at an early stage or later when a complication is suspected. CT scan can also help to indicate and safely perform a percutaneous therapeutic aspiration.

[MRI in subacromial pathology. Report of 20 cases]. / IRM dans la pathologie sous-acromiale. A propos de 20 observations.

The authors report the results of MRI performed in 20 patients presenting clinical symptoms of subacromial pathology. The MRI results are correlated to the results of arthrography or arthro CT scan and also to surgical results. MRI is an excellent technique if a precise protocol with T2 weighted images is respected in order to visualize tears or minor perforations of the supraspinatus muscle.

[Palliative percutaneous treatment under x-ray computed tomographic control of inoperable pulmonary aspergilloma. Apropos of 30 cases]. / Traitement percutané palliatif sous contrôle TDM des aspergillomes pulmonaires inopérables. A propos de 30 cas.

The authors report 30 cases of the percutaneous treatment of symptomatic pulmonary aspergilloma by injection of amphotericine paste in patients who were not considered to be operable. The treated aspergillomas had developed as a sequel to bacilliary infection and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection, the aim being to obtain complete filling of the cavity and creating an anaerobic environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other new treatments which have just appeared.

[Pulmonary dirofilariasis]. / Dirofilariose pulmonaire.

Dirofilariosis usually concerns dogs among which it is transmitted by mosquito bites. Human infection is rare and we describe here a case observed in a 75 years old woman in New Caledonia. A systematic pulmonary radiograph showed suspicious pulmonary nodules. At microscopic examination one can see pulmonary infarctus with thrombosis and Dirofilaria immitis inside a vessel. Diagnosis is usually made by histologic examination because biological investigations are of a little interest. Surgical treatment is enough. Chemioprophylaxia for dogs can reduce the risks of man infection.

Patient-controlled interscalene analgesia after shoulder surgery: catheter insertion by the posterior approach.

Insertion and maintenance of an interscalene catheter is technically challenging using lateral or anterior approaches. We report a technique to provide continuous brachial plexus blockade through a 48-h infusion of ropivacaine 0.1% (5 mL/h with a 5 mL bolus dose, 20-min lockout interval) using a catheter inserted with cannula-over-needle technique on the posterior side of the neck in 120 patients undergoing shoulder surgery. All catheters were successfully placed. There were no technical complications (impossibility to thread catheter, accidental vascular, epidural or subarachnoid location), catheter dislodgment, or analgesic solution leakage. Dysphonia, Horner's syndrome, and difficulty breathing were observed in 12 patients, four patients, and one patient, respectively. One patient complained of minor paresthesia that spontaneously resolved. Three patients complained of cervical pain. Pain scores as well as ropivacaine requirement via a patient-controlled analgesia device were low. Evaluation of acute and nonacute complications in a large-size study is needed to compare efficacy and safety of this approach with existing techniques.

High resolution chest CT in tuberculosis: evolutive patterns and signs of activity.

PURPOSE: The purpose of our study was to determine evolutive patterns and signs of active tuberculosis on high resolution CT (HRCT) scans. METHOD: We followed up over 15 months 27 patients with postprimary pulmonary tuberculosis that was proven bacteriologically. CT scans were performed before, during, and after 6 months of anti-tuberculosis treatment. Both 10-mm-thick sections and 1.5-mm-thick HRCT scans were performed. RESULTS: Ground-glass pattern was noticed 26 times, 9 times after 2 month treatment and only 2 times after 6 month treatment. Among these two patients, one did not undergo his treatment properly and the other one had an additional bacterial infection. Centrilobular nodules (n = 17) and poorly marginated nodules (n = 21) were present only before treatment. Reticular pattern (intralobular and septal thickening), interstitial nodules, and fibrosis were seen both before and after treatment. Ground-glass pattern, poorly marginated nodules, and infiltrates as well as centrilobular nodules were related to an active infection. CONCLUSION: This HRCT may be helpful to demonstrate activity in patients suspected of having tuberculosis and to assess antituberculous treatment efficiency.

[Multiple leiomyosarcoma of the small intestine. Apropos of a case]. / Léiomyosarcomes multiples du grêle. A propos d'un cas.

The authors report a case of multiple leiomyosarcomas of the small intestine, which is a very exceptional entity. After reviewing the pathological features and the distribution of leiomyosarcomas, they present the radiological and especially the computed tomographic findings of this type of tumour. They stress the difficulty of the differential diagnosis both in the solitary forms and in the exceptional multiple forms.

Percutaneous extraction of vertebral osteoid osteoma under computed tomography guidance.

The authors report two osteoid osteomas of the spine treated by percutaneous extraction under computed tomography (CT) guidance. CT helps to localize exactly and extract only the nidus with no further damage to the bone. This technique is very promising, with a limited approach and minimal bone resection allowing a short hospital stay and prompt functional recovery.

[Hepatic angiosarcoma. CT and MRI aspects. A case report and review of the literature]. / Angiosarcome hépatique. Aspect TDM et IRM. A propos d'un cas et revue de la littérature.

The authors report a case of hepatic angiosarcoma revealed by massive haemoperitoneum. They analyse the CT and MRI features of this rare tumour and recall the difficult diagnostic problems raised by cavernous angiomas. The new MRI diagnostic criteria must be recognized, but do not constitute formal proof of the diagnosis.

[Mesenterico-atrial shunt in the treatment of Budd-Chiari syndrome. Contribution of MRI in monitoring of 2 cases]. / Shunt mésentérico-atrial dans le traitement du syndrome de Budd-Chiari. Apport de l'IRM dans la surveillance à propos de deux cas.

The authors report the value of MRI in the long-term follow-up of two cases of mesenterico-atrial shunt for Budd-Chiari syndrome. They discuss the problems of differential diagnosis between slow flow and thrombosis, a significant risk with this type of shunt.