[Pituitary necrosis and antiphospholipid syndrome]. / Syndrome des anticorps antiphospholipides et nécrose hypophysaire.

Antiphospholipid syndrome (APS) is an acquired thrombotic disorder. It mainly occurs with systemic disease or as a primary disorder. All organs may be involved by thrombosis, but to date the most common endocrine manifestation is chronic adrenal insufficiency. Very few cases of hypopituitarism with primary APS have been reported. We report the case of a 27-year-old woman, victim of a stroke leading to double vision and intracranial hypertension. Magnetic resonance imaging showed a macro-adenoma with hemorrhage of a suprasellar lesion. Hormone assessment showed hyper prolactinemia with positive anticardiolipin antibody. Our case is the second reported associating APS with apoplexy. We discuss the clinical, biological and radiological features observed in our case. We conclude that APS should be searched for whenever a history of adenoma with apoplexy is found associated with recurrent thrombosis.

[Osteogenesis imperfecta and hearing loss in childhood]. / L'ostéogenèse imparfaite, cause rare de surdité chez l'enfant.

We report a case of bilateral hearing loss in a child, caused by osteogenesis imperfecta and we evaluate CT scan findings. A 12-year-old child consulted for bilateral hearing loss. A computed tomography scan of the petrous temporal bone showed bilateral extensive unmineralized bone involving the cochleae, vestibules, and semicircular canals extending to the internal auditory canals. Osteogenesis imperfecta of the temporal bone is a genetic connective tissue disorder with increased bone fragility, low bone mass, and other extraskeletal manifestations. Hearing loss is rare in the first 2 decades of life, but it is one of the frequent features of this disorder in adult patients. Thin-section CT scans of the temporal bone show a remarkable proliferation of unmineralized bone involving the otic capsule. This demineralization is similar to that observed in the cochlear form of otospongiosis.

[Maxillo-facial location of hydatic cyst]. / Kyste hydatique du massif facial.

OBJECTIVE: A maxillofacial location of a hydatid cyst is rare, accounting 2% of cases. The purpose of this study was to review clinical and radiological features by emphasizing diagnostic difficulties. MATERIALS AND METHODS: Two observations of hydatid cyst with a maxillofacial location are presented. Two cases were investigated by panoramic dental radiography, an ultrasound and CT scan. MRI was done in one case. RESULTS: The first observation reports a 23-year-old woman who consulted for jugal tumefaction with pharyngeal extension evolving in spurts. The second observation was a 16-year-old girl, which consulted for a genian and masseter tumefaction with a tight trismus. In both cases, the imaging studies suggested the diagnosis of the hydatid cyst confirmed by the anatomopathologic exam. CONCLUSION: The hydatid cyst is an endemic parasitic pathology involving most often the lung and the liver. The maxillofacial location is exceptional. In cases of a cyst mass in an endemic zone, the diagnosis of the hydatid cyst must be entertained. CT scan and MRI provided a complete lesion workup. Treatment is surgical.

[Retrovesical hydatid cyst in children: report of 3 cases]. / Le kyste hydatique rétrovésical chez l'enfant: à propos de trois cas.

Retrovesical hydatid cyst is rare, even in endemic regions. From a presentation of three cases, the authors will review the clinical findings and illustrate the imaging features of this pathology and relate diagnostic and therapeutic difficulties.

[Intussusception owing to pathologic lead points in children: report of 27 cases]. / Les causes inhabituelles d'invagination intestinale aiguë: à propos de 27 cas.

OBJECTIVE: Intussusception owing to pathologic lead points is a challenging condition for pediatric surgeons. The aim of this study was to review the particularities of clinical presentation, the place of morphologic investigation in depicting the presence of an organic lesion and the management of secondary intussusception. PATIENTS AND METHODS: The authors report a series of 27 patients treated from 1986 to 2004, for secondary intussusception. RESULTS: Nineteen boys and 8 girls, aged from 45 days to 11 years (mean age: 40 months) presented with secondary intussusception: Meckel's diverticulum (13 cases); lymphoma (8 cases); intestinal duplication (3 cases); heterotopic pancreas (2 cases); intestinal polyp (1 case). All patients were operated upon after failure of hydrostatic reduction. An intestinal resection with an end to end anastomosis was done for 26 patients. The biopsy of a large abdominal mass after an easy reduction of the intussusception was performed in 1 case. Chemotherapy was started at the sixth postoperative day for the 8 children having lymphoma. Two of them died during therapy. For the 25 others, the postoperative course was uneventful with a mean follow-up of 4 years. COMMENTARY: The improvement of the management and the prognosis of secondary intussusception requires an early diagnosis. Morphologic examination must not be limited to the diagnostic of intussusception but must aim at searching a lead point. The reduction of this particular form is based exclusively on surgery.

[Pulmonary embolism and Behçet's disease]. / Embolie pulmonaire et maladie de Behçet.

Pulmonary embolism is an unusual complication of Behçet's disease. Our aim study is to analyse epidemiological, physiopathological and evolutive aspects of this condition. Among 153 patients with Behçet's disease according to the criteria of the International Study Group for Behçet's disease, seven (5 men and 2 women mean aged at 26.6 +/- 6 years) were diagnosed as having pulmonary embolism. This was inaugural in 3 cases; for 2 females, pulmonary embolism complicated pregnancy. Cardiac thrombosis was presented in 2 cases and pulmonary aneurysm in 2 patients. Pulmonary infarction has been noted in 4 cases. Protein C, protein S and antithrombin III levels were normal in all cases. One patient was positive for IgG anticardiolipin antibody. The hyperhomocysteinemia has been noted (17 to 30 micromol/) in 5 cases. All our patients were treated successfully by anticoagulation therapy combined with high dose prednisone, colchicine and intravenous cyclophosphamide in 6 patients. Pulmonary embolism is one of the severe and worst prognostic manifestations of the disease. Furthermore, the hyperhomocysteinemia may play an important role in the pathogenesis of such complication. Immunomodulation therapy associated to folate may be beneficial to attenuate this hyperhomocysteinemia especially, when introduced in the early stages.

[Congenital esophageal stenosis due to tracheobronchial remnants: report of 2 cases and literature review]. / Sténose congénitale de l'oesophage par hétérotopie trachéobronchique: à propos de 2 cas et revue de littérature.

Congenital esophageal stenosis due to tracheobronchial remnants is a rare malformation whose diagnosis may be difficult. It is characterised by the abnormal presence of congenital tissue of tracheal origin in the esophageal wall, which is responsible for the narrowing of the esophagus. We report 2 cases whose treatment was surgical after failure of esophageal dilations. The presence of tracheal-bronchial tissue was confirmed by histological examination of the operative piece. Outcome was favourable and the final result was excellent. Recently, endoscopic ultrasonography has been proved useful in the diagnosis of congenital esophageal stenosis due to tracheobronchial remnants by showing the presence of cartilage, which explains the failure of dilation. The high rate of perforation in these cases is due to brutal fragmentation of the cartilaginous rings. Surgical resection of esophageal stenosis with the tracheobronchial tissue appears the only treatment susceptible to completely suppress the stenosis and its consequences.

[Asymptomatic saphenous vein graft aneurysm: a case report]. / Anévrisme asymptomatique d'un greffon veineux coronarien: a propos d'un cas.

The authors report the case of a 48-year-old man with a history of coronary bypass graft 15 years earlier. The follow-up by routine chest radiography showed a right paracardiac opacity, which MRI conformed to be an aneurysm of the saphenous vein graft.

[Superior mesenteric artery aneurysm revealing a Behçet disease: a case report]. / Anévrisme de l'artère mésentérique supérieure révélateur de la maladie de Behçet: a propos d'un cas.

Arterial involvement in Behçet's disease is rare. It represents one of the fashions of expression of this pathology. We report an observation of a 32-year-old man who was hospitalised for an intense abdominal pain. Doppler ultrasound and computed angiography showed a superior mesenteric artery aneurysm. The patient was operated in urgency and operating suites were simple. The etiologic inquiry of this aneurysm ended in the diagnosis of Behçet disease. The result underline the need to search for Behçet's disease in all cases of arterial involvement in young patient. The treatment of the aneurysm should not be delayed.

[A rare aetiology of the post-partum fever: ovarian vein thrombophlebitis]. / Une cause rare de fièvre du post-partum: la thrombophlébite de la veine ovarienne.

OBJECTIVES: To clarify the contribution of the doppler and the CT in the balance aetiology of a fever of the post-partum and to connect it with a thrombophlebitis of ovarian vein. PATIENTS AND METHODS: Five patients presented there post-partum a fever with pointed abdominal painful syndrome. A doppler and a CT were performed. RESULTS: Doppler showed a hypoechoic tubular structure located forward and laterally with regard to the psoas with a flat spectre in pulsed Doppler in every case. CT confirmed the diagnosis of a thrombophlebitis of the right ovarian vein in three cases and left in two cases. Evolution after anticoagulation and an antibiotic therapy was favourable with regression of clinical signs and doppler evaluation. CONCLUSION: In front of any fever of the post-partum, it is necessary to evoke a thrombophlebitis of the vein ovarian, although it is about a rare aetiology. In spite of the superiority of the CT-scan and RP imaging for such a diagnosis, doppler is a simple and reproducible diagnostic tool for the monitoring which must be practised in first intention.

[Laser coagulation in the endoscopic management of fourth branchial pouch sinus]. / Traitement endoscopique au laser des fistules de la 4e poche endobranchiale.

OBJECTIVES: To describe a new method of treatment of the fourth branchial pouch sinuses by laser endoscopic coagulation of the fistula. MATERIAL AND METHODS: Retrospective study of two children aged 3 and 12 years with fourth branchial pouch sinuses. Both children presented recurrent cervical abscesses. The diagnosis was established on results of ultrasound, barium study, CT scan and pharyngoscopy. After recovering from infection, the definitive treatment was a laser diode cauterization of the fistulous route and its pharyngeal opening. RESULTS: Outcome was rapidly favorable in both children without complications or recurrence. DISCUSSION: These two cases and other reports in the literature confirm the role of endoscopic management for the treatment of the fourth branchial pouch sinus. Laser treatment is especially useful because of its convenience, its harmlessness and its reliability. CONCLUSION: Fourth branchial pouch sinuses are rare. Surgery, which can be difficult and not without risks, is the generally accepted treatment. This new laser method combines ease of treatment and efficacy.

[Imaging of pulmonary hydatid cyst in children]. / Imagerie du kyste hydatique du poumon chez l'enfant.

PURPOSE: We present the various imaging features of pediatric pulmonary hydatidosis based upon a series of 232 cases. The importance of chest radiographs and thoraco-abdominal ultrasound is emphasized. PATIENTS AND METHODS: A retrospective study of 232 children with pulmonary hydatidosis is presented. The 232 cases (130 boys and 102 girls, age range: 18 months to 14 years) were studied between January 1982 and December 2001. Chest radiographs were available in all cases, chest ultrasound in 156 cases and abdominal ultrasound in 212 cases. CT was only performed in 40 cases. Surgery was performed for all patients. Diagnosis was confirmed with serology tests and/or pathological study of resected cysts. RESULT: The total number of pulmonary cysts detected on chest radiographs was 344. The right lung was more frequently affected than the left (208 lesions). A simple cyst was the most commonly observed lesion (220 cysts). Complicated forms were noted in 118 cases. 180 cysts were observed at ultrasound. A simple cyst presenting as an anechoic mass was noted in 140 cases. In 38 cases, the lesion was heterogeneous. In two lesions endocystic germinal membranes were detected. CT visualized 50 lesions. Thirty three lesions were complicated with endocystic floating or collapsed membranes. Bronchiectasis was observed in seven cases. CONCLUSION: Chest radiographs and thoraco-abdominal ultrasound are very useful for the diagnosis of pulmonary hydatidosis and evaluation of lesion extension. CT is useful for diagnosis of atypical or complicated lesions and to detect bronchiectasis.

[Omental lipoblastoma: a case report]. / Lipoblastome omental: à propos d'un cas.

Lipoblastoma is a rare benign neoplasm of foetal fat tissue. To our knowledge, less than ten cases of omental lipoblastoma have been reported in the literature. We present a new case of omental lipoblastoma in a 3-month old girl. The role of CT in the diagnosis and surgery planning of this tumor will be discussed.

[Recurrent pericarditis revealing a malignant mediastinal mesenchymoma]. / Péricardite récidivante révélatrice d'un mésenchymome malin du médiastin.

INTRODUCTION: The malignant mesenchymoma is a malignant tumour composed of two or more types of non-differentiated tissue, associated with fibrosarcomatous elements. Its mediastinal localisation is exceptional. OBSERVATION: In a 65 year-old woman, recurrent pericardial effusion revealed a malignant mesenchymoma measuring 11 x 9 x 4 cm, located in the mediastinum and extending towards the pericardium. The histological examination of the surgical piece showed the predominance of an osteo-sarcomatous component. Complete resection was performed with partial pericardectomy, followed by adjuvant radiotherapy. CONCLUSION: Malignant mediastinal mesenchymoma is an exceptional tumour. Its diagnosis is based on anatomopathological study of a mass of anarchic composition, and its poor prognosis is related to its localisation and its capacity to relapse locally.

MRI in amyotrophic lateral sclerosis: hyperintensity of the corticospinal tract.

Amyotrophic lateral sclerosis is the most common form of motor neuron disease. The diagnosis is based on clinical and electromyography criteria. The primary role of imaging in amyotrophic lateral sclerosis is to exclude other causes such as cervical degenerative disk disease, Chiari malformation or multiple sclerosis. Imaging is also helpful in atypical cases of the disease.

Balloon dilatation of anastomotic strictures secondary to surgical repair of oesophageal atresia.

The purpose of this study was to evaluate the efficiency and safety of oesophageal balloon dilatation in strictures secondary to surgical treatment of oesophageal atresia in 25 children. Patients comprised 15 males and 10 females, aged 1-36 months. Median age was 4 months (interquartile range (IQR)=19). The strictures were more than 50% of oesophageal lumen and the delay from surgical treatment to balloon dilatation varied from 1 month to 36 months. Associated gastroesophageal reflux was noted in 15 patients. All procedures were performed under sedation using fluoroscopic guidance. Balloons of increasing diameter, 4-20 mm were used. Water soluble contrast swallow was performed after each dilatation session. A total of 115 balloon dilatation sessions were performed with a range of 1-14 procedures per patient (median 4 dilatations, IQR=4.5). Dilatation relieved the stricture in all patients over a follow-up period varying from 4 months to 33 months. The best results were noted in children under 6 months, who needed two or few dilatation sessions, with relative risk (RR) of 0.52 and 95% confidence interval of 0.29-0.92. The presence of associated gastroesophageal reflux indicated a high risk (RR of 12, p<0.001) for undergoing more than two balloon dilatation sessions. The only serious complications observed were two cases of oesophageal perforation, which were treated conservatively. Fluoroscopically guided balloon dilatation is a safe and effective treatment in the management of strictures secondary to surgical repair of oesophageal atresia, especially when started early (within 6 months of surgery) and not associated with gastroesophageal reflux.

Unusual complication of liver irradiation: acute thrombosis of a main hepatic vein: CT and MR imaging features.

The pathologic changes resulting from liver irradiation include congestion, fibrosis, and veno-occlusive disease. We report an unusual complication of radiation induced injury: acute thrombosis of a main hepatic vein within the radiation port. CT and MR features are described and the etiology of this unusual complication is discussed.

[Epidermoid cysts of the spleen. Report of 6 cases]. / Kystes épidermoïdes de la rate. A propos de 6 observations.

The authors report 6 cases of epidermoid cysts of the spleen. They emphasize the rarity of the lesion, its pathological and clinical features, and describe the abnormalities which can be noted on plain films, ultrasonography and computed tomography.

[X-ray computed tomography of thoracic injuries. Apropos of 40 cases]. / Tomodensitométrie des traumatismes thoraciques. A propos de 40 observations.

On chest radiographs, the precise assessment of thoracic injuries consecutive to blunt trauma is often compromised by the nonspecific appearance of many lesions. Furthermore, significant injuries are frequently overlooked. However, the management of the patients with chest trauma is still often based primarily upon clinical and radiographic findings and Computed Tomography (CT) is often performed secondarily on the basis of unexplained clinical signs or suspected radiographic abnormality. Some authors have reported that CT was a highly sensitive method for detecting thoracic lesions frequently not seen or underestimated on conventional supine chest radiographs. However, the value that these new CT findings could have in the therapeutic management of these patients, have not been systematically investigated to our knowledge, except in a limited series suggesting that the course of critically ill patients could be substantially altered after thoracic CT. In order to estimate the role of early CT in the management of patient care, we report the therapeutic consequences of CT findings in forty patients who we report the therapeutic consequences of CT findings in forty patients who had a thoracic CT within few hours following a chest injury. We showed that early thoracic CT scan in patients with blunt trauma detected significantly more lesions than did chest X-Ray and appreciably modified the treatment modalities in 70% of our patients. We then recommend that all the patients admitted in ICU after chest trauma undergo a thoracic CT scan as soon as possible in order to optimize their treatment modalities.