[Imaging features of osseous and extra-osseous involvement in Erdheim-Chester disease]. / Imagerie des localisations osseuses et extra-osseuses de la maladie d'Erdheim-Chester.

Erdheim-Chester disease is a rare form of systemic non-Langerhans cell histiocytosis characterized by infiltration by lipid-laden or foamy histiocytes. Osseous involvement, major diagnostic criteria, is constant and characteristic. It presents as metaphyseal and diaphyseal osteosclerosis, mainly affecting the long bones of the lower limbs. A few cases with axial skeleton involvement have been reported. Extra-osseous lesions may affect the retroperitoneum, lungs, skin, heart, brain and orbits. Prognosis depends mainly on the extra-osseous disease, mainly heart and lung involvement. Diagnosis is based on the combination of radiographic features, nuclear medicine features and nearly pathognomonic immunohistochemical profile.

Carotid rete mirabile and pseudoxanthoma elasticum: an accidental association?

We report the case of a young female patient with a transient amaurosis due to a carotid rete mirabile (CRM), a rare congenital carotid malformation, and pseudoxanthoma elasticum (PXE), an inherited autosomal recessive systemic metabolic disorder characterised by fragmentation and mineralisation of elastic fibres in connective tissues (skin, eyes) and the vascular system. CRM is a rare form of intracranial carotid malformation whose association with PXE (6 cases at present) would appear not to be accidental. This observation suggests a new link between congenital arterial remodelling and the PXE.

[Dose reduction during CT coronary angiography]. / La réduction de dose en coroscanographie.

Dose delivery during CT coronary angiography with retrospective ECG gating is high especially due to the important slice overlapping. Optimization of the acquisition parameters is necessary to reduce patient exposure. First, the height of the scan field should be limited to the heart. Both kV and mA should be adjusted based on patient morphology. ECG gated exposure modulation with mA reduction during systole, a technique most applicable for patients with slow and regular heart rate, can result in a dose reduction up to 50%. The use of prospective ECG gating can also reduce patient dose. This technique also requires patients with slow and regular heart rate.

[Cystic and cavitary lesions of the lung: imaging characteristics and differential diagnosis]. / Kystes et cavités du poumon: description sémiologique et approche étiologique.

Gas containing lesions of the lung can be differentiated into cystic and cavitary lesions based on their imaging characteristics, which is helpful for differential diagnosis. The imaging features include number, size, thickness and smoothness of the walls, content, lesion distribution and occasional associated lesions. Some imaging features have characteristic diagnostic implications: mural nodule and meniscus sign. Cysts are characterized by thin and regular walls, less than 2 mm in thickness. The differential diagnosis includes: histiocytosis X, lymphangioleiomyomatosis, cystic metastases, septic emboli, pulmonary sequestration. Emphysema, honeycombing and cystic bronchiectases should also be considered. Cavitary lesion have thicker walls. The most frequent etiologies include abscess, cavitary tumors, mycobacterial infections and fungal infections.

Risk factors of early and late complications in patients undergoing endovascular aneurysm repair.

OBJECTIVES: to identify pre-operative factors that could predict complications following from transluminal repair of abdominal aortic aneurysms (AAA). METHODS: during a 5-year period, 96 consecutive patients underwent elective endovascular treatment of a AAA. In all patients, helical CT and/or Magnetic Resonance Imaging (MRI), and plain abdominal roentgenogram were performed at 1, 3, 6, 12, 18, and 24 months and yearly thereafter. Angiography was performed systematically 1 year after the stent-graft implantation, or earlier if helical CT or MRI diagnosed an increase in the maximal transverse diameter or a high flow endoleak. RESULTS: early (<30 days) morbidity (12%) was significantly increased by pre-operative renal insufficiency (p < 0.01). Early mortality (2%) correlated with ASA score (p = 0.01). Median follow-up was 27 months (range 3-66). Mortality (12%) during follow-up was correlated to the pre-operative coronary status (p = 0.01). A type I endoleak was diagnosed in 18 patients (19%). Common iliac artery diameter was correlated with the presence of type I endoleak (p < 0.001). A type II endoleak was diagnosed in 47 (49%) patients. The diagnostic of type II endoleak was significantly increased (p = 0.001) in patients with pre-operative patent IMA associated with more than four patent lumbar arteries. The anatomic characteristics of the aneurysm were correlated to the additional endovascular procedures during stentgraft implantation (p = 0.01), and to the implantation of a complementary iliac limb extension during follow-up (p = 0.01). CONCLUSIONS: the risk factors determined by this statistical analysis could help surgeons to select more accurately patients suitable for endovascular treatment.

Percutaneous endovascular treatment for stenoses and occlusions of infrarenal aorta and aortoiliac bifurcation: midterm results.

OBJECTIVE: evaluation and comparison of the endovascular treatment of isolated aortic and aortoiliac atherosclerotic lesions (stenoses and occlusions). METHODS: a percutaneous endovascular procedure was performed in 52 patients (38 men and 14 women) with a mean age of 52 years (range, 25-85 years). The baseline angiogram showed 35 aortic lesions (31 stenoses, 4 occlusions) and 17 aortoiliac lesions (14 stenoses, 3 occlusions). Percutaneous techniques used in this series included variable combinations of transluminal angioplasty and stenting. All stents placements were performed over-the-wire using the transfemoral route (most often bilateral approach). Clinical examination and Duplex-scan were performed at discharge, 1 month, 6 months, 12 months, and then yearly. RESULTS: technical success was 100% for aortic and aortoiliac lesions. Angiographic success rates were comparable for aortic (91%) and aortoiliac (94%) lesions. No death occurred during or early after the endovascular intervention. Duplex-scan confirmed 100% patency rate at discharge. There was no significant difference between the aortic (94%) and aortoiliac (96%) groups regarding immediate clinical improvement. Mean follow-up was 34+/-31 months (range, 0-130 months). The cumulative primary patency rate at 36 months was 85% in the aortic group and 86% in the aortoiliac group. Clinical success, defined as a symptom-free status at the end of follow-up, was also similar in both groups. CONCLUSION: endovascular treatment of isolated aortic lesions of the infra-renal aorta has favorable outcomes comparable to those of aortoiliac lesions.

[Renovaascular hypertension and Von Recklinghausen neurofibromatosis]. / Hypertension rénovasculaire et neurofibromatose de Von Recklinghausen.

This clinical case illustrates the diagnosis of a secondary cause of hypertension in a patient with Von Recklinghausen's disease. The hypertension resulted from a complex malformation of the right renal artery and dysplasic stenosis of the left inferior polar artery treated successfully by simple angioplasty. This case illustrates the high proportion of vascular (renal artery dysplasia, coarctation of the aorta) and endocrine (pheochromocytoma) causes of hypertension in patients with neurofibromatosis.

Embolization of type II endoleaks after aortic stent-graft implantation: technique and immediate results.

PURPOSE: We report the procedural details and immediate results of treatment of type II endoleaks after aortic stent-graft implantation. METHODS: In a consecutive series of patients who had either Vangard (n = 53) or Talent (n = 7) aortic stent-grafts implanted, type II endoleaks were confirmed by means of angiography in 18 patients, with a mean (+/- SD) age of 69 +/- 11 years; 16 patients had Vangard stent-grafts, and two patients had Talent stent-grafts. After superselective catheterization of the feeding vessel, with 3F microcatheters, and liberal injections of vasodilators, embolization was performed with either a mixture of biologic glue and Lipiodol (n = 16) or Microcoils (n = 2). RESULTS: The procedure was performed through the femoral artery in 16 patients and through the brachial artery in the remaining two patients. Overall, superselective catheterization and embolization were successfully undertaken in 17 (94.4%) of 18 patients. In the remaining patient, superselective catheterization proved impossible. This patient was treated with an injection of microparticles completed by means of embolization of biologic glue more proximally in an iliolumbar branch. During follow-up (mean, 13.3 months) after embolization, the aneurysm sac shrank in 13 (72.2%) of 18 patients. A new type II endoleak was diagnosed on helical computed tomography or magnetic resonance imaging in two (11.1%) of 18 patients. CONCLUSION: Percutaneous embolization is a safe and effective technique for treatment of type II endoleaks. However, despite these initially promising results, large long-term follow-up studies will be required to confirm its efficiency.

Diagnosis and treatment of type II endoleak after stent placement for exclusion of an abdominal aortic aneurysm.

After endovascular treatment of AAA, regular clinical and radiologic surveillance is necessary for early diagnosis and treatment of mid-term and long-term complications. The purpose of this report was to evaluate the efficacy of magnetic resonance imaging (MRI) in screening for type II endoleaks and assessing the results of treatment by embolization. From March 1996 to November 1999, 64 patients with uncomplicated infrarenal abdominal aortic aneurysm (AAA) were treated by endovascular exclusion with a covered aortic stent. Radiological surveillance included plain abdominal roentgenogram (PAR), CT scan, and pelvioabdominal MRI at 1 month, 3 months, 6 months, and every 6 months thereafter. Arteriography was performed routinely after 1 year or sooner if an endoleak was suspected. Based on the results of this study, MRI seems to be more sensitive than CT scanning for detection of type II endoleaks. The negative predictive value of MRI is also better. In this series, all endoleaks were treated by embolization. In most cases, the maximum transverse diameter and maximum anteroposterior diameter decreased after embolization. Further follow-up will be necessary to confirm these findings.

Mechanical thrombectomy in patients with deep venous thrombosis.

PURPOSE: To report our experience with mechanical thrombectomy in proximal deep vein thrombosis (DVT). METHODS: Eighteen patients with a mean (+/- SD) age of 37.6 +/- 16.1 years who presented with DVT in the iliac and femoral vein (n = 3), inferior vena cava (n = 5), or inferior vena cava and iliac vein (n = 10), were treated with the Amplatz Thrombectomy Device after insertion of a temporary caval filter. RESULTS: Successful recanalization was achieved in 15 of 18 patients (83%). Overall, the percentage of thrombus removed was 66 +/- 29%: 73 +/- 30% at caval level and 55 +/- 36% at iliofemoral level. Complementary interventions (seven patients) were balloon angioplasty (n = 2), angioplasty and stenting (n = 2), thrombo-aspiration alone (n = 1), thrombo-aspiration, balloon angioplasty, and permanent filter (n = 1), and permanent filter alone (n = 1). There was one in-hospital death. Follow-up was obtained at a mean of 29.6 months; three patients had died (two cancers, one myocardial infarction); 10 had no or minimal sequelae; one had post-phlebitic limb. CONCLUSION: Mechanical thrombectomy is a potential therapeutic option in patients presenting with proximal DVT.

Popliteal vascular disease: evaluation with spiral CT angiography.

PURPOSE: To evaluate the potential role of spiral computed tomographic (CT) angiography in the diagnosis of popliteal artery disease. MATERIALS AND METHODS: In 26 consecutive patients referred for popliteal arteriography, the authors performed additional spiral CT angiography with the following protocol: 3-5-mm collimation, 4-6 mm/sec table speed, and 2-3-mm overlap during 32 seconds, with use of 110 mL of contrast medium. Axial transverse sections and shaded surface display and multiplanar reformation reconstruction images were analyzed. All patients underwent previous Doppler ultrasound examination. RESULTS: In the 52 arteries imaged, arteriography showed 14 isolated hemodynamically significant (>50% diameter reduction) stenoses (due to popliteal artery entrapment in one case), four occluded arteries, and 11 aneurysms. CT angiography also demonstrated these 14 stenoses and four occlusions. However, axial transverse views at CT angiography showed that eight of the stenoses were associated with other abnormalities (aneurysm in six, popliteal artery entrapment syndrome in one, and cystic adventitial disease in one) and that two of the occlusions resulted from popliteal artery entrapment syndrome (n = 1) and thrombosis of an aneurysm (n = 1). CT angiography also demonstrated the 11 aneurysms shown with arteriography. CONCLUSION: Popliteal artery lesions can be diagnosed with spiral CT angiography, which provides detailed information on the wall and diameter of the artery and relation of the artery to adjacent structures.