[Giant left ventricular false aneurysme revealing a silent myocardial infarction]. / Volumineux faux anévrisme de la pointe du ventricule gauche révélant un infarctus du myocarde silencieux.

Left ventricular false aneurysms are rare. They are secondary to a myocardial rupture which is contained by adherent pericardium and scar tissue. LV pseudoaneurysm contains no endocardium or myocardium unlike left ventricular true aneurysm. Most cases of LV pseudoaneurysm are related to acute myocardial infarction in inferior or posterior wall. We report a case of a 56-year-old man with a medical history of chronic cigarette smoking, dyslipidemia, and obesity. The patient had no myocardial infarction before. He was admitted for evaluation of important shortness of breath at effort without chest pain for 5 months. Physical exam find an enlarged left ventricular. The electrocardiogram revealed Q waves and ST segment elevation in leads V1 to V6. Transthoracic echocardiogram showed a large thrombosed apical left ventricular false aneurysm, severe left ventricular dysfunction, which were confirmed by cardiac magnetic resonance imaging, this exam also showed no viability in the mid left anterior descending coronary artery territory. The coronary angiography showed an occlusion of the mid left anterior descending coronary artery and a stenosis of the first diagonal artery. The patient was offered a surgical aneurysectomy with coronary artery bypass. The surgery was successful with amelioration of symptoms. We present a rare case of a giant false left ventricular aneurysm complicating a silent myocardial infarction in the anterior wall. The diagnosis is made by cardiac echocardiogram and cardiac magnetic resonance imaging. Because of the important risk of rupture, the surgical treatment is required.

[Cauda equina syndrome revealing neuroblastoma]. / Syndrome de la queue de cheval révélant un neuroblastome.

INTRODUCTION: Neuroblastoma is the most common solid tumor of childhood. Neurological involvement is rare resulting from cord or nerve compression. CASE REPORT: A 7-year-old child was hospitalized for cauda equina syndrome. MRI showed retroperitoneal lesion with dumbbell intradural spreading. Blood and urinary catecholamine level were elevated confirming the diagnosis of neuroblastoma. She was treated with chemotherapy alone with partial neurological recovery. DISCUSSION AND CONCLUSION: Cauda equina compression revealing neuroblastoma is exceptional especially at an early phase in the youngest patients. Treatment is based on surgical resection and/or chemotherapy and/or radiation therapy. Long-term prognosis is sometimes poor with neurological sequels.

[Peroneal nerve schwannoma presenting with a peroneal palsy]. / Syndrome de paralysie péronière révélant un schwannome du sciatique poplité externe au col du péroné

Peroneal nerve injury in the lateral aspect of the knee is frequent, commonly dominated by traumatic or compressive etiologies. Tumors, generally synovial cysts, are exceptional causes. We report a case of a 70-year-old women referred for assessment of peroneal palsy syndrome found to be related to peroneal schwannoma in the lateral aspect of the knee. Schwannoma is the most frequent peripheral nerve benign tumor. It is commonly limited to cranial and upper limb nerves. Localization on the lower limbs (sciatic nerve) has been reported in 1 percent of cases. The peroneal nerve localizaton has not been reported to date. We underline difficulties of diagnosis inherent to this particular localization.

[Massive bilateral adrenal hemorrhage: role of imaging]. / Hémorragie surrénalienne bilatérale massive: apport de l'imagerie.

Bilateral adrenal hemorrhage is a rare and potentially life threatening situation in adults. The clinical presentation is non-specific, and the diagnosis is based on imaging. The purpose of this report is to provide an illustrative case of spontaneous bilateral adrenal hemorrhage that occurred during pregnancy. The sonographic and computed tomographic findings included large bilateral adrenal hematomas with no evidence of underlying malignancy. Since bilateral adrenal hemorrhage is a rare but potentially life threatening situation, prompt laboratory and imaging evaluation are essential and may reduce both morbidity and mortality.

[Imaging findings in 122 cases of Pott's disease]. / Imagerie du mal de Pott. A propos de 122 cas.

Spinal tuberculosis is a frequent skeletal involvement in tuberculosis. We report 122 cases between 1983 and 1998 of Pott's disease explored by plain radiographies in all cases, CT-scan in 22 cases and MRI in 6 cases. The lesion involved one localization in 98 cases, two localizations in 9 cases and multiple localizations in 15 cases. The usual form associating the discal and vertebral involvement was noted in 70%. Unusual forms were seen in 30% of the cases The localizations were: posterior arch (20 cases), centrosomatic (10 cases), suboccipital (4 cases) and subligamentar (2 cases). In addition, the CT scan noted vertebral lesion with soft tissue abscess in all cases and epidural lesion in 9 cases. MRI performed in 6 cases showed epidural lesions in 4 cases: epiduritis (2 cases) and abscess (2 cases). The disco-vertebral puncture-biopsy, performed in 12 cases, confirmed the diagnosis in 7 cases. The diagnosis of Pott's disease was confirmed biologically in 30 cases. Radiographic exploration of Pott's disease is improved by the contributions of CT and MRI which can identify sequestra, perilesional sclerosis and epidural or soft tissue abscesses. Discovertebral aspiration biopsy provides the key to diagnosis.

[Rib tuberculosis: value of imaging. Report of 4 cases]. / L'ostéite costale tuberculeuse: apport de l'imagerie. A propos de quatre cas.

We report 4 cases of tuberculous osteitis of the ribs in patients aged 25 to 60 years. All patients had thoracic CT scan. Two cases presented as multifocal tuberculosis, involving nodes and lung in one case, a costo-verebral joint and lung in the second case. In two patients, the aspect was a misleading pseudo-tumor form with a primitive malignant bone tumor and infiltration of perivertebral and endocanalar soft tissue in one case of costo-transverse joint tuberculosis with neurologial disorder; in the other case, the rib affection presented as a breast tumor due to the involvement of anterior thoracic wall in a 50-year-old woman. In all cases, the radiological aspect was quite extensive osteolysis of the rib with involvement of endo- and/or extrathoracic soft tissue noted as cystic or tissue density. We underline the value of CT scan for a complete investigation of rib lesions, which enables characterization of soft tissues involvement, guiding biopsies and search for associated vertebral lesions.

[Malignant bilateral mediastinal teratoma: a case report]. / Tératome malin bilatéral du médiastin: à propos d'un cas.

The authors report a case of bilateral malignant teratoma of the mediastinum in a 40 year old female presenting with chest pain. Two separate bilateral soft tissue masses were noted in the mediastinum at imaging. On the right side, the mass was heterogeneous with large calcification and infiltration of the pericardium. On the left side, the mass was well defined, heterogeneous and without evidence of local invasion. The analysis of samples obtained by US guided puncture biopsy and surgical specimen of the two masses confirmed the diagnosis of pluricellular malignant teratoma. Mediastinal malignant teratomas represent 1 to 5% of all mediastinal tumors. To our knowledge, no case of synchronous bilateral mediastinal teratoma has never been reported.

[Role of computed tomography in pulmonary aspergillosis. 20 cases]. / Apport de la tomodensitométrie dans l'aspergillose cavitaire. 20 observations.

OBJECTIVE: Aspergilloma is the most common form of pulmonary aspergillosis. The purpose of this work was to compare computed tomographic findings with features observed on standard radiographs. PATIENTS AND METHODS: We retrospectively reviewed 20 cases of pulmonary aspergilloma. These patients (mean age 36 years) were followed after cure of pulmonary tuberculosis and consulted for hemoptysis. All underwent computed tomography (CT) and standard radiographic explorations. Serology was positive for Aspergillus in 16 cases and clinical and radiographic findings led to the diagnosis in the 4 others. Both supine and prone positions were used for thoracic CT. Slice thickness was 5 mm without contrast injection. RESULTS: In many cases, standard films evidenced the typical mycetoma seen as a rounded mass of soft tissue density filling a portion of a preexisting cavity or as an air crescent sign, but atypical alveolar opacities, aeric images without aspergillosis colonization and parenchymal destruction predominated in certain cases. The CT-scan demonstrated these features even better revealing the typical cavity in 80% of the cases or an air crescent in 20%. Mobility of the fungus ball was demonstrated by comparison of the prone and supine images. The characteristic CT features allowed certain diagnosis of aspergilloma in 6 patients with atypical radiographic or serologic results. DISCUSSION: Computed tomography is highly contributive to the diagnosis of pulmonary aspergillosis, particularly in case of small cavities that may be missed on the standard films. Recognition of the mobility of the fungal ball enables differentiation from a tumor or infectious lesion. CT is also helpful for guiding transparietal treatment. CONCLUSION: A computed tomography series should be obtained in former tuberculosis patients consulting for hemoptisis.

[Renal angiomyolipoma imaging: report of 9 cases]. / Imagerie des angiomyolipomes du rein: à propos de neuf cas.

PURPOSE: To report the radiological polymorphism of angiomyolipoma (AML). MATERIAL AND METHODS: [corrected] A retrospective series of eight cases of AML explored by US and CT scan. The diagnosis was radiological in seven cases and histopathological in one case. RESULT: Five cases of AML were discovered fortuitously. The tuberous sclerosis of Bourneville disease (TSB) was noted in five cases. The cverage age was 37 years with female predominance noted in seven cases. The AML were multiple in half cases all of thein had TSB. The tumoral size ranged from 0.5 cm and 20 cm. The US showed an homogenous hyperechogenique mass in six cases and heterogenous in two cases. The CT scan showed polymorph parenchymal lesions. The fatty component was detected in seven cases. An intratumoral bleeding was noted in one case. CONCLUSION: The radiological feature of AML is variable, related to tumoral size. It's typical when a tumor of kidney contains fat. An association with TSB is a supplementary argument of diagnosis.

CT features of a voluminous gastric trichobezoar.

We report on the case of a 15-year-old girl with a voluminous gastric trichobezoar imaged by CT. The absence of any attachment of the mass to the gastric wall and the presence of air within the mass are very suggestive for diagnosis.

[Malignant stromal tumors of the small intestine: report of 9 cases]. / Les tumeurs stromales malignes du grêle: à propos de 9 cas.

PURPOSE: Analysis of imaging features of malignant stromal tumors of the small bowel and review of literature. MATERIAL AND METHODS: 9 cases of malignant stromal tumor of the small bowel with histological proof were imaged at US (8 cases), small bowel series (9 cases) and CT scan (3 cases). RESULTS: There were 6 cases of leiomyosarcoma and 3 cases of malignant schwannoma. Tumors involved the jejunum in 3 patients, the ileum in 4 patients, and the duodenum in 2 patients. The main clinical presentation was an abdominal mass (8 cases), which appeared heterogeneous and hypoechoic with eccentric lumen at US confirming its GI origin (7 cases). Small bowel series showed a bulky cavitary mass opacified via a thin fistula (7 cases), an ileo-ileal intussusception (1 case) and enlarged duodenal lumen (1 case). CT performed in 3 cases showed an intraperitoneal mass with soft-tissue density. A communication with the GI tract was noted in 1 case, and in another case, it showed an intestinal intussusception. US guided biopsy performed in 3 cases provided diagnosis in 2 cases (malignant schwannoma, leiomyosarcoma). Tumor growth was exophytic in 8 cases and dumbbell-shaped in 1 case. CONCLUSION: The imaging features of malignant stromal tumors of the small bowel are similar. It varies with the type of tumor growth and its size. The diagnosis may be suggested based on imaging features.

[Sellar hemangiopericytoma. Report of a case]. / Hémangiopéricytome sellaire. A propos d'un cas.

Authors report spontaneous necrosis of a sellar hemangiopericytoma, in a 44 year old man, revealed by a right cavernous syndrome. The initial CT scan showed a right sellar and parasellar spontaneous hyperdense process, intensely and homogeneously enhanced by contrast-agent. This process invaded the right cavernous sinus and extended to the sphenoid sinus. Magnetic resonance imaging showed a lesion in isointense on T1-weighted sequence and slightly hyperintense on T2-weighted sequence, with an intense and homogenous enhancement. The follow-up CT scan performed 6 months later, showed a total necrosis of the lesion. Angiography showed a slightly vascularised process, with mass effect on the carotid and sylvian vessels. The sellar and parasellar localization of hemangiopericytoma is rare. The spontaneous necrosis is exceptional, but it enabled us to distinguish it from meningioma.

[Intracranial hydatid cyst: contribution of scanography]. / Kyste hydatique cérébral. Apport de la scanographie.

We reviewed 14 cases of intracranial hydatid cysts, describing the clinical features and radiographic findings. The clinical presentation was dominated by signs of increased intracranial pressure and neurological manifestations. Diagnosis was established on the basis of CT findings, most valuable as a diagnostic tool.

[Cavernous sinus dermoid cyst with unusual parapharyngeal development]. / Kyste dermoïde de la loge caverneuse à développement inhabituel parapharyngé.

We report a case of dermoid cyst arising in the cavernous sinus and parapharyngium areas through the foramen lacerum. A 12-year-old girl was hospitalized in October 1966 for progressive intracranial hypertension. CT before a prior surgical intervention in 1994 showed an intracranial process suggesting a dermoid cyst. CT performed in October 1996 showed a temporal process at the left side measuring 8 cm x 5 cm and well circumscribed with a thin wall. This process extended towards the parapharyngium area through the foramen lacerum. The exocranial part measured 4 cm in diameter. The density of the process strongly suggested a mature dermoid cyst with fatty and calcium components. The histology study confirmed the diagnosis of dermoid cyst. The frequency of intracranial dermoid cysts is 2 to 3 times less than that of epidermoid cysts. This is an uncommon process accounting for 1% of intracranial tumors occurring in children. In the sustentorial spaces, the process occurs more frequently in the parasellar area. To our knowledge, exocranial extension has not been reported to date.

[Hydatid cyst of the mediastinum: 2 cases]. / Kyste hydatique du médiastin. A propos de 2 cas.

Hydatid cysts of the mediastinum are very uncommon. We report two cases of mediastinal hydatic cyst. The first case was located in the cardiophrenic recess while the other was within both the heart and mediastinum. A review of the imaging findings and value of various techniques is presented.

[Angiosarcoma of the breast. Radiological aspects. About one case]. / Angiosarcome du sein. Aspects radiologiques. A apropos d'un cas.

Angiosarcoma of the breast in an uncommon entity. The authors report a well documented case of angiosarcoma. The patient, a 23 years old woman, had a voluminous mass of the left breast without inflammation. The evolution was rapidly fatal. Physical examination revealed a large painful breast mass with purplish discoloration cutaneous area in front of the lesion. The palpation revealed a thrill. The mammography had shown an area of increased density in the left breast. A complementary ultrasound examination detected a well circumscribed voluminous mass with hypoechogenic heterogenous echostructure. The Doppler examination detected a venous blood flow in the tumor. This finding was compatible with vascular tumor as angioma or angiosarcoma. The angioscanner showed a peripheral vascular enhancement and a centripetal diffusion of the contrast product. This vascular kinetic is seen commontly in the angioma. Magnetic resonance imaging in the T1 and T2 relaxation times detected an intermediate signal mass with bleeding areas. The patient had had a mastectomy and the histopathologic examination confirmed the diagnostic of angiosarcoma. The radiological aspacts of angiosarcoma of the breast are discussed depending on the literature data.

[Centrosomatic spinal tuberculosis: radiographic features in 10 cases]. / Tuberculose rachidienne centrosomatique: aspects radiologiques. A propos de 10 cas.

We report a series of 10 cases of centrosomatic tuberculosis of the spine. The mean age of the patients was 36 years. Plain x-rays of the spine showed isolated defects in 3 cases, a defect with wedge fracture in 3 and a wedge fracture alone in 2. A sequestrum was found in 2 cases and bony condensation around the defect in 6. A CT scan performed in 3 cases showed, in addition to the bone lesions, a perilesional bony condensation in all cases. Soft tissue abscess formation was noted in 1 case and epidural involvement in the 2 others. MRI performed in 2 cases evidenced an alteration of the vertebral body signal with localized anterior epiduritis at the site of a small epidural abscess. CT scan and MRI contribute usefully to the radiographic diagnosis of centrosomatic tuberculosis, evidencing sequestra, bony condensation at the periphery of defects, and the presence of soft tissue abscesses and or epidural involvement. When these signs are absent, the differential diagnosis may be difficult with other causes of tumor formation, requiring vertebral biopsy.

[Cystic meningioma. Apropos of 6 cases]. / Méningiomes kystiques. A propos de six cas.

We report six cases of meningioma, uncommon tumors which accounted for 2.7 of all meningiomas observed in our series. Computed tomography was performed in all patients and produced the diagnosis in only 40% of the cases. Surgical treatment was given. Histological examinations of the surgical specimens confirmed the diagnosis. CT and magnetic resonance imaging were sometimes misleading, suggestive of metastasis or glioblastoma. Selective carotid arteriography with opacification of the external carotid artery established the diagnosis. Prognosis was good after surgery.