[Combined pulmonary fibrosis and emphysema: the natural history of the disease. The chronological evolution of clinical features, respiratory function and the CT scan]. / Syndrome emphysème - fibrose pulmonaire : histoire naturelle de la maladie. Évolution chronologique clinique, fonctionnelle respiratoire et scanographique.

INTRODUCTION: The syndrome of combined basal pulmonary fibrosis and apical emphysema (CPFE) is characterised by severe dyspnoea not fully explained by pulmonary function tests that show subnormal lung volumes and expiratory flows while CT imaging reveals varying degrees of emphysema and interstitial fibrosis. CASE REPORT: A man presented with chronic obstructive pulmonary disease associated with severe emphysema. Airflow obstruction was associated with early over-inflation. Five years later he developed interstitial fibrosis with CT appearances compatible with non-specific interstitial pneumonitis. Simultaneously, the decreased expiratory flows due to emphysema had become normal and the pulmonary distension had resolved. CONCLUSION: When CPFE develops, the reduced expiratory flows and thoracic distension due to emphysema can resolve. These changes may be explained by the late development of interstitial changes, which balance the functional consequences of emphysema by an increase in elastic recoil and reduction in volume. This is the first case report that describes the evolutionary profile in a single patient. It reinforces the pathophysiological hypothesis that explains the normal pulmonary volumes and expiratory flows in CPFE.

[Peritoneal parasitic teratoma and chemical dermoid peritonitis]. / Tératomes parasitiques péritonéaux et péritonites chimiques dermoïdes.

Chemical peritonitis occurs following intraperitoneal rupture of a mature ovarian dermoid. Rupture may be acute and spontaneous, typically during pregnancy, or iatrogenic. Low grade ruptures lead to parasitic peritoneal dermoid cysts, usually involving the greater omentum, cul-de-sac of Douglas and perihepatic region. Radiologists should be familiar with their appearance to correctly diagnose the condition and not mistake the disease for peritoneal carcinomatosis.

[Impact of whole body magnetic resonance imaging (MRI) in the management of melanoma patients, in comparison with positron emission tomography/computed tomography (TEP/CT) and CT]. / Apport de l'imagerie en résonance magnétique (IRM) du corps entier dans la prise en charge du mélanome : comparaison avec la tomoscintigraphie par émission de positons couplée à la tomodensitométrie (TEP-TDM) et à la TDM seule.

BACKGROUND: PET/CT has proven extremely useful in the management of melanoma patients, with great sensitivity (Se), but it tends to give false-positive results. Whole-body MRI (wb-MRI) is a new method that has made considerable progress. STUDY AIMS: The aim of this study was to assess the Se and specificity (Sp) of wb-MRI with a diffusion sequence for detecting melanoma metastasis compared to PET/CT. METHODS: This was a prospective study, including patients at any AJCC (American Joint Committee on Cancer) stage of melanoma. PET/CT, wb-MRI and CT, including the brain, were performed on the same day. For each of the three exams, the number of lesions per patient was counted. The treatments proposed by the doctor immediately after PET/CT and then MRI were compared. RESULTS: Forty patients were included and a total of 72 metastases were noted. CT detected 53 of these metastases (Se 80%, Sp 95%), while PET/CT detected 53 metastases, with four false-positive (Se 74%, Sp 89%) and Wb-MRI detected 59, with two false-positive (Se 83%, Sp 96%). The sensitivity of MRI was distinctly superior to PET/CT for both hepatic and pulmonary lesions. The treatment proposed after PET/CT and MRI differed in three cases: one patient was falsely reclassified by MRI (AJCC IV instead of IIB) while two others were falsely reclassified by PET/CT (AJCC IV instead of IB and IIIC). Exclusively whole-body scan influenced the treatment of four patients (10%). CONCLUSION: Wb-MRI with diffusion sequence, which is less costly than PET/CT and is also non-radioactive, could play an important role in the detection of metastases in melanoma patients.

Additional benefit of procalcitonin to C-reactive protein to assess disease activity and severity in Crohn's disease.

BACKGROUND: Serum procalcitonin level may reflect non-infectious inflammation. AIM: To assess the correlation of serum procalcitonin level with clinical, biological, endoscopic and radiological markers of disease activity in inflammatory bowel diseases (IBD), and to evaluate the additional diagnostic benefit of measuring serum procalcitonin level to that of C-reactive protein (CRP) for disease activity appraisal. METHODS: We performed a prospective observational study. Spearman's rank correlation and receiver operating characteristic analysis were used to evaluate correlation and diagnostic accuracy respectively. RESULTS: In Crohn's disease (CD) (n = 30), serum procalcitonin level was strongly correlated with clinical, biological, endoscopic and radiological disease activity markers. In CD, the serum procalcitonin level >0.14 µg/L demonstrated a high accuracy for detecting severe disease (Sensitivity = 100%; Specificity = 96%; AUROC = 0.963; P = 0.0001). The diagnostic accuracy of the 'serum procalcitonin level-CRP strategy' (CRP >5 mg/L and serum procalcitonin level >0.05 µg/L) was significantly superior to that of CRP alone for diagnosing severe CD (AUROC = 0.783 vs. 0.674; P = 0.01). In ulcerative colitis (UC) (n = 27), serum procalcitonin level was correlated with CRP and with endoscopic and radiological disease activity markers. CONCLUSIONS: In CD, the serum procalcitonin level was correlated with all disease activity markers and a cut-off of 0.14 µg/L could distinguish severe forms of the disease. The 'serum procalcitonin level-CRP strategy' was superior to CRP alone for diagnosing active or severe CD.

[Liver calcifications in adults: the KUB stars are too frequently neglected in the CT era]. / Calcifications hépatiques de l'adulte: les stars de l'ASP trop souvent négligées à l'ère du scanner.

Liver calcifications have been extensively described on plain radiographs, either from KUB or angiography examinations. On the other hand, their characteristics are seldom reported on cross-sectional imaging: they are frequently considered as non-specific compared to multiple other imaging features. However, clinical practice demonstrates that in specific situations (such as parasitic infections and calcified metastases), the presence of calcifications may be a determining factor in avoiding misdiagnosis with potential deleterious effects to the patient. Both CT and US can detect a large number of "benign" calcifications without associated focal lesion and knowledge of their imaging features is useful to avoid unnecessary additional imaging work-up. A review of the literature and a series of 100 cases of liver calcifications on CT are presented to review the imaging features of calcified liver lesions and isolated liver calcifications without associated focal lesion.

[Do all cryptogenic organizing pneumonias require lung biopsy and steroid treatment?]. / Pneumopathie organisée cryptogénique : biopsie et corticoïdes sont-ils constamment utiles ?

INTRODUCTION: Diagnostic guidelines recommend a lung biopsy to make the diagnosis of cryptogenic organizing pneumonia (COP). However, in some cases, in the presence of a typical clinical picture, the diagnosis can be made without histological proof: the combination of a "reversed halo sign" and migratory areas of patchy alveolar consolidation on the CT-scan is strongly suggestive. Steroids are the recommended treatment, but relapses and complications of steroids occur frequently whereas the morbidity of COP is usually low and the evolution is often the same with or without treatment. CASE REPORT: We report the case of a 51 year old woman with mild COP. The diagnosis was made according to the clinico-radiological criteria that we propose, without any formal histological proof. Treatment consisted of a short course of steroids, which led to spectacular clinical and radiological improvement but was withdrawn due to poor tolerance. The patient refused further treatment but clinical progress was favourable. After a follow-up period of 2.5 years a CT-scan showed evidence of a radiological relapse but the patient remained asymptomatic. CONCLUSION: In this article, we do not attempt to prove that lung biopsy and steroid treatment are unnecessary in the management of COP, but we would like to propose that, in some situations with the coexistence of a "reversed halo sign" and migratory areas of patchy consolidation on the CT-scan, in the context of a typical clinical presentation and mild symptoms, the usefulness of lung biopsy and steroid treatment is debatable.

[Radiofrequency ablation for palliation of soft tissue tumor pain]. / La radiofréquence dans le traitement palliatif à visée antalgique des tumeurs des parties molles.

PURPOSE: To assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain. MATERIALS AND METHODS: Retrospective study of 12 patients receiving palliative treatment for soft tissue tumors (5 primary tumors including 4 sarcomas and 1 PEComa and 7 metastatic tumors) with pain refractory to standard management. RF ablation was performed under CT or ultrasound guidance. RESULTS: The efficacy was determined by using pain scores and treatment regimen modifications after RF ablation. Response was graded as absent, partial or complete. Short term symptomatic relief was observed in 100% of cases, with complete response in 43% of cases ; Mid term and long term symptomatic relief was observed in 70% and 83% of cases respectively. We also observed dosage reduction for narcotics with corresponding reduction in related side-effects and functional improvement in some patients. A single case of complication with serosanguinous collection within a region of necrosis was observed. CONCLUSION: Radiofrequency ablation for palliation of soft tissue tumor pain may be a useful complement to standard management. It results in symptomatic improvement with few complications.

[Protocols for lung cancer screening: Limitations, and consequences]. / Les protocoles de dépistage du cancer bronchique: limites et conséquences.

Lung cancer is the leading cause of cancer mortality in the world. Its incidence is still rising, especially in women, and its prognosis is poor with a 5-year survival of 15%. Since 1970, several studies on lung cancer screening have been conducted using different investigations. Screening by chest X-ray and sputum cytology does not lead to improved survival in lung cancer. Screening by CT scan has the same outcome but the detection of lung cancer, especially in its early stages, is better than with chest X-ray and sputum cytology. Fluorescence endoscopy is a valuable examination for the detection of pre-invasive bronchial lesions. Genetic studies and identification of circulating tumour cells are being developed. All these examinations are very stressful for the patients. Only few trials have studied the consequences of lung cancer screening on the quality of life. In this review, we analyze the various screening strategies, their impact on quality of life and health and their adverse effects.

Benign intraductal papillary-mucinous neoplasm of the pancreas associated with spontaneous pancreaticogastric and pancreaticoduodenal fistulas.

Invasive intraductal papillary-mucinous neoplasms (IPMNs) of the pancreas may be associated with pancreaticogastric fistulas as shown by case reports. We report the case of a benign IPMN associated with pancreaticogastric and pancreaticoduodenal fistulas. A 70-year-old woman was admitted with intestinal obstruction. Computed tomography and MRI showed a large dilatation of the main pancreatic duct (>1 cm) with intraductal nodules, and pancreaticogastric and pancreaticoduodenal fistulas. Several features in imaging were present to support a malignant IPMN, so that the patient underwent a pancreaticoduodenectomy. The histopathological examination of the surgical specimen showed a benign IPMN. This case proves that a benign IPMN can cause pancreaticogastric and pancreaticoduodenal fistulas, probably resulting from mechanical factors.