Ultrasound and CT of peritoneal recesses and ligaments: a pictorial essay.

US and CT permit one to visualize peritoneal recesses and ligaments. Ultrasonic analysis relies mostly on the liquid contrast of peritoneal effusions. CT demonstrates more readily the fatty and vascular contents of ligaments. Thus ultrasound displays essentially the thin part of ligaments, which CT is unable to show due to kinetic blur, whereas CT demonstrates readily the thick fatty parts of those peritoneal elements.

Acute fatty liver of pregnancy: CT evaluation. Case report.

CT scans of two patients with acute fatty liver of pregnancy were reviewed in conjunction with the clinical evolution of this uncommon and potentially fatal disorder. In each of the CT scans, liver density measurements were less than those of the spleen. While the findings are non-specific, in the proper clinical context they are highly suggestive and may be the sole method of diagnosis, as these patients often have coagulation problems which rule out liver biopsy. It is an important diagnosis, as the high maternal and fetal mortality rates appear to be considerably reduced by early foetal delivery.

[Acute pancreatitis disclosing an uncommon form of annular pancreas]. / Pancréatite aiguë révélant une forme particulière de pancréas annulaire.

We report a case of an acute pancreatitis revealing an annular pancreas associated with a pancreas divisum. Diagnosis was performed by endoscopic retrograde pancreatography with successful injection of major and minor papillae. Coexistence of pancreas divisum and annular pancreas is a rare congenital anomaly. Our case is original because the annular duct system encircling the duodenum is the ventral pancreas duct.

[Vascular radiology without hospitalization. Apropos of 306 angiographies and/or peripheral percutaneous transluminal angioplasties done on an ambulatory basis]. / La radiologie vasculaire sans hospitalisation. A propos de 306 angiographies et/ou angioplasties transluminales percutanées périphériques réalisées en ambulatoire.

A study on the safety of outpatient angiography and interventional radiology was undertaken. The authors reviewed the medical files of 286 patients and conducted a late telephone inquiry in 249 patients (87%) who underwent these procedures on an outpatient basis : arteriographies (221) or percutaneous transluminal angioplasties (76) and a few intravenous studies (9). The results revealed a high degree of satisfaction from the patients (98%), no major complications and a very low incidence of minor complications (3%).

[Hepatic steatosis in obesity in children]. / Stéatose hépatique par surcharge pondérale chez l'enfant.

The fatty liver infiltrations of the children are not uncommon and are often seen in particular diseases, mainly related to intoxication or metabolic diseases. The authors reported a case of heterogeneous fatty liver infiltration due to obesity with a good evolution after a hypocaloric diet.

[Ultrasonics in abdominal emergencies. Results of a series of 179 cases]. / L'échographie dans l'urgence abdominale. Résultats d'une série de 179 observations.

The study of a series of 179 emergency ultrasonic examinations showed a sensitivity of 97% and a specificity of 98%. Such results confirm the reliability of real-time sonography in the assessment of the acute abdomen, obstructive intestinal syndromes still requiring mainly conventional procedures. With this exception, the part of ultrasound in the diagnostic and the therapeutic strategies is essential. Associated to plain X-ray films, it enables one to curb down the number of other imaging procedures, such as IVP, angiography, or CT. Emergency ultrasound, particularly in traumatology, requires trained, competent radiologists. Performant machines should be available in admittance and intensive care wards.

[Yellow nail syndrome. Apropos of a case. A review of the main radiologic manifestations]. / Le syndrome des ongles jaunes. A propos d'un cas. Revue de ses principales manifestations radiologiques.

The authors report a case of "yellow nail syndrome" and emphasize the radiological features of this recently described entity which physiopathology has not yet been established. A new feature to be described: a non symptomatic pericardial effusion in association with long standing bilateral pleural effusions.

[Müllerian cyst. Apropos of a case of the prostatic region]. / Kyste müllérien. A propos d'un cas de la région prostatique.

One case of the unusual entity, prostatic müllerian duct cyst, is reported. Depending on their volume, they may, like in our case-report, or may not be symptomatic. Ultrasonography, C.T. scan and vasoseminal vesiculogram precised its midline location and its relationships with other adjacent anatomic structures. The endo-uretral approach to drainage was used successfully.

[Radiographic aspect of enterocystoplasties using the Kock technic]. / Aspect radiographique des entéro-cystoplasties selon la technique de Kock.

Normal radiologic images obtained during postoperative review examinations of patients with bladder epithelioma, treated by cystectomy and continent enterocystoplasty using the recently introduced Kock's technique, are described and a programme of radiologic follow up of these patients proposed.

[Vesico-ureteral reflux. Ultrasonographic aspect of endoscopic treatment (excluding follow-up)]. / Reflux vésico-urétéral. Aspect échographique du traitement endoscopique (en dehors de la surveillance).

Thirty four children, mean age 6 years, with reflux of 56 ureters were treated by an endoscopic approach. The technique, a recent innovation, attempts to reinforce the intravesical trajectory of the ureter by the injection of a Teflon disk below the vesical mucosa at the ureteral meatus level. The Teflon disk used is radiotransparent but could always be detected by ultrasound imaging, whatever its size, as a very reflecting image with a posterior cone shadow.

[Tomographic study of the intra-abdominal digestive tract. Contributions of percutaneous echography and scanner in daily practice]. / Exploration par coupes du tube digestif intra-abdominal. Apports de l'échographie percutanée et du scanner en pratique quotidienne.

Endoscopy and radiological imaging are complementary. However the gastro-intestinal tract is routinely being imaged in CT and ultrasound, often performed for other indications. When an abnormality is discovered, several questions have to be addressed. Is the lesion due to a bowel abnormality? When bowel wall thickening is present, is it due to poor opacification or is it due to inflammation or tumor? Circumferential symmetrical thickening is more in favor of an inflammatory lesion, while focal asymmetrical thickening is more in favor of a neoplastic lesion. Inflammatory and lymphomatous lesion can have similar appearances. Guidelines to aid in diagnostic interpretation of gastrointestinal lesions are discussed, including features of appendicitis and obstruction.

[Splenic infarction in Plasmodium falciparum malarial attack]. / Infarctus splénique au cours d'un accès palustre a Plasmodium falciparum.

Splenic infarct during P. falciparum malaria is rare but well known. We report one case where ultrasonography and computed tomography suggested the diagnostic, showing respectively in splenic parenchyma a peripheral hypoechoic lesion and a low attenuation lesion. Diagnostic was confirmed by spontaneous regression during following days. We shall encounter more frequently than nowadays this rare entity due to expanding tourism and P. falciparum resistance.

[X-ray computed tomography in purulent pleurisy]. / Apport de la scanographie au cours des pleurésies purulentes.

Complementary CT scan imaging during investigation of 18 cases of empyema showed it to be an essential examination, since it established the diagnosis in all cases, determined possible extension of the infectious process and possible causal lesion, defined the most effective approach for percutaneous drainage and evaluated efficacy of the later.

[Inflammatory pseudotumors of the liver. Apropos of a pediatric case with radiological and ultrasonographic features and anatomopathological correlations]. / Les pseudotumeurs inflammatoires du foie. A propos d'un cas pédiatrique avec aspects radiologiques et échographiques et corrélations anatomopathologiques.

Inflammatory pseudo-tumor of the liver (IPT) are benign encapsulated masses. IPT or inflammatory myofibroblastic tumor is a myofibroblastic proliferation with chronic inflammatory cell infiltration of unknown origin. A four-year-old girl, with cutaneous flushing of the face and biological inflammatory syndrome was referred for abdominal investigation. Ultrasound examination showed a 5-cm mass located in the anterior segment of the right hepatic lobe. After abdominal CT showing slightly vascular feature of this right hepatic mass, diagnosis was made through percutaneous US-guided fine needle biopsy. Surgical resection was performed and pathologic examination of the mass confirmed preoperative diagnosis. Clinical outcome was good.

[Ultrasonography and x-ray computed tomography in the diagnosis of intra-abdominal textiloma. Apropos of 12 cases]. / Apport de l'échographie et de la scanographie dans le diagnostic des textilomes intra-abdominaux. A propos de 12 cas.

Feared by every surgeon, retained surgical sponges (or gossypiboma) are rare iatrogenic entities. Ultrasonography and computed tomography are very valuable, providing an immediate answer in the majority of cases. We report 12 cases of intra-abdominal retained surgical swabs. The ultrasonic pattern was made whether of a large poorly echogenic mass with a hyper-echogenic center and sharply delineated posterior acoustic shadow (7 cases) or of a large acoustic shadow posterior to a solitary highly echogenic area (4 cases). Computed tomography demonstrated whether large peripherally enhanced cystic mass associated with serpiginous or spongiform central area (5 cases) or heterogeneous abscess-like fluid mass.

[Acute fatty liver of pregnancy. Apropos of 4 cases: contribution of x-ray computed tomography]. / Stéatose hépatique aiguë gravidique. A propos de 4 cas: apport de la tomodensitométrie.

Acute fatty liver of pregnancy is a disease of the third trimester, generally considered to be rare and to have a grave prognosis. Histologically the characteristic fine droplet steatosis usually produces distinct vacuolization. Successful treatment depends on accurate diagnosis and early delivery. Computed tomography is of value in the diagnosis of fatty liver through liver and spleen attenuation value measurements. We reviewed 4 cases of acute fatty liver of pregnancy. Computed tomography was performed in two cases and was very helpful in the diagnosis of this condition.

[Chemical colitis caused by glutaraldehyde]. / Colite chimique au glutaraldéhyde.

Glutaraldehyde disinfectant solution may be a cause of toxic chemical colitis. We report two cases. Ultrasonic features were studied in one case and mimic colonic ischemia, inflammatory and/or infectious colitis. These findings were colonic wall thickening especially mucosal (hypoechogenicity) and submucosal (hyperechogenicity) layers. This diagnosis should be discussed when one sees a patient with echographic findings of acute left-sided colitis just after uncomplicated colonic endoscopy.

[Purulent pleurisy caused by anaerobic bacteria. A retrospective study of 19 cases]. / Pleurésies purulentes à anaérobies. Etude rétrospective de 19 cas.

A retrospective clinical, biological, radiological and evolutive study of 19 cases of pleural empyema caused by anaerobic organisms diagnosed between 1980 and 1986 was carried out. These 19 cases accounted for 30.6 p. 100 of all cases of pleural empyema diagnosed during the same period. A local or general contributory factor was found in all patients; false passage, gastrointestinal pathology and buccal or dental diseases were the most frequent aetiological circumstances. The clinical picture was rather torpid, with a body temperature below 38 degrees C in 42 p. 100 of the cases, which delayed the diagnosis: the mean time interval between onset and diagnosis was 20 days. In nearly one half of the cases, blood stained expectoration was present and air-fluid levels were visualized at standard radiography and computerized tomography, which is the best exploratory method to evaluate the size and appearance of the pleural lesion, to guide percutaneous drainage and later to assess possible sequelae. The predominant anaerobic flora consisted of Gram-positive cocci and Bacteroides spp; in 70 p. 100 of the cases the anaerobic organism(s) was (were) sensitive to penicillin G. The course of the disease was favourable in all patients. Surgery was performed in 3 of the 19 patients on account of chest wall gangrene due to Clostridium perfringens in 1 case and of the presence of multiple fluid pockets making drainage ineffective in 2 cases.