[Imaging in the screening and diagnosis of hepatocellular carcinoma in cirrhosis liver in Tunisia. A series of 30 cases]. / L'imagerie dans le dépistage et le diagnostic du carcinome hépatocellulaire sur foie de cirrhose en Tunisie. A propos de 30 cas.

UNLABELLED: The aim of our study is to expose a practical screening and diagnosis strategy of HCC occuring in cirrhosis liver, which is nowadays a health public matter in Tunisia. METHODS: HCC routine screening in cirrhosis liver has been conducted every 6 months using a combination of abdominal sonography and serum alpha-foetoprotein levels. PCUS, CT scan or MRI have been performed each time a focal liver lesion was discovered in US, or in case of elevated serum alpha-foetoprotein levels. 30 cases of HCC were identified. RESULTS: US has shown a unique nodule in 46% of the cases, multiple nodules in 50% of them. No lesion has been discovered in 4% of the cases. Nodule size ranged from 8 to 140 mm. Heterogenous hyperechoic pattern was the most frequent one (41%). Hypervascular doppler feature was authentified in 20% of the cases. Serum alpha-foetoprotein levels had respectively a sensitivity and a specificity of 14% and 44% in lesions inferior to 3 cm, 62% and 80% in lesions superior to 3 cm. Typical arterial enhancement of HCC was depicted in 1 case for PCUS, in 76% for CT scan and 60% for MRI. CONCLUSION: Combination of abdominal sonography and serum alpha-foetoprotein levels practiced every 6 months represent a good compromise between cost and effectiveness. Second intention imaging is based on CT scan in Tunisia because of its availability compared to MRI. PCUS is becoming in the near future the best modality for lesion caracterization thanks to its safety and relative inexpensiveness.

[Multiple abdominal venous aneurysms revealed by pulmonary embolism]. / Anévrismes veineux multiples intra-abdominaux révélés par une embolie pulmonaire.

Venous aneurysms are rare lesions, they have been reported in most venous territories. Abdominal location is unusual. A 61-year-old man presented with chest pain and dyspnea attributed to pulmonary embolism. Computed tomography of the abdomen showed multiple thrombosed venous aneurysms of the left external iliac vein and the inferior vena cava. There were no signs of rupture. The patient received anticoagulant treatment. He had no surgical treatment.

[Pituitary and ovarian mass syndrome in primary hypothyroidism]. / Syndrome de masse hypophysaire et kystes ovariens dans un cas d'hypothyroïdie périphérique.

INTRODUCTION: Hyperprolactinemia and a pituitary mass syndrome can occur in patient with primary hypoyhroidism. In young women, hypothyroidism can be associated with ovarian cysts. EXEGESIS: We report a case of a 30 year-old women who was treated for an anemia. She had clinical and biological signs of primary hypothyroidism with hyperprolactinemia at the biology. Pituitary MRI showed a pituitary mass. The pelvic ultrasound examination and CT scan showed a right ovarian cyst. The subsequent thyroid hormone replacement was associated with a clinical, a biological and radiological resolution. It was a pituitary and ovarian mass syndrome secondary to primary hypothyroidism. CONCLUSION: The recognition of these associations may eliminate unnecessary surgery and lead to the choice of hormone replacement therapy.

[Meningioma of the jugular foramen with a large cervical extension]. / Meningiome du foramen jugulaire à large extension cervicale.

Meningioma rarely gives an extra cranial extension. The authors report a case of meningioma of the jugular foramen reaching the left side of the neck. Epidemiological and clinical aspects of meningiomas of the neck are presented. The pathogenesis of this ectopic meningioma is discussed. We stress the contribution of imaging to evoke the diagnosis, determine the exact extent of the tumor, guide biopsies and allow post-therapeutic surveillance. Histological diagnosis of meningiomas of the neck is difficult since it can mimic more commonly encountered neck tumours. Difficulties of surgical techniques used to manage the tumor are also reported.

[Splenic nodules and sickle cell anemia]. / Nodules spléniques et drépanocytose.

OBJECTIVE: We report 4 patients with sickle cell anemia presenting with intra-splenic benign nodules corresponding to islands of preserved tissue within splenic ferro-calcinosis. MATERIAL AND METHODS: Ultrasound, CT and MRI findings were evaluated and compared to a follow-up study by ultrasound and CT done after 6 to 12 months. RESULTS: Ultrasound showed multiple well-defined rounded nodules appearing hypoechoic compared to the rest of the spleen that was hyperechoic. On CT, the nodules were homogenous, hypodense relative to the spleen, isodense to the liver in 3 cases and hypodense to the liver in 1 case. On MRI, the nodules appeared relatively hyperintense within low-signal-intensity spleens. The ultrasound and CT follow-up study demonstrated no remarkable change. CONCLUSION: In sickle cell patients, intra-splenic benign nodules corresponding to normal splenic tissue may be identified on imaging studies. The differential diagnosis is discussed.

[Tumor of the bone palate in tertiary syphilis. Contribution of x-ray computed tomography]. / Tumeur du palais osseux sur syphilis tertiaire. Apport de la TDM.

The authors report the case of two patients presenting with increased bone density and lytic lesions of the skull due to tertiary syphilis. A malignant tumor has late developed on these lesions. Only one patient was imaged with CT Scan which was very useful to determine the tumoral extension.

[Sialo-ultrasonographic approach of primary tuberculosis of the salivary glands. Apropos of 3 cases]. / Approche sialo-échographique de la tuberculose primitive des glandes salivaires. A propos de 3 observations.

Primary tuberculotic involvement of the salivary glands makes up two per cent of all cases of salivary gland tumefaction that we have had to explore with ultrasonography and sialography. The patients are generally young adults of a low socioeconomic status. Sialography is nonspecific, whereas ultrasonography can suggest the diagnosis in the presence of heterogeneous, hypoechogenic intraglandular lesions associated to adenopathies. An IDR with tuberculin is essential for the diagnosis before treatment.

[Teratoma of the parotid region: an uncommon disease. Apropos of a case with review of the literature]. / Le tératome de la région parotidienne: une affection exceptionnelle. A propos d'un cas avec revue de la littérature.

Cervicofacial teratoma is an infrequently reported tumor that is usually diagnosed at birth and is very rarely seen after one year of age. In the case reported, an exceptional finding was a teratoma of the parotid region in an adolescent. A literature review underlines the rarity of the lesion, diagnosis being assisted by radiologic and CT scan imaging.

[Agenesis of the diaphragm in a young adult. Apropos of a case]. / Agénésie du diaphragme chez un adulte jeune. A propos d'un cas.

We report a case of asymptomatic right diaphragm agenesis, in a 20-year-old adult hospitalized for internal bleeding. This kind of malformation is rare, particularly in adults thus it must be recognized. Imaging modalities are the main tool for diagnosis. It may be suggested by chest X-Ray US, baryum opacification and CT allow to establish a definite diagnosis depicting the herniated organs. The treatment is surgical and the prognosis is in general good.

[Small intestine occlusion caused by the silent opening of liver hydatid cysts into the peritoneum. Apropos of an uncommon case]. / Occlusion du grêle par ouverture de Kystes hydatiques du foie dans le péritoine à bas bruit. A propos d'un cas exceptionnel.

The authors report one exceptional case of organic small bowel occlusion. The etiological diagnosis was performed by ultrasonographic examination and showed two hydatid cysts of the liver opened into the peritoneum and a peritoneal fluid collection corresponding to the hydatid fluid. The authors emphasize the absence of clinical symptoms during the opening of the hydatid cysts of the liver into the peritoneum and the usefulness of emergency ultrasonographic examination of the entire abdomen in cases of small bowel obstruction without any evident etiology.

[Parotid haemangioma: MR imaging findings in 3 cases]. / Hémangiome parotidien: aspects IRM. A propos de trois cas.

OBJECTIVE: Parotid gland hemangioma is uncommon in infancy and childhood and even rarer in adulthood. The clinical presentation, supported by imaging findings provides the diagnosis. The aim of this work is to discuss the different clinical and radiological aspects of this lesion with a special emphasis on MRI findings. METHODS: Three patients with unilateral hemangioma are presented. Radiological investigations including ultrasound and magnetic resonance imaging (1 Tesla) were performed. RESULTS: Sonographic studies showed a lobulated mass with intermediate echogenicity, enlarging most or all of the visualized parotid gland. Correlative MR images in all cases showed a well-defined mass with an intermediate signal on T1-weighted images. On T2-weighted images, all masses appeared bright, heterogeneous with low signals within the masses consistent with flow voids representing blood vessels. Phleboliths were present in one case. CONCLUSION: MRI is the investigation of choice allowing an accurate diagnosis and avoiding invasive procedures including biopsy.

[Measurement of the obstetrical pelvis by tomodensitometry (110 cases)]. / Mensurations du bassin obstetrical par tomodensitometrie (à propos de 110 cas).

We had studied in one year 110 cases of scano-pelvimetry, the clinical examination had not found a shrink pound in 41%, revealed by the sceno-pelvimetry. This method is more precisely than the classic pelvimetry, but more expansive. The simultaneous study of echography and pelvimetry had contributed to a better obstetrical decision.

[Diagnostic imaging in neuro-Behçet's disease. Report of 5 cases]. / Apport de l'imagerie au diagnostic du neuro-Behçet. A propos de 5 cas.

The authors report five patients with neuro-Behçet's disease. Computed tomography showed low-density lesions with or without mass effect and contrast enhancement. Magnetic resonance imaging revealed scattered areas of high signal intensity on T2-weighted images, and iso or low signal intensity on T1-weighted images with enhancement after gadolinium injection. These lesions affected all the central nervous system structures with predilection to the brain stem, basal brain ganglia, internal capsula, subcortical and deep cerebral white matter. By its availability, computed tomography remains a precious tool for diagnosis and assessment of severity of neurological involvement. Brain magnetic resonance imaging reveals silent lesions on CT, specifies their exact topography, identifies lesional association reminiscent of neuro-Behçet and contributes to the differential diagnosis with multiple sclerosis. CT and MRI permit the follow-up of lesions under treatment and evaluate prognosis.

[Value of magnetic resonance imaging in neuro-lupus: report of 10 cases]. / Apport de l'imagerie par resonance magnetique au diagnostic du neuro-lupus: a propos de 10 cas.

This study shows the contribution of MRI to diagnosis and follow up of the cerebral lesions in neuro-lupus. Ten cases of neuro-lupus have been reported. The affected patients are 7 women and 3 men having an average age of 34 years. For 8 patients, MRI revealed lesions that were not detected using computed tomography. These lesions were high signal zones on T2, scattered with predilection to deep and sub-cortical cerebral white matter. MRI has also shown cortical and sub-cortical cerebral atrophy for 3 cases, cortical and deep infarcts for 2 cases and both atrophy and infarcts in one case. The MRI diagnosis was normal for the two remaining patients. MRI contributes to the diagnosis confirmation and localization of the cerebral lesions and to the follow-up. In spite of MRI sensitivity, the detection of these lesions remains non specific to neuro-lupus. New methods of exploration as the spectroscopy by magnetic resonance and the cerebral scintigraphy with Technetium 99m could be very helpful in diagnosis of cases for which MRI has shown limitations.