Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip.

We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip.

Magnetic resonance imaging changes in periarticular soft tissues during flares of medial compartment knee osteoarthritis. Preliminary study in 10 patients.

OBJECTIVE: To quantify changes in magnetic resonance imaging signals from the deep and superficial capsulo-ligamentous planes and the medial collateral ligament in flares of knee osteoarthritis. PATIENTS AND METHODS: Preliminary prospective study of ten patients with medial compartment knee osteoarthritis meeting American College of Rheumatology criteria and associated with a Lequesne index of 5 or more. A grid was used to evaluate signal changes as compared to the opposite (asymptomatic) knee. Magnetic resonance images were read independently by two radiologists blinded to clinical data. RESULTS AND DISCUSSION: In all ten patients the capsulo-ligamentous planes and medial collateral ligament generated low signal on T1 images and high signal on T2 images. No significant changes were seen in the asymptomatic knee. The evaluation grid produced satisfactory interobserver agreement. CONCLUSION: Flares of medial compartment knee osteoarthritis are associated with changes in magnetic signal as compared to the contralateral asymptomatic osteoarthritic knee. The grid developed for this study could be used to evaluate the effects of treatment in a larger number of patients.

[Arterial lipiodol chemoembolization of a left liver metastasis through the right internal thoracic artery]. / Chimioembolisation artérielle lipiodolée d'une métastase du foie gauche via l'artère thoracique interne droite.

The purpose of this article is to illustrate the efficacy of the chemoembolization in patients with hypervascular metastases and to describe the post-embolization change in vascularization pattern. Unusual collaterals may develop following embolization. A 59-year-old woman, followed for unresectable small bowel carcinoid tumor since 1991, underwent successful chemoembolization of several liver metastases. Only one liver lesion, located in segment IV, showed interval increase in size. This lesion was supplied by the right internal mammary artery. A branch of the right internal mammary artery was catheterized using a microcatheter and embolization was performed using doxorubicine-Lipiodol (Adriblastine, Lipiodol) and gelfoam (Spongel). No complications occurred after the procedure. The right internal mammary artery should be considered as a possible source of collateral arterial supply to the liver and should be evaluated in patients with local progression of disease.

[Post-traumatic aneurysmal dissection of the extracranial internal carotid artery; helical computed tomographic and angiographic aspects: a case]. / Dissection post-traumatique anévrismale de la carotide interne extracrânienne; aspect tomodensiométrique hélicoïdal et angiographique: un cas.

A 20-year-old man presented with mild intracranial bleeding, a Horner's syndrome, and left neck swelling following head injury. Following noncontrast CT of the brain, a contrast-enhanced helical CT was performed through the neck that showed a hematoma in the poststyloid space (carotid sheath) with irregular diameter of the ICA. Selective digital subtraction angiography confirmed the presence of left cervical ICA dissection with pseudoaneurysm formation. The aneurysm was resected and an end-to-end anastomosis was done using an inverted saphenous graft. Histology confirmed a diagnosis of traumatic ICA dissection with pseudoaneurysm formation and there was no evidence of pre-existing pathology. Helical CT is a simple, widely available, and relatively non-invasive imaging technique that correlates well with angiography. It should be considered in the evaluation of patients with suspected cervical ICA dissection.

[Positional occlusion of the descending scapular artery in transverse thoraco-brachial syndrome with neurologic symptoms]. / Occlusion positionnelle de l'artère scapulaire descendante dans un syndrome de la traversée thoraco-brachiale à traduction neurologique.

We report a thoracic outlet syndrome revealed by neurological complications. Angiography of the subclavian artery depicted an isolated positional occlusion of the descending scapular artery. This side branch of the subclavian artery is anatomically located close to and supplies the brachial plexus. Surgical treatment led to improvement of most symptoms and post-operative control angiography was normal. Not previously described, this sign illustrates the objective compression of the brachial plexus. Ischemia is perhaps intricated with compression, a well-known pathophysiological mechanism of neurological complications in this syndrome. This artery feeding the brachial plexus is usually ligated during surgical neurolysis but must be preserved in order to improve recovery of neurological function and prevent surgical failures.

[Late solitary metastasis of a renal cancer to the contralateral adrenal gland]. / Métastase solitaire surrénalienne métachrone controlatérale d'un cancer du rein.

We report a case of metachronous metastasis from renal cell carcinoma to the contralateral adrenal gland detected one year after radical nephrectomy. The initial tumor was incidentally discovered in the setting of acute aortic dissection. A large left adrenal tumor was detected on CT follow-up at two years. Retrospectively, a hypervascular lesion was present on the first yearly CT examination. Adrenalectomy was performed. There is no evidence of recurrent disease at 12 months. The patient was also treated with oral steroids. Because of their location and of the particularities of available therapeutic options, and because these metastases can occur late, long-term sonographic and CT follow-up should be performed. The clinical, imaging, therapeutic and prognostic aspects of these lesions will be discussed.