[Late portal vein thrombosis caused by hematoma after liver transplantation]. / Thrombose porte tardive par hématome après transplantation hépatique.

Late portal vein thrombosis of liver grafts is uncommon and is usually revealed by variceal bleeding. We herein report a case of thrombosis discovered in an adult 10 months after liver transplantation, due to stenosis of the portal vein by extrinsic compression, probably secondary to a biopsy-induced hematoma. Development of venous collateral circulation allowed for normal function of the liver graft.

[MR cholangiopancreatography]. / Cholangio-wirsungographie par IRM.

MR cholangiopancreatography (MRCP) is a new technique allowing noninvasive investigation of the bile ducts and pancreatic duct. Due to the extremely intense signal of water on T2-weighting, MR sequences can be obtained only demonstrating liquids. The bile and pancreatic ducts can therefore be studied spontaneously even in the case of major cholestasis. The contraindications of MR cholangiography are exclusively those of MR. MRCP can visualize the level of a bile duct obstruction and often the nature of this obstruction (stone, tumour). Complementary axial T1- and T2-weighted sequences can also visualize the parenchyma around the ducts. MR cholangiography therefore appears to be a technique of the future for noninvasive investigation of the bile ducts.

[Intraluminal diverticulum of the esophagus. Case report]. / Diverticule intraluminal de l'oesophage. A propos d'un cas.

Intraluminal diverticulum of the esophagus is exceptive. It characteristic radiograhic appearance is of a smooth ovoid collection of barium surrounded by a smooth, thin radiolucent line. The diverticulum was plainly within the esophageal lumen. The diverticulum was not demonstrated on every barium study. One case of a 79 year old goitred female with intraluminal esophageal diverticulum is reported. Possible causes are considered.

[Waterhouse Fridericksen syndrome in adults. Radiological diagnosis. Apropos of a case]. / Le syndrome de Waterhouse Fridericksen de l'adulte. Diagnostic radiologique. A propos d'une observation.

Waterhouse-Fridericksen syndrome is a rare possibility in the adult. The case reported here included full radiological evaluation. The diagnosis was made by ultrasonographic and CT scan imaging. Nuclear magnetic resonance imaging was obtained for the purposes of documentation.

[Percutaneous biliary prostheses. Type of material and indications]. / Les prothèses biliaires percutanées. Type de matériel et indications.

The results of percutaneous transhepatic endoprosthesis in the treatment of biliary stenosis are discussed on the basis of the reports of the literature and a personal experience of more than 400 patients treated for about 15 years. Advantages and disadvantages of conventional stents as compared with metal endoprosthesis are discussed, the latter being now preferred by most authors. However they do not prove to be more efficient than conventional stents which are suitable for those patients who have a relatively short life expectancy. Percutaneous treatment of benign biliary stenosis has grown as well but the choice of the best procedure remains difficult. Metal endoprostheses are controversial because the risk of delayed obstruction has not yet been clearly evaluated. However it might become an interesting therapeutic procedure in the future.

[Evaluation of the role of angiography in the diagnosis and surveillance of hepatic alveolar echinococcosis]. / Evaluation de la place de l'angiographie dans le diagnostic et la surveillance de l'échinococcose alvéolaire hépatique.

The authors recall the main pathologic and physiopathologic data necessary to understand the angiographic patterns of hepatic alveolar echinococcosis, by means of a rereading of a personal series of 37 cases. They show that this affection has a diagnostic angiographic shape which associate four signs: avascular aspect of the lesions, regular invasion of vessels, presence of a collateral circulation, absence of neovascularisation. Digestive angiography stays a good diagnostic method for the parasitosis, when epidemiological context, ultrasound or CT scan gave no explicit conclusion. It keeps an interest in the preoperative evaluation and in the supervision of portal vein.

[Lateral radiculography in the vertical position for the diagnosis of narrow lumbar canal]. / Intérêt de la radiculographie de profil en station verticale pour le diagnostic de canal lombaire étroit.

Results obtained in 66 cases emphasize the value of lateral imaging to increase sensibility of radiculography in the diagnosis of narrow lumbar canal. In all cases, in fact, the anteroposterior diameter of the opacified canal diminished in the standing position in proportions varying from 20 to 50%, and furthermore, in 20% of patients diagnosis was only possible from this image. Narrowing of the canal was considered as being present in patients with an anteroposterior canal diameter in the standing position that was less than 11 mm in corrected values. This image appears therefore to be an essential one, particularly as clinical symptomatology of narrow lumbar canal is very often atypical (62% of cases). Moreover, contrary to widespread opinions, computed tomography is sometimes less sensitive than radiculography in this type of disorder.

[Leiomyosarcoma and stromal tumor of the pancreas]. / Léiomyosarcome et tumeur stromale du pancréas.

A tumor of the head of pancreas was an incidental finding on US of two patients aged 52 and 61 years presenting with abdominal pain. The tumor was studied by computed tomography, MRI and endoscopic ultrasonography. Surgical biopsy of a liver lesion was performed in one case and partial duodenopancreatectomy was performed in the other case. Histological evaluation, including immunohistochemistry, showed leiomyosarcoma and stromal tumor respectively. Whatever the site of origin, most mesenchymal pancreatic tumors are hypervascular, heterogeneous and have a necrotic center.

[Contribution of spiral CT for the early diagnosis of hepato-cellular carcinoma in cirrhotic patients]. / Intérêt du scanner hélicoïdal dans le diagnostic précoce des carcinomes hépatocellulaires sur cirrhose.

PURPOSE: To evaluate the specificity of spiral CT for early diagnosis of small hepato-cellular carcinoma. PATIENTS AND METHODS: One or several hepatic hypervascular nodules, with a diameter smaller than or equal to 3cm and suspected of corresponding to small hepato-cellular carcinoma, were detected during the arterial phase of spiral CT in 55 patients. The diagnosis of the main nodule could be established in 31 patients by pathologic examination, elevated alpha-foeto-protein level or follow-up examination. RESULTS: Among the 31 studied nodules, 19 were hepato-cellular carcinomas (61%) and 12 were benign (39%). Seven (78%) of the 9 nodules>20mm and 12 (54%) of the 22 nodules<=20mmm were hepato-cellular carcinomas. Three benign lesions (2 angiomas and 1 pseudo-nodule of hemodynamic origin) were showing typical radiological characteristics which retrospectively allowed their identification. On the other hand, the appearance of the 9 other benign nodules (29%) was exactly the same as the one of the hepato-cellular carcinoma. CONCLUSION: Although, in cirrhotic patients, hepato-cellular carcinoma is the most frequent cause of detected nodules during the arterial phase of the spiral CT, 29% of hypervascular lesions<=3cm were benign in this study. In some cases, only follow-up examinations are able to confirm the diagnosis.

[Factors of image quality in spiral x-ray computed tomography]. / Facteurs de qualité de l'image en scanner spiralé.

In helical CT, there are 4 mains factors of quality: The in-plane spatial resolution that is the same in conventional CT; The spatial resolution on the Z axis, which is the slice thickness. The increase factor of the slice thickness between a conventional and a helical CT depends on the pitch and the reconstruction algorithm. The value of the increase factor can be easily calculated; The signal to noise ratio which depends on the collimation, the mA, the KV and the reconstruction algorithm. The signal to noise ratio is not depending on the table speed; The reconstruction interval which can be less than the slice thickness. Then the contrast of small lesion is improved and stair-step artifacts are reduced in 3D reformations.

[Palliative treatment of neoplastic jaundice by a percutaneous transhepatic endoprosthesis. Apropos of 73 cases]. / Traitement palliatif des ictères néoplasiques par endoprothèse transhépatique percutanée. A propos de 73 observations.

Seventy three patients with malignant obstruction of the extrahepatic bile ducts were submitted to palliative drainage through percutaneous transhepatic endoprosthesis (P.T.E.). Complications occurred within the first month following the procedure in 13 patients (18%) and 8 of them died (10%). Cholangitis was the main complication resulting, from dysfunction of the endoprosthesis due to an incorrect placement of the stent in most cases. On the other hand, not any significant vascular complication such as previously reported following P.T.E., was encountered in our series. Late complications are mainly due to endoprosthesis obstruction (5 cases) or dislodgement (2 cases). The mortality rate within the first month following P.T.E. is 19%, resulting from either a complication of the procedure (11%) or the underlying disease (8%). The mean survival of these 73 patients, is 4, 7 months. When considering only the 59 patients who are alive one month following the procedure, the mean survival (post-operative deaths excluded) is 6 months. According to our experience P.T.E. remains a valuable palliative procedure when other endoscopic or surgical methods either have failed or cannot be resorted to provided a correct placement of the stent allowing for a good bile drainage can be achieved. Thus P.T.E. is able to provide in many cases the same long-term survival as palliative surgery, allowing the patients to resume their normal daily activity.

[Colonic complications of pancreatitis. A report on 39 cases (author's transl)]. / Le retentissement colique des pancréatites. A propos de 39 observations.

Colonic complications of pancreatitis are not infrequent occurrences, as illustrated by the fact that the authors have personally treated 39 such cases. Lesions are found in the colon at sites which correspond perfectly to diffusion of pancreatic necrotic lesions along mesenteric pathways as described by Meyers. They occur mainly in the left colic flexure (17 cases) and transverse colon (10 cases) but may affect the ascending (6 cases) and descending (4 cases) colon by diffusion of the pancreatitis into the anterior extrarenal space. These topographical characteristics, associated with the extrinsic and inflammatory nature of the lesions, produce a very specific and typical radiological syndrome which should assist diagnosis.

[Massive rectal hemorrhage by colonic fistulization of a pancreatitis lesion]. / Hémorragies rectales de grande abondance par fistulisation colique d'une lésion de pancréatite.

Rectal hemorrhage of massive proportions in 4 patients was due to vascular erosion of a necrotic pancreatitis focus, and fistulization at the splenic angle of colon. This serious complication may arise during the course of acute pancreatitis or an acute episode of chronic pancreatitis. A literature review showed 22 similar cases reported. Diagnosis is suggested by the discovery of a stenosis of colon in a case of pancreatitis, and can be confirmed by emergency arteriography or operative findings. Hemorrhage is usually from the splenic artery but erosion of a left renal artery has been described. Treatment is by embolization during angiography followed by drainage of the pancreatic necrosis and a colon bypass operation, or by splenopancreatectomy combined with colectomy. Use of these two procedures led to recovery in the 4 cases reported.