Association of systemic lupus erythematosus and choriocarcinoma: a role of hormonal immunomodulation?

We report the first case of choriocarcinoma occurring during the course of systemic lupus erythematosus (SLE). This choriocarcinoma was revealed by pulmonary metastasis associated with pulmonary hypertension secondary to neoplastic thrombi and pulmonary embolism, in parallel to a flare up of the SLE. The role of hormones in SLE is discussed.

Effects of two low osmolality contrast media on red blood cell filterability and aggregation in vitro.

The in vitro effects of ionic ioxaglate and non-ionic iopamidol were compared. Filtration measurements were carried out on an hemorheometer; erythrocyte aggregation was evaluated by means of an erythrocyte aggregometer, and red blood cell morphology was observed with an optical microscope. Ioxaglate and iopamidol reduced erythrocyte filterability to the same extent; by contrast neither ionic nor non-ionic contrast media significantly modified aggregation or shape of red blood cells. The decrease of erythrocyte deformability observed in this study may cause clotting in catheters or syringes during angiographies investigations.

CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases.

OBJECTIVE: To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. MATERIAL AND METHODS: Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. RESULTS: Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. CONCLUSION: This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.

Interventional chest radiology.

The authors review the various interventional radiology techniques currently used in 1996 by a Medico-Radio-Surgical team. CT guided needle biopsy has an important place in the diagnostic approach to parenchymal as well as mediastinal tumours. But CT guidance allows also routine drainage of thoracic collections and sometimes thoracic sympatholysis. Superior vena cava and tracheobronchial stenting are palliative treatments as the percutaneous aspergilloma treatment. Embolization of bronchial and thoracic systemic arteries are also palliative but effective therapeutic procedures as well as vasoocclusion for arterio-venous fistulae.

Imaging of hyperparathyroidism: US, CT, MRI and MIBI scintigraphy.

Hyperparathyroidism is a rare condition although recently the incidence has increased, particularly the asymptomatic form, as a result of routine serum calcium measurements. A definitive diagnosis can be made using modern bio-assays giving direct measurements of parathormone (PTH). Various methods are currently available for pre-operative localisation of pathological parathyroid glands. Ultrasound is sufficient prior to the initial surgery. However, if primary surgical exploration fails to localise the parathyroid glands then the surgeon faces a more complex problem and requires precise localisation prior to repeat surgery to reduce operating time and risk. No radiological method is available to localise pathological glands in 100% of cases. The surgeon is usually satisfied when two different methods are positive and in concordance. The non-invasive methods such as ultrasound, CT, MRI and scintigraphy are initially performed and if the result remains equivocal then more invasive methods such as arterial or venous sampling are undertaken. Our preliminary results in secondary hyperparathyroidism, before repeat surgery, indicate that associated and complementary tests, morphological and functional, MRI (fat-sat, T1, gadolinium) and MIBI scintigraphy, have greater efficacy.

Diagnostic approach to mediastinal masses.

Mediastinal masses represent a vast group of tumours and pseudo-tumours which can involve the various compartments of the mediastinum. The authors propose a radiologic diagnostic approach starting from the plain thoracic radiograph with study of the mediastinal lines and oesophageal transit and going on to the classifications made possible by modern CT and MR imaging. The proposed diagnostic procedure is based on nine mediastinal lines and two 'threads of Ariadne' which are the compartments where the masses are located and their behaviour at CT (densitometry before and after administration of an iodinated bolus) and at MRI (T1, T2, gadolinium-enhanced T1-weighted sequences). The definitive aetiological diagnosis may be established by surgery, but also in certain cases by percutaneous needle biopsy.

[Leiomyosarcoma of the femoral vein. Apropos of a case]. / Les léiomyosarcomes de la veine fémorale. A propos d'un cas.

A 51 years old woman developed an edema of the right lower limb. Phlebographic examination revealed an occlusion of the femoral vein. This was a tumor at operation. A leiomyosarcoma was diagnosed by microscopic study. The authors emphasize the difficulty of diagnosis, value of phlebography and discuss the treatment.

[Localized osteoplastic bronchopathy with tumoral expression, including Al amyloidosis]. / Bronchopathie ostéoplastique localisée à expression tumorale avec amylose AL.

We report a case concerning a 65 year old man who suffered from a drug resistant asthma and radiographically visible mass in the right lower lobe of the lung. Pathological studies demonstrated it to be "Bronchopathia Osteoplastica", involving segmental bronchi, with completed hematopoietic metaplasia. This rare dystrophic lesion was associated with localized lambda light chain amyloidosis as was proved by the immunohistochemistry. This association suggests a possible relation between amyloidosis and abnormal osteogenesis.

[Pseudomalignant, hyperacute circumscribed myositis. Contribution and limitations of echography. Review of the literature. Apropos of a case]. / Myosite circonscrite hyperaiguë, pseudomaligne. Apports et limites de l'échographie. Revue de la littérature. A propos d'un cas.

The very sudden onset of a painful muscular tumefaction was suggestive of a para-ostal osteosarcoma or myosarcoma. Ultrasound imaging showed a heterogeneous echogenic mass with several extending shadow cones, raising the possibility of the benign nature of the lesion, but urgent operation showed the pseudomalignant circumscribed myositis nature of the affection.

[Imaging of the pulmonary arteries: when, how and when?]. / Quand, comment et pourquoi réaliser une imagerie des artères pulmonaires?

For several years, catheter angiography was the standard imaging technique used for evaluating the pulmonary arteries. Technical advances with computed tomography have had a significant impact on chest imaging, especially the increasing availability of multidetector row CT units. CT pulmonary angiography (CTPA) is now the first line imaging technique to evaluate pulmonary arterial diseases, including pulmonary embolus. Pulmonary angiography is now essentially limited to the endovascular management of pulmonary arteriovenous malformations, pulmonary arteriovenous fistulas or pulmonary arterial aneurysms. Gadolinium enhanced MR angiography of the pulmonary arteries may be helpful in patients with contraindications to the use of iodinated contrast material.

[Complication of a central venous catheter related to malposition in the Braine vein. Contribution of x-ray computed tomography]. / Accident d'un cathéter veineux central en rapport avec une malposition dans la veine de Braine. Apport de la tomodensitométrie.

We report one case of emergency related malposition central venous catheter in left superior intercostal vein. The CT examination corroborate the venous perforation, showing contrast media effusion in mediastinum, pericardium and pleural cavities.

[Lateral view of the thorax: the profile]. / L'incidence latérale du thorax: le profil.

The lateral view of the chest is a complementary incidence performed less frequently nowadays with the great frequency of chest CT. In fact, this lateral radiograph has important potential and can even give some exclusive information. With the 3-dimensional visualization provided by CT, the lateral radiograph of the chest is even easier to understand. Following in the footsteps of our great predecessors (Felson, Heitzman, Proto) we propose the left lateral view and offer our opinion about indications, techniques and results. The left lateral view can be performed with perfect perpendicular orientation or with a slight lateral shift that can be chosen with the right shoulder forwards (shifted right anterior lateral) or the contrary (shifted left anterior lateral). The left lateral view, like the antero-posterior view must be interpreted in a circular-concentric fashion.

[Bronchiolitis obliterans with pneumonic organization. Apropos of a case and review of the literature]. / La bronchiolite oblitérante avec organisation pneumonique (BOOP). A propos d'un cas et revue de la littérature.

The authors report a case of bronchiolitis obliterans with organizing pneumonia (BOOP) pathologically proved. They give an analysis of the radiological semiologic findings on plain-film and high-resolution CT (HR-CT). In 1985, Epler proposed a nosologic status but the review of the literature and the findings of their own case give to the authors, the opportunity to discuss the entity on the clinical, evolutive, radiological and pathological point of view.

[Discitis in small children (author's transl)]. / Les discites du petit enfant.

Discitis was diagnosed in 5 children under 3 years of age, the initial clinical manifestations being difficulty in walking and abdominal pains in one case. Diagnosis was not made before periods varying from 8 days to 3 months, and no etiological basis for the disease was discovered. Pinching of the disc was always present in the first radiographic image, and the vertebral plate was ill-defined in 3 cases. Repeat radiological examinations were carried out in 3 children after 6 months, 2 and 5 years respectively. There was partial restauration of the disc space in 2 cases; the last one presented signs of late collapse after early recuperation. Early perilesional bone sclerosis was noted in 2 cases, while it was posterior and late in one child. There were no sequelae (fusion, vertebra plana, scoliosis). Two investigations are essential if a disc lesion is suspected: -- radiography of the spinal column, even if there are no disturbances in walking or abdominal pains. -- scintigraphy with technitium 99, which is the only means of establishing an early diagnosis.

[Value of x-ray CT used in thin sections for evaluating sarcoidosis. Apropos of 57 cases. Comparison with other methods]. / L'intérêt de la TDM en coupes millimétriques pour l'évaluation des sarcoïdoses. A propos de 57 cas. Comparaison aux autres méthodes.

The authors have staged by CT 57 cases of sarcoidosis. In all cases CT has given superior semiologic pattern in comparison with plain-films which are the classical baseline references (Turiaf)...up to date. 30% of type I sarcoidosis are staged as type II by thin-section CT slices. This radio-clinic evaluation must be continued on months to find if this group is an homogeneous one in the prognostic meaning and if cortico-therapy is useful. The authors propose a systematic CT evaluation of sarcoidosis in 1987 and a CT actualization of the radiologic classification of the disease.

[Vagal paraganglioma associated with a rare malformation of the aortic arch. Apropos of a case and review of the literature]. / Paragangliome du vague associé à une malformation rare de la crosse aortique. A propos d'un cas et revue de la littérature.

The authors report about a very peculiar case of cervical paraganglioma which had two specific features. This is a familial case with 2 sisters presenting with bilateral paragangliomas. In addition, this patient's aortic trunk is very peculiar, with a retroesophageal right subclavian artery and, above all, a divided intrathoracic right common carotid artery, producing an ascending pharyngeal supply for the right paraganglioma, which can be embolized without any risks of reflux.

[Role of x-ray computed tomography in the preoperative evaluation of aneurysm of the abdominal aorta]. / Place de la TDM dans l'évaluation pre-opératoire des anévrismes de l'aorte abdominale.

The authors have studied the files of 50 consecutive patients (1987-89) operated for abdominal aortic aneurysm (AAA) and examined with CT. The criteria for inclusion were surgical features. CT can be made more accurate for the study of AAA: Thus the location of the neck of the aneurysm relative to the renal arteries was defined in 94% of all cases. In addition, CT yields information about the wall of the aneurysm, whether it be thickened (3 inflammatory aneurysms were properly diagnosed) or, mor importantly, weakened (solution of continuity in the wall in the "prior-to-rupture" appearance). Owing to the quality of its performances and to its noninvasive character, the authors regard CT with contrast injection as an essential technique for the preoperative assessment of abdominal aortic aneurysm in most cases. The examination must be carried out strictly, especially for the contiguous sections of the renal arteries and their extension to the crural arch. As it demonstrates weakened areas more easily, a more accurate study of the aneurysmal wall with CT might increase the surgical indications for some smaller aneurysms, the potential evolution of which does not seem to be associated with their diameter only.

[Pulmonary opacities in the shape of ribbon streamers. Apropos of a case]. / Opacités pulmonaires rubanées "en serpentins". A propos d'une observation.

The authors report a case of chronic interstitial pneumonia with a very unusual appearance (on plain films and CT); in fact such ribbon-like linear opacities with concentric and pseudo-cavitary disposition have not been previously described. They are comparable but different from the linear opacities described by Carrington in some cases of chronic eosinophilic interstitial pneumonia, which are vertical and peripheral. They are also different from the curvilinear sub-pleural opacities reported in some cases of asbestosis. On the basis of the anatomic findings they discuss the specificity of such radiologic patterns or their sole value as an evolutive state.

[Embolization treatment of a traumatic adrenal hemorrhage]. / Traitement par embolisation d'un traumatisme hémorragique de la surrénale.

We report a case of adrenal hemorrhage in a blunt abdominal trauma after a motor vehicle crash. The patient was treated by a percutaneous embolization without any complication.

[Value of thoracic CT in the management of severe hemoptysis]. / Hémoptysies sévères: apport de la tomodensitométrie thoracique.

PURPOSE: To assess the value of thoracic CT in the management of patients with severe hemoptysis. PATIENTS AND METHODS: Between January 1997 and January 2001, 62 patients were investigated for severe hemoptysis (>300 ml/24H). The protocol, performed before angiography and embolization, included bronchial fiberoptic examination (BFE) followed by thoracic spiral CT-angiography. Data recorded at CT and BFE were the presence and location of bleeding, the etiology of hemoptysis and the therapeutic modality. RESULTS: Nine patients with life-threatening hemoptysis directly underwent bronchial embolization. CT was available in the 53 remaining patients. No abnormality was found in 4 patients. CT assessed the presence (n=49) and the location (n=38) of the bleeding. The etiology was determined in 49 patients. BFE was feasible in 38/53 patients. BFE assessed the presence (n=38) and location (n=15) of the bleeding. The etiology was determined in 12 cases of bronchial tumour. The available findings of CT and BFE for the presence and the location of the bleeding were concordant. Comparing fiberoptic examination and thoracic CT, the percentages of localized bleedings (39% and 72%) and demonstrated etiologies (32% and 92%), were significantly different (p<0,005 and p<0.0001 respectively). CONCLUSION: Although retrospective and limited by the small number of cases, our study provides arguments to perform thoracic CT before bronchial fiberoptic examination for the management of severe hemoptysis.