Axe fragment pulmonary embolism. Interest of enhanced multislice helical CT with cardiac synchronised acquisitions.

A case of pulmonary embolism by an axe fragment investigated with enhanced mdCT with cardiac synchronised acquisitions is described. The authors stress the advantages of the techniques versus angiography for the exploration of foreign body pulmonary artery embolism.

[Value of the pubic tubercle as a CT reference point in groin hernias]. / Valeur de l'épine du pubis comme repère TDM des hernies de l'aine.

PURPOSE: To assess the value of the pubic tubercle as a CT reference point in diagnosing the different types of groin hernia before surgery in patients presenting with mechanical bowel obstruction. MATERIALS AND METHODS: Retrospective review of CT examinations performed for small bowel obstruction in our department during 2003. Twelve cases of groin hernia causing small bowel obstruction were included. All CT examinations were reviewed by 2 abdominal radiologists. The surgical report of all 12 included cases was reviewed for final diagnosis. RESULTS: Twelve cases of groin hernia causing small bowel obstruction were reviewed in our department during 2003. Eight cases corresponded to small bowel obstruction caused by inguinal hernia (4 direct and 4 indirect) and 4 to small bowel obstruction caused by femoral hernia. In each case, the diagnosis suggested at CT using the pubic tubercle as a reference point was surgically confirmed. CONCLUSION: The pubic tubercle is an excellent reference point at CT for diagnosing inguinal and femoral hernias. Preoperative diagnosis is important because it may change the choice of surgical procedure.

[Value of the small bowel feces sign at CT in adhesive small bowel obstruction]. / Le feces sign: valeur d'un signe TDM dans l'occlusion du grêle sur bride ou adhérences péritonéales.

PURPOSE: The purpose of this study is to describe the CT features of the small bowel feces sign and to determine its value as a positive criteria of non-severity in adhesive small bowel obstruction. MATERIALS AND METHODS: We performed a retrospective study of adhesive small bowel obstructions diagnosed by CT from January 2001 to December 2002. All CT examinations featuring a small bowel feces sign were included. Clinical follow-up was available for all included patients. RESULTS: Twenty patients were included in this study. Twelve patients underwent successful conservative treatment with nasogastric aspiration. Urgent laparotomy performed in 6 cases and delayed surgical intervention performed in 3 did not show ischemic complication. Surgical management always consisted in lysis of adhesions without intestinal resection. CONCLUSION: Recently described in the radiological literature, the small bowel feces sign appears to be the first criteria of non-severity in adhesive small bowel obstruction.

[Large bowel obstruction secondary to lumbar hernia following latissimus dorsi flap]. / Occlusion colique sur hernie lombaire secondaire à un prélèvement de lambeau du muscle grand dorsal: à propos d'un cas.

The authors report the case of a 46-year-old woman with large bowel obstruction secondary to lumbar hernia following latissimus dorsi flap. Diagnosis was made by CT. This paper describes the CT features of this rare pathology. A brief review of the literature is also presented.

[Value of MRI in the evaluation of congenital anomalies of the heart and great vessels]. / Apport de l'IRM dans l'exploration des anomalies cardiaques congénitales et des gros vaisseaux.

Management of congenital heart diseases (CHD) frequently is a diagnostic challenge. MRI, as a complement to echocardiography, plays an important role in the non-invasive evaluation of these anomalies. MRI allows high resolution anatomical evaluation of these structures in multiple planes as well as functional evaluation. These features are helpful to further characterize extra-cardiac anomalies that may be difficult to assess at US and even angiography. MRI is thus a valuable imaging tool in the evaluation of CHD.

Multidetector ct diagnosis of jejunal perforation by a chicken bone.

We report a case of perforation of the proximal jejunum by a sharp chicken bone. This case emphasizes the effectiveness of multislice CT in complex abdominal situations thanks to its possibilities of multiplanar reconstructions obtained with thinner collimation and higher resolution.

[True isolated atherosclerotic aneurysm of the axillary artery]. / Anévrisme vrai isolé d'origine athéromateuse de l'artère axillaire.

The true atherosclerotic aneurysm of the axillary artery is a rare condition. It either presents as a pulsatile axillary mass or arterial emboli in the hand and fingers. We report the case of a 70-year-old man with a 5 cm aneurysm of the axillary artery presenting with embolic disease to the hand. Angiography is helpful and provides valuable preoperative anatomic details. Surgery remains the treatment of choice but endovascular treatment can also be considered.

[Stellate ganglion radiofrequency neurolysis. Report of a case followed over a 3-year period]. / Neurolyse par radiofréquence du ganglion stellaire. A propos d'un cas traité et suivi sur trois ans.

We present the case of a patient who experienced residual ischemic symptoms and invalidating chronic pain after an injury where three fingers of his left hand were sliced off by a chain saw. He underwent 5 stellate ganglion RF neurolysis over a two year period, followed by progressive and complete pain relief. We will underscore the value of CT guidance during needle placement and the efficacy of RF neurolysis.

[Stellate ganglion radiofrequency neurolysis under CT guidance. Preliminary study]. / Neurolyse du ganglion stellaire par radiofréquence sous guidage scanographique. Etude preliminaire.

Sympathetically maintained pain syndrome of the upper limb is difficult to treat even with high doses of specific medication. Stellate ganglion block by in situ injection of a local anesthetic is an efficient and accepted method for diagnosis and treatment. The sedative effect is however transitory linked to the short effect of the drug. CT guidance, displaying an excellent contrast between soft tissues, bones, vessels and nerves, is a well suited and safe mean of guidance. Seven patients suffering from reflex sympathetic dystrophy were treated by stellate ganglion radiofrequency (RF) neurolysis at two sites (C7 and T1). Patients were evaluated for pain before and immediately after the procedure and at three months. Four patients had a significant (50%) pain relief lasting at 3 month. One patient had a temporary pain (one week) and 2 no pain relief. No patient had a Horner syndrome. One patient had a temporary neuralgia of surrounding nerves (brachial plexus). RF neurolysis of stellate ganglion under CT-guidance is precise and appears efficient but further investigation on a larger cohort of patients is needed.