Cystic adventitial disease of the popliteal artery with unusual spontaneous regression: A case report with literature review.

This report highlights the case of cystic adventitial disease of the left popliteal artery in a 45-year-old male patient. Imaging modalities confirmed the diagnosis and high resolution MRI found a cystic connection to the adjacent knee joint. The evolution was unusual with spontaneous regression of the symptoms.

Unusual bone localization of sarcoidosis mimicking metastatic lesions: case report and review of literature.

Sarcoidosis is a multisystem disease of unknown origin. Diagnosis remains challenging, based on organ site involvement, histological confirmation of non-caseating granuloma and an appropriate clinical syndrome. Granulomatous bone involvement is rare and may be ignored because it is usually asymptomatic. Vertebrae, ribs and skull localizations are rarely reported. We described an interesting case of a woman with chronic and multiorgan sarcoidosis with unusual bone localizations.

Giant pulmonary hydatid cyst in children.

BACKGROUND: Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related to higher lung tissue elasticity. AIM: To compare clinical and imaging features, types of surgical interventions, and postoperative complications in pulmonary GHC and non-giant pulmonary hydatid cysts (NGHC) in children. METHODS: A retrospective study was undertaken. The data analyzed were taken from medical records of children with pulmonary hydatid cyst (PHC) hospitalized in a pulmonary department in Tunisia between January 2004 and February 2019. Cysts were divided according to their size into GHC ( ≥10cm) and NGHC (<10cm). RESULTS: In the study period, 108 PHC were recorded in 84 children. GHC accounted for 21 (19.4%) and NGHC for 87 (80.6%). The median of age of the children was 11 years (IQR 1-9, IQR 3-14) and the mean age was 11.6 years (10.5 in GHC vs. 11.4 years in NGHC). Hemoptysis was found in 25% of the GHC group vs. 48.4% of the NGHC group (P=0.27). Cysts were multiple in 23.8% of cases and predominated in the right in 64.3% of cases and in the inferior lobes in 71.4% of the cases. GHCs were less frequently complicated (60% vs. 78.1% in NGHC, P≤0.11), although not significantly. Parenchymal resection was realized in 50% of GHC vs. 18.8% of NGHC (P=0.006). No significant difference was found in postoperative complications between the two groups and there was no recurrence in either group. CONCLUSION: GHC is a special clinical entity in children. It requires major surgery with parenchymal resection, and therefore early diagnostic and therapeutic management is warranted.

Distance education in times of covid 19: a leap into the future?

INTRODUCTION: Online education has grown a lot in recent months in our country during the global health crisis (COVID19). It has been widely used at all levels and fields of education ranging from elementary school to graduate and postgraduate studies. The aim of this study is to evaluate this teaching method compared to classical face-to-face teaching by referring to the learner's point of view. METHODS: It was a prospective and descriptive cross-sectional study targeting residents in medical imaging (all levels approximately 200 people) It was based on an online questionnaire sent to all residents after attending synchronous online teaching sessions at the College of Medical Imaging and Nuclear Medicine. The assessment was done by the learners using a 5 points Likert scale. RESULTS:    Ninety-seven residents answered the questionnaire. Sixty percent of our learners were satisfied with this new way of teaching. 73% of the students found the logistical means suitable for this course. The main advantages noted by our residents were accessibility to sessions from any location and the ability to replay lessons later. The weaknesses put forward were the lack of interaction with the teacher compared to face-to-face teaching and the occurrence of technical problems which could sometimes hamper the smooth running of the sessions. CONCLUSION: Our study allowed us to get feedback from our learners on this teaching. The multiplication of learning means, in particular a hybrid education should be considered to overcome the shortcomings of exclusive online teaching.

Unusual cause of laryngeal dyspnea and swallowing troubles in a 2-year old child.

Plexiform neurofibromas are rare benign tumors developed from peripheral nervous system often associated with neurofibromatosis type 1. We report the case of multifocal plexiform neurofibromas in a 2-year-old child with cervical mass obstructing the trachea causing respiratory distress. A cervical ultrasound examination was performed followed by enhanced CT and MRI. Imaging revealed an expansive cervical mass extended from the base of the skull to the mediastinum associated with similar pelvic and sacral foraminal masses. The target like MRI aspect on T2-weighted images was suggestive of the neural origin. Biopsy under ultrasound control confirmed the diagnosis of plexiform neurofibroma.

Radiofrequency ablathermia of pulmonary nodules : CT follow-up and prognostic study.

INTRODUCTION: Radiofrequency ablathermia of pulmonary nodules is a local curative treatment whose efficacy assessment is still a current topic. AIMS: To specify the monitoring protocol, the scannographic aspects of treated lesions, deduce criteria of incomplete ablation, and identify the prognostic factors influencing overall and progression-free survivals. METHODS: A prognostic descriptive retrospective study conducted in the medical imaging department of Abderrahman Mami Hospital. The nodules were monitored at 24-hour, 2.4,6,9,12,15,18 and 24 months after treatment and then once a year. The study of overall and progression-free survivals was done using Kaplan Meier's method. RESULTS: Sixteen patients with 21 nodules were included, 20% of them were pulmonary carcinomas and 80% were secondary nodules. 6 nodules presented an incomplete response.The appearance of a convex outline was the first sign of incomplete ablation. 5 out of 6 nodules had a nodular focal enhancement. The cumulative probability of overall survival at 12, 36, and 60 months was 80%, 66% and 39% with a median survival of 31 months. The number of nodules treated was found to be directly related to overall survival. The cumulative probability of progression-free survival was 65% at 12, 36 and 60 months. Pleural contact was the factor influencing progression-free survival. CONCLUSION: Radiofrequency ablathermia is an effective technique. Regular CT monitoring allows early detection of tumor recurrence.

Diagnostic characteristics of acute myocarditis.

BACKGROUND: Acute myocarditis is an inflammation of the heart muscle. Its unpredictable evolution justifies the importance of its early recognition. The clinical polymorphism associated with the lack of sensitivity of conventional diagnostic means make diagnosis a challenge for the clinician. However, the magnetic resonance imaging has been of great interest for the differential diagnosis as well as for the evolutionary follow-up of this pathology. AIM: Determine the clinical profile of acute myocarditis and the contribution of multimodal imaging in its diagnosis. METHODS: This was a descriptive, retrospective study, including 31 patients hospitalized for acute myocarditis at the cardiology department of the Internal Security Forces Hospital-La Marsa between 2011 and 2017. RESULTS: The mean age of our patients was 36.5 ± 13.3 years [17-63] with a clear male predominance (sex ratio = 6.75). Smoking was the most common cardiovascular risk factor (60%). Fifty percent of the population had only two cardiovascular risk factors. The most common clinical picture was acute chest pain (84%) preceded by influenza-like illness (53%). The electrocardiogram was pathological in 97% of cases. Hyperleukocytosis was objectified in 33% of cases. Elevation of C-reactive protein was present in 80% of cases. As for troponins, they were high in 94% of cases. Overall myocardial contractility was conserved in 84% of cases with segmental kinetic disorders in 45%. Cardiac magnetic resonance imaging showed pericardial effusion (10%), spontaneous myocardial hypersignal in triple-reversal-T2 recovery (42%) and which corresponded to the zones of late enhancement. Late contrast enhancement was predominant at the lateral wall (39%), with epicardial involvement occurring in 100% of cases.28 patients had a favorable outcome after a follow-up of 24 months. However, there was only one case of death at 3 months and two cases that progressed to dilated cardiomyopathy. CONCLUSION: Acute myocarditis is mainly a disease of the young male subject. Cardiac magnetic resonance imaging is of crucial interest for positive diagnosis.

Spontaneous hemothorax and neurofibromatosis type 1: How to explain it, how to explore it and how to treat it?

Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen's disease is an autosomal dominant genetic disorder. It is the most common of phacomatoses. Pulmonary complications have been rarely described in the literature. It is generally a benign disease, but has the potential for rare and fatal complications, such as spontaneous hemothorax. We reported two cases of patients with a history of von Recklinghausen's disease. Both of them suffered sudden chest pain. Chest-X ray revealed a hemi-thoracic opacity. Enhanced chest computed tomography showed massive hemothorax, but no evidence of tumors or an obvious bleeding point in the thorax. After we had ensured a stable hemodynamic condition, we performed video-assisted thoracic surgery to remove the hematoma. No evidence of bleeding was noticed in the first patient whereas an active bleeding was observed in the second patient. We could not determine which vessel was responsible of the hemorrhage. Electrocoagulation and clot removal were performed.  Evolution was favorable for both patients. Spontaneous hemothorax is a rare and potentially life threatening NF1's complication. A tumor like neurofibroma or more rarely vascular involvement of large or small caliber arteries may be at hemothorax's origin.

Tracheobronchopathia osteochondroplastica : a rare cause of hemoptysis.

Tracheobronchopathia osteochondroplastica (TO) is a rare and benign pathological condition of the upper pulmonary tract of unknown cause. Often diagnosed after 50 years of age, it is more common in men. Clinical manifestations are variable and unspecific. Endoscopic findings are the main argument for the diagnosis. We report the case of a 41 year-old woman with TO, presenting a chronic cough and recurrent hemoptysis.

Unicentric Castleman's disease: an uncommon cause of chronic cough.

Castleman disease (CD) or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder characterized by lymph node hyperplasia of uncertain etiology. CD is divided clinically into unicentric (localized to one region of the body) considered as a benign disease and multicentric with less favourable prognosis. We describe a case of intrathoracic unicentric CD revealed by a chronic non-productive cough in a 50-year-old non-smoker female. Chest computed tomography revealed a bulky right hilar mass with intense homogenous contrast enhancement. The patient underwent a right upper lobectomy and mediastinal lymphadenectomy. Histopathology was consistent with hyaline-vascular (HV) type CD. The patient remained asymptomatic throughout the subsequent 6-months of follow-up.

Interstitial lung diseases: Imaging contribution to diagnosis and elementary radiological lesions.

Interstitial pneumonias comprise a heterogeneous group of disorders in which a multidisciplinary approach is important for accuracy in diagnosis; indeed, one might say, even mandatory. The team of collaborators should include radiologists, because high resolution computed tomography (HRCT) of the thorax is the first, and most of times, the only imaging examination to be prescribed after chest X-ray. Elementary lesions of the interstitium can be accurately described with HRCT, inasmuch as lung windowing with sharp filtering in this technique reproduces the microscopic features of the lung. Guidance of bronchoalveolar lavage and biopsy procedures is also possible with HRCT.

Angiofibrolipoma of Posterior Mediastinum with Transforaminal Extension.

Angiofibrolipoma is a histological variant of lipoma, which commonly occurs in subcutaneous tissues. In the present report we illustrate the case of an angiofibrolipoma of the posterior upper mediastinum in a 75-year-old man presented with progressive chest pain. Xray chest showed a homogeneous opacity vertically oriented along the right lateral aspect of thoracic vertebrae with an obtuse angle to the mediastinum. The upper extremity of the mass extended above the superior clavicle, suggestive of a posterior mediastinal lesion. Thoracic magnetic resonance imaging revealed a posterior mediastinal mass, in keeping with a nonaggressive lesion, with particular endocanalar extension and heterogeneous signal and enhancement patterns that was highly suggestive of a mixed mesenchymal tumor. The tumor was incompletely removed by right postero-lateral thoracotomy with final diagnosis of angiofibrolipoma. To the author's knowledge, such a case of angiofibrolipoma located in the posterior mediastinum has not been previously reported in the literature.