[Imaging of acute pelvic pain in women]. / Imagerie de la douleur pelvienne aiguë

Acute pelvic pain in women is a routine situation in any emergency unit. The radiologist should know how to explore the patient with regards to the history and clinical findings. Ultrasonography is the primary and sometimes the only necessary imaging tool in the assessment of acute pelvic pain in women. MRI is the preferred technique in pregnant or young women. CT is more valuable for assessing nongynecologic disorders or post-partum and post-operative infections. This article reviews the contribution of each imaging technique in this clinical situation. Emphasis is put on the importance of age and clinical findings in the diagnostic strategy.

CT diagnosed jejunal intussusception revealing metastatic renal cell carcinoma.

We report the case of a 77-year-old woman presenting with a jejunal intussusception as the primary symtom of metastatic renal cell carcinoma. Both lesions were demonstrated by abdominal CT which detected also pancreatic metastasis. This case emphasizes the significance of CT to diagnose intussusception and to characterize its cause.

[Which initial tests should be performed to evaluate meno-metrorrhagias? A comparison of hysterography, transvaginal sonohysterography and hysteroscopy]. / Quelle exploration réaliser de première intention face aux méno-métrorragies? A propos d'une série prospective comparant l'hystérographie, l'hystérosonographie et l'hystéroscopie.

OBJECTIVE: Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause. All patients underwent an hysterography and transvaginal sonohysterography, in random order, followed by an hysteroscopy with histological sample. The results were compared with the histo-pathological examination that was used for reference diagnosis. Statistical study of sensitivity, specificity and Positive and Negative Predictive Value (PPV-NPV) of each investigation; rate of agreement by the coefficient of Kappa. RESULTS: The hysterography offers a PPV of 83% and a NPV of 100%. The interpretation errors were associated with the simple mucous hypertrophy interpreted as "hyperplasy". The limits correspond to a contrast agent allergy. The sonohysterography had a VPP of 89% and a VPN of 100%. The false positive is due to the difficulties of distinguishing the clots from the polyps. The limits correspond to the difficulties of cervix catheterization (13%). As regards the hysteroscopy, the VPP was 81.5% and the VPN of 75%. The interpretation mistakes were associated with mucous hypertrophy and the hyperplasy. CONCLUSIONS: The most useful examination for abnormal uterine bleeding, in the first instance, is transvaginal sonography with saline instillation. A complement by Doppler study would probably make it possible to limit the false positives.

[Imaging of the endometrium]. / Imagerie de l'endomètre.

During genital activity, physiological and pathological modifications can be observed; Pre- and postmenopausal menometror-rhagia are the principle clinical signs of various endometrial pathologies: benign (polyp, atrophy or endometrial hypertrophy), malignant (cervical or endometrial carcinoma) or neighboring pathologies (myometrium or ovary). The value and methods of various imaging techniques (B-mode and Doppler abdominal and endovaginal ultrasonography, hysterosonography, computed tomography, MR imaging and hysteroscopy) are described together with symptomatological features permitting identification of the endometrial pathology.

[Endometrial imaging]. / L'endomètre: quelle imagerie?

The diagnostic value of endovaginal sonography in benign or malignant endometrial pathology is high, increased by sonohysterography. Sonohysterography is useful in the diagnosis of endometrial thickness and to determine further investigations. MRI is accurate in the uterine adenomyosis diagnosis and is the imaging modality of choice for the preoperative endometrial cancer staging.

[MRI evaluation of placenta accreta treated by embolization. Apropos of a case. Review of the literature]. / Evaluation IRM d'un placenta accreta traité par embolisation. A propos d'un cas. Revue de la littérature.

Placenta accreta results from an abnormal attachment of the placenta to the uterine myometrium. The reported incidence in literature is variable, with an average of 1/7000 pregnancies. This condition is associated with a significant risk of bleeding at the time of delivery, usually requiring hysterectomy. Sonography associated with color Doppler is useful for diagnosis, but MRI can be used successfully to evaluate the degree of placental tissue invading into the myometrium, the serosa, and for follow-up after conservative management. To our knowledge, only two cases of placenta accreta evaluated with MR and six cases of placenta accreta treated by embolization have been reported in the literature. The authors report one case of placenta accreta treated successfully by embolization, and followed-up by MRI.

[Spontaneous rupture of the bladder. Apropos of 2 cases with an unusual presentation]. / Rupture spontanée de vessie. A propos de deux cas de présentation inhabituelle.

Spontaneous bladder ruptures is the accepted term of bladder rupture not associated with trauma. This rare condition occurs when an obstacle to urinary outflow is associated with a diseased bladder wall. The diagnosis is usually made on the retrograde cystogram. We report two cases of atypical spontaneous bladder rupture with intravesical herniation of the small bowel. The diagnosis was not suspected clinically but was made on CT and MRI.

[Ultrasonography of the urethra: prognostic value of the ultrasonographic structure of corpus spongiosum peristenotic fibrosis: prospective study of 33 patients]. / Echographie de l'urètre: valeur pronostique de l'échostructure de la fibrose spongieuse péristénotique. Etude prospective sur 33 patients.

OBJECTIVES: The contribution of ultrasonography to pretreatment morphological assessment of strictures of the anterior urethra and assessment of the risk of recurrence after internal urethrotomy. MATERIAL AND METHODS: 33 patients (16-89 years) operated by internal urethrotomy for stricture of the anterior urethra and followed for at least 6 months. Preoperative urethral ultrasonography, recording the number, length and degree of strictures and echostructure of the peristenotic fibrosis of the corpus spongiosium. RESULTS: Ultrasound visualization of all urethral strictures, with no false-positives and no false-negatives. 11 patients relapsed after a mean interval of 5.7 months (1-16 months), 22 patients did not present recurrence: mean interval: 15.5 months (6-36 months). Corpus spongiosum fibrosis associated with urethral stricture is isoechoic to the corpus spongiosum (19 cases) or hyperechoic to the corpus spongiosum (14 cases). No statistical correlation was observed between the echostructure of the fibrous tissue and the risk of recurrence after internal urethrotomy. CONCLUSION: Ultrasonography allows excellent analysis of the morphological characteristics of a stricture of the male anterior urethra. In our experience, and in contrast with the limited data of the literature, no correlation was observed between the echostructure of the peristenotic fibrosis and the risk of recurrence after internal urethrotomy.