Occlusion of the middle cerebral artery due to synthetic fibers.

We report an unusual etiology for a thromboembolic complication. Occlusion of the middle cerebral artery occurred before embolization of an intracranial aneurysm. Attempts to recanalize the artery failed by using both fibrinolytics and IIb/IIIa inhibitors but succeeded with mechanical thrombectomy with a micro-snare. Pathologic analysis of the thrombus showed numerous synthetic fibers that were determined to have originated from unsealed gauze that was used during the procedure.

Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome after failure of surgical shunting.

A case of acute Budd-Chiari syndrome in a 26-year-old woman is reported. After a mesocaval shunt, the patient remained asymptomatic for 21 months, but ascites and hepatomegaly reappeared due to inferior vena cava stenosis subsequently treated by balloon dilation. Recurrence of stenosis indicated the need for a cavoatrial shunt with an expanded polytetrafluoroethylene prosthesis, which was followed by a complete recovery during the next 29 months. Radiological follow-up with magnetic resonance imaging demonstrated progressive hepatomegaly, thrombosis of the cavoatrial shunt, and stenosis of the mesocaval shunt. A transjugular intrahepatic portosystemic shunt was carried out, despite the absence of any patent residual hepatic vein at the usual level, by perforating the inferior vena cava and liver up to the right portal vein. An expandable 12-mm stent was successful in decreasing liver congestion. Dilation of the transjugular intrahepatic portosystemic shunt was done 15 months later, and the patient remains asymptomatic after a follow-up of 18 months.

Percutaneous transvenous embolization through the thrombosed sinus in transverse sinus dural fistula.

Each of two patients presented with a dural arteriovenous fistula involving the transverse sinus. The sinus was thrombosed proximal and distal to the dural arteriovenous fistula with the venous drainage being retrograde through cortical veins. An ipsilateral percutaneous transjugular approach was used in both cases and allowed recanalization of the thrombosed sinus and embolization of the dural arteriovenous fistula with coils. Complete cure was achieved in one patient and 95% reduction in arteriovenous shunting including elimination of the cortical venous reflux in the other. This technique avoided surgical exposure of the sinus.

Endovascular treatment of intracranial dural arteriovenous fistulas with spinal perimedullary venous drainage.

Intracranial dural arteriovenous (AV) fistulas with spinal perimedullary venous drainage are rare lesions that have distinctive clinical, radiological, and therapeutic aspects. Five patients presented with an ascending myelopathy, which extended to involve the brain stem in three cases. Myelography and magnetic resonance imaging showed slightly dilated spinal perimedullary vessels. Spinal angiograms were normal in the arterial phase. Diagnosis was only possible after cerebral angiography, which demonstrated posterior fossa AV fistulas fed by meningeal arteries and draining into spinal perimedullary veins. Endovascular treatment alone resulted in angiographic obliteration of the lesion in three patients. Two patients required surgery in addition to endovascular therapy. One patient died postoperatively, and in one a transient complication of embolization was observed. Improvement after treatment was good in two cases and fair in two. Transverse sinus thrombosis was observed in three cases and was probably the cause of the aberrant venous drainage of the fistula into the spinal perimedullary veins. The pathophysiology is related to spinal cord venous hypertension. These lesions were classified as Type 5 in the Djindjian and Merland classification of dural intracranial AV fistulas. Endovascular therapy is a safe effective method in the treatment of these fistulas and should be tried first.

Selective endovascular treatment of 71 intracranial aneurysms with platinum coils.

Seventy-one intracranial aneurysms were treated by endovascular techniques, with the placement of minicoils inside the aneurysmal sac. Most aneurysms were manifest by hemorrhage (67 cases), and 43 of these were treated within the first 3 days after presentation. At the 1-year follow-up examination, the outcome was scored as good in 84.5% of cases, but the morbidity and mortality rates were 4.2% and 11.3%, respectively. Twenty-nine aneurysms in the anterior circulation and 42 in the posterior circulation were treated. In this series, 23 patients were classified as Hunt and Hess neurological Grade I, 27 as Grade II, 12 as Grade III, nine as Grade IV, and none as Grade V. Thirty-three aneurysms were less than 10 mm in diameter, 28 were 10 to 25 mm, and 10 were larger than 25 mm. The preliminary results from this study appear to justify the emergency treatment of aneurysms by this approach. Aneurysms in the posterior circulation are particularly well suited for this type of surgery.

[Tomodensitometric aspects of brain lymphomas: apropos of 19 cases. Brain lymphoma]. / Aspects tomodensitométriques des lymphomes cérébraux: à propos de 19 cas. Lymphomes cérébraux.

The authors present the results of CT studies for 19 patients with cerebral lymphoma (including 12 primary tumors). CT appearances varied considerably, because 5 of the 12 primary lymphomas presented as multifocal lesions, and lesion sites included the corpus callosum (3 cases), the central caudate nucleus (4 cases), the posterior fossa (3 cases), and the cerebral hemispheres (6 cases). These findings are in agreement with literature data. Although a solitary, hyperdense and homogeneous lesion in the corpus callosum or the central caudate nucleus is indicative of cerebral lymphoma, numerous other aspects are possible and owing to the increasing frequency of this pathology should suggest this diagnosis. There is no specific appearance for secondary lymphomas, but diagnosis is often facilitated by concomitant systemic involvement.

[Echography and computed tomography in the evaluation and follow-up of uterine cancers]. / Echographie et scanographie dans le bilan et la surveillance des cancers de l'utérus.

In this review of 139 cancers of the cervix uteri and 43 cancers of the corpus uteri, the authors compare clinical, sonographic and CT data. For the 58 patients with cervical cancer who presented infiltration of the parametrium at physical examination under general anesthesia, sonography gave 11 false negative errors while CT gave 8 false positives. By contrast, for the 47 tumors staged IIb after examination under general anesthesia, sonography disclosed additional abnormalities in 20 cases and CT in 22 cases. A series of 52 disease recurrences in patients who had received curative treatment for uterine cancer was also reviewed; overall, an association of physical examination and ultrasonography had the same value as CT. In light of these results, the authors propose an algorithm for the exploration of uterine cancers in which the results of physical examination condition examination by ultrasonography or CT.

[Cutaneous hemangioma associated with eosinophilia]. / Angiome cutané associé à une éosinophilie.

A patient with a cutaneous angioma developed an intravascular coagulation syndrome with a eosinophilic leukocytosis and multiple arterial and venous thromboses affecting the vital prognosis. The possible role of the eosinophilia in the mechanism of complications is discussed. Local modifications in the angioma are suggestive signs preceding the onset of general thrombotic complications, their severity contrasting with the simplicity of the secondary surgical excision of the angioma.

[Intracranial dural arteriovenous fistula with spinal venous drainage]. / Fistules artério-veineuses durales intracrâniennes à drainage veineux médullaire.

Two cases of intracranial dural arteriovenous fistulae draining into the medullary veins are reported. One patient was a 68-year old man who experienced brief and repeated episodes of paraplegia, followed by a permanent spinal cord syndrome. The other patient was a 74-year-old woman who rapidly developed a syndrome of the medulla and spinal cord. In both cases spinal cord angiography failed to show vascular malformations, but myelography revealed venous imprints and magnetic resonance imaging of the cervical spinal cord disclosed a pre-medullary signal. Cerebral angiography showed an intracranial arteriovenous fistula fed by the external carotid artery and draining into the veins of the posterior fossa and the spinal venous network. Complete occlusion of the fistula was achieved by embolization with microparticles. Intracranial dural arteriovenous fistulae draining into the medullary veins are rare: to our knowledge, only 4 cases have been reported. Such lesions must be considered whenever a spinal cord syndrome has no detectable cause.

[Pregnancy after embolization of a uterine leiomyomata]. / Grossesse évolutive après embolisation d'un utérus fibromyomateux.

Uterine artery embolization could be useful in the treatment of myoma, either before surgery to facilitate dissection, or totally in place of surgery. Nowadays, this technique seems attractive, considering the development of a conservative and non-invasive medicine. However the question of fertility in women of childbearing-age remains. The case of a pregnancy following uterine artery embolization is here described. All pregnancies from the literature have been reviewed and the discussion includes benefits and drawbacks of this method.

[Ultrasonographic surveillance of treated breast cancer]. / La surveillance échographique du cancer du sein traité.

Clinical, radiographic (mammograms) and ultrasonographic data were compared retrospectively for 171 patients to evaluate the utility of ultrasound for the follow-up of breast cancer patients treated medically or by conservative surgery. When used to follow-up patients treated medically by induction or exclusive chemotherapy, ultrasonography accurately quantified tumor and nodal regression. After conservative surgery, sonograms are an ideal means to diagnose (and sometimes to treat) early complications (hematoma, lymphocele, abscess). Ultrasonography was more sensitive than mammography for the detection of recurrent disease (95.5% sensitivity for radiography versus 90% for ultrasonography). After radical surgery and breast reconstruction, ultrasonography is the only procedure required to follow-up of patients with breast implants, because it can determine the size and penetration of cutaneous recurrences. The fact that 30% of patients treated by lumpectomy and irradiation ultimately develop malignant or benign abnormalities justifies systematic ultrasonography for the follow-up of treated breast cancers. All sonographically demonstrable abnormalities warrant ultrasound-guided puncture biopsy.

[Imaging of renal metastases]. / Imagerie des métastases rénales.

Metastases are the most frequent malignant tumors of the kidney, but these lesions are of late onset in neoplastic disease. The 19 cases reported here were all investigated with various imaging techniques (CT 12 cases, ultrasonography 12 cases, urography 8 cases, angiography 2 cases, MRI 1 case). The most common primary malignancies were lung cancer, melanoma and cancer of the contralateral kidney. In this series, 8 of the lesions were solitary, and 9 were unilateral. Tumor vascularity was evaluated in 15 cases: 14 of these lesions were hypovascular. The differential diagnosis includes small cysts, lymphoma, bilateral renal cancer, multiple small abscesses and multiple small infarcts.

[The isolated pulmonary nodule. Biopsy guided by x-ray computed tomography]. / Nodule pulmonaire isolé. Biopsie guidée par la scanographie.

Transparietal CT-guided biopsy location can be successfully performed for isolate pulmonary nodules, defined as lesions with a maximal diameter of 3 cm, without any other parenchymal or mediastinal abnormality. A 21 G needle has been used according to an identical protocole in 64 cases (10 benign, 54 malignant). The biopsy was successful in 77.7% of the malignant cases. In relation to the diameter of the nodules, biopsy was successful in 66.7% of the nodules smaller than 2 cm and in 76% of the nodules ranging from 2 to 3 cm. The complications observed were rare (1 case of pneumothorax requiring drainage, 9 cases of pneumothorax without clinical signs and simply followed up, 4 cases of minor hemoptysis requiring no treatment and 5 cases of hematomas smaller than 5 cm on CT).

[Cysts of the spleen. Spontaneous involution checked by imaging]. / Kystes de la rate. Involution spontanée contrôlée par l'imagerie.

The splenic cysts are rare diseases and the diagnosis is now easier with modern imaging modalities. The authors report two cases of asymptomatic splenic cysts. The spontaneous involution in less than 3 years has been followed by CT Scan. This possible evolution which has never been described, the improvements of the splenic surgery and the risk of serious infectious complications after splenectomy, must modify the indications of the treatment. A US or CT follow up can be purposed for non symptomatic cyst and a partial splenectomy when these lesions are clinically symptomatic.

[Fortuitous discoveries of digestive tract tumors during the evaluation of hepatic tumors by lipiodol intra-arterial injection. Diagnostic application in a case of pancreatic tumor]. / Découvertes fortuites de tumeurs du tube digestif lors de bilan de tumeurs hépatiques par injection intra-artérielle lipiodolée. Application diagnostique dans un cas de tumeur pancréatique.

The authors report three cases of extrahepatic lipiodol enhancement: two fortuitous discoveries of gastric and duodenal leiomyomas during the management of malignant hepatic lesion and a pancreatic surgical detection of an insulinoma which had not been detected with conventional techniques. The principles of the technique are described. The basis of its application to the pancreatic region is purposed and the future developments of pancreatic studies are discussed.

[Hepatic x-ray computed tomography. Value of delayed (6 hours) scanning in patients with normal biliary function]. / Scanographie hépatique. Utilité des coupes tardives (6 heures) chez des patients ayant une fonction biliarie normale.

Delayed hepatic CT (DH-CT) was studied in 250 patients without any major bile duct pathology. One hundred thirty-five of these patients had liver metastases. All patients were administrated 76 grams of iodine. Tolerance of the examination was good. Six hours after injection, average contrast enhancement in the normal liver was 24 HU (greater than 1.3 g/kg iodine), 22 HU (1 to 1.3 g/kg) and 14 HU (1 g/kg). Comparison of scans taken before, immediately after, and 6 hours post-injection revealed the frequent superiority of postinjection scans for diagnosis of liver metastases. Focal steatosis is the only benign pathology to benefit from DH-CT, because of the parallelism in the difference in density between the normal and steatotic tissue regardless of the time of scanning. Aside from isolated tumors requiring exploration by conventional CT (pre- and post-contrast studies), the workup of liver metastases can be optimized by postcontrast and DH-CT scans.

[Imaging of non-functional retroperitoneal paragangliomas. Apropos of a case]. / Imagerie des paragangliomes rétropéritonéaux non fonctionnels. A propos d'un cas.

The non functional extraperitoneal paragangliomas are rare tumors (less than 50 cases reported). We report a case with ultrasound and CT scan imaging. The tumor is usually large with important necrotic areas leading to a cystic aspect. The malignant tumors more frequent than the benign tumors present with a regional extension and delayed metastasis.

[X-ray computed tomography in surveillance of colorectal cancers treated by radical surgery]. / Apport de la scanographie dans la surveillance des cancers colorectaux traités par chirugie radicale.

This retrospective study covered 44 patients treated by abdominoperineal amputation (17 normal postoperative cases, 25 relapses, 2 abscesses) and 13 patients with disease recurrence after resection of a colorectal cancer. Twenty-nine of the 38 relapses occurred in less than two years. Recurrent lesions after abdominoperineal amputation (25 cases) were convex and generally larger than 3 cm in diameter; 13 of these lesions invaded contiguous structures. Endoscopic findings were positive for 11 of the 13 post-resection relapses whereas CT was positive in only 9 of the 13 cases (but included the 2 cases not diagnosed by endoscopy). 13 cases were punctured under CT guidance, but results were positive in only 11 cases. Endoscopy remains the first examination that should be performed for the follow-up of colic resections, but CT should be performed systematically when monitoring patients who have undergone abdominoperineal amputation.

[Imaging of malignant lymphoma of muscular sites]. / Imagerie des lymphomes malins de topographie musculaire.

Seventeen cases of muscular lymphoma are reported (5 primary non-Hodgkin lymphoma, 11 secondary NHL, 1 secondary Hodgkin's disease). The psoas or gluteus muscle was involved in 10 cases, and the lower limb was affected in the remaining 7 cases. Nine cases of muscular extension of bone NHL are also reported. On sonograms these lesions were always large and less echogenic than adjacent structures, with no signs of necrosis before treatment. US and CT patterns were comparable for both primary and secondary lesions, regardless of the type of lymphoma or whether or not there was any previous bone lesion. Associated lymphomatous lesions were observed in 14 cases. On angiograms, muscular lymphomatous involvement presented a hypovascular pattern. While ultrasonography is an excellent monitoring technique for soft tissue lymphomas (specially for the lower limbs), a major contribution of CT is the detection and the follow-up of deep or thoracic wall lesions.

[Venous relations in cervical adenopathy. Review of a series of 300 cases]. / Rapports veineux. des adénopathies cervicales. Revue d'une série de 300 cas.

Three hundred cases of cervical adenopathies were reviewed in connection with head and neck cancers (205 patients) and lymphoma (95 patients). Overall, physical examination failed to detect such adenopathies in 83 cases. The echostructure of the cervical node was less echoic than that of the muscles in 111 cases (58 cases of lymphoma, 53 cases of metastasis), more echoic than the muscles in 185 cases (35 cases of lymphoma, 150 cases of metastasis), and nucrotic in 4 cases (2 cases of lymphoma and 2 cases of metastasis). Jugular vein thrombosis was noted in 78 cases (75 cases of metastasis, 3 cases of lymphoma); jugular vein compression without thrombosis was observed in 65 cases (35 cases of metastasis, 30 cases of lymphoma). Before histologic proof is obtained, jugular thrombosis suggests a diagnosis of metastasis, regardless of node size. The presence of nodular intraparotid lesions (12 cases) suggests lymphoma. By contrast, neither node size nor echostructure suggest the etiology of cervical adenopathies.