Ovarian hyperthecosis on grayscale and color Doppler ultrasound.

OBJECTIVES: To describe the grayscale and color Doppler ultrasound findings in women with ovarian hyperthecosis. METHODS: In a retrospective study, we reviewed the findings on ultrasound examination of the ovaries in 10 patients with proven hyperthecosis. Clinical features had been recorded and testosterone levels measured in all cases. The ovaries had been examined using grayscale ultrasound in all patients and color Doppler in six patients. Bilateral stromal hyperthecosis had been pathologically confirmed in all patients. RESULTS: The clinical features were polymorphic, with symptoms of virilization in four patients. Type 2 diabetes was present in four patients. Testosterone levels were greater than 2 ng/mL in four patients. On grayscale ultrasound examination, the ovaries were normal in two patients but showed bilateral abnormalities in eight; both ovaries were increased in size in seven patients and had a round shape in two patients, the ovary being both increased in size and round in shape in one of these patients. A very peculiar nodular stromal pattern was observed in two out of 10 patients, while a homogeneous stromal pattern was observed in eight patients. On color Doppler, performed in six patients, no areas of hypervascularization were observed. CONCLUSION: Findings on grayscale ultrasonography and on color Doppler examination, in association with clinical and biological findings, are useful in the diagnosis of ovarian hyperthecosis and in ruling out the presence of an androgen-secreting tumor.

[Non invasive imaging of bilateral vertebral arteries agenesis]. / Imagerie non invasive d'une agénésie bilatérale des artères vertébrales.

Imaging descriptions are lacking for vertebral artery variants reported in the anatomy literature. We report thus a variant of vertebral arteries discovered incidentally in a patient admitted for aortocoronary bypass. Doppler of the supra-aortic arches revealed the absence of cervical segments of both vertebral arteries. Transcranial doppler revealed the presence of intracranial segments of these arteries that continued in a normal basilar trunk. MR-angiography performed on a 3T machine confirmed the bilateral absence of cervical segments and the presence of normal intracranial segments arising from the occipital arteries, branches of the external carotid arteries. Embryologic analysis explains this variant by an involution of cervical segments and persistence of anastomoses between the external carotid system and the vertebrobasilar system that normally regresses during fetal life. This anastomosis enables irrigation of the intracranial vertebrobasilar system by the external carotid artery. The introduction of 3T MR-angiography has enabled better and more precise detection of vascular variants without invasive angiography.

[Limb fractures: ultrasound imaging features]. / Aspect échographique des fractures des extrémités.

US, a non-irradiating imaging modality, is complementary to radiographs in the evaluation of limb fractures. US may in some cases demonstrate or suggest the presence of a fracture without corresponding abnormality on radiographs, or confirm or exclude a possible fracture detected on radiographs. Knowledge of the US features of fractures is necessary. In this article, the different direct and indirect US findings of fractures will be reviewed, with radiographic correlation. Direct findings include cortical discontinuity or irregularity. Indirect findings include subperiosteal or juxtaphyseal hematoma suggesting cortical or physeal fractures respectively.

[Value of US imaging following mastectomy]. / Intérêt de l'échographie systématique du site de mastectomie.

PURPOSE: To assess the value of US of the mastectomy site at the time of follow-up of the contralateral residual breast. MATERIALS AND METHODS: Over a 5 year period, 251 patients with previous mastectomy underwent 505 unilateral mammographies with US of the mastectomy site. The time delay between imaging and mastectomy ranged between 1-15 years, with a mean of 7.5 years. Lesions at the mastectomy site were classified as follows: BIRADS 2 for a cyst or prominent edema, BIRADS 3 for a lymph node with preserved fatty hilum or mildly echogenic cyst, BIRADS 4 for well-defined hypoechoic lesions, and BIRADS 5 for ill-defined lesions. RESULTS: None of the lesions classified as BIRADS 1, 2 or 3 was malignant. Eleven lesions were classified as BIRADS 4: 3 benign lesions, 7 malignant lesions, and 1 non-verified lesion. No lesion was classified as BIRADS 5. CONCLUSION: Systematic US evaluation of the mastectomy site appears warranted since only 1 of 7 malignant lesions was clinically palpable prior to US whereas all were retrospectively palpable after US.

[Pseudoaneurysm of the abdominal aorta due to retroperitoneal lymph nodes, diagnosed by Doppler ultrasound and treated by embolization]. / Faux anévrysme de l'aorte abdominale naissant dans un magma ganglionnaire: diagnostic par écho doppler et traitement par embolisation.

OBJECTIVE: To report a case of pseudoaneurysm of the abdominal aorta due to retroperitoneal enlarged lymph nodes. MATERIALS AND METHODS: A 40 years old patient, with known sarcoma and metastatic retroperitoneal lymph nodes was referred for abdominal ultrasound because severe abdominal pain after defecation. RESULTS: The Doppler examination revealed magma of retroperitoneal lymph nodes surrounding the abdominal aorta inside of which a saccular collection of circulating blood, communicating with the aorta, was detected. The spectrum registered in the channel revealed a bidirectional flow compatible with a pseudoaneurysm. MR angiography confirmed the diagnosis. Successful occlusion was done by coil embolization. CONCLUSION: Pseudoaneurysms of the abdominal aorta are very rare. We report the first case of pseudoaneurysm arising in retroperitoneal lymph nodes. Diagnosis by Doppler ultrasound allowed a rapid treatment by embolization.

[Regression of Morton neuroma after local injection of steroids]. / Régression du névrome de Morton après infiltration de corticostéroïdes.

Morton neuroma is a non neoplastic lesion corresponding to perineural fibrosis encircling the common interdigital plantar nerve. Several therapeutic approaches are possible: conservative treatment or surgery. We report a case treated by local steroid injection where follow-up MR showed near complete regression of the lesion. Although local injection of steroid is a classical treatment, it is the first time to our knowledge that resolution or such a striking diminution of size is reported after infiltration.

[Left segmental omental infarction in a child: conservative treatment]. / Infarctus segmentaire gauche du grand épiploon chez l'enfant: traitement conservateur.

Omental infarction is a rare cause of acute abdomen that usually occurs on the right side. Left omental ischemia is rare in adults and to our knowledge not yet described in children. Its diagnosis, although difficult, is important because it can avoid surgery. We report a case of left segmental omental infarction in an 11-year-old child, diagnosed by imaging studies, treated conservatively, and followed up by ultrasound until complete disappearance of the lesion.

[Traumatic perinatal cervical dislocation]. / Dislocation traumatique cervicale périnatale.

We report on a case of cervical dislocation in which the severity of the lesion contrasts with the paucity of the symptoms. An eight-month-old girl presented with weakness of the left upper limb. She had a normal cephalic delivery. On the following days, increased weakness of the limb showed a spontaneous, partial regression. Clinical examination at eight months showed a normal physical and psychical development, a falling neck and an impossibility to maintain the sitting position, but a normal mobility of the lower limbs. Cervical radiography performed showed a complete dislocation. CT confirmed the diagnosis and eliminated congenital vertebral anomalies. Magnetic resonance imaging showed an important stretching and compression of the spinal cord. Cervical spine damage in the newborn are scarce and serious. The here reported case is characterized by a complete vertebral dislocation associated with medullar stretching and compression, but few initial symptoms.

Thoracic splenosis. Case report and literature review.

Thoracic splenosis is the autotransplantation of splenic tissue into the thoracic cavity after thoracoabdominal trauma. We report a case of thoracic splenosis in a 35-year-old woman who had had a thoracoabdominal gunshot wound 12 years earlier. A review of the literature revealed 15 cases already reported. All patients had an asymptomatic thoracic lesion discovered on a plain chest film 9 to 32 years (mean 16) after the initial accident. In 13 cases an operation was necessary to establish the diagnosis. In two cases technetium 99m and indium 111 scans established the diagnosis.

Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer.

Nineteen patients with middle and lower rectal carcinomas were operated on, with abdominoperineal resection in 10 patients, lower anterior resection with coloanal anastomosis in 6 patients, and colorectal anastomosis in 3 patients. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by computed tomography in 12 (63%) of 19 patients and by magnetic resonance imaging in 13 (68%) of 19 patients, while digital examination correctly assessed the distance in 15 (79%) of 19 patients. Computed tomography and magnetic resonance imaging were unable to assess extension through the rectal wall. No significant difference was observed between computed tomography and magnetic resonance imaging in assessing extension to the perivesical fat, adjacent organs, pelvic side wall, or lymph nodes. According to the TNM classification, magnetic resonance imaging correctly staged 74% (14/19) of carcinomas, while computed tomography correctly staged 68% (13/19).

Magnetic resonance imaging of pseudomyxoma peritonei.

MRI findings in three cases of pseudomyxoma peritonei, in two cases associated with visceral invasion, are described. MR imaging using the same morphologic criteria as described in ultrasonography and CT suggested the diagnosis in all three cases. In T 1 weighted images (SE 400/28 ms) the hypointensity of signals of both implants and mucoid ascites was found to approach that of muscle tissue. In T 2 weighted images (SE 1600/40, 80, 120 ms), however, there was general hyperintensity of signals, which was more pronounced in mucoid ascites than in implants, and which approached signal intensities of water. Invasion of the viscera was very well depicted in all cases.

Fat suppression techniques in MR imaging of mature ovarian teratomas: comparison with CT.

OBJECTIVE: The aim of this study is to analyze the ability of MR fat suppression techniques to characterize fat components of ovarian mature cystic teratomas (MCT) shown by CT. SUBJECTS AND METHODS: MR images of eight MCTs of the ovary were obtained using standard sequences followed by a SPIR (spectral presaturation with inversion recovery) sequence in six cases and by Dixon sequences in two cases. In all cases correlation with CT and pathologic findings was achieved. RESULTS: MR fat suppression sequences showed to be as accurate as CT in detecting fat inside the cystic part of the teratomas (8/8). CONCLUSION: MR fat suppression sequences should be performed when presence of fat is suspected on images of ovarian tumors produced by standard MR sequences.

Mature cystic teratomas of the ovary: CT and MR findings.

OBJECTIVE: To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). SUBJECTS AND METHODS: CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. RESULTS: At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: -95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on T1 and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from -13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. CONCLUSION: Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.

Emergency arteriography in the assessment of penetrating trauma to the lower limbs.

One hundred emergency arteriographies (EA) were performed in 87 patients with lower limb trauma due to high-velocity missiles. Thirteen patients had bilateral injuries. In 79 cases, EA findings were positive and led to emergency surgery. In 76 cases an arterial injury was found and treated, a positive predictive value of 96% (76/79). In the other 3 cases, no arterial lesion was found (3 false positives). Among the 21 patients with normal findings from angiography, 10 had surgical exploration because of high clinical suspicion of vascular injury. Arterial injury was found in 2 cases (2 false negatives). In 8 patients, arteriography modified the surgical procedure. In the 11 remaining patients, clinical and echo Doppler follow-up results were normal, a negative predictive value of 90% (19/21). Sensitivity was 97%, specificity 86%, and accuracy 95%. These data show that arteriography in stable patients is a safe and accurate procedure. It permits avoidance of unnecessary surgical exploration in selected patients and helps modify the surgical procedure.

[Imaging of an aberrant occipital artery arising from the extracranial segment of the internal carotid artery]. / Imagerie d'une artère occipitale aberrante naissant de l'artère carotide interne à l'étage cervical.

We report a case of asymptomatic occlusion of the right internal carotid artery owing to the presence of a rare anatomic variant (occipital artery originating from the extracranial segment of the internal carotid artery). During the preoperative workup for a coronary artery bypass grafting (CABG) in a 65-year-old patient, an occlusion of the right internal carotid artery was visualized on Duplex ultrasound. Distally to the occluded site, the artery was patent thanks to a vessel parallel to it but with a reverse blood flow. MRA and angiography of the brachiocephalic trunk confirmed the occlusion of the internal carotid artery and its opacification distally via an aberrant occipital artery arising at the supra-bulbar level and communicating with the right vertebral artery. Therapeutic abstention was decided and the patient was operated of CABG without any neurological complication. Occipital artery arising from the internal carotid artery is a rare anomaly. Its association with internal carotid artery occlusion may be beneficial because it makes surgery possible, even in a chronic stage, if the patient is symptomatic. If the patient is asymptomatic, therapeutic abstention could be considered.

[Cardiac wounds. Experience from 10 years of war. Apropos of 32 cases treated surgically]. / Plaie cardiaque. Une expérience de dix ans de guerre. A propos de trente-deux cas opérés.

Thirty-two patients with cardiac wounds from high velocity firearms (bullets or shrapnel) were operated. Seven of these patients who had no cardiac activity on arrival underwent emergency thoracotomy with a mortality of 85%. The other twenty-five patients underwent planned sternotomy with a mortality of 12%. The authors analyse these case with emphasis on the diagnostic and therapeutic management.

[Thoracic splenosis. Review of the literature apropos of a case]. / Splénose thoracique. Revue de la littérature à propos d'un cas.

Thoracic splenosis consists of autotransplantation of splenic tissue in the thorax following thoraco-abdominal trauma. The authors report a case of thoracic splenosis in a 35 year old woman who suffered a thoraco-abdominal gunshot wound 12 years previously. Sixteen cases of thoracic splenosis have been reported in the literature. Always asymptomatic, the thoracic lesions were discovered by chance on chest x-rays performed for various reasons 9 to 32 years after the initial trauma. Surgery was required in 13 patients in order to establish the diagnosis. In 2 cases Tc99 and Indium 111 isotope scans revealed the diagnosis, avoiding the need for surgery.

[Malignant tumors of the ovaries: role of imaging]. / Tumeurs malignes de l'ovaire. Rôle de la radiologie.

Malignant ovarian tumors are developed in more than 95% in the epithelium surface of the ovary. In the mainly cystic forms, vegetations greater than 2cm, with an irregular surface, with a broad base on implantation, containing vessels on color Doppler are very suggestive of malignancy. Ultrasound is highly accurate in these forms. In most of the mixed forms on mainly solid forms, the irregular solid portions with degenerative changes containing tumoral vessels are very suggestive of malignancy. CT scan or MR imaging are usually more indicative of showing malignancy than ultrasound. In the multilocular forms, diagnosis of malignancy or benignity is often difficult. Extension to the pelvis, peritoneum and lymph nodes is easier to define on CT scan.

[X-ray computed tomography of endometrioid cancers of the ovary. Apropos of 4 cases]. / Tomodensitométrie des cancers endométrioïdes de l'ovaire. A propos de 4 cas.

The preoperative CT scan of 4 patients who had surgery for endometrioid adenocarcinoma of the ovaries were studied retrospectively and the results correlated to operative and pathological findings. 1) All tumors were bilateral. 2) Uterine involvement was diagnosed in 1 out of 3 cases. 3) Fallopian tubes involvement was present in 3 cases but was never seen on CT scan. 4) Ascites and peritoneal metastasis were correctly diagnosed in 2 out of 3 cases.

[Acute cholecystitis using computed tomography: usefulness of the trabeculation of the peri-cholecystic adipose tissue]. / Cholécystite aiguë en tomodensitométrie: utilité de la trabéculation de la graisse périvésiculaire.

PURPOSE: To evaluate the significance of pericholecystic fat stranding on CT, and to compare it to other CT findings in patients with acute cholecystitis. MATERIALS AND METHODS: The CT examinations of 14 patients with proven acute cholecystitis were retrospectively reviewed and evaluated for the presence of findings consistent with this diagnosis. RESULTS: The most common CT finding was stranding of the pericholecystic fat (13 patients), followed by gallbladder distension (11 patients). Pericholecystic or perihepatic fluid was present in 6 patients in association with severe acute cholecystitis (6 patients) and biliary peritonitis (2 patients). CONCLUSION: Stranding of the pericholecystic fat was the most common CT findings in patients with acute cholecystitis, followed by gallbladder distension.