[MRI and pituitary adenoma]. / IRM et adénomes hypophysaires.

Pituitary is the most important gland of the organism which can be affected by many diseases, especially by adenomatous processes. Classically macroadenoma, microadenoma and picoadenoma are described, according to the size of the pituitary adenoma. The diagnosis of microadenoma was long considered a highly difficult task and that of picoadenoma was impossible by computed tomography. Recently, the high resolution of multiplanar MRI has enabled the diagnosis of microadenomas measuring less than 3 mm (picoadenoma). For macroadenoma, MRI not only contributes to diagnosis but is particularly important to assess the extension and to detect possible complications. The aim of our study is to illustrate MRI features in pituitary adenoma.

[Elastofibroma: imaging features]. / Imagerie de l'élastofibrome dorsal.

Elastofibroma dorsi is a rare benign and slow growing fibro-proliferative lesion of unknown pathogenesis. It has a characteristic location (periscapular region) and a specific imaging appearance (songraphy, CT, MRI) allowing accurate prospective diagnosis. The recognition of this benign lesion avoids unnecessary biopsy and/or surgery. We report three cases of elastofibroma dorsi illustrating the characteristic features on sonography, CT and MRI. Involvement was bilateral in two cases.

[Morphological diagnosis of pseudocystic tumors of the liver]. / Diagnostic morphologique des tumerus pseudo-kystiques du foie.

Ten cases of pseudocystic hepatic tumors were observed during the past ten years. This entity is very rare in comparison with benign hepatic cysts. Careful analysis of the characteristics of these lesions usually allows to differentiate them from benign cysts. Of importance are wall thickness, mural nodules and fluid/fluid levels on ultrasound and/or computed tomography scanning. In our series, sonography depicted the true morphology of these cystic masses more clearly than computed tomography. If definitive diagnosis cannot be made by morphologic examinations, percutaneous aspiration of the cystic lesion, a simple and safe method, should be considered.

[Unresectable hepatic adenomas. Management by selective hepatic artery embolization]. / Adénomes hépatiques non résécables. Place de l'embolisation artérielle dans la conduite thérapeutique.

Four patients with unresectable hepatic adenoma underwent selective hepatic artery embolization. Non-operability was related to the size and the situation of the tumor, and the clinical background. The only subsequent postembolization syndrome was one case of acute renal failure, reversible after diuretic treatment. In 3 cases the decrease in tumoral size was delayed and appeared six months after the first embolization, allowing surgical resection in 2 cases. Because of lack of tumoral devascularization and presence of residual nodules on the resected specimen, this technique is not a satisfactory alternative to surgery, at least with the employed technique. However, preoperative selective hepatic artery embolization can play an important role in the management of hepatic adenomas as it may permit safer surgical resection.

[Chondrosarcoma of the mandible. Clinicopathological study of a case]. / Le chondrosarcome de la mandibule. Etude anatomoclinique d'un cas.

The authors report a new case of chondrosarcoma of the mandible in a 24 year-old female patient. They insist on the rareness of this entity and on the difficulties in establishing this diagnosis from the clinical, radiological and pathological points of view. Elements of prognosis are discussed through a review of the literature.

[Hydatic acute pancreatitis: a case report]. / Pancréatite aiguë d'origine hydatique: à propos d'un cas.

Acute pancreatitis caused by hydatic cyst of the liver was rarely reported. The authors report a new case of hydatic pancreatitis characterized by visualization of hydatid membranes in the biliary tract without any biliary stone or alcoholic consumption.

[Comparative study of Hexabrix and Lipiodol UF in sialography]. / Etude comparative de l'Hexabrix et du Lipiodol UF en sialographie.

Many new lipid- and water-soluble contrast media can be used in sialography, the three main criteria of choice being the cost, the quality of filling, particularly of the parenchyma, and its evacuation and clinical tolerance. Duroliopaque possesses very similar physicochemical properties to those of Lipiodol UF, but a sufficiently satisfactory filling of the parenchyma is not obtained. Comparison of Lipiodol UF and Hexabrix in parotid and submaxillary contrast imaging showed good clinical tolerance for both products, but improved parenchymatous filling with Lipiodol UF. However, the more effective glandular evacuation with Hexabrix makes this the product most suitable at the present time for morphologic exploration of salivary glands.

[Subcapsular hematoma complicating acute pyelonephritis]. / Hématome sous-capsulaire compliquant une pyélonéphrite aiguë.

Spontaneous subcapsular renal hematoma is rare and essentially associated with malignant, or benign tumor vascular diseases, inflammatory processes. In few cases, no cause was detected. We observed one additional case in a diabetic women. She presented fever, and bilateral flank pain. Ultrasonography showed bilateral subcapsular hematoma. Computed tomography confirmed these findings and demonstrated multiple area of acute focal pyelonephritis.

[Pseudo-aneurysm in acute necrotico-hemorrhagic pancreatitis: direct transcutaneous embolization. Apropos of 2 cases]. / Pseudo-anévrysme au cours d'une pancréatite aiguë nécrotico-hémorragique: embolisation directe transcutanée. A propos de deux observations.

Massive hemorrhage associated with pancreatitis is rare but frequently lethal complication. We report two patients with gastrointestinal hemorrhage related to pseudo-aneurysms, the control of these lesions was not possible without risk by vascular selective embolization. The technique we reported for clotting aneurysms by direct injection (Ethibloc) stopped hemorrhage temporary in one case and permanently in the other.

[Emphysematous pyelonephritis. Apropos of a case diagnosed by ultrasonography]. / Pyélonéphrite emphysémateuse. A propos d'un cas diagnostiqué par échographie.

Emphysematous pyelonephritis is a severe infection of the Kidney observed mainly in diabetic patients. The disease is characterized by the production of intra-renal and occasionally perirenal gas. Because of the high mortality associated with this fulminant septic infection, it is imperative to establish a prompt diagnosis and start an appropriate therapy early in the course of the disease. We report a case of emphysematous pyelonephritis diagnosed by sonography: sonographic features consist of multiple high amplitude echoes within the renal parenchyma, renal sinus and perirenal space associated with distal shadows containing low level echoes. We discuss the value of the radiologic imaging methods.

[Bone anomalies in von Recklinghausen disease]. / Anomalies osseuses dans la maladie de Von Recklinghausen.

28 cases of neurofibromatosis are reported. Principals bone anomalies are reviewed. The skeletal manifestations are numerous and varied. These anomalies interest specially cranial vault, spheno-orbital area and vertebral spine. It is imperative to keep in mind skeletal manifestations because neurologic and cutaneous signs can be absent.

[Primary lymphoma of bone: imaging features]. / Lymphomes osseux primitifs: apport de l'imagerie médicale.

Primary lymphoma of bone (PLB) has benefited from recent advances in medical imaging and immunohistochemical study that are of prognostic and therapeutic value. From 3 case reports of PLB involving the iliac bone and the skull base, we review the definition of PLB and their main features. The importance of complete initial workup for staging in order to exclude secondary bone lymphomas, more frequent and of worse prognosis, is emphasized. Diagnosis of PLB involving the skull base is more difficult to obtain and nearly always requires neurosurgical biopsy unlike PLB of peripheral bones that are more readily amenable to percutaneous biopsy.

[Adrenal tumors in Beckwith-Wiedemann syndrome. Apropos of a case]. / Tumeurs surrénaliennes dans le syndrome de Beckwith-Wiedemann. A propos d'un cas.

A case of a neonate with Beckwith-Wiedemann syndrome is presented. Antenatal sonography detected a right adrenal cystic mass confirmed in post-natal which resolved spontaneously within 1 month. The child developed an adrenal adenoma detected by abdominal sonography at six months of surveillance. The authors review the different adrenal lesions possibly associated with Beckwith-Wiedemann syndrome and specially the pseudo-tumorous lesions. The value of abdominal sonography in the neonatal periods and in the surveillance of children with Beckwith-Wiedemann syndrome is emphasized.

[Ultrasonographic aspects of kidney pelvis tumors associated with infectious hydronephrosis of lithiasic origin]. / Aspects échographiques des tumeurs pyéliques sur hydronéphrose infectée d'origine lithiasique.

The ultrasonographic findings of 4 patients with surgically confirmed urothelial tumors associated with calculic pyonephrosis are presented. All the involved were markedly enlarged and hydronephrotic with obstructive calculi, stigmata of pyonephrosis and, an echoic pelvic mass, extending in calyceas in 2 cases. The sonographic appearance correlated well with the gross pathological findings. The histological types were 2 squamous cell carcinomas, 1 adeno-squamous cell carcinoma and 1 transitional carcinoma. The chronic calculic irritation was proved to induce squamous and glandular metaplasia. The subsequent squamous carcinoma and adenocarcinoma were documented in the literature. The preoperative diagnosis of the associated tumor was rarely done. The sonographic features reported are highly suggestive of urothelial tumor and may lead to an accurate preoperative diagnosis.

[Cavitary tumor lesions of the small intestine. Radio-ultrasonic diagnosis. Apropos of 4 cases]. / Les lésions tumorales cavitaires du grêle. Diagnostic radio-échographique. A propos de 4 observations.

Excavated lesions of small intestine are rare and generally of a malignant nature, the must frequent cause being metastases. In Tunisia these lesions are usually the aneurysmal type of lymphoma. The etiology in a series of four cases of excavated lesion of small intestine was not always lymphomatous. Radiologic and ultrasound semeiology are outlined and etiologies discussed. Scan images are not available since whole-body scanners are not in use in Tunisia.

[Pyogenic abscess of the psoas]. / Les abcès à pyogènes du psoas.

11 cases (7 primary and 4 secondary) of pyogenic psoas abscesses are reported. In all cases Staphylococcus aureus was isolated on blood culture or pus drained under ultra-sonographic control. US is very useful for diagnosis and the follow up of psoas pyogenic abscesses. Percutaneous aspiration and drainage of psoas abscesses under ultrasonographic control combined to antibiotherapy is an effective therapeutic procedure. Our experience suggests that antibiotherapy alone is an effective therapy of presuppurative pyogenic psoas abscesses and even in collected and non complicated primary psoas abscesses.

[Primary cardiac sarcoma: report of 3 cases and review of the literature]. / Les sarcomes primitifs du coeur: revue de la littérature, illustrée par 3 cas.

Primary cardiac sarcoma is a rare tumor with a poor prognosis. We report 3 cases with a review of literature about this disease. There were 2 males and 1 woman. The main symptoms were thoracic pain. The clinical features were various and the thoracic ultra sonography exam allowed the diagnosis in the 3 cases. All patients had surgical remove of their cardiac tumor followed by chemotherapy. All of them died within 13 to 36 months after the diagnosis. Primary cardiac sarcoma has a poor prognosis with a mean survival less than 12 months.

[Does arterial embolization have a role in the treatment of cavernous hemangioma of the liver in adults?]. / L'embolisation artérielle a-t-elle une place dans le traitement des hémangiomes caverneux du foie de l'adulte?

Embolization of the hepatic artery for cavernous haemangioma is discussed on the basis of 7 cases (3 giant haemangiomas, 4 medium sized or small), all symptomatic. Therapeutic embolization reduced the tumoral mass in 3 cases but had little effect on the symptoms. There was no complication. Arterial embolization is a relatively non-aggressive method, but it does not suppress the lesion. It should therefore be reserved to symptomatic or complicated cases, where reduction of the mass can be expected to result in functional improvement. Such cases are too exceptional for embolization to be performed routinely in adult patients with cavernous haemangioma of the liver.