Computed tomography and post-laparotomy intra-abdominal abscesses.

Thirty-one patients were prospectively studied and had abdominal computed tomography for post laparotomy sepsis. Computed tomography is of particular interest in seriously ill post-operative patients, 15 of our patients were on ventilators, and it enabled diagnosis and localization of abscesses in 15 patients. Drainage could therefore be achieved via a limited surgical approach, and extensive laparotomy was avoided. Of 16 patients without abscess, the abdominal computed tomogram was negative in 14 cases and there were two false positives. The overall accuracy was 0.94 with a sensitivity of 1 and a specificity of 0.88. The ability to screen the whole abdomen and exactly localize the lesion are the advantages of this non-invasive method.

Lumbar phlebography in the diagnosis of disc herniations.

The authors report their experience with 240 cases with lumbar phlebography in the diagnosis of lumbar disc herniations. The normal radiological anatomy and the radiological signs of disc herniations are described. Indications for phlebography are given, and the reliability of this test is compared with that of myelography performed with water-soluble agents.

Computerized tomography in the evaluation of the late complications of acute pancreatitis.

The role of computerized tomography in the diagnosis and treatment of late complications of acute pancreatitis was evaluated in 25 patients with acute pancreatitis. The clinical severity of the pancreatitis was assessed by Ranson's criteria. In each patient. the scan showed abnormalities of the pancreatic and at least one intraabdominal extrapancreatic extension of the disease. The scan precisely locates the intraabdominal extensions secondary to acute pancreatitis, and thus can guide surgical drainage, but it is less accurate in differentiating solid infiltration of fat planes from necrotic collections. However, in most of our patients, the association of general signs of sepsis with a collection shown on computerized tomographic scan indicated necrosis requiring surgical drainage.

[Digital angiography of bone sarcoma in the child]. / Intérêt de l'angiographie digitalisée dans les sarcomes osseux de l'enfant.

The authors analyze the results of 50 computed angiographies made for osteosarcoma and Ewing's sarcoma. Better tolerated than conventional angiography computed angiography is also more sensitive in preoperative evaluation of effectiveness of neoadjuvant chemotherapy. Automatic subtraction, direct measuring of tumor size and vascularization density give to angiographic changes after chemotherapy the most predictive value. After conservative surgery or radiotherapy digital angiography provides most reliable local follow up.

Computed tomography diagnosis of an atheromatous aneurysm of a right aberrant subclavian artery.

A patient presented with an asymptomatic mass which was found to be an artheromatous aneurysm of an aberrant right subclavian artery. Diagnosis was made by computed tomography. It is proposed that CT be carried out before arteriography for the diagnosis of congenital abnormalities of the aortic arches and great vessels.

[Suppurating splenic infarction originating from endocarditis]. / Infarctus spléniques suppurés d'origine endocarditique.

Three cases of splenic infarction complicated by abscess formation during bacterial endocarditis are reported. In all three cases there were associated clinical abdominal signs and, in one case, there was persistently positive hemocultures. The diagnosis was made by CAT scanning. The three patients underwent splenectomy and one patient also underwent valve replacement the same day. The methods of early diagnosis of splenic complications during endocarditis and the indications of splenectomy are discussed. Ultrasonography and abdominal CAT scanning are the most sensitive diagnostic methods for splenic lesions. As splenic rupture is associated with a high mortality and this complication may occur at any time during infarction complicated by abscess formation, early splenectomy is justified when abdominal clinical signs are elicited associated with a persistent, infectious syndrome with or without positive blood cultures, under appropriate antibiotic therapy. Splenectomy should also be considered if valve replacement is carried out in the same circumstances to avoid infection of the prosthesis.

[Hepatic angioscanner in normal subjects and in patients with hepatic tumors. Hemodynamic and morphologic characteristics]. / Etude de l'angioscanner hépatique normal et au cours des tumeurs hépatiques. Caractéristiques hémodynamiques et morphologiques.

Hepatic angio-CT was performed according to a standardized schedule in 100 healthy subjects and 260 patients with a liver tumor. In normal subjects, it was possible to determine an arterial phase (15 s), a parenchymatous arterial phase (30 s), a parenchymatous portal phase (45 s) followed by a progressive return to liver densities observed before injection. a) Among the 62 cases of hepatocellular carcinoma, 56 were characterized by hypodensity, 3 cases by hyperdensity and 3 cases by isodensity before injection. After injection, slices obtained at the tumor level showed heterogeneous hypervascularisation in 34 cases, and an early homogeneous hypervascularisation (15th-30th s) in 7 small carcinomas (diameter less than 3 cm); a lesion was disclosed in the other hepatic lobe in 12 cases. Slices obtained at the level of the portal vein allowed to assess tumoral involvement in 61 p. 100 of cases. b) Out of 150 cases of hepatic metastases, a hypodense lesion surrounded by hypervascularisation just after injection was the most frequent aspect. c) Out of 40 cases of hemangiomas, lesions were hypodense and well limited in 37 cases; at the 15th s after injection, contrast medium accumulated at the periphery, then diffused to the center of the lesion. d) Adenomas and focal nodular hyperplasias appeared as hypodense lesions with precocious and fugacious hypervascularisation, and were characterized, although inconstantly, by the presence of fat and vessels in the hypodense central zone, respectively. These results provide a rational basis for a better diagnostic approach of liver tumors.

[Irregular hepatic steatosis. Ultrasonic and computed x-ray tomographic aspects]. / Stéatose hépatique irrégulière. Aspects échographiques et tomodensitométriques.

A 39-year-old moderately obese and alcoholic man complained of abdominal pain and nausea. An ultrasound examination of the liver showed large hyperechoic areas surrounding a limited pseudotumorous zone of relatively decreased echogenicity. CT scan showed a decreased density (35 UH) in the hyperechoic areas, suggesting fatty liver which was confirmed histologically; conversely, the hypoechoic area appeared normal on CT scan. Six months later, after reduction of caloric intake and cessation of alcohol ingestion, ultrasound examination and CT scan of the liver were normal.

[Contribution of scanning to the diagnosis and evaluation of acquired anomalies of the aorta (author's transl)]. / Apport diagnostique de la tomodensitométrie en pathologie aortique. A propos de 50 observations.

Acquired anomalies of the aorta represent at the present time an excellent indication for scanning in vascular diseases. This form of examination permits perfect visualization of aneurysms, wherever they are located, frequently enabling a tumour in the vicinity of the aorta to be eliminated. It provides an exact topographic picture of the lesions with a quantitative indication of their height. The detection of a peri-aortic hematoma facilitates the diagnosis of cracking of the aneurysm. Scanning has a far from negligible contribution to make to the diagnosis of aortic dissections. The visualization of intraluminal calcifications at a distance from the wall, of a floating membrane or a false channel provides confirmation of the diagnosis and suggests the possibility of an angiography. As an additional bonus in the case of acute ischaemia of the lower limbs, scanning permits an easy and inexpensive diagnosis of a complete thrombosis of the aorta and an indication of its extent. Computerised scanning as a non-invasive and easily repeated examination, has numerous and widely varying indications in the pathology of the aorta. Its potential contribution in certain cases appears to be so great as to envisage its delaying angiography.

[Diagnostic contribution of computer tomography in muscular pathology]. / Apport diagnostique du scanner X en pathologie musculaire.

CT analysis in 26 patients with well-identified muscle diseases, and 4 normal controls was performed to evaluate its diagnostic interest. Scans were obtained through pelvis, thigh and calves at comparable levels in all subjects. Results showed that elementary changes were devoid of specificity and density measurements did not significantly increase the diagnostic significance of images. A good correlation was found between the degrees of CT changes and clinical evaluation of the muscles. However, CT allowed a more precise study of abnormalities in muscles difficult to assess clinically and, in all pathological cases, led to a clear analysis of the topography and the selectivity of the pathological process. If safety criteria are fulfilled, CT would allow a precise follow-up study of muscle atrophies.

[Erdheim-Chester disease. The multiviceral form presenting as exophthalmos]. / Maladie d'Erdheim-Chester. Forme multiviscérale révélée par une exophtalmie.

Erdheim-Chester disease is a rare visceral xantho-granulomatosis, the 17th case of which is reported here. The initial symptom, bilateral exophthalmos, was uncommon. The picture was completed by a retroperitoneal xanthogranuloma and by bilateral and symmetrical osteosclerosis of the long bones. The lack of X-bodies at electron microscopy differentiated the disease from Hand-Schüller-Christian disease. The patient's condition improved with chemotherapy (vinblastine and doxorubicin) combined with corticosteroid therapy. After a 5-month remission period, he died of an intercurrent infection. No autopsy was performed.

[Venous extension of renal cancer. Diagnostic value of computed tomography (author's transl)]. / Extension veineuse des cancers due rein. Rôle de la TDM.

The CT scan is of diagnostic value in cases of renal cancer extension. Details concerning 23 cases of renal tumours are described, 13 of these patients having venous invasion from the cancer, confirmed by operation. Computed tomography, is therefore of primordial value for the diagnosis of the degree of renal cancer spread.

[Radiological appearance of bone manifestations in acute drepanocytic syndromes in adults (author's transl)]. / Manifestations radiologiques osseuses des syndromes drépanocytaires majeurs chez l'adulte.

The authors describe 18 cases of this syndrome and emphasize that attenuated clinical forms of homozygotic drepanocytosis exist, as well as, in a more general manner, in acute drepanocytic syndromes. The disease may first appear in adult life. The frequency of radiological signs in the spine has to be stressed, and the authors emphasize the diagnostic value of the "staircase" deformation of the vertebrae, representing the sequelae of bone ischemic lesions. The discovery of this radiological sign suggested the diagnosis of a hemoglobinopathy in two cases. This attenuated form of the disease presents the same risks of thromboses but these complications can be reduced by prophylactic treatment. This underlines the need for early detection and radiological investigation can be of great assistance.

[Diagnostic value of computed tomography in blood diseases (author's transl)]. / Intérêt de l'examen tomodensitométrique dans le bilan d'une maladie hématologique.

Study of a series of 108 patients with blood disease explored by computer tomography showed that this is a reliable method for investigating retroperitoneal lymph node lesions, and that the cost and irradiation level was equivalent to conventional radiological examination. The scanner can also explore the liver, spleen, and lymph node chains, not revealed by the latter. Computer tomography, which is easily accepted by the patient, can be proposed, therefore, for initial and follow-up examinations of these patients.

[Contribution of computed tomography to the exploration of congenital anomalies of the inferior vena cava. A report on five cases (author's transl)]. / Intérêt de la tomodensitométrie dans l'exploration des anomalies congénitales de la veine cave inférieure. A propos de 5 cas.

3 cases of abnormalities of the inferior vena cava are reported: one isolated left inferior vena cava, one duplication of the inferior vena cava with continuation by a left inferior hemi-azygos vein and a simple duplication of the post-renal inferior vena cava. Finally, 2 cases of retro-aortic left renal vein are described. These abnormalities may be fully studied by computed tomography which in certain cases makes it possible to avoid inferior cavography. The authors emphasize potential sources of error in interpretation and the value of being aware of the congenital malformation of the inferior vena cava.

[Value of computed tomography for the investigation and diagnosis of aortic aneurysms (author's transl)]. / Apport de la tomodensitométrie dans le diagnostic et le bilan des anévrysmes de l'aorte.

Abdominal or thoracic aneurysms can be perfectly well visualized by computed tomography, and tumors lying close to the aorta and simulating ectasia can often be eliminated. The exact topographical features of the lesions can be defined as well as their extension superiorly. In many cases, calcifications, clots, a permeable channel, or even a periaortic hematoma showing fissuration can be demonstrated. On many occasions the value of computed tomography is such that angiography may not be necessary.

[Value of the transscapular view in radiological of shoulder trauma (author's transl)]. / Intérêt du profil tangentiel de l'omoplate dans le bilan radiologique des épaules traumatiques.

With a one year experience concerning 67 patients, the authors suggest to use for any shoulder trauma, a transscapular view associated with the routine antero postereiur film of the shoulder. This incidence has a major advantage on all the other lateral positions to be always possible at the exclusion of severely polytraumatised patients. Luxations of the shoulder, humerus and scapula fractures and lesions of acromio clavicular joints are quite correctly visualized.

[Left coronary artery arising from the pulmonary artery : a report on two cases of this anomaly in adults (author's transl)]. / Naissance anormale de l'artère coronaire gauche (CG) dans l'artère pulmonaire (AP) chez l'adulte. A propos de deux cas.

The presence of an abnormal origin of the left coronary artery from the pulmonary artery was observed in two adults. The clinical, radiological, and hemodynamic characteristics of this disorder are described. The author emphasizes the value of exploring these malformations by means of a strict technique, including the injection of a large quantity of contrast medium.

[Value of x-ray computed tomography in evaluating the spread and therapeutic strategy in cancer of the bladder]. / Intérêt de la tomodensitométrie dans le bilan d'extension et la stratégie thérapeutique du cancer de vessie.

Fifty four computed (CT) examinations were performed on patients with bladder carcinoma. A pathological assessment was obtained in 24 cases and the accuracy of CT in local staging was 91%. The accuracy of CT in detecting lymph nodes invasion was also 91%. Moreover, CT is helpful in the follow-up of patients under treatment. As it provides a correct pre-therapeutic evaluation in 83% cases, CT appears as an effective examination to perform in the evaluation of bladder carcinoma.

[Retro-aortic left brachiocephalic venous trunk. A rare anomaly: 2 cases]. / Le tronc veineux brachio-céphalique gauche rétro-aortique. Une anomalie rare: deux cas.

Two cases of a rare anomaly of the trajectory of the left brachiocephalic venous trunk were detected by CT scan imaging. In both patients the trunk passed under the aortic arch before emptying into the superior vena cava. One patient presented, in addition, a complex anomaly of the aortic arch.