[Chest CT: spectrum of normal findings]. / Les frontières de la normalité en tomodensitométrie thoracique.

A fundamental issue in the interpretation of chest CT lies in the ability to determine normality. Technical advances have resulted in an increasing number of submillimeter sections which in turn has resulted in the identification of a large number of minor abnormalities with no significant pathophysiological consequence. These images should be properly interpreted in order to avoid unnecessary follow-up examinations and radiation exposure. Often they are due to respiratory or cardiac motion artifacts. Others are explained by aging, anatomic variants, physiological phenomenon or tobacco use. These borderline imaging features detected on chest CT are described according to the main anatomical compartments of the thorax: lung and vessels, airways, pleura and chest wall, mediastinum and heart.

[Pleural mesothelioma: imaging contribution]. / Le mésothéliome pleural: place de l'imagerie.

Imaging plays an essential role in management of patients of with pleural mesothelioma. In this article, we discuss the respective roles for ultrasonography, computed tomography, magnetic resonance imaging, and positon emission tomography for the diagnosis, staging, and postherapeutic evaluation of pleural mesothelioma.

A validation of a flow quantification by MR phase mapping software.

AIM: We evaluated a Siemens software of flow quantification (FQ) by MR phase mapping, in the framework of a common practical use. METHODS: Experiments with a laminar flow phantom and in vivo pulsatile flow were performed. In particular, FQ in ascending aorta was investigated in healthy volunteers. RESULTS AND CONCLUSION: Flow phantom experiments reveal that the FQ slightly underestimates (8% on the average) actual velocities (mean velocities over a vessel area), and also that velocity uncertainties are related to the encoding velocity value, whatever the measured velocity. Furthermore, using well characterized working criteria, we found low intraobserver variability and negligible interobserver variability in ascending aorta FQs. The role played by the choice of reference area in FQ accuracy is emphasized. When recording several cardiac cycles during the same acquisition, it is shown that the FQ software may provide erroneous results. Several comments for FQ software use in the ascending aorta are added.

[Comparison of echocardiographic automatic border detection and magnetic resonance imaging. Measurements of the left ventricle in normal subjects]. / Comparaison des mesures ventriculaires gauches par échocardiographie en quantification acoustique et par imagerie magnétique nucléaire chez le sujet normal.

Echocardiographic automatic border detection (ABD) has been the object of several studies with diverging results. The aim of this study was to verify the validity of ABD measurements by comparison with magnetic resonance imaging (MRI). Twenty healthy subjects underwent measurement of end systolic surface (ESA) and end diastolic surface areas (EDA) and fraction of surface variation (FSV), end systolic volume (ESV), end diastolic volume (EDV and ejection fraction (EF). These results were compared with the same parameters measured by cine MRI and a study of the variability of interpretation was performed on the echocardiographic parameters. An ABD analysis was possible in 80% of the study population. The correlations were satisfactory between the EDA and EDV (EDA; r = 0.84; SD = 1.9 cm2; EDV; r = 0.90; SD = 12 ml) with acceptable confidence intervals (CI) (EDA; [-4.02; 1.19 cm2]/EDV; [26; +7.9 ml]) and an underestimation of ABD values (EDA; -9%/EDV: -10%). With regards to the end systolic measurements, the correlations were not as good (ESA: r = 0.68; SD = 1.5 cm2/EDV: r = 0.59; +12 ml) with a more important measurement error (ESA: -2.05; +3.45 cm2)/EDA: (-9; +27 ml) and an overestimation of the ABD values (ESA; +10%; ESV; +18%). No correlation was observed between the FSV and EF. The intra and inter-observer errors were compared with those of conventional echocardiography (intra-observer error; 10.7-16.9%/inter-observer error; 10.8-16.6%). The authors conclude that ABD has a non-negligeable measurement error which limits its application in clinical practice. New transducers, automatisation of gain adjustment and new technologies should improve ABD measurements.

[Myocardial infarction in a child with an anomalous left coronary artery arising from the right coronary sinus. Value of echocardiography]. / Infarctus du myocarde chez un enfant et anomalie de naissance du tronc coronaire gauche du sinus coronaire droit. Apport de l'échocardiographie.

An anomalous left coronary artery arising from the right sinus of Valsalva with a trajectory between the aorta and the main pulmonary artery is a rare isolated congenital anomaly carrying a high risk of sudden death and of acute myocardial ischaemia, especially in children and young adults in a context of exercise. It is usually a post-mortem finding. The authors report the rare case of a 12 year old child who suffered acute myocardial infarction on exercise due to this condition. The diagnosis was made in the acute phase by echocardiography. Surgical correction was performed as this is the only means of prevention of sudden death of an ischaemic recurrence. Effort syndromes in children or young adults should lead to a request for echocardiographic examination to exclude the diagnosis in a non-invasive manner as well as those of hypertrophic cardiomyopathy or congenital aortic stenosis.

[Diagnostic and therapeutic value of lymphography in persistent postoperative chylothorax]. / Intérêt diagnostique et thérapeutique de la lymphographie dans un chylothorax postopératoire persistant.

Chylothorax is a rare but generally severe complication of surgery of congenital heart disease. The authors report the clinical history of a young boy with complex congenital heart disease operated on several occasions and who developed severe and recurrent unilateral chylothorac after a bicavo-bipulmonary derivation. Conservative treatment followed by continuous somatostatin infusion was ineffective. Diagnostic Lipiodol lymphography was required before the chylothorax was cured. The authors describe management of this difficult case and discuss the therapeutic possibilities with reference to a brief review of the literature.

[Hematoma of the aortic wall: from diagnosis to treatment]. / Hématome de la paroi aortique: du diagnostic au traitement.

Haematoma of the thoracic aortic wall is a relatively new concept, the physiopathology of which remains controversial. It results from an haemorrhage of the aortic wall due to rupture of the vasa-vasorum without communication with the arterial lumen. This is a diagnosis of elimination of dissection of the aorta which has been made possible by modern techniques of imaging, such as transoesophageal echocardiography, helicoidal scanner and magnetic nuclear resonance imaging. The prognosis of haematoma of the aortic wall is not as bad as that of dissection of the aorta. Recent studies have shown that the condition may stabilise, regress or progress towards complications of two types: early, dissection or fissuration of the aorta, and late, aortic aneurysm. This is a medico-surgical emergency, the treatment of which is not well codified. However, schematically, haematoma of the aortic wall should be managed in the same way as dissection of the aorta: surgery when the ascending aorta is affected, medical treatment in other cases in the absence of complications.

[Transthoracic aspiration. Evaluation of cytologic and histologic diagnosis in a pulmonary nodule by retrospective comparison of 2 series of 267 cytoaspirations and 292 coaxial needle aspirations]. / La ponction trans-thoracique. Evaluation du diagnostic cytologique et histologique d'un nodule pulmonaire par comparaison rétrospective de 2 séries de 267 cytoponctions et de 292 ponctions à l'aiguille coaxiale.

Percutaneous fine-needle aspiration is a well established method for the diagnosis of peripheral lung lesion. In order to compare different methods of aspiration, we analyze retrospectively two different series: 267 fine needle aspirations (FNA) compared with the histological diagnosis on surgical specimens and 292 lung biopsies using a coaxial technique with comparison between cytological diagnosis--smears and imprints--and histological diagnosis simultaneously obtained on the same specimen. The sensitivity (91%), the specificity (90%) and the overall typing accuracy related to the histological types obtained by FNAB are equivalent to those of the literature. The low rate of pneumothorax in the series (6%) is related to the use of immediate interpretation of the specimen. Automated biopsy with a coaxial cutting needle provide cytological specimens--smears and imprint--with a high rate of sensibility (95.3%) and of sensibility (98%). The overall sensitivity of the cytological methods alone is better than biopsy (95.3% vs. 92.9%), but the typing accuracy is not as good as biopsy alone (98% vs. 100%). False-positive and false-negative diagnoses are the same in both series. In conclusion the percutaneous aspiration method choose to establish a morphological diagnosis in lung lesion depends now on the habits of the radiologist and the pathologist.

[Thoracic pathology without apparent radiographic sign: re-interpretation basis]. / La pathologie thoracique sans traduction radiographique apparente: base de ré-interprétation.

A chest radiograph may falsely be initially read as being normal or "apparently" normal. The clinical settings where such a false reading may occur are numerous and variable. The most significant situation is the initially missed single pulmonary nodule, with a reported estimated incidence ranging between 30% and 50%. Airway diseases are also typically silent on chest radiographs. The trachea and main bronchi are not well evaluated and some small airways diseases may have very little manifestations, even when advanced. Vascular diseases, when diffuse with bilateral symmetrical hypo- or hyperperfusion, are difficult to detect along with localized but symmetrical vascular disorders and endo- or transthoracic extracardiac shunts. Finally, any disease involving the pleura, pericardium, mediastinum, or lung interstium may be undetectable radiologically at the time of presentation. This paper reviews and illustrates these various diseases and their radiological findings.

[Inflammatory and infectious lesions of the breast. Contribution of ultrasonography]. / Les lésions inflammatoires et infectieuses du sein. Contribution de l'échographie.

Non puerperal abscess associated with periductal mastitis assumes increasing importance. US is an excellent tool for detection of an abscess cavity, which many have a variety of scanographic findings. Mammography may be difficult to perform properly because of pain and edema of the breast.

[Air trapping revealing endobronchial tuberculosis]. / Piégeage expiratoire révélant une tuberculose endobronchique.

We report a case of endobronchial tuberculosis located in the main left bronchus suspected on a CT scan and assessed by fiberoptic bronchoscopy. This localisation is not unusual, and is often associated with a normal chest radiography. Air trapping present on high resolution CT scan led to focus the examination on proximal airways and to suspect their involvement. This observation underlines the value of expiratory CT scan in demonstrating proximal stenosis of main bronchi.

[Hypoplasia of the inferior vena cava with intrahepatic continuation. Color Doppler ultrasonography and MRI]. / Hypoplasie de la veine cave inférieure avec continuation intrahépatique. Echo-Doppler couleur et IRM.

We report a rare case of inferior vena cava hypoplasia discovered fortuitously, with intra-hepatic venous shunts, explored only by color-doppler ultrasound and MRI. These noninvasive imaging tests demonstrated that the intra hepatic collateral pathway arose from an inferior (accessory) right hepatic vein and flowed into the right and middle hepatic veins. Due to these findings a cavography was avoided in this asymptomatic patient.

[Mediastinal sarcoidosis and vascular thrombosis: a fortuitous association?]. / Sarcoïdose médiastinale et thrombose vasculaire: association fortuite?

A 43-year-old woman presented with a recent history of intermittent dyspnea with wheezing. The chest x-ray evidenced mediastinal nodes. A CT scan showed vascular embolism. Mediastinoscopy was performed and pathology examination of the node confirmed the diagnosis of sarcoidosis. The patient responded to corticosteroid and anticoagulation therapy. Is this a fortuitous association? A vascular localization of sarcoidosis? Thrombosis by compression?

[Sarcoidosis and renal insufficiency]. / Sarcoïdose et insuffisance(s) rénale(s).

Renal complications of sarcoidosis are rare but they may lead to renal failure. The two most common mechanisms are interstitial nephritis and acute hypercalcaemic renal failure. We report the case of a woman who presented both of these complications.

[Inflammatory and infectious lesions of the breast. Contribution of ultrasonography]. / Les lésions inflammatoires et infectieuses du sein. Contribution de l'échographie.

Non puerperal abscess associated with periductal mastitis assumes increasing importance. US is an excellent tool for detection of an abscess cavity, which many have a variety of scanographic findings. Mammography may be difficult to perform properly because of pain and edema of the breast.

[MRI and the thorax]. / IRM et thorax.

In the field of thoracic pathology, the indications for MRI are well established in pleural, mediastinal and vascular disease. Compared to CT, MRI, with its superior contrast resolution, allows better tissue characterization of tumours, as well as an accurate assessment of mediastinal or parietal invasion prior to surgery. MRI is a non-ionizing imaging technique, which can be repeated for the follow-up of aortic diseases such as dissections or aneurysms. Clinicians should be aware of the contraindications to MRI and the adverse effects of gadolinium.