CT diagnosed jejunal intussusception revealing metastatic renal cell carcinoma

We report the case of a 77-year-old woman presenting with a jejunal intussusception as the primary symtom of metastatic renal cell carcinoma. Both lesions were demonstrated by abdominal CT which detected also pancreatic metastasis. This case emphasizes the significance of CT to diagnose intussusception and to characterize its cause.

[Ischemic orchiditis: review of 5 cases diagnosed by color Doppler ultrasonography]

PURPOSE

To study color-doppler ultrasoundfeatures of testicular infarction caused by orchiepididymitis, a severe complication of orchiepididymitis.

MATERIAL

and Methods. Five patients were included over a 2 year period. All presented with more than 24 hours of pain. A final diagnosis of testicular infarction caused by orchiepididymitis and color doppler ultrasound was available in all cases.

RESULTS

All patients showed doppler ultrasound signs of testicular ischemia. Either vascularisation was not detectable or intratesticular resistive index was increased with a negative diastolic flow. Orchidectomy was performed in all patients.

CONCLUSION

Color doppler examination of the scrotum should include measurement of intratesticular resistive index. An elevated RI can be suggestive of ischemia.

[Endometrial imaging]

The diagnostic value of endovaginal sonography in benign or malignant endometrial pathology is high, increased by sonohysterography. Sonohysterography is useful in the diagnosis of endometrial thickness and to determine further investigations. MRI is accurate in the uterine adenomyosis diagnosis and is the imaging modality of choice for the preoperative endometrial cancer staging.

Anal endosonography after sphincter repair: specific patterns related to clinical outcome

BACKGROUND

This study evaluates the endosonographic patterns of the anal sphincter after sphincteroplasty to define specific postoperative findings and to identify factors related to clinical outcome after sphincter repair.

METHODS

Thirty-one incontinent patients (29 women, two men; mean age = 57 years) who underwent surgical repair for an external sphincter defect were studied postoperatively by endosonography. Twenty patients were found to improve after surgery.

RESULTS

Postoperative endosonograms showed specific images: direct visualization of the surgical process was represented by the "overlapping sign" in 17 cases and the "end-to-end suture" in four cases. These echographically favorable cases were associated with improvement after surgery in 18 of 21 patients (p < 0.005). Persistent defects were reduced in five patients and unchanged in five other patients and were associated with poor outcome in eight of 10 patients (p < 0.005).

CONCLUSIONS

Postoperative endosonography of the external anal sphincter presented some specific endosonographic aspects. The association between anal endosonographic findings and clinical outcome suggests the use of this procedure to assess patients following sphincteroplasty.

Pudendal neuralgia: CT-guided pudendal nerve block technique

Chronic anoperineal pain without any apparent etiology may be caused by compression of the pudendal nerve. This presentation illustrates the course of the pudendal nerve and the technique of computed tomography-guided infiltration of the nerve.

[MRI evaluation of placenta accreta treated by embolization. Apropos of a case. Review of the literature]

Placenta accreta results from an abnormal attachment of the placenta to the uterine myometrium. The reported incidence in literature is variable, with an average of 1/7000 pregnancies. This condition is associated with a significant risk of bleeding at the time of delivery, usually requiring hysterectomy. Sonography associated with color Doppler is useful for diagnosis, but MRI can be used successfully to evaluate the degree of placental tissue invading into the myometrium, the serosa, and for follow-up after conservative management. To our knowledge, only two cases of placenta accreta evaluated with MR and six cases of placenta accreta treated by embolization have been reported in the literature. The authors report one case of placenta accreta treated successfully by embolization, and followed-up by MRI.

[Spontaneous rupture of the bladder. Apropos of 2 cases with an unusual presentation]

Spontaneous bladder ruptures is the accepted term of bladder rupture not associated with trauma. This rare condition occurs when an obstacle to urinary outflow is associated with a diseased bladder wall. The diagnosis is usually made on the retrograde cystogram. We report two cases of atypical spontaneous bladder rupture with intravesical herniation of the small bowel. The diagnosis was not suspected clinically but was made on CT and MRI.

[Ultrasonography of the urethra: prognostic value of the ultrasonographic structure of corpus spongiosum peristenotic fibrosis: prospective study of 33 patients]

OBJECTIVES

The contribution of ultrasonography to pretreatment morphological assessment of strictures of the anterior urethra and assessment of the risk of recurrence after internal urethrotomy.

MATERIAL AND METHODS

33 patients (16-89 years) operated by internal urethrotomy for stricture of the anterior urethra and followed for at least 6 months. Preoperative urethral ultrasonography, recording the number, length and degree of strictures and echostructure of the peristenotic fibrosis of the corpus spongiosium.

RESULTS

Ultrasound visualization of all urethral strictures, with no false-positives and no false-negatives. 11 patients relapsed after a mean interval of 5.7 months (1-16 months), 22 patients did not present recurrence: mean interval: 15.5 months (6-36 months). Corpus spongiosum fibrosis associated with urethral stricture is isoechoic to the corpus spongiosum (19 cases) or hyperechoic to the corpus spongiosum (14 cases). No statistical correlation was observed between the echostructure of the fibrous tissue and the risk of recurrence after internal urethrotomy.

CONCLUSION

Ultrasonography allows excellent analysis of the morphological characteristics of a stricture of the male anterior urethra. In our experience, and in contrast with the limited data of the literature, no correlation was observed between the echostructure of the peristenotic fibrosis and the risk of recurrence after internal urethrotomy.

[Value of helical CT scan in the preoperative assessment of the ureteropelvic junction syndrome]

INTRODUCTION

The search for anatomical variants of the renal blood supply is an important element in the choice of surgical technique for the treatment of ureteropelvic junction syndrome.

MATERIAL AND METHODS

Prospective study of 17 patients (mean age: 33 years), assessed by spiral CT with acquisition of overlapping thin sections during the arterial phase. The renal blood supply anatomical findings were then compared with operative findings in all patients.

RESULTS

We observed a solitary renal artery in 8 cases, a lower pole pedicle crossing the junction in 9 cases and vascular abnormalities in 4 cases. All of these radiological findings were confirmed intraoperatively. Spiral CT, with rapid acquisition during the arterial phase and overlapping thin sections, allows accurate analysis of the renal blood supply. Axial sections are sufficient to provide the necessary anatomical information. Three dimensional reconstructions allow a better spatial visualization of the various structures.

CONCLUSION

This examination allows visualization of a possible lower pole artery associated with UPJ syndrome, with identical accuracy to that of renal arteriography, but constitutes a less invasive and less expensive investigation.

[A case of hemangiopericytoma of the pelvis]

Haemangiopericytoma is an uncommon tumour of vascular origin. The authors report a case of one of the rarer sites of this tumour in man: paravesical pelvic haemangiopericytoma. Although modern imaging techniques have provided useful information concerning the hypervascular and clearly demarcated appearance of this tumour which displaces but does not invade adjacent organs, its diagnosis can only be established by histology. Its degree of malignancy and its invasive potential are unclear. The risk of local recurrence and metastases in more than one half of cases justifies wide surgical excision, possibly combined with adjuvant radiotherapy, and long-term follow-up.

[Percutaneous retrieval of catheters migrated in the circulatory system]

The migration of catheter in the central venous system is a rare but serious iatrogenic complication. At short term this life threatening complication induces arythmias and then infectious, thrombotic and mechanical complications. Simple interventional procedures, rapidly achieved can prevent these complications.

Fine needle aspiration of retroperitoneal human dirofilariasis with a pseudotumoral presentation

The accidental finding of a pseudotumoral para-aortic mass in a 60-year-old woman led to the performance of a fine needle aspiration (FNA) biopsy under ultrasonographic guidance. The milky aspirate was centrifuged and processed as a cell block. The examination of sections confirmed the lymphatic origin of the sample, but also revealed some unexpected parasitic structures. While a complete identification could not be made on a few sections, the morphologic and epidemiologic evidence suggested Dirofilaria repens. The mass was surgically removed and identified as an adenolymphocele, which appears to be a new localization of dirofilariasis in humans. This case emphasizes the utility of FNA in diagnosing such unexpected findings without the use for exploratory surgery.

Transluminal angioplasty of failing infrainguinal arterial by-pass grafts: initial and long-term results in 13 patients

Thirteen stenotic infrainguinal arterial bypasses (12 venous, 1 Gore-tex graft) were treated by transluminal angioplasty, either percutaneously (10 patients) or surgically (3 patients). Eleven procedures were immediately successful (two at the proximal portions of femoropopliteal grafts, six near the distal anastomoses, and three at the distal parts of femoroinfrapopliteal grafts) and dilated stenoses are still patent with a mean duration of 24 months in all patients except 2 who died during the follow-up period. The calculated cumulative patency rate is 85% at 36 months. Two procedures were followed by immediate disruption near the distal end of an in situ saphenous bypass graft where balloon inflation was performed. These required immediate surgical repair. Dilatation of the distal ends of in situ saphenous femoropopliteal bypasses may not be as safe as in other locations.

Primary left atrial angiosarcoma: follow-up by magnetic resonance imaging

We report the case of a primary left atrial angiosarcoma followed by MRI over a period of 1 year. The tumor was lobulated, with an initial central hyperintensity on T1-weighted images which disappeared after radiotherapy. Compared with other imaging modalities, MRI offered the most accurate information about the location, extent, and outcome under treatment.

MR appearance of the normal chest after pneumonectomy

Magnetic resonance (MR) imaging of the chest was performed in nine patients who had undergone pneumonectomy, to evaluate postoperative chest anatomical changes. The main criterion of selection in this study was the absence of cancer recurrence at the time of the study and 6 months later (normal clinical, fiberoptical and cytological data and normal laboratory values). All the MR studies were compared with chest CT performed within 15 days after MR imaging. Postpneumonectomy space revealed in all cases a heterogeneous signal both on T1- and T2-weighted spin-echo sequences. Vascular and bronchial stumps were clearly delineated and surrounded by low signal areas, considered to be postoperative scars. Spatial involvement was well understood with frontal and axial views. Calcifications were poorly identified. Surgical clips were easily detected, but they were difficult to locate accurately. No adverse effects was reported, either in patients with or without surgical clips.

Post-pneumonectomy evaluation of the chest: a prospective comparative study of MRI with CT

A comparative study of 11 pneumonectomized patients was undertaken in order to evaluate the respective advantages and drawbacks of MRI and CT in post-operative follow-up. Nine patients were healthy at the time of the study and two presented with tumor recurrence. MR examination included 500/40 ms axial, and frontal 800/40-80 ms or 1300/60-120 ms nongated spin echo sequences. MRI was slightly more efficient in identifying vascular stump and main nodal stations, and detected better than CT tumoral and metastatic spread in cancer recurrences. It was as informative as CT in evaluating postpneumonectomy space and bronchial stump. It was noncontributory in the detection of calcifications. Although clips were visible with MRI, their location was less definite than with CT, a potential pitfall when radiotherapy is planned.

[Role of arteriography and x-ray computed tomography in the current evaluation of pigmented villonodular synovitis]

The angiographic characteristics of five surgically proven cases of pigmented villonodular synovitis are reported. A CT scan was performed in one case. CT scan arthrography is very useful when it demonstrates regions of high attenuation. The angiography never demonstrated in the five cases capillary blush nor arteriovenous shunting, but a regular hypervascular mass. These findings are helpful for the surgeon suggesting the best surgical approach and the best site of biopsy.

Intracranial aneurysmal bone cyst: a rare CT appearance

Aneurysmal bone cyst occurring within the calvarium is uncommon. We report a case presenting as an intracranial space-occupying lesion. Fluid levels within a lesion on CT is very suggestive but inconstant. The theory of a pre-existing lesion is noted.

[Optochiasmatic tuberculoma and MRI. 2 cases]

Two cases are reported of optochiasmatic tuberculoma, an exceptional complication difficult to diagnose in the absence of any tuberculous context. Although diagnosis of the optochiasmatic occupying process is simple by scan or NMR imaging, it is generally difficult to identify the chiasma in a process of this type. It is therefore impossible to recognize the two forms of these tuberculomas: intra- and peri-chiasmatic histologic types, and yet these have an incidence on therapy and prognosis. Surgical exploration is justified when the diagnosis remains in doubt or when the functional prognosis is implicated.

[Post-traumatic paraosteoarthropathy of the hip. Analysis with x-ray computed tomography and 3-dimensional reconstruction. 2 cases]

Two cases of paraosteoarthropathy developed soon after hip trauma and without associated spinal disorders are described. CT perfectly discriminates ectopic bone formation from osseous fragments and calcified hematoma. These lesions display different signs and have different locations, which allows an easy differentiation. The aetiology of these traumatic osteomas (hip trauma associated with surgical repair in one case coma in the other) is compared to literature. The effectiveness of CT with 3D reconstruction is emphasized in paraosteoarthropathy and hip trauma screening.

Relationship between results of radiological pelvic floor study and anorectal manometry in patients consulting for constipation

The aim of this study was to assess (a) the incidence of perineal descent and (b) the relationship between radiological abnormalities of the pelvic floor and rectoanal manometric disturbances in patients consulting for constipation. Lateral radiographs in both the left lateral and supine positions studied pelvic floor descent. Results obtained in the 25 patients (mean age 47 years) studied were compared with those of 12 controls (mean age 58 years). Pelvic floor descent, never seen in controls, was demonstrated in 14 patients who were older (53 +/- 3 years, mean +/- SD) than the 11 with a normal radiological examination (38 +/- 3 years, p less than 0.05). Anal low pressures (3 cases) and a low amplitude of rectoanal inhibitory reflex (RAIR) (5 cases) were shown only in patients with perineal descent and anal high pressures only in those with normal radiology. Our results suggest that (a) perineal descent is a common finding in over 50% of constipated patients and (b) anorectal motility is related to pelvic floor function.

[X-ray computed tomographic aspects of benign mesotheliomas. Apropos of 4 cases]

Localized pleural mesothelioma or benign mesothelioma is a rare tumor and it has a good prognosis. The value of computed tomography (CT) in the evaluation of pleural disease is now well recognized. However, little information has been written regarding the value of CT in localized pleural mesothelioma. We describe four cases. CT findings include sharply delineated, smoothly contoured masses, often with homogeneous soft tissue density. Angles with the chest wall are obtuse or acute. In case of acute angles, a smoothly tapering margin may be encountered.

[Late empyema after pneumonectomy. Demonstration in x-ray computed tomography]

The authors describe CT signs of a thoracic empyema, developed several years after a pneumonectomy. The disappearance of the concavity of post-pneumonectomy space in contact with mediastinum, associated to the absence of retraction of the hemithorax are the main signs of the diagnosis.

MRI in the pre-operative assessment of tracheal cylindroma. Case report

Compared with malignant neoplasms of the chest, benign tumours are quite rare; cylindroma (or salivary gland adenoma) is exceptional. The apparent histological benignancy belies its high potential for invasiveness. This can, in some cases, lead to extensive, non-conservative surgery. By a different approach in the imaging of the chest, Magnetic Resonance Imaging in this condition may provide an accurate pre-operative assessment. We present a case in which MRI provided the information necessary for the surgical approach, and describe its accuracy and the results obtained.

[Evaluation of elementary radiologic images of Crohn's ileitis. Retrospective study of a homogeneous series of 238 double-contrast transits in the small intestine]

An homogeneous series of 238 double contrast examinations of the small bowel were reviewed. In this study, 32 regional enteritis (RE) were encountered. Statement of different semiologic signs of RE was established. This study exhibited various signs in RE; some of them were observed in various other enteritis (mainly tumors, ischemia and variation enteritis). Sensitivity varies between 6 and 84%. Highest values are noted with ulcerations, nodules, narrowing of the lumen wall. Specificity and predictive values vary from 64% to 100%. The best results are obtained with graduate lesions, fistulae, skipped area and cobblestone. Only graduate lesions are really pathognomonical but uncommon lesions. Analysis of double contrast small bowel examination has to be compared with the whole medical report in order to improve diagnosis accuracy.

Common origin of the arterial blood flow for an arteriovenous medullar fistula and the anterior spinal artery: a case report

A common origin of the blood supply to a dural arteriovenous malformation and to the spinal cord from the same segmental artery is very rare. This obviously contraindicates embolization of the fistula. Demonstrating the location of the normal spinal blood supply system is therefore mandatory to avoid postoperative complications. The visualization of the normal blood vessels can be masked by a steal phenomenon, but it must at all costs be obtained. The authors describe one such case.

[Cervico-occipital injury and bilateral paralysis of cranial nerve XII. Apropos of a case]

A patient with bilateral traumatic hypoglossal palsy is presented. Evaluation of the atlanto-occipital articulation is difficult. Prompt radiographic diagnosis of this injury can be made by computed tomography. In this case, there was bony avulsion of the alar ligament from the occipital condyle. We suggest a severe blow to the head in a lateral direction.

[Evaluation of digital subtraction angiography, ultrasonography and Doppler velocimetry versus conventional angiography in the femoral bifurcation]

Thirty patients were examined by 4 procedures, conventional angiography (C.A.), peripheric intravenous digital subtraction angiography (D.S.A.), ultrasonography and Doppler on femoral artery bifurcation. These arteries are divided into several sections on which findings were classified into three or five categories. There is an excellent correlation between conventional and digital angiograms. Various results of D.S.A. versus C.A. were obtained in 2% of these sections. More differences were noticed between C.A. and Doppler (7%), C.A. and ultrasonography (10%). There is a positive correlation of D.S.A. versus C.A. With Doppler and ultrasonography, arterial map is difficult to establish especially in case of many stenoses of the iliac arteries or thrombosis on femoral superficialis arteries.

Infrahepatic interruption of the inferior vena cava with portal continuation

Asymptomatic infrahepatic interruption of the inferior vena cava with portal continuation is described. The diagnosis was established by ultrasound and confirmed by inferior cavography and computed tomography. Hemodynamic studies showed portal hypertension due to increased blood flow through the liver.

[Inter-observer variability in the interpretation of arteriographies of the carotid arteries and lower limbs]

This study attempts to measure inter-observer variability in reading 14 carotid angiograms and 8 aortograms. 24 surgeons and radiographs with training in arterial diseases participated in the study from different hospitals. The results were analysed with the Kappa statistical method which incorporate a correction for the extend of agreement expected by chance alone, in the evaluation of the reliability of diagnostic procedures. From a topographic point of view, the interpretation of the proximal arterial segments is more reliable than the distal segments, with the exception of the aorto-iliac bifurcation and the profunda femoral arteries. Inter-observer agreement is the most important for the occlusive lesions and the identification of stenosis is of poor reliability.

[Lumbar phelbography without catheterization. Technic, indications and results in the diagnosis of intervertebral disk herniation]

The authors present a new method of lumbar phlebology without catheterism by direct venous puncture of the femoral veins. An analysis of 300 contrast tests maked it possible to identify different types of pathological images characterized by disappearance and displacement of epidural veins corresponding as a rule to discal hernia when the uncharacteristic shadowy images do not allow one to make a precise conclusion or to determine whether an operation is needed. With equal reliability (96 percent), lumbar phlebography without catheterism is, by its simplicity and harmlessness and the absence of minor and major venous complications, preferable to phlebography by catheterism. Carried out in all subjects, whatever their age, without special precautions, it seems to us to now be the most desirable test to be used in the radiological investigation of lumbar discal hernias.

[Therapeutic arterial embolization in hemobilia. Apropos of 3 cases]

Three patients with bleeding into the bile ducts were explored by angiography. Two of them (severe post-operative bleeding and following needle-biopsy of the liver) were completely cured by highly selective arterial embolus production. No definite diagnosis was established in the third case (liver angioma with large artero-portal fistula). It can be seen from these observations, that angiography is essential in patients with bleeding into the bile ducts. The reason is not to establish the diagnosis but to find the precise location of the lesion and, under certain conditions, to apply radical treatment by highly selective arterial embolus production.