Spontaneous resolution of cryptogenic organizing pneumonia in pediatrics: A case report.

Cryptogenic organizing pneumonia (COP) is a rare entity in childhood, particularly in previously healthy children. Moreover, the spontaneous remission of the disease is exceptional. We report on the case of a previously healthy 10-year-old girl who consulted her doctor for a 2-month history of mild pyrexia, fatigue, weight loss, and exertional dyspnea with no response to amoxicillin. A chest CT revealed bilateral, asymmetrical peribronchovascular consolidation areas predominating in the lower lobes and imaging features of COP. The bronchoalveolar lavage and the biological findings were negative. On follow-up, the girl showed clinical and radiological remission of the disease with no treatment. Our report describes an extremely rare case of spontaneously resolving COP in a child, the diagnosis being made based on the imaging pattern.

[Cystic and cavitary lesions of the lung: imaging characteristics and differential diagnosis]. / Kystes et cavités du poumon: description sémiologique et approche étiologique.

Gas containing lesions of the lung can be differentiated into cystic and cavitary lesions based on their imaging characteristics, which is helpful for differential diagnosis. The imaging features include number, size, thickness and smoothness of the walls, content, lesion distribution and occasional associated lesions. Some imaging features have characteristic diagnostic implications: mural nodule and meniscus sign. Cysts are characterized by thin and regular walls, less than 2 mm in thickness. The differential diagnosis includes: histiocytosis X, lymphangioleiomyomatosis, cystic metastases, septic emboli, pulmonary sequestration. Emphysema, honeycombing and cystic bronchiectases should also be considered. Cavitary lesion have thicker walls. The most frequent etiologies include abscess, cavitary tumors, mycobacterial infections and fungal infections.

[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.

[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.

[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.

[Left innominate artery arising from the ascending aorta in the absence of right innominate artery]. / Tronc artériel brachiocéphalique gauche naissant de l'aorte ascendante en l'absence de tronc artériel brachiocéphalique droit.

It is important to detect anatomic variants of the supraaortic trunks prior to cardiovascular surgery in order to adjust the surgical technique. We report here, an anatomic variant that was not described previously, detected on a chest multidetector CT and confirmed during surgery. This variant consists of a left innominate artery, arising from the ascending aorta before the right subclavian and common carotid arteries that arise separately from the aortic arch. It is important to notice the absence of associated cardiovascular malformations. We formulate a possible explanation of the described variant through an embryologic study of the vasculogenesis.

[Unusual variation of popliteal arterial branches: 4 axes by early division of the peroneal artery]. / Une variante anatomique inhabituelle des branches de l'artère poplitée: quatre axes jambiers par division précoce de l'artère péronière.

Embryonic development of arteries of the lower limb results from the union of dorsal and ventral systems, explaining many variations at different levels. Some of these are important to recognize during the radiological exam because they can affect therapeutic management. These variations are most often bilateral and symmetrical predominating at the popliteal and subpopliteal levels. Lippert classified them into three types: normal level of popliteal arterial branching, high division of popliteal artery, hypoplastic or aplastic branching with altered distal supply. The length of the tibioperoneal trunk may also vary, rarely measuring more than 5 cm. We report a case combining three variations, two of them previously described in the literature and the third one not yet reported: our patient presented four arteries due to early bifurcation of the peroneal artery.

[Aberrant thyroidovertebral artery]. / Artère vertébrothyroïdienne aberrante.

Radiological documents are lacking for many descriptions of variants of vertebral and inferior thyroid arteries reported in the anatomic literature. We report two simultaneous variants, discovered incidentally during a catheterization procedure of the left vertebral artery in a patient admitted for arteriovenous malformation. The vertebral and inferior thyroid arteries arose from a common trunk, issuing directly from the aortic arch. Ipsilateral cervical arteries arose from the subclavian artery that gave no thyroid branch. This aspect was also well documented by Doppler ultrasound. We give an embryological analysis, which would explain these variants by lack of involution of specific arterial segments. More recently, multidetector CT has been found to be helpful in facilitating detection and study of vascular variants.

[Unusual location of a parathyroid adenoma: the carotid sheath]. / Localisation atypique d'un adénome parathyroïdien: la gaine carotidienne.

We report the imaging features of an occult parathyroid adenoma with unusual location in the carotid sheath. Our patient presented with primary hyperparathyroidism. Following negative neck ultrasound and scintigraphy, exploratory neck dissection with partial thyroidectomy was performed twice over a 2 day period without biological response. Cervical and mediastinal CT and MRI were performed with no result. Digital angiography showed a tumoral blush supplied by the left inferior thyroid artery and located in close contact with the carotid artery. Venous sampling of the neck confirmed the left location of the adenoma and a third surgical intervention found the adenoma embedded in the left carotid sheath. This is an unusual case of parathyroid adenoma that necessitated the use of several imaging techniques.

[Gadolinium-medium filter-protected percutaneous stended carotid angioplasty]. / Stenting carotidien protégé sous gadolinium.

We report on a patient who underwent a percutaneous carotid angioplasty with stenting. The procedure was protected by a filter and used gadolinium instead of iodine. No neurological or renal complication occurred. This observation represents one of the first publications describing the use of this contrast medium in a complex neuroradiological intervention.