Oral ulcer: an uncommon site in primary tuberculosis.

Tuberculosis is a chronic infectious disease and a major cause of morbidity and mortality worldwide. It can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, have been observed in both primary and secondary stages of the disease. This article presents a case of primary tuberculosis manifested as a non-healing, tender ulcer on the lingual mucosa of the edentulous right mandibular arch molar zone, an uncommon site. The diagnosis was confirmed after histopathology examination, polymerase chain reaction and purified protein derivative tests and chest radiograph. A recommended treatment plan of six months with four anti-tuberculotic antibiotics was commenced. Clinically, the oral ulcer disappeared three months after the commencement of treatment. The resurgence of tuberculosis should compel clinicians to include the disease in the differential diagnosis of various types of non-healing oral ulcers.

[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.

[Hydatid disease diagnosed following a pulmonary embolism]. / Une hydatidose diagnostiquée à l'occasion d'une embolie pulmonaire.

Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst.

[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.

[Left segmental omental infarction in a child: conservative treatment]. / Infarctus segmentaire gauche du grand épiploon chez l'enfant: traitement conservateur.

Omental infarction is a rare cause of acute abdomen that usually occurs on the right side. Left omental ischemia is rare in adults and to our knowledge not yet described in children. Its diagnosis, although difficult, is important because it can avoid surgery. We report a case of left segmental omental infarction in an 11-year-old child, diagnosed by imaging studies, treated conservatively, and followed up by ultrasound until complete disappearance of the lesion.

[Regression of Morton neuroma after local injection of steroids]. / Régression du névrome de Morton après infiltration de corticostéroïdes.

Morton neuroma is a non neoplastic lesion corresponding to perineural fibrosis encircling the common interdigital plantar nerve. Several therapeutic approaches are possible: conservative treatment or surgery. We report a case treated by local steroid injection where follow-up MR showed near complete regression of the lesion. Although local injection of steroid is a classical treatment, it is the first time to our knowledge that resolution or such a striking diminution of size is reported after infiltration.

[Traumatic perinatal cervical dislocation]. / Dislocation traumatique cervicale périnatale.

We report on a case of cervical dislocation in which the severity of the lesion contrasts with the paucity of the symptoms. An eight-month-old girl presented with weakness of the left upper limb. She had a normal cephalic delivery. On the following days, increased weakness of the limb showed a spontaneous, partial regression. Clinical examination at eight months showed a normal physical and psychical development, a falling neck and an impossibility to maintain the sitting position, but a normal mobility of the lower limbs. Cervical radiography performed showed a complete dislocation. CT confirmed the diagnosis and eliminated congenital vertebral anomalies. Magnetic resonance imaging showed an important stretching and compression of the spinal cord. Cervical spine damage in the newborn are scarce and serious. The here reported case is characterized by a complete vertebral dislocation associated with medullar stretching and compression, but few initial symptoms.

Adenomyoma of the ampullary region: imaging findings in four patients.

BACKGROUND: We report the imaging features of adenomyoma of the distal common bile duct (CBD) and increase awareness of this rare benign disease. METHODS: Four patients (age range = 66-71 years) with abdominal pain and biliary obstruction had spiral computed tomography (CT) and cholangiography with or without papilla biopsy. Two patients also had endoscopic ultrasound. RESULTS: The CT appearance of adenomyoma was that of a rounded, well-circumscribed, soft tissue mass in the ampullary region, which appeared on cholangiography as a well-defined intraluminal filling defect or caused abrupt and regular stenosis of the CBD. Unfortunately, none of our patients was diagnosed before surgery, and cephalic duodenopancreatectomy was performed in all of them. CONCLUSION: Although imaging findings are not specific, their presence should raise the possibility of a benign tumor. If a proper preoperative diagnosis is made, cephalic duodenopancreatectomy can be avoided.

[Percutaneous computed tomography-guided thermal ablation of osteoid osteoma]. / Thermocoagulation percutanée scannoguidée de l'ostéome ostéoïde.

PURPOSE OF THE STUDY: Progress in medical imaging has improved recognition and management of osteoid osteoma. The purpose of this study was to assess the efficacy of computed tomography (CT)-guided percutaneous thermal ablation and discuss the advantages and disadvantages. MATERIAL AND METHODS: We reviewed retrospectively 33 consecutive patients with osteoid osteoma who had undergone CT-guided radiofrequency ablation. The diagnosis was established on the basis of the clinical presentation and pathognomonic radiographic findings (CT and bone scintigram) without histological proof. We recorded patient age and gender, tumor location, clinical signs and duration, imaging findings, duration of the ablation procedure, type of anesthesia, hospital stay, and complications. We evaluated their effect on final outcome. RESULTS: Weight-bearing was possible in all patients with a lesion of the lower limb a few hours after surgery. Patients resumed their normal activities in 24-48 hours. Pain resolved immediately after radiofrequency ablation in 26 patients and limping, when present, disappeared within 24 hours. At mean follow-up of 34 months (minimum 12 months) there was one case of recurrent pain. Clinical cure was confirmed by CT and bone scintigraphy in twelve patients. DISCUSSION AND CONCLUSION: This precise and minimally invasive method is an effective and safe way to reduce healthcare expenditures. It can be recommended as the primary treatment for osteoid osteoma.

[Adrenal hematoma associated with rheumatoid purpura]. / Hématome surrénalien associé à un purpura rhumatoïde.

UNLABELLED: Schönlein-Henoch purpura is a systemic vasculitis involving primarily the skin, musculoskeletal system, gastro-intestinal tract, and kidneys. The purpose of this paper was to report the first described pediatric case, to our knowledge, of adrenal hemorrhage occurring in Schönlein-Henoch purpura. CASE REPORT: Our patient was a 12 year-old girl who presented a right adrenal hematoma diagnosed following an episode of acute right flank pain, ten days prior to the appearance of the clinical symptoms of Schönlein-Henoch purpura. CONCLUSION: We think that Schönlein-Henoch purpura should be included in the diagnosis of adrenal hematomas.

Left-sided omental torsion: CT appearance.

A 34-year-old male presented with exquisite left flank pain. Computed tomography showed a hyperdense vascular structure surrounded by whirling linear streaks situated in the greater omentum under the splenic flexure of the colon. Omental stranding extended caudally into the pelvis where part of the inflamed omentum entered a left inguinal hernia sac. Surgery revealed left-sided torsion of the greater omentum. Left-sided omental torsion is infrequent and pre-operative diagnosis is rarely established. The CT findings of an omental fatty mass with a whirling pattern is characteristic of omental torsion. Preoperative diagnosis is important because conservative management has been suggested.

[Acute cholecystitis using computed tomography: usefulness of the trabeculation of the peri-cholecystic adipose tissue]. / Cholécystite aiguë en tomodensitométrie: utilité de la trabéculation de la graisse périvésiculaire.

PURPOSE: To evaluate the significance of pericholecystic fat stranding on CT, and to compare it to other CT findings in patients with acute cholecystitis. MATERIALS AND METHODS: The CT examinations of 14 patients with proven acute cholecystitis were retrospectively reviewed and evaluated for the presence of findings consistent with this diagnosis. RESULTS: The most common CT finding was stranding of the pericholecystic fat (13 patients), followed by gallbladder distension (11 patients). Pericholecystic or perihepatic fluid was present in 6 patients in association with severe acute cholecystitis (6 patients) and biliary peritonitis (2 patients). CONCLUSION: Stranding of the pericholecystic fat was the most common CT findings in patients with acute cholecystitis, followed by gallbladder distension.

[Recurrent multifocal chronic osteomyelitis: scintigraphy or MRI. Apropos of 2 cases]. / Ostéomyélite chronique multifocale récurrente: scintigraphie ou IRM. A propos de deux cas.

We report two cases of chronic recurrent multifocal osteomyelitis. In both cases, MRI demonstrated the presence of asymptomatic lesions that the technetium bone scan failed to show. The asymptomatic lesions were located in the acetabelum and the distal femur. Despite the actual literature, MRI was more specific than bone scan in these two cases.