Facteurs scannographiques influençant les résultats audiométriques post opératoires dans l'otospongiose / Computed tomographic factors influencing postoperative audiometric results in otosclerosis

Etudier les facteurs pronostiques scannographiques de l'otospongiose en corrélant les résultats audiométriques post opératoires aux données scannographiques préopératoires. Méthodes: Nous avons mené une étude rétrospective, descriptive et analytique entre Janvier 2013 et Décembre 2018. Elle a inclus 50 patients soit 54 oreilles opérées pour otospongiose, explorés en préopératoire par une tomodensitométrie (TDM) des rochers et en postopératoire par des audiogrammes. Les critères de succès fonctionnel étaient un rinne résiduel postopératoire (RRPO) ≤10 dB et une réserve cochléaire (RC) ≤0. Résultats: La sensibilité de la TDM pour le diagnostic d'otospongiose était de 94% et le type II de la classification de Veillon était le plus fréquent (41%). La confrontation des données de la TDM préopératoire aux résultats audiométriques a permis d'identifier comme facteurs tomodensitométriques de bon pronostic audiométrique: les stades radiologiques localisés type I et II de Veillon et l'absence d'effraction endostée. L'absence d'atteinte de la fenêtre ronde ainsi que l'absence de variantes anatomiques étaient corrélées à un meilleur taux de fermeture du rinne en postopératoire. L'étude multivariée n'a pas retenu de facteurs scannographiques indépendants de succès fonctionnel. Conclusion: D'après notre étude, il s'avère que la tomodensitométrie des rochers préopératoire ne prédit pas le résultat audiométrique de la chirurgie de l'otospongiose. Néanmoins, elle reste indispensable pour la confirmation diagnostique, la classification de la maladie et la détection des anomalies associées.

Facteurs scannographiques influençant les résultats audiométriques post opératoires dans l'otospongiose

Objectif: Etudier les facteurs pronostiques scannographiques de l'otospongiose en corrélant les résultats audiométriques post opératoires aux données scannographiques préopératoires. Méthodes: Nous avons mené une étude rétrospective, descriptive et analytique entre Janvier 2013 et Décembre 2018. Elle a inclus 50 patients soit 54 oreilles opérées pour otospongiose, explorés en préopératoire par une tomodensitométrie (TDM) des rochers et en postopératoire par des audiogrammes. Les critères de succès fonctionnel étaient un rinne résiduel postopératoire (RRPO) ≤10 dB et une réserve cochléaire (RC) ≤0. Résultats: La sensibilité de la TDM pour le diagnostic d'otospongiose était de 94% et le type II de la classification de Veillon était le plus fréquent (41%). La confrontation des données de la TDM préopératoire aux résultats audiométriques a permis d'identifier comme facteurs tomodensitométriques de bon pronostic audiométrique: les stades radiologiques localisés type I et II de Veillon et l'absence d'effraction endostée. L'absence d'atteinte de la fenêtre ronde ainsi que l'absence de variantes anatomiques étaient corrélées à un meilleur taux de fermeture du rinne en postopératoire. L'étude multivariée n'a pas retenu de facteurs scannographiques indépendants de succès fonctionnel. Conclusion: D'après notre étude, il s'avère que la tomodensitométrie des rochers préopératoire ne prédit pas le résultat audiométrique de la chirurgie de l'otospongiose. Néanmoins, elle reste indispensable pour la confirmation diagnostique, la classification de la maladie et la détection des anomalies associées.

[An unusual cause of hypertension]. / Une cause inhabituelle d'hypertension artérielle.

Secondary hypertension is relatively rare. Its etiologies are essentially renal or endocrine. The adrenocortical carcinoma, a rare malignant tumor, is one of the most exceptional causes of hypertension. We report the case of a young woman presenting with hypertension and ascites of great abundance. She had hypokalemia, hepatic cytolysis and cholestasis. Thoracic, abdominal and pelvic CT scans showed adrenal mass, liver and lung nodules, osteolytic lesions of the sacrum. The biopsy of liver nodules confirmed the diagnosis of a metastatic malignant adrenocortical carcinoma. The hormonal investigations revealed cortisol and testosterone hypersecretion. The evolution was quickly fatal, the patient passed out a few days after her hospitalization.

[Pulmonary actinomycosis. Diagnostic and therapeutic features]. / Actinomycose pulmonaire. Particularités diagnostiques et thérapeutiques.

INTRODUCTION: Actinomycosis is a rare suppurative infection, subacute or chronic caused by bacteria of the genus Actinomyces. OBSERVATIONS: A case study of 4 patients with prolonged respiratory symptoms. The clinical examination was poor in all cases. The CT-scan showed, in all cases, a suspicious tissue mass. The bronchoscopy diagnosis showed, in 2 cases, a tumor budding and was normal for the 2 other cases. Bronchial biopsies were negative in all cases. Before the prolonged symptomatology, the poor general condition, the endoscopic and the CT aspects; there was a suspect around a pulmonary neoplasia diagnosis, thus raising the need of a surgical treatment for diagnostic and therapeutic purposes. The anatomopathological examination of the resected specimen was in favour of the actinomycosis. The aim of these observations is to draw the attention to the radio-clinical, histological, therapeutic and evolutive aspects as well as the diagnostic difficulties of this condition. CONCLUSION: The radio-clinical presentation of the actinomycosis is often misleading, thus a diagnostic confirmation is required before any useless surgical resection.

Contribution of imaging in the initial management of ballistic trauma.

INTRODUCTION: The purpose of this study is to specify the role of imaging in the initial management of ballistic traumas. METHODS: This is a retrospective study that colligated 83 victims of a gunshot wound during demonstrations, treated in our trauma centre between 12 January and 3 February 2011. All of the patients were haemodynamically stable and examined by conventional radiography and/or ultrasound and/or 16-slice CT-scan (CT). RESULTS: The mean age of the victims was 26years with a sex ratio of 0.02. All wounds were unique. Injury to the limbs was most common in 75.5% of the cases (n=64) followed by that of the torso in 19.5% of the cases (n=16). Wounds in the spine (n=2), brain (n=2) and facial skeleton (n=1) were observed. Conventional x-rays objectified 32 cases of open fractures 95% of which were in the legs. Twenty-one of the victims of gunshot wounds had a CT-scan that objectified the path of the bullet and an assessment of the wound was made in all cases. The confrontation of the data from the CT-scan and that noted during surgery and during the monitoring demonstrated that the CT-scan is very efficient in the diagnosis of pleural effusion, vascular wounds, thoracic parenchymatous wounds and wounds of the solid organs and brain lesions and the facial skeleton. However, the sensitivity is low for the diagnosis of hollow organs. CONCLUSION: The CT-scan is very useful in the initial care of stable patients with gunshot wounds as regards the haemodynamics and helps objectify the path of the bullet and obtain a precise assessment of the damage. Conventional x-rays are unavoidable for wounds to the legs and spine.

[Spontaneous isolated dissection of the superior mesenteric artery: an uncommon cause of acute abdomen. A case report]. / Dissection spontanée isolée de l'artère mésentérique supérieure : une cause rare d'abdomen aigu. À propos d'un cas.

INTRODUCTION: Isolated spontaneous dissection of the superior mesenteric artery is the most common digestive artery dissection. It is a rare cause of acute abdomen. Only a few hundred cases have been reported in the literature. CASE REPORT: We report a 40-year-old man with a past medical history of high blood pressure who presented abdominal pain that was related to a spontaneous dissection of the superior mesenteric artery. Computed tomography revealed an isolated dissection of superior mesenteric artery. There were no evidence of bowel ischemia. We decided a conservative treatment and the outcome was favorable, without recurrent symptoms or disease progression. CONCLUSION: Based on this case report, we discuss the etiology of this vascular lesion and the contribution of computed tomography in the diagnosis, the therapeutic strategy and the follow-up of spontaneous dissection of superior mesenteric artery.

[Contribution of imaging in the diagnosis of epiploic appendagitis]. / Apport de l'imagerie dans le diagnostic des appendagites épiploïques.

INTRODUCTION: Primary epiploic appendagitis is known to be a rare finding among causes of acute abdomen. Depending on location, it may mimic several disorders such as colonic diverticulitis and acute appendicitis. Diagnosis is sometimes performed during surgery. METHODS: This is a retrospective descriptive study. The authors report the contribution of imaging for the diagnosis of appendagitis in seven patients investigated between July 2010 and April 2013 by abdominal and pelvic ultrasound or computed tomography (CT). RESULTS: CT scan confirmed the diagnosis in six patients avoiding unnecessary surgery and hospitalization. The seventh patient was a pregnant woman in whom the diagnosis of appendagitis was made during surgery for appendicitis. CONCLUSION: Appendagitis is a rare cause of acute abdominal pain. Outcome is favorable with medical treatment only. Abdominal ultrasound and CT are helpful diagnostic tests avoiding useless surgical procedure.

Eagle's syndrome.

Eagle's syndrome is a rare entity, which is not commonly suspected in clinical practice. The occurrence of similar signs in diseases other than Eagle's syndrome may make a precise diagnosis difficult and time-consuming for many clinicians. Radiological examinations are useful to make the accurate diagnosis. Three-dimensional volume-rendering CT scan is the most valuable diagnostic tool.

[Endobronchial hamartochondroma]. / Hamartochondrome endobronchique.

INTRODUCTION: Endobronchial hamartochondroma is a form of rare benign tumour. Compared to those that occur in the lung parenchyma, the endobronchial form can potentially be managed by relatively conservative treatment involving per-endoscopic resection. COMMENT: A 61-year-old patient had a dry cough and chest pain for 3 months. Their clinical examination was normal, but thoracic CT scan showed lingular collapse. Bronchoscopy revealed the presence of a multilobar tumour occluding the orifice of the lingula bronchus. Bronchial biopsies were consistent with the diagnosis of a hamartochondroma. Before the destruction of any of the left upper lobe parenchyma, the tumor was resected surgically and the patient had an uneventful postoperative course. CONCLUSION: Endobronchial hamartochondroma support must be rapid to avoid irreversible parenchymal consequences downstream obstruction involving an often mutilating surgery. Essentially endoscopic treatment should be the most conservative possible.

[Parietal complications of hydatid cyst of the liver. Report of two cases in Tunisia]. / Les complications pariétales du kyste hydatique du foie. À propos de deux cas en Tunisie.

The aim of this study is to consider the parietal complications of the hydatid cyst of the liver: the subcutaneous rupture of the cyst and spontaneous cutaneous fistula of liver hydatid cyst. 1(st) case: A 24-year-old woman, who underwent surgery 10 years ago for hydatid cyst of the liver, was admitted for a right hypochondrium mass and a fistula draining clear liquid containing cystic elements. Computed tomography (CT) showed a large cystic lesion in the subcutaneous tissue communicating with another cystic mass in the liver. The diagnosis of a cyst-cutaneous fistula due to a peritoneal hydatid cyst was established. The patient underwent surgical treatment and recovered uneventfully. 2(nd) case: A 40-year-old woman presented with a mass in her right hypochondrium. The diagnosis of subcutaneous rupture of a hydatid cyst of liver was established by ultrasonography and CT-scan. The patient underwent surgical treatment and recovered uneventfully. Parietal complications of hydatid cyst of the liver are extremely rare, clinical presentation can be derailing. The diagnosis is usually established by ultrasonography and CT-scan.

Femoral parosteal osteosarcoma 18 years after its discovery: a case report.

Osteosarcomas are a heterogeneous group of tumors with diverse anatomical, clinical, and progressional characteristics. Parosteal osteosarcoma, or juxtacortical osteosarcoma, is a rare form of osteosarcoma that develops at the bone surface, but has a better prognosis than other conventional osteosarcomas. We report the observation of a 22-year-old female patient whose initial presentation was an enormous tumefaction of the knee that had been progressing for 10 years. The biopsy concluded in PO of the lower third of the femur. Staging was negative. The tumor had reached an enormous size and required amputation of the left lower extremity. A custom external prosthesis was manufactured to get her back to walking. Eight years after surgery, no local recurrence or metastasis has been detected. Parosteal osteosarcoma is a rare form of osteosarcoma with very slow progression (in spite of the particularly dramatic presentation in our observation), with an excellent prognosis and very rare metastasis.

[Ganglion cyst at the spinoglenoid notch. A case report and literature review]. / Kyste du défilé spinoglénoïdien. A propos d'un cas et revue de la littérature.

INTRODUCTION: Entrapment of the suprascapular nerve at the spinoglenoid notch due to a ganglion cyst is an uncommon event and remains a challenge for clinicians. EXEGESIS: We describe the findings in a 35-year-old patient with nonspecific pain in the shoulder and in whom MR revealed a ganglion cyst in the spinoglenoid notch, confirmed surgically. CONCLUSION: Entrapment of the suprascapular nerve at the spinoglenoid notch due to a ganglion cyst must be considered in the differential diagnosis of nonspecific shoulder pain. MR imaging and electromyography can reach a positive, topographic, and etiologic diagnosis of suprascapular neuropathy.

Imaging features of spinal epidural cavernous malformations.

Cavernous angioma or cavernoma is a vascular malformation that may affect any area in the neuraxis. Epidural location is very rare and therefore seldom considered in the differential diagnosis of spinal cord compression. We report two cases of epidural cavernous angiomas. The first case is a solitary and purely epidural dorsal cavernous angioma without foraminal expansion or bone modification causing spinal cord compression in a 35 year old woman. The second case is a solitary epidural dorsal cavernous angioma with foraminal extension causing spinal cord compression in a 56 year old woman. Histological confirmation is available for both cases. We describe the MRI features of this lesion insisting on its differential diagnosis on imaging.

[Cervico-thoracic localization of a hydatid cyst]. / Localisation cervico-thoracique d'un kyste hydatique.

The authors report a case of cervico-thoracic region hydatid cyst suspected by the presence of a palpable right lower neck mass. This location is very rare. Neck ultrasound and computed tomography showed the cyst. Magnetic resonance imaging can be useful for diagnosis and provided the best anatomo-topographic evaluation before surgery.

[Tuberculous meningitis with pituitary abscess]. / Méningite tuberculeuse avec abcès hypophysaire.

Although rare, the possibility of pituitary tuberculoma should be considered in the diagnosis of non-pituitary intrasellar masses, especially in an endemic area and if radiologic imaging shows pituitary stalk thickening. We describe the case of a 52-year-old patient who presented tuberculous meningitis complicated by a pituitary abscess. He was treated with antituberculous drugs. The follow-up MRI 16 and 48 months later showed the decreased size of the pituitary mass. Radiological features and a review of the literature of pituitary tuberculoma are briefly discussed.