[Hydatid cysts of the liver opening in the biliary tract. Report of 64 cases]. / Les kystes hydatiques du foie rompus dans les voies biliaires. A propos de 64 cas.

STUDY AIM: The aim of this retrospective study was to report a series of patients with hydatid cyst opened in the biliary tract, who were operated in Morocco. PATIENTS AND METHOD: From 1991 to 1998, among 250 hydatid cysts of the liver operated in the same center, 64 were in communication with the biliary tract (25%). There were 39 men and 25 women. The mean age was 34.2 years (range: 6-60). The revealing symptoms were abdominal pain, jaundice or cholangitis, but the biliary fistula was asymptomatic in more than 50% of the patients. The hydatid cysts were recognized by ultrasonography in all the patients but the biliary fistula was only suspected in 17 patients. The surgical procedure included drainage and sterilization of the cyst, resection of the protruding wall of the cyst (84.4%), unblockage of the main hepatic duct (n = 21) associated with a Kehr drainage, and treatment of the bilio-cystic fistula with suture (n = 23) or double side drainage (n = 24) or cystobiliary disconnection (n = 15). RESULTS: There were two postoperative deaths due to septic shock (n = 1) and encephalopathy secondary to a biliary cirrhosis (n = 1). The morbidity rate was 25%. Among complications, there were four subphrenic abscesses, four prolonged biliary leakages and two intestinal obstructions. The main hospital stay was 20 days. CONCLUSION: The opening of hyatid cysts of the liver into the biliary tract may be silent or revealed by biliary symptoms. The results of this series favour a conservative procedure, including resection of the protruding wall of the cyst and cysto-biliary disconnection, in spite of a high morbidity rate and a long hospital stay.

[Invasive thymoma extending into the superior vena cava and the right atrium: a case report and review of the literature]. / Thymome invasif à extension intra-cave supérieure et intra-atriale droite: à propos d'un cas et revue de la littérature.

If the neoplastic extension with the higher vena cava can be observed during the evolution of the invasive thymomes, the tumoral extension in the right auricle, remains on the other hand an exception. We report an invasive case of thymome to higher intracellar extension, right intraatrial and pleuropulmonary revealed by a syndrome undermines higher and a left pleurisy. The transthoracic echocardiography supplemented by the echocardiography transoesophageal pose the cardiac diagnosis of tumor, and it is the thoracic tomodensitometry which highlights a tumoral process mediastinal of malignant pace invading the left inominal venous trunk, the higher vena cava and extending in the right auricle. The diagnosis of certainty is carried by the endobronchial biopsy and the puncture tomodensitometric biopsy under control of the mediastinal mass after anatomopathological examination. Under chemotherapy, the evolution over 18 months is marked by the absence of cardiovascular complications in spite of the non regression of the tumoral mass. This observation stresses the importance of the realization of the echocardiography especially transoesophageal in front of all invasive thymome and the reliability of the puncture biopsy scanoguided like diagnoses technique not very invasive in the forms not extirpables. The forecast of this affection depends on the effectiveness of the processing. The surgery when it is possible, remains the principal therapeutic measurement which really proved reliable.

[Imaging of urinary Candida bezoars]. / Imagerie des bézoards candidosiques urinaires.

OBJECTIVES: To describe the renewed interest in Candida infections in general and urinary tract infections in particular, due to a recrudescence of immunodepressed patients and a better knowledge of their clinical and radiological manifestations. MATERIAL AND METHODS: The authors report 2 cases of Candida bezoars diagnosed by IVU, ultrasonography and CT scan in two insulin-dependent diabetics. RESULTS: The first case presented with right renal involvement, in the form of delayed renal secretion on IVU with the presence of a pelvic filling defect, dilatation of the upper tract cavities on ultrasonography with a dilated renal pelvis occupied by an echogenic formation with no posterior acoustic shadow. CT showed a slightly heterogeneous low-density lesion with no contrast enhancement. The second case presented with right pelvic and vesical involvement. The diagnosis of urinary candidiasis was confirmed, in the first case, by the presence of whitish lumps on catheterization, for which analysis and culture were in favour of candidiasis and, in the second case, by direct examination and urine culture. Treatment with amphotericin B led to improvement followed by disappearance of the signs in both cases. CONCLUSION: In addition to laboratory examinations, noninvasive imaging techniques, mainly ultrasonography and CT, but also percutaneous aspiration, constitute a decisive element in the diagnostic and therapeutic management of urinary candidiasis.

[Malignant small-cell thoracic pulmonary tumor (Askin tumor)]. / Tumeur maligne thoraco-pulmonaire à petites cellules (tumeur d'Askin).

We report 4 cases of malignant thoraco-pulmonary small-cell tumors (Askin tumor). Only two cases were operated. We emphasize the difficult histological diagnosis and demonstrate the importance of complete removal for survival. Prognosis remains poor.

[Hydatid thymic cyst. A case report]. / Kyste hydatique du thymus. A propos d'une observation.

Hydatid thymic cyst is exceptional. The diagnosis is suspected by radiology and epidemiology. Serology tests provide variable results and surgery is the only treatment. We report a case of thymic hydatid cyst in a 20-year-old man who had no other localizations. Diagnosis was confirmed at surgery and by histology.

[Right atrial hemangioma presenting as pericardial tamponade. A case report]. / Tamponnade péricardique révélant un hémangiome de l'oreillette droite. A propos d'un cas.

Intracardiac haemangioma is a very rare benign primary cardiac tumour. A 40-year-old patient, with no notable history, presented with chest pain, accentuated by deep inspiration, associated with NYHA stage III dyspnoea. Physical examination revealed signs of right heart failure and electrocardiogram showed low voltage with diffuse repolarization disorders. Chez x-ray showed a cardiothoracic index CTI > 0.70, and enlarged right margins. A large pericardial effusion with a tumour mass filling the right atrial cavity was discovered on transthoracic echocardiography. Chest computed tomography demonstrated the tissue origin of the tumour and suggested extension to the inferior vena cava and hepatic veins. The patient was referred to a surgeon for tumour resection. Histological examination revealed intracardiac capillary haemangioma. Five month postoperative follow-up did not reveal any abnormalities.

[Apropos of a case of acute pancreatitis revealing cystic dilatation of the common bile duct]. / A propos d'un cas de pancréatite aiguë révélant une dilatation kystique du cholédoque.

Dilatation of the common bile duct is rarely caused by cystic formations. Though the pathogenesis is uncertain, congenital disorders have been suggested. Most cases are observed in small children (80% female predominance) with only 20% of the cases reported in adults. Clinical signs vary. Recurrent acute pancreatitis has been reported but is rare. New imaging techniques using CT-scan cholangiography and sometimes MR cholangiography have greatly improved the diagnostic approach. MR of the bile ducts is a recent noninvasive technique enabling an analysis of the biliopancreatic ducts without contrast injection into the bile. To our knowledge, cystic dilatation of the common bile duct has not been previously reported in the literature. We report an interesting case in a 25-year-old woman who developed an episode of acute pancreatitis during the post partum period. We describe the clinical aspects and the different imaging findings, including magnetic resonance cholangiography results.

[Urogenital tuberculosis in children]. / Tuberculose urogénitale chez l'enfant.

BACKGROUND: Tuberculosis of the uro-genital tract is uncommon in both sexes before puberty. CASE REPORTS: Case 1. A 10 year-old boy suffered from chronic cystitis. Urine examination showed pyuria without bacteria and absence of mycobacterium tuberculosis on direct smears and culture. Intravenous pyelography showed left ureterohydronephrosis and a non functioning right kidney with calcifications. A right nephrectomy was performed which showed caseous lesions with granulomas. A triple specific therapy failed to completely cure the vesicoureteral lesions. Case 2. A 9 year-old boy was admitted for the suspicion of appendicitis. Renal ultrasonography showed features of abscesses located to the right kidney and the liver. Laparotomy showed their tuberculous origin which was confirmed by histological examination and positive search for Mycobacterium tuberculosis in urine. The course was favorable under specific treatment. CONCLUSIONS: Diagnosis of tuberculosis of the uro-genital tract may be difficult leading to a delayed treatment and sequellae.

[Wegener's granulomatosis. Apropos of a case]. / Granulomatose de Wegener. A propos d'un cas.

A rare case of granulomatosis of Wegener is rapported in this study. One patient presented with ENT and pulmonary symptoms. The differential diagnosis with tuberculosis was raised. Based on a literature review, the authors discuss clinical, pathological and imaging features of the condition and its management.

[MR cholangiopancreatography]. / Cholangio-wirsungographie par IRM.

MR cholangiopancreatography (MRCP) is a new technique allowing noninvasive investigation of the bile ducts and pancreatic duct. Due to the extremely intense signal of water on T2-weighting, MR sequences can be obtained only demonstrating liquids. The bile and pancreatic ducts can therefore be studied spontaneously even in the case of major cholestasis. The contraindications of MR cholangiography are exclusively those of MR. MRCP can visualize the level of a bile duct obstruction and often the nature of this obstruction (stone, tumour). Complementary axial T1- and T2-weighted sequences can also visualize the parenchyma around the ducts. MR cholangiography therefore appears to be a technique of the future for noninvasive investigation of the bile ducts.