[A rare etiology of abdominal calcifications: lithopedion]. / Une étiologie rare de calcifications abdominales: le lithopédion.

We report a case of a rare and particular cause of abdominal calcifications represented by the lithopedion. We describe different radiologic appearances observed by: abdominal plain film, echography and CT. It appeared to us that abdominal plain film alone is sufficient for diagnosis and undertaking surgery. Echography and CT are helpful, especially for complementary evaluation.

[Fontanel ultrasonography of purulent meningitis in children in Abidjan (Ivory Coast)]. / Echographie transfontanellaire dans les méningites purulentes de l'enfant à Abidjan (Côte d'Ivoire).

A prospective study of 100 newborns and young babies suffering from purulent meningitis was carried out over a period of 11 months in the radiology department of CHU in Treichville. All the children included in the study were hospitalised in the pediatric department of the CHU. We found cerebral complications in 76% of cases. The most frequent complication was ventricular dilation which occurred in 82.6% of cases. Pericerebral bleeding occurred in 9.3%, cerebral ischemia in 3.5%, brain abscesses in 2.3% and ventriculitis in 2.3% of cases. Our study demonstrated the two important uses of trans-fontanelle ultrasound scans in the study of meningitis: (i) in diagnosis, for the detection of cerebral complications; (ii) in treatment, interventional use of ultrasound makes it possible to evacuate intra-cranial septic fluids.

[Ultrasonography of changes in the retroperitoneal vessels and perivascular spaces during retroviral infection: preliminary results]. / Modifications échostructurales des vaisseaux et des espaces périvasculaires rétropéritonéaux au cours de l'infection rétrovirale: résultats préliminaires.

The abdomen in patients with acquired immunodeficiency syndrome (AIDS) is subject to various damage. In AIDS patients, manifestations in the retroperitoneal region, including apparent changes in the pancreas, kidney and lymph nodes, have been well described in the radiological literature. However, abnormalities of the vessels and perivascular spaces have not been well investigated in this syndrome. We performed abdominal sonography in 10 patients who were seropositive for HIV. They had no history of known risk factors such as drug abuse or homosexuality. Also, 4 healthy male controls were examined for comparison. Our aim was to demonstrate and to characterize the pathological changes of the retroperitoneal vessels and perivascular spaces from sonographic observations. The sonographic evaluation included determination of the morphologic and dynamic aspects of the aorta, vena cava and superior mesenteric vessels. The echostructure of the perivascular spaces was analyzed. In this prospective and preliminary study, we have not considered the presence of an AIDS condition. We have precisely analyzed the upper umbilical areas. In all cases, there were supposed to be the same landmarks. The sonographic scans were obtained through the left renal and mesenteric vessel areas, essentially through axial scans. In all 10 patients, sonography showed at least two abnormalities. Three patients had abnormal echostructural changes in all the sites. The images showed echostructural disorganization with poor definition and "fuzzy" and "dirty" aspects of the retroperitoneal vessels and perivascular spaces. The aorta was normal in 2 patients and abnormal in 8 patients with diminished hyperechography and regularity of the aortal wall. The aortic diameter was smaller than 1.5 cm in 7 cases, with a significant attenuation of the beating of the aorta. Despite these abnormalities, the aorta had a normal left paramedian position ahead of the rachis. The inferior vena cava was normal in 1 case and abnormal in 9 cases with diminished hyperechography and regularity of the wall. The vena cava position was normal in 4 cases, displaced in 6, and laminated in 3. The superior mesenteric vessels were abnormal in 8 cases, with poorly defined aims in 6, an indefinite position in 2, and spreading in 2. Adenopathy was present in 6 patients, multiple in 5 and singular in 1 case. A retrocaval location was always observed. A perivascular infiltration and thickening was noted which was diffuse in 6 cases and micronodular in 1 case. From our observations, we conclude that these echostructural changes could be related to AIDS. However, further studies are necessary to confirm these observations and to determine if this sonographic pattern may be seen during the course of the disease. This is the first study to our knowledge which stressed the echostructural changes of the retroperitoneal vessels and perivascular spaces in patients with AIDS.

[Ultrasound scanning of abdominal contusions in children: experience at the Yopougon CHU (Ivory Coast)]. / Exploration échographique des contusions abdominales chez l'enfant: expérience du CHU de Yopougon (Côte d'Ivoire).

Ultrasound scans were used to study 23 cases of abdominal contusion in children, between January 1992 and December 1993. Thirteen boys and 10 girls were studied. They were all aged between 4 and 14 years, with a mean age of 6 years. The main causes of their injuries were road accidents (12 cases) and play (11 cases). Ultrasound scans were normal in 6 patients and pathological in 17 patients. The most frequently observed injuries were visceral effects (12 cases), almost always associated with hemoperitoneum. In three cases, hemoperitoneum was detected in the absence of visceral effects. The spleen (4 cases) and the liver (4 cases) were the most frequently injured organs. The other injuries detected included renal hematoma, bladder rupture and parietal hematoma. Diagnosis on the basis of ultrasound scans was found to be incorrect in three cases where diagnosis was repeated after the scan. One case involved a blocked perforation of the rectum, one a benign cyst and the other a mesenteric cyst. Despite these misdiagnoses, ultrasound scanning is a highly sensitive and specific method for examination of contusions in children. It is very useful and often sufficient for accurate diagnosis, particularly in units with only modest technical support.

[Subcutaneous and soft tissue involvement associated with AIDS: ultrasonographic aspects. Apropos of 3 cases]. / Atteintes sous-cutanées et des parties molles associées au SIDA: aspects échographiques. A propos de trois cas.

Subcutaneous and soft tissue involvement is frequent in AIDS patients. Although the relevant clinical characteristics have been extensively described in the literature, there has been little work on the radiological features. We therefore report three cases of AIDS with subcutaneous and soft tissue involvement: two cases of pyomyositis and one case of non-Hodgkin's lymphoma. All three were black African men and were aged 22, 28 and 41 years. They were diagnosed as suffering from AIDS and were HIV1 and HIV2 positive. Diagnosis was established using needle puncture and histological (lymphoma) and bacteriological (pyomyositis) examination. We report ultrasound scan findings. The features of the pyomyositis differed from those usually observed in immunocompetent patients. The lymphoma nodules were similar to those described in the literature. They were hypoechoic and homogeneous, with no necrotic center. We believe that subcutaneous and soft tissue infectious involvement, for example pyomyositis, is more frequent in tropical regions than tumors (Kaposi's sarcoma, lymphoma) which are more frequent in Europe. This soft tissue involvement can be considered to be part of the particular picture which is "tropical AIDS".

[The application of ultrasonography: uterovaginal and pelvic masses in black African women]. / Apport de l'échographie: masses utéro-vaginales et pelviennes chez la femme noire africaine.

Echography was prospectively performed in 345 black African female patients with pelvic masses which had been clinically detected in some cases. The women were between 11 and 65 years old. The aims of this study were to list the pelvic masses observed in black. African women, to record any potentially distinguishing features and to evaluate the sensitivity and the specificity of echography as applied here. A total of 477 masses were listed. Ovarian masses were the most frequent (56.66%) followed by uterine masses (31.45%). Most masses were benign. We observed only two cases of ovarian cancer. The sensitivity was 100% and the specificity was 97.69%. Eleven cases (2.3%) of the ultrasound diagnoses did not correspond with the final diagnoses. As for distinguishing aspects, these patients were younger than European patients-this was particularly true for patients with fibroid masses (a range of 31 to 40 years compared to 40 to 50 years). Genetic factors in these patients could explain the high rate and early appearance of fibroids. Because the diagnosis of vaginal masses is well established by clinical examination rather than by echography, this lesion was rarely observed. The most frequent clinical complaint was pelvic pain (36.94%), followed by pelvic mass impression (28.65%). We found high rates of both past histories of miscarriage and abortion (60.7%) and postabortion pelvic hematoma. The hematomas comprised 45.4% of the non-genital pelvic masses. Misdiagnosis of pyosalpinx was often a source of diagnostic error. Thus, to avoid false diagnoses of pyosalpinx in evaluating pelvic masses with a void in ultrasound, the possibility of an infectious episode should be evaluated by definitive questioning. Ultrasound examination is of value in evaluating the pelvic masses of women; however, this should be considered within the appropriate disease context.

[Tuberculous pleurisy followed by bronchial cancer in a patient with HIV infection]. / Pleurésie tuberculeuse suivie d'un cancer bronchique chez un sujet infecté par le VIH.

Both clinical and radiologic manifestations can have unusual figures in patients with acquired immunodeficiency syndrome (AIDS). Infectious involvement, as in particularly tuberculosis, may simulate a neoplasm, and vice versa. We report a case of a tubercular pleuresy followed 14 months later by a lung cancer in a patient infected with the human immunodeficiency virus (HIV). This observation pose the delicate diagnostic problem of a recurred endobronchial tuberculosis we describe the chest roentgenograms and the computed tomography-scans patterns. We give the place of both of them. We call attention to the valuable rôle of the endobronchial endoscopy in the differential diagnosis between a recurrence of the tuberculosis or a lung cancer. This case demonstrate quite well that thoracic complications in AIDS are multiple and can be variable in the course of the disease. That command a definite exploration for an appropriate diagnosis and treatment.

Echographie dans le reflux gastro-oesophagien du nouveau-ne et du nourrisson: experience du CHU de Yopougon (Cote d'Ivoire)

53 enfants dont 23 filles et 30 garcons provenent du service de Pediatrie ont ete explores a l'echographie a la recherche d'un RGO; sur une periode de 3 ans. Cette etude realisee dans le service de Radiologie du CHU de Yopougon d'Abidjan; a pour but d'affirmer la realite du RGO chez nous et de determiner les anomalies de la jonction oesocardio-tuberositaire par la methode echographique. La demande de l'examen echographique a ete motivee par une amnese et un examen clinique orientant vers une pathologie de reflux. L'etude echographique a permis la mise en evidence de 26;4 per cent de reflux pathologue. Des anomalies morphologiques ont ete notees dans 8 cas (57;1 per cent); essentiellement representees par la beance du cardia et la malposition cardiale. Cet examen apparait interessant dans le diagnostic de RGO et merite une meilleure diffusion du fait de ses avantages multiples alliant faible cout; non irradiation; efficacite et sensibilite. Aussi; les auteurs proposent-ils une meilleure vulgarisation de cette methode

Anthrographie opaque dans les derangements internes du genou (a propos de 200 cas)

A partir d'une etude prospective portant sur 7 ans; 2000 cas de derangements internes du genou ont ete analyses. Les lesions sont frequentes chez les sujets jeunes de sexe masculin (87 pour cent) avec pour cause essentielle les traumatismes surtout lors de la pratique du football. Les resultats arthrographiques revelent l'atteinte frequente des menisques surtout avec une predominance des fissurations