Skeletal involvement as the initial disease manifestation in Hodgkin's disease: a review of 6 cases.

Initial signs of malignant lymphoma are rarely due to bone lesions. We reviewed 6 cases with early skeletal involvement, recently observed in the rheumatology and hematology departments. In 3 patients, magnetic resonance imaging (MRI) was added to traditional investigations, including radiography, radionuclide bone scan and computerized tomography. We stress the possibility of bone involvement in the clinical onset of malignant lymphoma and the usefulness of early bone assessment using MRI.

[Villonodular synovitis. An uncommon localization: the ankle. Apropos of a case]. / Synovite villo-nodulaire. Une localisation rare: la cheville. A propos d'un cas.

The authors report an uncommon soft tissue tumor, a diffuse giant cell tumor of tendon sheath. The location is uncommon too, the ankle, behind tibial shaft and forward achilleus tendon. The primary diagnosis of ankle and leg lymphoedema, has been for a long time. But CT Scan and MRI allowing the discovery of a firm and multinodular mass, have permitted surgical excision and histological diagnosis. This case agrees with the literature review. The pigmented villonodular synovitis is rather uncommon in comparison to localized form. Young people and lower extremities are more affected; symptoms are of relatively long duration. Histological examination gives diagnosis but surgical excision has to remove the tumor completely as possible because of local recurrence rate of about 50%.

[Bone manifestations disclosing Hodgkin's disease and non-Hodgkin's malignant lymphoma. Analysis of 11 cases]. / Manifestations osseuses révélatrices de maladies de Hodgkin et de lymphomes malins non hodgkiniens. Analyse de onze observations.

Bone localizations revealing Hodgkin's disease or non-Hodgkin's malignant lymphoma, are unusual. We are reporting 11 recent cases collected in rheumatology and haematology departments, including 4 where a comprehensive study of X-rays, scintigrams, axial tomograms and nuclear magnetic resonance imaging was performed. Review of the literature as well as our experience concerning the type of onset of the bone involvement, the clinical correlation, the imaging techniques, have led us to consider nuclear magnetic resonance as a decisive factor which should be offered at an early stage in the diagnostic approach.

[Detection of parietal lesions using magnetic resonance imaging in arrhythmogenic dysplasia of the right ventricle]. / Mise en évidence par l'IRM des lésions pariétales au cours de dysplasies arythmogènes du ventricule droit.

Seven patients with arrhythmogenic right ventricular dysplasia were explored by magnetic resonance imaging (MRI), using the spin-echo technique (TR = the patient's own RR cycle; TE = 28 ms, 56 ms, 84 ms) with multiple, contiguous, 7 to 10 mm thick sections performed in two planes: axial plus sagittal or frontal planes. In 5 out of 7 patients, MRI showed dysplastic lesions in the right ventricular wall presenting typically as fat-like high signals contrasting with the normal myocardium. In 2 patients, no lesion was clearly visualized. The parietal lesions were located in the anterior wall of the right ventricle and conus arteriosus in 5 cases and in the lower wall of the right ventricle in one patient who had two dysplastic areas. In 3 patients the lesions extended up to the tip of the interventricular septum and of the left ventricle. In the 2 patients whose lesions were most extensive, their predominance in the subepicardial region and the concordance between the sites of abnormalities at MRI and angiography were clearly observed. Thus, despite its present technical limitations MRI seems to be one of the first techniques capable of visualizing the parietal lesions in patients with arrhythmogenic right ventricular dysplasia.

[MRI features of expansive processes of soft tissues. Contribution to etiologic diagnosis. Apropos of 32 cases]. / Séméiologie IRM des processus expansifs des parties molles. Apport au diagnostic étiologique. A propos de 32 observations.

This study concerns the investigation of 32 soft-tissue tumors by MRI, subsequently verified by biopsies or surgery (n = 28) or other investigations (n = 4). MRI can suggest the diagnosis in some cases: lipomas cysts, hematomas, neuromas, desmoid tumors, hemangiomas, by contrast analysis and morphologic aspects; sometimes, malignant lesions are suspected on particular anatomic criteria. MRI is excellent in the evaluation of local extension. MRI can therefore be performed when the staging of soft tissue tumor is incompletely provided by other investigations (CT or US).

[Magnetic resonance imaging in studying injuries of the ligaments and menisci of the knee. 85 cases controlled by arthroscopy]. / L'imagerie par résonance magnétique dans l'exploration des lésions ménisco-ligamentaires du genou. 85 examens contrôlés par arthroscopie.

The authors report a prospective study of eighty-five patients with suspected meniscal or ligament lesions examined using Magnetic Resonance Imaging (MRI). In all cases, the results were compared with the findings at arthroscopy. The technique seems to be a good non-invasive diagnostic procedure, whose accuracy is 87 p. cent for the medial meniscus, 95 p. cent for the lateral meniscus and 100 p. cent for the anterior cruciate ligament (ACL). The most interesting indications at the present time are in the diagnosis of meniscal lesions, the evaluation of the menisci in chronic cruciate ligaments insufficiency, and the diagnosis of acute tears of the ACL (especially when examination is limited by pain or muscle spasm). In the future, MRI should take the place of arthrography. The total scanning time is rather short, as most lesions are detected by T1 weighted sagittal images.

[Aseptic osteonecrosis of the femur head and pregnancy. Apropos of 2 cases with MRI study]. / Ostéonécrose aseptique de la tête fémorale et grossesse. A propos de deux observations avec étude IRM.

Two further cases of aseptic osteonecrosis of femoral head during pregnancy are reported, and the literature reviewed of this rare etiology of debatable etiopathogenicity. The value of MR imaging is demonstrated both for early positive diagnosis and for the differential diagnosis from decalcifying algodystrophy.

[Magnetic resonance imaging in menisco-ligamentous lesions. Comparison with arthroscopy. Apropos of 37 cases]. / L'imagerie par résonance magnétique dans les lésions ménisco-ligamentaires du genou. Comparaison avec l'arthroscopie. A propos de 37 observations.

Results of magnetic resonance imaging of 37 cases of lesions of meniscus and ligaments of knee are reported and compared with arthroscopy findings. Use of MRI appears to be an excellent non-invasive diagnostic method, with current major indications in acute knee injuries and for evaluation of chronic laxity. It also allows guidance of surgical procedures. In the future, MRI should replace the more aggressive arthrography, this with a relatively short examination time, since sagittal section imaging in TI permits detection of the majority of lesions.

[Mediastinal lymph node extension in primary bronchial cancer: correlation of x-ray computed tomography, magnetic resonance imaging and mediastinoscopy. Apropos of 50 cases]. / L'extension ganglionnaire médiastinale dans le cancer primitif des bronches: corrélations entre la tomodensitométrie, l'imagerie par résonance magnétique et la médiastinoscopie. A propos de 50 observations.

Based on a homogeneous series of 50 cases investigated within less than a week by CT scan and NMR imaging with mediastinoscopic correlation, and in 32 of theses cases with correlation with operative findings, a critical study was carried out of modern imaging methods for detection of mediastinal gland invasion from primary bronchial cancer. Axial mediastinoscopy presented absolute specificity and very high sensitivity (93%) markedly superior to those of CT scan and NMR imaging. The two latter examinations were practically of equal efficacy: sensitivity of NMR (80%) was somewhat higher than that of CT scan (70%) whereas specificity of CT scan was 83% as against 70% for NMR. Lack of efficacy of axial mediastinoscopy was in cases with extra-axial lymphatic extension (anterior mediastinal chains) from primary cancer. These results suggest that, in view of current inconveniences of NMR imaging, the best means for local and regional exploration of primary bronchial cancer preoperatively is combined CT scan and mediastinoscopy. The diagnosis of glandular enlargement of anterior mediastinal lymphatic chains should lead to performance of an anterolateral mediastinoscopy.

[MRI and tumors of the mediastinum. Correlation with CT x-ray]. / IRM et tumeurs du médiastin. Confrontation avec la TDM.

This correlative study concerns the investigation of 22 mediastinal tumors by MRI and CT, subsequently verified by biopsies or surgery. It allows us to better define the technical aspects in the realization of MRI, including an assessment of the use of ECG gating. It also permits an appreciation of the respective performances of these 2 imaging methods: there is a good correlation between the two technics for both the positive and etiologic diagnosis of mediastinal tumors: in etiologic diagnosis, the same limitations were encountered with the two technics. However, MRI offers some advantages in the evaluation of tumoral extension. So, we suggest once a mediastinal mass has been shown using plain films, when available, MRI alone should be performed.

[Straight azygos continuation of the inferior vena cava. Apropos of 3 cases using an NMR study]. / Continuation azygos droite de la veine cave inférieure. A propos de 3 observations avec étude IRM.

Three patients with straight azygos vein continuation of inferior vena cava (IVC) were studied by nuclear magnetic resonance (NMR) imaging. In all three cases the diagnosis had been established previously by ultrasound and/or computed tomography imaging, but NMR images provided better anatomical precision of the venous anomaly : visualization of the total trajectory of the major azygos vein, the caliber of which can exceed that of aorta, and absence of retrohepatic segment of IVC but presence of a short supradiaphragmatic segment towards which converge the suprahepatic veins; anastomotic etwork between IVC and major azygos vein contributing to ensure continuity of venous drainage superior to its renal segment. The advantages of NMR are described and the precise diagnostic role of this new method of imaging in the diagnosis of this type of anomaly discussed.

[Magnetic resonance imaging with cardiac synchronization in chronic thrombosis of the main pulmonary arteries. Apropos of a case with computed x-ray tomographic correlation]. / L'imagerie par résonance magnétique avec synchronisation cardiaque dans les thromboses chroniques des gros troncs artériels pulmonaires. A propos d'une observation avec corrélation tomodensitométrique.

Results of nuclear magnetic resonance exploration in a patient with chronic thrombosis of main pulmonary arteries are used to outline an elementary semiology in agreement with current documented data. Signs observed relate to the thrombosis and showing of flow due to associated pulmonary artery hypertension. Cardiac synchronization is essential: obtaining 2 echos by the spin-echo technique allows differentiation of circulatory slowing phenomena, which provoke increased strength of 2nd echo, from the thrombus itself. Correlations established with V/Q scintigraphy, angiography and CT scan findings in this case provided preliminary evaluation of use of this imaging technique in this affection.

[Pericardial effusion with involvement of the superior aortic recessus of the pericardium. An x-ray computed tomographic case]. / Epanchement péricardique avec atteinte du récessus supérieur aortique du péricarde. Observation tomodensitométrique.

Computed tomography imaging in a patient with a pericardial effusion showed fluid collection in the superior recessus of pericardium confirmed by mediastinoscopy. Topographic and morphologic criteria and anatomic bases of the radiologic diagnosis are described, and emphasis placed on the fact that because of density variations in pericardial effusions the latter has to be added to the already long list of abnormal opacities of Barety's space.

[Severe bronchoalveolitis in chickenpox]. / Bronchiolo-alvéolite sévère au cours d'une varicelle.

Varicella pneumonia, is commonly an easy diagnostic because of specific eruption. We report a case in an 8 years old child with moderately with-spread macular and purpuric rash. Hematologic data showed anemia and thrombocytopenia from central origin. Surgical biopsy of lung was performed with bacteriologic, parasitologic and virologic studies. The diagnostic was brought by ascension of serum complement fixation titers to varicella virus from 1/8 to 1/1024. This case is compared to those recorded in the literature.