A carotid artery dissection presenting with dysphagia due to a dilation of upper oesophagus.

Carotid and vertebral artery dissection is one of the major causes of ischemic stroke in young patients and diagnosing it remains a challenge for the clinician due to its variable clinical presentation. We report the case of a 57-years old man admitted to the emergency department complaining of dysphagia and a hoarse voice. Physical examination revealed a left deviation of his tong and some weakness of the left side of his soft palate. A gastroscopy and a cervical tomodensitometry revealed the presence of an important dilation of his upper oesophagus. A cerebral magnetic resonance was performed, showing en excentric high signal intensity on the left carotid artery, and the MR angiography confirmed the presence of an acute dissection on the left internal carotid artery. Our patient suffered of a left carotid artery dissection presenting with ipsilateral Xth and XIIth nerve palsies. His main symptom was a dysphagia due to a dilation of his upper oesophagus; the pneumogastric nerve being responsible for the parasympathic innervation of the upper muscles of the oesophagus.

[Malignant peripheral nerve sheath tumor in the posterior mediastinum]. / Tumeur maligne de la gaine d'un nerf périphérique: une lésion rare du médiastin postérieur.

We report the case of a 52-year-old male patient who developed a malignant peripheral nerve sheath tumor (MPNST) localized in the posterior mediastinum. The diagnosis of this rare tumor is difficult because the clinical presentation of the benign or malignant types is often similar, i.e. elective pain and bone erosions. Similarly, radiological procedures do not always allow distinction between the two types. MNR and CT-scan are the first line procedures: they localize and characterize the lesions, and CT-scan can also be a guide for biopsies. Histological diagnosis is required, but diagnosis can be compromised by the heterogeneous nature of the tumor. Surgical treatment should be undertaken whenever possible. Survival was unusually long in our patient, more than 5 years after discovery of the MPNST. This type of sarcoma is often very aggressive with frequent development of local recurrences and metastases.

[Port-site metastasis following laparoscopic radical prostatectomy for mucinous adenocarcinoma of the prostate]. / Métastase orificielle après prostatectomie radicale coelioscopique pour un adénocarcinome mucineux de la prostate.

A 52-year-old man underwent laparoscopic radical prostatectomy for mucinous adenocarcinoma. Eight months later, an abdominal wall metastasis developed at the trocar site through which the laparoscope had been introduced. To our knowledge, it is the first reported case of port site metastasis after laparoscopic radical prostatectomy.

[Gallstone ileus. Abdominal CT usefulness]. / L'iléus biliaire. Intérêt de la tomodensitométrie abdominale.

The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

[Tuberculous sacroiliitis: report of a case]. / Sacro-iliite tuberculeuse: à propos d'un cas.

Our case concerns a 32-year old Cameroonian male presenting with tuberculous sacroiliitis. Diagnosis was made on the basis of a positive abscess needle aspirate. Tuberculous sacroiliitis is rare and generally an isolated phenomenon. Its insidious presentation leads to delayed diagnosis. The affection is often overlooked due to lack of awareness of the clinicians, the usually good condition of the patient and minimal signs of sacroiliac joint infection. Haematological data are frequently non contributory. High risk groups include developing countries immigrants, immunodepressed patients and low socioeconomic status. Accurate diagnosis is based on percutaneous synovial fluid or abscess aspirate bacteriology. CT-scan and NMR are the most helpful radiological examinations.

[Jejunal lipomatosis with intussusception and volvulus. A case report]. / Lipomatose du jéjunum avec invagination et volvulus: à propos d'un cas.

We report the unusual case of a 48 year old woman with jejunal lipomatosis complicated by intestinal intussusception and volvulus. Showing fatty masses CT allowed accurate diagnosis.

Pulmonary nodular lesions in a 70-year-old man.

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon but increasingly recognized clinicopathologic syndrome. This report illustrates a proteiform clinical presentation of BOOP in a 70-year-old patient with cough, low-grade fever, weight loss, and hemoptysis. Chest radiograph and computed tomography (CT scan) showed nodular lesions. A video-assisted thoracoscopic procedure for biopsy of the largest nodule was performed at the end of an extensive work-up. A diagnosis of BOOP was established and, because of persistent symptomatology, corticosteroid therapy was initiated. This observation illustrates that the clinical and radiological findings of BOOP are non-specific and can sometimes mimic primary and/or secondary pulmonary malignancies.

[Subcutaneous emphysema in a borderline patient]. / Emphysème sous-cutané et troubles de la personnalité

This report concerns a 31-year-old woman. It is an intricate case including bilateral self-induced pneumoparotitis, cervical and facial subcutaneous emphysema and limited pneumomediastinum. Besides, this borderline patient simulated asthma attacks. The clinical picture was characteristic of Munchausen's syndrome with multiple hospitalisations in various hospitals, automutilations and intentional production of physical symptoms. The diagnosis and the treatment are discussed.

[Pulmonary and hepatic arteriovenous malformations in a case of Rendu-Osler disease]. / Malformations artérioveineuses pulmonaire et hépatiques dans un cas de maladie de Rendu-Osler.

The authors report one case of Rendu-Osler disease in a 59-year-old woman presenting with pulmonary and hepatic arteriovenous malformations. She suffered from high-output heart failure due to a left-to-right intrahepatic shunt. Diagnosis and treatment by coil embolization of pulmonary and hepatic fistulas were performed by radiological techniques. Pulmonary shunting can produce severe neurologic complications. The disease is hereditary and progressive. Follow-up of treated patients and family screening are recommended.

[Spontaneous regression of testicular tumor]. / Tumeur testiculaire spontanement involuee.

We report the case of a 33-year-old man presenting with a retroperitoneal seminoma secondary to a testicular tumor which had completely and spontaneously disappeared (burned-out or shrinking seminoma). Ultrasound only showed a fibrous scar in the right testis. A careful study of the testicles should be considered in all male retroperitoneal tumor, even if they are asymptomatic, to exclude an occult cancer or more rarely a spontaneously involuted tumor. Testicular ultrasonography is today the gold-standard technique and any parenchymal echostructure abnormality should be verified histologically.

[Post traumatic intercostal lung herniation: a case report]. / Hernie pulmonaire: à propos d'un cas de hernie intercostale post-traumatique.

The authors report a case of post traumatic lung herniation in a 76 year old obese retired coalminer with chronic obstructive pulmonary disease. Lung herniation is a rare event. It is typically is iatrogenic or post traumatic and sometimes occurs after a delay of several months or years. CT is useful for diagnosis.

[Metastasis to the gallbladder secondary to a clear cell renal tumor]. / Métastase de la vésicule biliaire secondaire à une tumeur rénale à cellules claires.

Metastases from renal cell carcinoma metastases can involve unusual sites. We report the US and CT findings of such a metastasis to the gallbladder.

Pineal body metastasis.

We present a rare case of a pineal body metastasis developed from an oat cell carcinoma of the lung. Diagnosis by CT brain scan was easy but could have been difficult if the metastasis was solitary with the primary focus of tumor unknown. This lesion was temporarily radiosensitive but non-responsive to cytotoxic drugs and the patient died after other metastases developed.

[Perforation of the pulmonary artery by the Swan-Ganz catheter. Description of a case]. / Perforation d'une artère pulmonaire par une sonde de Swan-Ganz. Description d'un cas.

Pulmonary artery perforation by a Swan-Ganz catheter is an uncommon but severe complication with high mortality. We report a case of perforation and discuss mechanisms and predisposing factors associated with this accident.

[Iatrogenic pseudo-aneurysm of the popliteal artery. Complication of arthroscopic meniscectomy. Apropos of a case]. / Pseudo-anévrysme iatrogène de l'artère poplitée. Complication d'une méniscectomie par arthroscopie. A propos d'une observation.

A case of popliteal artery pseudoaneurysm is reported. It is a rare complication following arthroscopic surgery for meniscal repair. The echographic, computed tomographic and arteriographic findings are described. Both sonography and CT-Scan detect the false aneurysm but arteriography is important for determination of the distal vascularization of the leg.