The "Jokari Sign", An Imaging Feature Diagnostic of a Wandering Accessory Spleen.

If cross-sectional imaging techniques often disclose the presence of an accessory spleen, they seldom detect a wandering accessory spleen. This latter diagnosis can be challenging but important and derives great benefit from computed tomography with curved multiplanar and three-dimensional reconstructions displaying the long vascular pedicle connecting the small mass to the splenic vessels. We call this anatomical complex the "Jokari sign", in reference to the ball-on-a-string racket game.

Primary aortic thrombosis: role of enhanced multislice CT demonstrated in three exceptional cases.

Primary aortic thrombosis remains a rare entity that can be defined as clotting of the vessel without any obvious atheromatous lesion. Cancer chemotherapy, cocaine intake, essential thrombocythemia, some hypercoagulable states, heparin-induced thrombocytopenia, inflammatory disease of the digestive tract and acute pancreatitis are, beside some cases of rather unknown etiology, the causes of primary aortic thrombosis. Intravenous contrast-enhanced multislice CT, which is widely available, noninvasive and affordable in terms of cost, is the imaging modality of choice for the investigation of primary aortic thrombosis and the assessment of potential complications. Three cases due to chemotherapy, antiphospholipid syndrome and acute pancreatitis are reported.

Comparative Doppler flow measurements of the ulnar artery and of the postanastomotic radial artery in radiocephalic arteriovenous fistulas to detect steal syndromes.

OBJECTIVE: This study aims to assess whether a comparison of the Doppler flow measurements of the ulnar artery and of the postanastomotic radial artery can help detect steal syndromes at the level of native dialysis fistulas of the wrist. PATIENTS AND METHODS: We have prospectively analyzed 35 distal radiocephalic arteriovenous fistulas presenting with postanastomotic radial artery Doppler inversion of flow. The flows of the ulnar artery and of the postanastomotic radial artery have been measured and compared. Subsequent clinical examination to detect any sign of ischemia at the hand level was performed and the results of medical imaging were confronted with the clinical data. RESULTS: A steal syndrome was discovered in a total of 6 patients (17%), 4 patients out of 23 displaying an ulnar flow lower than the postanastomotic radial one and 2 patients among 12 with an ulnar flow higher than the radial one. Sensitivity, specificity, positive predictive value and negative predictive value of the test were 67%, 34%, 17% and 83%, respectively. Paradoxically, the mean intensity of ulnar flow deficiency has been measured at 40% among true positive patients and at 70% among false positive ones. We have not been able to identify any difference, be it in terms of systolic upstroke time, maximum systolic speed, telediastolic speed or in terms of global architecture of the curves between the Doppler waveforms of 4 true positive and 4 false positive patients. CONCLUSION: The comparative Doppler study of the flows of the ulnar and postanastomotic radial arteries does not enable us to detect steal syndromes at the level of wrist dialysis fistulas. Hence we consider that a systematic study of the postanastomotic radial artery flow, during routine Doppler examination of distal dialysis fistulas, proves superfluous.

[Thrombosis of an aorto-iliac stent graft used for treating an iliocaval arteriovenous fistula following lumbar disc surgery]. / Thrombose d'une endoprothèse couverte aorto-bi-iliaque posée en cure d'une fistule artério-veineuse après chirurgie discale lombaire.

OBJECTIVES: Major vessel injury is a rare complication of spinal surgery. Iliac artery injury is the most common. Frequently, a chronic arteriovenous fistula develops. METHODS: We describe the case of a 63-year-old woman who had developed a chronic arteriovenous fistula following lumbar disc hernia surgery. The patient was treated using an Anaconda™ stent graft (Vascutek Terumo). After 2years, the prothesis thrombosed and an aorto-iliac bypass was performed. RESULTS: A gel soft prosthesis 18/9 (Vascutek Terumo) was implanted by laparotomy. The postoperative period was uneventful. A month later, the patient had recovered good lower limb function. CONCLUSION: The choice between endovascular versus open surgery must take into account the patient's age, the risk of long-term complications, and the need for radiographic surveillance. Curative open surgery remains a valid option for young patients.

A spontaneous pre-anastomotic occlusion does not necessarily impair forearm native dialysis fistulas: echo-Doppler, 3D MR angiographic and digital subtraction angiographic imaging.

Renal transplantation is the choice treatment of end-stage renal disease. When it is not indicated or not immediately feasible, hemodialysis must be performed, preferably via a native arteriovenous fistula in the forearm. A pre-anastomotic occlusion of this type of fistula is often accompanied by a thrombosis of its draining vein. In some instances, the venous segment may remain permeable thanks to the development of arterial collateral pathways and may even allow efficient dialysis without any clinical syndrome of distal steal. We present the echo-Doppler, magnetic and angiographic characteristics of three of these collateralized shunts that have remained functional, in one of the cases following a percutaneous dilation.

Combined mRNA microarray and proteomic analysis of eutopic endometrium of women with and without endometriosis.

BACKGROUND: An early semi-invasive diagnosis of endometriosis has the potential to allow early treatment and minimize disease progression but no such test is available at present. Our aim was to perform a combined mRNA microarray and proteomic analysis on the same eutopic endometrium sample obtained from patients with and without endometriosis. METHODS: mRNA and protein fractions were extracted from 49 endometrial biopsies obtained from women with laparoscopically proven presence (n= 31) or absence (n= 18) of endometriosis during the early luteal (n= 27) or menstrual phase (n= 22) and analyzed using microarray and proteomic surface enhanced laser desorption ionization-time of flight mass spectrometry, respectively. Proteomic data were analyzed using a least squares-support vector machines (LS-SVM) model built on 70% (training set) and 30% of the samples (test set). RESULTS: mRNA analysis of eutopic endometrium did not show any differentially expressed genes in women with endometriosis when compared with controls, regardless of endometriosis stage or cycle phase. mRNA was differentially expressed (P< 0.05) in women with (925 genes) and without endometriosis (1087 genes) during the menstrual phase when compared with the early luteal phase. Proteomic analysis based on five peptide peaks [2072 mass/charge (m/z); 2973 m/z; 3623 m/z; 3680 m/z and 21133 m/z] using an LS-SVM model applied on the luteal phase endometrium training set allowed the diagnosis of endometriosis (sensitivity, 91; 95% confidence interval (CI): 74-98; specificity, 80; 95% CI: 66-97 and positive predictive value, 87.9%; negative predictive value, 84.8%) in the test set. CONCLUSION: mRNA expression of eutopic endometrium was comparable in women with and without endometriosis but different in menstrual endometrium when compared with luteal endometrium in women with endometriosis. Proteomic analysis of luteal phase endometrium allowed the diagnosis of endometriosis with high sensitivity and specificity in training and test sets. A potential limitation of our study is the fact that our control group included women with a normal pelvis as well as women with concurrent pelvic disease (e.g. fibroids, benign ovarian cysts, hydrosalpinges), which may have contributed to the comparable mRNA expression profile in the eutopic endometrium of women with endometriosis and controls.

Dialysis arteriovenous fistulas: the critical role of color doppler ultrasound.

Despite being time-consuming and observer-dependent, CDUS is a method of choice for performing and controlling dialysis shunts. It contributes to increasing the number of native AVFs and enables early detection of lesions therefore allowing quick percutaneous or surgical therapy.

Exceptional, potentially fatal combination of emphysematous pancreatitis and gas-forming cholecystitis: successful multidisciplinary conservative treatment supported by repeated CT-staging.

Usually considered as a life-threatening disease, emphysematous pancreatitis requires early diagnosis and aggressive multidisciplinary treatment including the Departments of Gastroenterology, Intensive Care Medicine, Interventional Radiology and even Surgery. The prognosis for emphysematous cholecystitis is also quite poor. It requires surgery even if a percutaneous cholecystostomy can contribute to a temporary stabilization of the patient. Computed tomography is the imaging modality of choice to detect emphysematous pancreatitis and gas-forming cholecystitis. It enables their grading and helps identify their complications. Moreover, it proves essential in the follow-up of the lesions.

Bleeding duodenal varices, an unusual presentation of portal hypertension: 3D MSCT of the feeding branches facilitates temporizing treatment by percutaneous transhepatic embolization.

Though duodenal varix ruptures account for only 5% of variceal hemorrhages, they often have a fatal outcome with a mortality as high as 40%. Their detection and treatment, which often prove quite difficult endoscopically, benefit of CT imaging and percutaneous endovascular radiological techniques.

Assessment of renal graft obstruction due to ureteral inguinal hernia: US detection and 3D MR confirmation.

In most cases, renal graft obstruction is caused by ureteral stenosis due to ischemia or technical error. Exceptional cases have been published where the obstacle was the result of incarceration of the ureter in an inguinal hernia. We report a case of this type, which prompt assessment was possible due to ultrasound and magnetic resonance imaging with 3D reconstruction.

[Arterial duplex and aortic valve stenosis: sensitivity and specificity of findings]. / Echo-Doppler artériel et sténose valvulaire aortique: étude de la sensibilité et de la spécificité des signes.

UNLABELLED: Purposes. In this prospective study, we sought to determine the sensitivity and the specificity of arterial Doppler findings of valvular aortic stenosis (VAS). PATIENTS AND METHODS: 20 control subjects and 20 patients with various degrees of VAS underwent Doppler ultrasound of the carotids, abdominal aorta, renal arteries and limb arteries. We analyzed and compared the shape of the spectral profiles, peak systolic velocity (PSV), systolic upstroke time (SUT) and systolic upstroke index (SUI) of every tracing. The protodiastolic notch (PDN) of the common femoral arteries were recorded too. RESULTS: VAS hardly modifies the overall shape of the Doppler spectrums of the aorta or limb arteries but it implies a biphasic deformation or a doubling of the systolic peak of the neck vessels. We also encountered biphasic profiles in renal arteries of patients with tight VAS. The PSV, SUI and depth of the PDN tend to diminish in cases of VAS but the variations are inconstant and rarely proportional to the severity of the narrowing. The increase of the SUT, on the contrary, is linearly correlated to the severity of the stenosis in every arterial system: SUTs in the common carotid artery, internal carotid artery or brachial artery that are shorter than or equal to 70 milliseconds (msec) are the obvious marks of the absence of VAS. It was not possible to differentiate between the intermediate stenoses (aortic valve area between 0.8 and 2 square centimeters) whereas critical aortic stenoses, whose area is less than or equal to 0.7 square centimeter, can be detected by the presence of at least two of the four following criteria of SUT: equal to or above 180 msec for the common carotid, 200 msec for the internal carotid, 130 msec for the aorta and 110 msec for the common femoral artery. CONCLUSION: During routine arterial Doppler ultrasound, a precise analysis of the spectrums and some SUT measurements allow the assessment of the aortic valve.

Diagnosis of inguinal bladder hernias: the current role of sonography.

We present a case of inguinal bladder hernia detected initially with sonography in an adult patient. Compared with digestive or omental hernias, inguinocrural bladder herniations are a rarer occurrence (1 to 4% of all cases). Their detection is nevertheless highly imperative in order to avoid inadvertent injury to the bladder during routine hemiorrhaphy. Since the advent of high frequency equipment, ultrasonography has become the essential method of diagnosing vesical hernias. It is simple and fast, totally non-invasive, inexpensive, and widely available.

Post-cardiac catheterization femoral fistula corrected by ultrasound-guided compression.

We present a case of post-cardiac catheterization femoral fistula diagnosed by color and pulsed Doppler sonography and treated by ultrasound-guided compression. We avail ourselves of the case to review the echo Doppler semiology of the different types of arteriovenous fistulas with an emphasis on the functional analysis of the dialysis accesses. We also stress the therapeutic options in front of undesirable shunts.

Incidental sonographic finding of an extracranial internal carotid artery aneurysm confirmed by CT angiography.

We report a rare case of an extracranial internal carotid artery aneurysm (EICAA) discovered incidentally by color Doppler sonography (CDUS) and confirmed by CT angiography with three-dimensional reconstructions. As both brain MRI and cerebral angiography were normal and the patient remained asymptomatic, he was neither operated on nor stented but was discharged with appropriate antiplatelet therapy. The volume of his EICAA is checked regularly by CDUS.

[Doppler ultrasound and aortic regurgitation. Evaluation of the sensitivity and specificity of Doppler findings]. / Echo-Doppler artériel et insuffisance valvulaire aortique. Etude de la sensibilité et de la spécificité des signes.

PURPOSE: The purpose of this study was to determine the sensitivity and specificity of arterial Doppler findings of aortic regurgitation to assess if the amplitude of changes of Doppler tracings can accurately quantify the degree of regurgitation. PATIENTS AND METHODS: We analysed and compared the arterial Doppler tracings and echocardiograms of 250 patients. RESULTS: Even if the obvious pitfall of vascular stenoses is avoided, the global sensitivity of arterial Doppler findings for aortic regurgitation remains weak (30%). However, our study demonstrates that it can reach 100% if only significant AR (> or =2/4) is taken into account. Since the clear false-positive cases have been carefully excluded from the very start, the specificity of the classical criteria already proves excellent (above 95%). It will reach perfection if additional simple criteria gathered from the data mentioned in this study are considered. Quantifying precisely the degree of aortic regurgitation on the basis of arterial Doppler tracings is impossible. Nevertheless, we show that it is easy to identify significant AR (> or =2/4) that should be further assessed with echocardiography. CONCLUSION: Arterial Doppler sonography is unable to detect all cases of aortic regurgitation but those that are overlooked are not significant (1/4). If AR signs happen to be detected by arterial Doppler, the amplitude of the leak cannot be accurately determined based on tracing analysis. Yet, simple criteria will indicate whether it is important enough (> or =2/4) to require complementary echocardiogram, with well documented accuracy for morphological and hemodynamic evaluation.

A pitfall of neck vessels Doppler ultrasound: left subclavian artery occlusion without vertebral steal syndrome.

In most cases, ostial occlusion of the subclavian artery induces a reversal of the blood flow in the ipsilateral vertebral artery. This hemodynamic diversion is obviously brought out by Doppler ultrasound of the neck vessels. Nevertheless, when the subclavian ostial lesions are less severe or in case of anatomical variations, the alterations of the vertebral flux are more discrete. An accurate Doppler examination is then required to avoid pitfalls. In the light of a particularly complex case, we reviewed the Doppler signs of vertebral blood flow in normal conditions and in patent or less obvious subclavian steals.

Patent internal and external carotid arteries beyond an occluded common carotid artery: report of a case diagnosed by color Doppler.

Occlusion of the common carotid artery (CCA) is most often associated with thrombosis of the distal vessels. In rare cases, however, a weak antegrade flow can still be detected in the internal carotid artery (ICA). This patency is the result of a retrograde perfusion of the ipsilateral external carotid artery (ECA) via its collaterals. Such situation should not be ignored since bypass surgery can easily allow for effective restoration of flow. Most authors agree to say that color flow duplex imaging (CFDI) has now become the hallmark to detect a patent ICA in spite of a CCA occlusion.

Abdominal calcifications in mesenchymal chondrosarcoma: case report and review of the literature.

Mesenchymal chondrosarcomas are rare malignant cartilaginous tumors arising either in bones or in extraosseous sites. Their diagnosis is essentially based on medical imaging and pathological analysis. Despite heavy treatment, their prognosis remains extremely poor.