Value of transesophageal echocardiography combined with computed tomography for assessing repaired type A aortic dissection.

Thirty-two patients with repaired type A aortic dissection were examined by transthoracic echocardiography (TTE) (n = 32), transesophageal echocardiography (TEE) (n = 30), computed tomography (CT) (n = 29), or a combination of all 3, to assess course and complications as a function of the surgical procedure. The mean follow-up period was 55.7 months (range 3 to 132). Surgery consisted of a replacement of the ascending aorta in 25 patients (group 1) with extension to the transverse aorta in 7 (group 2). The transverse diameter of the aorta, the persistence of the false lumen, thrombus formation and flow dynamics in the false lumen were evaluated by TEE. Ten patients (31%) had a dilation in the initial ascending aorta (sinus of Valsalva aneurysm in 6 patients, and a false aneurysm in the other 4). Three of 4 patients with a proximal pseudoaneurysm underwent operation after TEE and CT evaluation. In the descending thoracic aorta, there was good agreement between TEE and CT scan determinations of transverse vessel diameter. Persistence of flow within the false lumen was significantly more frequent in patients with a dilated aorta (p < 0.05), whereas thrombosis was seen more often and false lumen less often in patients with nondilated aorta. No significant differences in vessel status or outcome were observed between the 2 groups, although this may have been due to the small size of group 2. TEE is thus a well-tolerated method for postoperative follow-up of type A aortic dissection whatever the type of surgery. For the upper ascending aorta, CT provided sufficient data.

[Cardiac compression by a large thymic cyst. Apropos of a case, review of the literature]. / Compression cardiaque par un volumineux kyste thymique en bissac. A propos d'un cas, revue de la littérature.

Thymic cysts are rare and almost always asymptomatic. The authors report the case of a 45 year old woman with a thymic cyst diagnosed after recurrent right sided heart failure resulting in signs suggestive of adiastole, regressing after "pleural" (mainly cystic) aspiration and diuretic therapy without any morphological or functional changes on Doppler echocardiography. This report concerns a rare tumour, with an exceptional volume (2 litres) extending down the cardiac borders and causing cardiac compression. It illustrates the diagnostic difficulty of a pathology with an unusual clinical presentation, despite complementary investigations including CT scan and MRI, very sensitive in this type of problem. A complete cure was obtained by total surgical ablation.

Ultrasound and computed tomographic findings in pancreatic metastases.

This is a retrospective study of a series of seven patients with pancreatic metastases studied by ultrasonography and computed tomography. They were detected during tumor staging, or in the follow-up period of over 10 years of patients with advanced known malignancy. Lesions were multiple in two patients and solitary in five; solid in six cases and cystic in one. Clinically, four cases were asymptomatic and three cases presented with jaundice or epigastric pain. Ultrasonography and computed tomography findings were non-specific. Consequently it was not possible to differentiate solitary metastases from primary solid adenocarcinoma and cystadenocarcinoma of the pancreas. In these cases, computed tomography- or ultrasonography-guided biopsies had to be performed to obtain histological proof. However, multiple lesions discovered in a patient with a known malignancy can be assumed to be due to metastases.

Bronchial carcinoma following pulmonary and thoracic wall actinomycosis: report on one case with emphasis on CT findings.

A case of bronchial carcinoma following pulmonary and thoracic wall actinomycosis is presented. Although pulmonary defense mechanisms are known to decrease with actimyces infection, the development of malignancy following chronic inflammation as in our case, has not in our knowledge been previously reported.

[Imaging of malignant lymphoma of muscular sites]. / Imagerie des lymphomes malins de topographie musculaire.

Seventeen cases of muscular lymphoma are reported (5 primary non-Hodgkin lymphoma, 11 secondary NHL, 1 secondary Hodgkin's disease). The psoas or gluteus muscle was involved in 10 cases, and the lower limb was affected in the remaining 7 cases. Nine cases of muscular extension of bone NHL are also reported. On sonograms these lesions were always large and less echogenic than adjacent structures, with no signs of necrosis before treatment. US and CT patterns were comparable for both primary and secondary lesions, regardless of the type of lymphoma or whether or not there was any previous bone lesion. Associated lymphomatous lesions were observed in 14 cases. On angiograms, muscular lymphomatous involvement presented a hypovascular pattern. While ultrasonography is an excellent monitoring technique for soft tissue lymphomas (specially for the lower limbs), a major contribution of CT is the detection and the follow-up of deep or thoracic wall lesions.

[Contribution and limits of x-ray computed tomography and magnetic resonance imaging in evaluating the extent of primary cancers of the bronchi]. / Apports et limites de la TDM et de l'IRM dans le bilan d'extension des cancers primitifs des bronches.

The authors report the contribution and the limits of CT and MRI in the thoracic and extrathoracic staging of bronchogenic carcinoma. From data of a personal study and of the literature, findings and performances of CT and MRI are reported and compared for the evaluation of mediastinal and parietal extension and in the detection of nodes and metastases. Their respective places and indications are underlined.

[Epithelioid hemangioendothelioma of the liver and superior vena cava. Radiological results apropos of a case in an adult]. / Hémangioendothéliome épithélioïde du foie et de la veine cave supérieure. Résultats radiologiques à propos d'une observation chez l'adulte.

Epithelioid hemangioendothelioma is a rare, ubiquitous, vascular tumor, difficult to diagnosis but sometimes identified after detection of metastases, and with a prognosis intermediary between angioma and angiosarcoma. The tumors have been described as developing in the large venous trunks and recently lesions have been reported in liver. Little documented data exist with respect to radiologic appearances. A case is reported with a histologically confirmed hepatic localization in association with a lesion in superior vena cava.

[Detection and quantification of carotid atheroma. Respective value of vascular ultrasonography, spectrum analysis and digital intravenous angiography]. / Dépistage et quantification de l'athérome carotidien. Intérêts respectifs de l'échotomographie vasculaire, de l'analyse spectrale et de l'angiographie numérisée intraveineuse.

This retrospective study involved 37 subjects who were examined by means of intravenous digitalised angiography, vascular ultrasonography and spectral analysis of the Doppler signal. The last two examinations were found to give the most precise images and functional information. The concordances between angiography and ultrasonography on the one hand and spectral analysis on the other were 82 and 90 per cent. The authors have established a protocol in order to limit and systematize these examinations during screening for carotid atheroma: the risk factors are weighted; a score is obtained by summation; depending on the value of this score and the patient's age, the investigation procedure is pursued or not. The sequence always consists of ultrasonography followed by spectral analysis when plaque is detected and by angiography when the plaque is stenotic or ulcerated. In symptomatic patients, ultrasonography and digitalised angiography are performed routinely.