[Diagnosis of thoracic outlet syndrome. Value of angiography in the sitting position]. / Diagnostic des syndromes du défilé cervico-thoraco-brachial: apport de l'artériographie réalisée en position assise.

PURPOSE: Thoracic outlet syndrome includes arterial, venous or neurological symptoms. Frequently difficult to diagnose clinically, confirmatory imaging studies are usually required. The purpose of this study is to review the diagnostic work-up during management of patients with thoracic outlet syndrome and demonstrate the value of angiography in the sitting position. MATERIALS AND METHODS: Retrospective study of 81 surgical procedures for thoracic outlet syndrome, between 1997 and 2005, in 56 patients aged 17-57 years. Surgery was bilateral in 26 cases, with bilateral surgery in a single setting for 1 patient. All patients presented clinical symptoms confirmed on US, angiography, venogram or EMG. Angiography, from a transfemoral approach, was initially performed in the supine position, without and with dynamic maneuver, and in the sitting position with dynamic maneuver when needed. RESULTS: In 48 patients, supine rest angiography showed stenosis in 6% of cases and supine dynamic angiography showed stenosis in 81% of cases, with severe stenosis in only 35% of cases (stenosis>80% or arterial occlusion). Angiography in the sitting position was performed in 33 patients, showing worsening of stenosis in 91% of cases, with severe stenosis in 87%. CONCLUSION: Angiography in the sitting position with dynamic maneuver improves the sensitivity for detection of thoraci coutlet syndrome. This procedure may be considered in addition to other imaging modalities routinely used including Doppler US, CT and MRI.

[Post-traumatic hematoma of the duodenum. A case in a young child]. / Hématome post-traumatique du duodénum. Un cas chez un jeune enfant.

We report a case of traumatic duodenal hematoma. The patient's age (2.5 y.) and the absence of evidence of trauma when the symptoms began led to perform plain films of the abdomen, upper GI series, US, CT, and MR. This excess of imaging modalities emphasize the diagnostic value of plain X Rays of the abdomen and opacification of the duodenum.

[Inferior vena cava injury. X-ray computed tomographic and angiographic aspect]. / Traumatisme de la veine cave inférieure. Aspect tomodensitométrique et angiographique.

We report one case of traumatic rupture of the inferior vena cava. CT was performed during the acute phase and showed retroperitoneal hematoma near the inferior vena cava with extravasation of contrast agent. After stabilization angiography showed pseudo-aneurysmal picture of inferior vena cava.

[Spiral cholangioscanners and tridimensional reconstructions of the biliary tract in children]. / Cholangioscanner en mode spiralé et reconstructions tridimensionnelles de l'arbre biliaire chez l'enfant.

PURPOSE: endoscopic retrograde cholangiography may be difficult or unfeasible in children. It also may be complicated by acute pancreatitis. The purpose of this study was to determine the diagnostic contribution of spiral CT cholangiography in pediatric patients. SUBJECTS AND METHODS: seven patients, age ranging from 10 months to 13 years were explored without general anesthesia. Eight spiral CT cholangiographies were performed. The patients were suspected to have biliary or pancreatic lesions. Spiral CT was performed 60 minutes after slow infusion of iodipamide (Transbilix-Guerbet). The dose was correlated to the body surface. 3D reconstructions were done using the surface rendering or the MIP technique. RESULTS: biliary tract opacification and 3D reconstructions were considered of good quality in 6 out of 8 studies. It was normal in 2 cases. A duplication of the duodenum communicating with the choledocus was found in 1 case. Biliary lithiasis with a stone in the cystic duct was found in 1 case. Two choledocal cysts with bile ducts dilatation were diagnosed. A post operative biliary leak with bile ducts dilatation was found in one case. The spiral CT was not diagnostic in 2 patients: a case of choledocal cyst, the study was of poor quality due to inadequate sedation and a case of Caroli's disease with a high serum bilirubin level. Four patients had an endoscopic or a percutaneous cholangiography: to explore the pancreatic ducts (2 cases), poor CT study due to the inadequate sedation in 1 child, and the case of Caroli's disease. CONCLUSION: spiral CT is feasible even in young children. It should reduce the indications for endoscopic or percutaneous cholangiography. It has to be performed as the first examination in cases of biliary or pancreatic diseases when surgery is contemplated.

[A case of intrapancreatic duodenal duplication communicating with the biliopancreatic channel]. / Un cas de duplication duodénale intra-pancréatique communiquant avec le canal bilio-pancréatique.

Intestinal duplications are rare and are usually diagnosed in the first two years of infancy. They can occur at any level of the alimentary tract from the oral cavity to the anus. Duodenal duplication accounts for approximately 7% of all intestinal duplications. A previously healthy 4-year 6-month old boy was admitted with progressive increasing vomiting. Physical examination was normal, the serum amylase level was moderately increased. Upper gastrointestinal series showed an extrinsic compression defect of the proximal duodenum. Ultrasonography showed a 3 cm diameter cyst in the head of the pancreas. A duplication was suggested. Helical CT cholangiography showed a communication between duplication and the biliopancreatic common channel. The biliary tree was normal. Surgical resection of the intrapancreatic lesion was performed. Microscopic examination of the specimen revealed a duodenal duplication.

[Intramedullary glioma. Postoperative MRI aspects]. / Gliomes intramédullaires aspects post-opératoires en IRM.

MRI is the standard exploration of intramedullary tumours. Following up the patients is of prime importance to detect and treat possible recurrences at an early stage. The purpose of this paper is to specify the postoperative MRI semiology of intraspinal gliomas. During the 1986-1992 period, 47 patients operated upon in the Bicêtre hospital for primary intraspinal tumours were followed up with high-field MR (1.5 Tesla, Signa, G.E.). The retrospective visual study was carried out by two neuro-radiologists. The patients' group consisted of 24 women and 23 men aged from 15 to 67 years (mean 38 years). The tumours treated were 29 ependymomas and 18 astrocytomas. Eighty-five MRI examinations were analysed. Most of them comprised at least two planes in T1 and T2-weighted spin echo sequences with gadolinium injection, then only T1-weighted spin echo sequences after gadolinium injection (0.1 mmol/kg). The mean postoperative follow up period in the 47 patients was 32 months (range 7 to 84 months). Contrast enhancement of the spinal cord was observed in 20 cases. In the 6 patients with recurrence (5 astrocytomas, 1 malignant ependymoma) there was a segmental increase of spinal cord volume with contrast enhancement after gadolinium injection. In 3 out of these 6 patients clinical deterioration appeared later than MRI semiology. In clinically stable patients neither enhancement nor increase in spinal cord size was found in 27 cases, and enhancement alone was noted in 12 cases. There was no reliable criterion in the analysis of post gadolinium signal enhancement that could be used to differentiate recurrence from cicatricial contrast enhancement.(ABSTRACT TRUNCATED AT 250 WORDS)