[Retro-aortic left brachiocephalic venous trunk. A rare anomaly: 2 cases]. / Le tronc veineux brachio-céphalique gauche rétro-aortique. Une anomalie rare: deux cas.

Two cases of a rare anomaly of the trajectory of the left brachiocephalic venous trunk were detected by CT scan imaging. In both patients the trunk passed under the aortic arch before emptying into the superior vena cava. One patient presented, in addition, a complex anomaly of the aortic arch.

Computerized tomography in the evaluation of the late complications of acute pancreatitis.

The role of computerized tomography in the diagnosis and treatment of late complications of acute pancreatitis was evaluated in 25 patients with acute pancreatitis. The clinical severity of the pancreatitis was assessed by Ranson's criteria. In each patient. the scan showed abnormalities of the pancreatic and at least one intraabdominal extrapancreatic extension of the disease. The scan precisely locates the intraabdominal extensions secondary to acute pancreatitis, and thus can guide surgical drainage, but it is less accurate in differentiating solid infiltration of fat planes from necrotic collections. However, in most of our patients, the association of general signs of sepsis with a collection shown on computerized tomographic scan indicated necrosis requiring surgical drainage.

[Erdheim-Chester disease. The multiviceral form presenting as exophthalmos]. / Maladie d'Erdheim-Chester. Forme multiviscérale révélée par une exophtalmie.

Erdheim-Chester disease is a rare visceral xantho-granulomatosis, the 17th case of which is reported here. The initial symptom, bilateral exophthalmos, was uncommon. The picture was completed by a retroperitoneal xanthogranuloma and by bilateral and symmetrical osteosclerosis of the long bones. The lack of X-bodies at electron microscopy differentiated the disease from Hand-Schüller-Christian disease. The patient's condition improved with chemotherapy (vinblastine and doxorubicin) combined with corticosteroid therapy. After a 5-month remission period, he died of an intercurrent infection. No autopsy was performed.

[Digital angiography of bone sarcoma in the child]. / Intérêt de l'angiographie digitalisée dans les sarcomes osseux de l'enfant.

The authors analyze the results of 50 computed angiographies made for osteosarcoma and Ewing's sarcoma. Better tolerated than conventional angiography computed angiography is also more sensitive in preoperative evaluation of effectiveness of neoadjuvant chemotherapy. Automatic subtraction, direct measuring of tumor size and vascularization density give to angiographic changes after chemotherapy the most predictive value. After conservative surgery or radiotherapy digital angiography provides most reliable local follow up.

[Comparison of different methods of medical images in the assessment of local extension of osteogenic sarcomas]. / Comparaison des différentes méthodes d'imageries médicales dans le bilan d'extension locale des sarcomes ostéogènes.

The authors compared different methods of medical visualisation (standard radiography, arteriography, quantitative isotope bone scan, telethermography, CT scan, visualisation by nuclear magnetic resonance) in 52 osteogenic sarcomas. In the majority of cases the diagnosis was suggested by standard X-rays at the first visit. CT scan and visualisation by nuclear magnetic resonance are the two basic examinations both in terms of assessing the future single block excision as well as deciding the approach to be used for biopsy. Telethermography and quantitative isotope bone scan usefully complement clinical examination and standard X-rays in following the course during chemotherapy. Arteriography is indicated only in the presence of large tumors threatening the vessels directly.

Dynamic CT features of hepatic abscesses.

Forty hepatic abscesses were examined with dynamic computed tomography (CT). A "double target sign," consisting of a hypodense central area surrounded by first a hyperdense ring and then a hypodense zone, seems to be highly suggestive of abscess formation. In 12 cases, the hepatic parenchyma surrounding the lesion demonstrated transient hyperdensity after contrast injection, possibly due to localized hepatic venous obstruction secondary to acute hepatic inflammation. This is similar to the appearance of an arterioportal fistula.

[Value of x-ray computed tomography in evaluating the spread and therapeutic strategy in cancer of the bladder]. / Intérêt de la tomodensitométrie dans le bilan d'extension et la stratégie thérapeutique du cancer de vessie.

Fifty four computed (CT) examinations were performed on patients with bladder carcinoma. A pathological assessment was obtained in 24 cases and the accuracy of CT in local staging was 91%. The accuracy of CT in detecting lymph nodes invasion was also 91%. Moreover, CT is helpful in the follow-up of patients under treatment. As it provides a correct pre-therapeutic evaluation in 83% cases, CT appears as an effective examination to perform in the evaluation of bladder carcinoma.

[Diagnostic contribution of computer tomography in muscular pathology]. / Apport diagnostique du scanner X en pathologie musculaire.

CT analysis in 26 patients with well-identified muscle diseases, and 4 normal controls was performed to evaluate its diagnostic interest. Scans were obtained through pelvis, thigh and calves at comparable levels in all subjects. Results showed that elementary changes were devoid of specificity and density measurements did not significantly increase the diagnostic significance of images. A good correlation was found between the degrees of CT changes and clinical evaluation of the muscles. However, CT allowed a more precise study of abnormalities in muscles difficult to assess clinically and, in all pathological cases, led to a clear analysis of the topography and the selectivity of the pathological process. If safety criteria are fulfilled, CT would allow a precise follow-up study of muscle atrophies.

Portal vein involvement in hepatocellular carcinoma: dynamic CT features.

The authors conducted a retrospective examination of 62 hepatocellular carcinomas, taking dynamic CT scans of selected sections after an intravenous contrast bolus. The proximal portal vein was involved in 40% of cases and the distal segment in 16%. Angiographic correlation was available in 23 patients. CT signs of main or lobar portal vein involvement included (a) hypodensity and enlargement, (b) periportal arterial hypervascularization surrounding the hypodense intraluminal region, (c) nonvisualization of the lobar portal vein, (d) arterioportal shunting, and (e) differences in lobar attenuation. The characteristic appearance of tumor within the portal vein was noted in many cases; in others, distinction between tumor and bland thrombus could not be made. Peripheral portal vein obstruction was suggested when a small, hypervascular tumor became hypodense during the portal phase of CT. The frequency and significance of these CT signs of portal vein involvement are discussed.

The value of computed tomography in osseous hydatid disease (echinococcosis).

The authors report three cases of osseous hydatid disease (echinococcosis) in which examination by computed tomography (CT) was found to be helpful in establishing the diagnosis. Recognition of this rare bone infection in orthodox radiographs is notoriously difficult, but is aided by knowledge of the patient having lived in an area in which the disease is endemic. In two instances, one involving the shoulder and the other the thoracic spine, radiological abnormalities had been attributed at first to tuberculosis. In the third case, in which a destructive lesion in the sacrum had been interpreted correctly, CT studies provided confirmation of a recurrence. CT has proved to be an effective and sensitive method of demonstrating these destructive lesions in bone, of determining their spread, and of establishing the presence of other hydatid cysts in adjacent soft tissues. This technique has been found to be of value in preoperative planning of the surgical approach to hydatid lesions of the skeleton.

Primary dissecting aneurysms of the coronary arteries: case report and literature review.

We describe a case of dissecting aneurysm that occurred in a 33-year-old woman suffering from acute myocardial infarction, which was discovered by coronary angiography. Angiographic diagnosis of dissections is rare with only six such cases previously reported. Sixty cases in the literature are reviewed to ascertain the main characteristics of this rare entity. The distinct predominance of this disease among women, particularly post partum, suggests an hormonal influence on its pathogenesis.

[Hepatic angioscanner in normal subjects and in patients with hepatic tumors. Hemodynamic and morphologic characteristics]. / Etude de l'angioscanner hépatique normal et au cours des tumeurs hépatiques. Caractéristiques hémodynamiques et morphologiques.

Hepatic angio-CT was performed according to a standardized schedule in 100 healthy subjects and 260 patients with a liver tumor. In normal subjects, it was possible to determine an arterial phase (15 s), a parenchymatous arterial phase (30 s), a parenchymatous portal phase (45 s) followed by a progressive return to liver densities observed before injection. a) Among the 62 cases of hepatocellular carcinoma, 56 were characterized by hypodensity, 3 cases by hyperdensity and 3 cases by isodensity before injection. After injection, slices obtained at the tumor level showed heterogeneous hypervascularisation in 34 cases, and an early homogeneous hypervascularisation (15th-30th s) in 7 small carcinomas (diameter less than 3 cm); a lesion was disclosed in the other hepatic lobe in 12 cases. Slices obtained at the level of the portal vein allowed to assess tumoral involvement in 61 p. 100 of cases. b) Out of 150 cases of hepatic metastases, a hypodense lesion surrounded by hypervascularisation just after injection was the most frequent aspect. c) Out of 40 cases of hemangiomas, lesions were hypodense and well limited in 37 cases; at the 15th s after injection, contrast medium accumulated at the periphery, then diffused to the center of the lesion. d) Adenomas and focal nodular hyperplasias appeared as hypodense lesions with precocious and fugacious hypervascularisation, and were characterized, although inconstantly, by the presence of fat and vessels in the hypodense central zone, respectively. These results provide a rational basis for a better diagnostic approach of liver tumors.

[Suppurating splenic infarction originating from endocarditis]. / Infarctus spléniques suppurés d'origine endocarditique.

Three cases of splenic infarction complicated by abscess formation during bacterial endocarditis are reported. In all three cases there were associated clinical abdominal signs and, in one case, there was persistently positive hemocultures. The diagnosis was made by CAT scanning. The three patients underwent splenectomy and one patient also underwent valve replacement the same day. The methods of early diagnosis of splenic complications during endocarditis and the indications of splenectomy are discussed. Ultrasonography and abdominal CAT scanning are the most sensitive diagnostic methods for splenic lesions. As splenic rupture is associated with a high mortality and this complication may occur at any time during infarction complicated by abscess formation, early splenectomy is justified when abdominal clinical signs are elicited associated with a persistent, infectious syndrome with or without positive blood cultures, under appropriate antibiotic therapy. Splenectomy should also be considered if valve replacement is carried out in the same circumstances to avoid infection of the prosthesis.

[Irregular hepatic steatosis. Ultrasonic and computed x-ray tomographic aspects]. / Stéatose hépatique irrégulière. Aspects échographiques et tomodensitométriques.

A 39-year-old moderately obese and alcoholic man complained of abdominal pain and nausea. An ultrasound examination of the liver showed large hyperechoic areas surrounding a limited pseudotumorous zone of relatively decreased echogenicity. CT scan showed a decreased density (35 UH) in the hyperechoic areas, suggesting fatty liver which was confirmed histologically; conversely, the hypoechoic area appeared normal on CT scan. Six months later, after reduction of caloric intake and cessation of alcohol ingestion, ultrasound examination and CT scan of the liver were normal.