-Arthrography and computed tomography arthrography of the wrist-. / Arthrographie et arthroscanner du poignet.

After a brief review of the pertinent anatomy of joint compartments and main ligaments of the wrist, the authors present the technique of wrist arthrography and CT arthrography. They discuss the normal and pathological patterns. The main indications are the chronic painful wrist and posttraumatic wrist. Imaging can reveal ligament defects (particularly scapholunate ligament, or lunotriquetral ligament), triangular fibrocartilage tears, capsular defects, cartilage thinning, foreign bodies, synovial ganglia or synovitis of the wrist.

[Imaging of external instabilities of the patella. State of the art]. / Imagerie des instabilités externes de la rotule. Mise au point.

External femoropatellar instability is a dynamic abnormality from various origins: osseous, cartilaginous or musculotendinous; X-rays films cannot give a precise enough description of this phenomenon. Attention is drawn by anterior pain or a sensation of instability. Clinical analysis distinguishes between permanent, traumatic or transient dislocations which are now more frequently discovered as part of a femoro-patellar syndrome with or without cartilage involvement. Conventional imaging, CT-scan and MR imaging are based on faultless techniques. Lateral views precisely report femoropatellar architectural abnormalities and patellar instability. Skyline views are able to quantify the various parts of the dysplasia. Dynamic tests increase the sensitivity of the plain films. But the main shortcoming of these techniques is the lack of visualization of the initial patellar engagement in the trochlea. The femoropatellar component of the knee arthrography visualizes rather large cartilaginous lesions. CT-scan, better than skyline views, allows examining the patellar bone without interference with the trochlea (extended knee), during the engagement (15 degrees flexed knee) and after the engagement (30 degrees flexed knee). However, the examination technique varies from one author to another according to his own pathophysiologic understanding. With the bicondylar plane reference, the reliability of the CT-scan measurements are better than skyline views. Like the dynamic tests during the beginning of the patellar engagement at 15 degrees, flexion is more sensitive than those at 30 degrees. Finally, CT-scan arthrography demonstrates thinner cartilaginous lesions than conventional arthrography. Presently the main contribution of MR imaging consists of detecting transient patellar dislocation that a single clinical examination cannot differentiate from other internal knee disorders. MR imaging is more precise in analyzing the cartilaginous structure. Kinematic MR imaging, still in an experimental stage, offers a new approach to the dynamic study of the patellar tracking.

[Pubalgia in sportsmen]. / Pubalgie du sportif.

Pubalgia is a painful syndrome of the groin which particularly affects young athletes. Although soccer players are the athletes most often affected, they are not alone. Also included in this group are fencers, tennis players and rugbymen. This ailment is associated with varying degrees of lesions of the muscles of the lower frontal abdomen, pubic symphysis and adductor muscles. The clinical diagnosis is confirmed by standard X-rays which can show radiological anomalies of the pubic symphysis in cases of microtraumatic pubic osteo-arthropathy or insertion tendinitis. Scintigraphic anomalies occur earlier than radiological anomalies and return to normal before them; thus allowing confirmation of healing even when the radiographs are still abnormal. Sonogram and MRI can be advantageous in the detection of a lesion of the abdominal muscles or adductor muscles. MRI can also detect a lesion of the pubic symphysis. The principal differential diagnosis is pubic osteitis. Treatment is medical and combines rest, analgesics and anti-inflammatories. Surgery, namely Nesovic's operation, is reserved for those forms resistant to medical treatment, and must be bilateral.

[Views necessary for the traumatic wrist]. / Clichés nécessaires pour le poignet traumatique.

Wrist injuries are an extremely common occurrence. The origin of these injuries may be due to a fracture of the two bones of the forearm or the wrist bones, which may sometimes require specific X-rays views. They are rarely responsible for a dislocation of the wrist. Strains wrists may be misdiagnosed and may result in instability of the wrist. The initial examination of all wrist injuries should systematically include the following four views: (1) a PAview of the wrist in pronation (with the palm facing downward). (2) a lateral view according to the Meyrueis technique. (3) an oblique view. (4) a scaphoid view. An additional, fifth view with the wrist in supination (with the palm facing upward) may be required. If there is clinical evidence of instability of the wrist or if the initial examination results in a probably strained wrist, a further more complete radiological examination can then be undertaken. This examination, known as "the instability examination" includes stress views, which can allow detection of a discrete instability of the wrist. Finally, it is sometimes necessary to carry out this examination in a bilateral and comparative manner.

[Villonodular synovitis of the knee. Contributions of MRI]. / Synovite villo-nodulaire du genou. Apports de l'IRM.

This retrospective study included eight patients with villonodular synovitis of the knee (7 nodular forms and one villous form) who underwent magnetic resonance imaging and at least one arthroscopy. Joint enlargement and mild pain were the main manifestations. Other imaging studies provided little information. Magnetic resonance imaging showed highly suggestive hemosiderin-laden masses. Hemosiderin was most clearly seen on gradient echo sequences. Magnetic resonance imaging was also useful for determining the distribution of lesions. Intravenous gadolinium provided no additional information. Arthroscopy allowed to collect biopsy specimens and to perform synovectomy when called for. In our opinion, after a physical examination and plain roentgenograms, magnetic resonance imaging and arthroscopy should both be performed to determine the extent of lesions and to allow histological diagnosis and synovectomy, respectively.

[Colonic involvement in systemic mastocytosis (author's transl)]. / Atteinte colique au cours d'une mastocytose systémique.

The most common gastrointestinal lesions encountered in systemic mastocytosis are the gastric, duodenal and small bowell lesions. The authors present a case of diffuse colonic involvement diagnosed on a double contrast examination. The radiological signs correlated with the endoscopical and histological findings are due to a submucosal edema and a polymorphic cellular infiltrate. The involvement of the colon is probably more frequent then previously thought. It could explain the diarrhea encountered in some patients affected by this disease.

[Radiological investigations to establish etiology in patients with hematuria. A report on nearly 2,000 consecutive cases (author's transl)]. / Le diagnostic étiologique des hématuries. Apport de la radiologie dans près de 2 000 cas consécutifs.

A prospective study was conducted in 1,878 patients found to have hematuria, among 11,000 new cases attending for consultation over a period of 27 months, who were then followed-up for several months to several years. The results confirmed some well-established facts but several unusual features were observed. Intravenous urography, when technically complete, detected urinary tract lesions in 60 p. cent of cases. Complementary examinations (cystoscopy, angiography, renal biopsy), which should not all be conducted systematically, but only as a function of the results of the IVU, the type of hematuria, and clinical and biological findings, considerably increase the percentage of positive results. The etiology remained obscure in less than 10 p. cent of cases but not all of these patients had benefited from a full range of complementary examinations, that should have been conducted. Associated anticoagulant treatment and the microscopic nature of the hematuria should never lead to delay in IVU examination, and a reassuring diagnosis of a benign lesion. The authors emphasize the high frequency of associated lesions. For this reason, a complete IVU should be conducted whatever the initial findings. Furthermore, the reassuring diagnosis of an atypical benign cause for the hematuria (renal cyst, prostatic adenoma, etc.) should not be too easily accepted before exploring the possibility of a second lesion, truly responsible for the hematuria and having an entirely different prognosis.

[Value of radiological investigations in patients with dysuria after prostatic adenomectomy (author's transl)]. / Intérêt de l'exploration radiologique chez les adénomectomisés dysuriques.

Dysuria is a relatively frequent complication after prostatic adenomectomy. The authors review 107 patients with this complication and demonstrate that radiological investigation, including a micturition study, preferably after IVU, shows the presence of an obstructive cause for the dysuria in the vast majority of cases (92.5%). There are two main types of obstructive lesion: - parietal stenosing lesions, - compression lesions. - The most frequent parietal stenosing lesions, apart from those of the bladder neck, are urethral stenoses. - Stenoses with total compression of the capsule are often the cause of severe dysuria. - Localized compression of the capsule and urethral stenosis usually cause only moderate dysuria. - An irregular lacunar image should suggest cancer of the prostate.

[Rupture of an aneurysm of the splenic artery into the pancreas, a rare cause of gastrointestinal bleeding (author's transl)]. / Rupture d'un anévrysme de l'artère splénique dans le pancréas, cause exceptionnelle d'hémorragie digestive par wirsungorragie.

In a 73 year old man, repeated gastrointestinal haemorrhages first attributed to peptic oesophagitis, recurred despite anti-reflux surgery. Upper endoscopy being negative, arteriography was performed which revealed the presence of a fissured aneurysm of the splenic artery. This was successfully treated by left splenopancreatectomy. A communication between the aneurysm and wirsung's duct was found in the operative specimen. This a very rare cause of gastrointestinal bleeding. The diagnosis can be made only by arteriography.