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.

[Value of the transscapular view in radiological of shoulder trauma (author's transl)]. / Intérêt du profil tangentiel de l'omoplate dans le bilan radiologique des épaules traumatiques.

With a one year experience concerning 67 patients, the authors suggest to use for any shoulder trauma, a transscapular view associated with the routine antero postereiur film of the shoulder. This incidence has a major advantage on all the other lateral positions to be always possible at the exclusion of severely polytraumatised patients. Luxations of the shoulder, humerus and scapula fractures and lesions of acromio clavicular joints are quite correctly visualized.

[Value of computed tomography for the investigation and diagnosis of aortic aneurysms (author's transl)]. / Apport de la tomodensitométrie dans le diagnostic et le bilan des anévrysmes de l'aorte.

Abdominal or thoracic aneurysms can be perfectly well visualized by computed tomography, and tumors lying close to the aorta and simulating ectasia can often be eliminated. The exact topographical features of the lesions can be defined as well as their extension superiorly. In many cases, calcifications, clots, a permeable channel, or even a periaortic hematoma showing fissuration can be demonstrated. On many occasions the value of computed tomography is such that angiography may not be necessary.

Computed tomography of aortic dissection.

Fourteen patients suspected of having dissection of the thoracic aorta, two with possible extensions into the abdomen of previously diagnosed dissection of the thoracic aorta, and one patient who had undergone surgical repair of an aortic dissection were examined by CT (computed tomography). Findings included localized increase of the aortic caliber, displaced intimal calcifications, intimal flaps, and false channels. These findings were confirmed by angiography or at necropsy. Two patients in whom CT showed no abnormalities had a favorable outcome. The authors conclude that CT is the examination of choice in removing doubt from the clinical diagnosis of aortic dissection.

[Radiological appearance of bone manifestations in acute drepanocytic syndromes in adults (author's transl)]. / Manifestations radiologiques osseuses des syndromes drépanocytaires majeurs chez l'adulte.

The authors describe 18 cases of this syndrome and emphasize that attenuated clinical forms of homozygotic drepanocytosis exist, as well as, in a more general manner, in acute drepanocytic syndromes. The disease may first appear in adult life. The frequency of radiological signs in the spine has to be stressed, and the authors emphasize the diagnostic value of the "staircase" deformation of the vertebrae, representing the sequelae of bone ischemic lesions. The discovery of this radiological sign suggested the diagnosis of a hemoglobinopathy in two cases. This attenuated form of the disease presents the same risks of thromboses but these complications can be reduced by prophylactic treatment. This underlines the need for early detection and radiological investigation can be of great assistance.

[Aortocoronary bypass permeability explored by tomodensitometry. Preliminary study]. / Perméabilité des pontages aorto-coronaires explorés par tomodensitométrie. Etude préliminaire.

The patency of 24 aorto-coronary grafts was studied by tomodensitometry. --16 out of the 18 bypasses examined within the two weeks following surgery were seen. --4 older bypasses were not visible, either by scanner or by angiography and were therefore occluded: two more, performed more than a year previously, were patent on tomodensitometric examination. The interpretation of the results, discussed taking into account the small number of angiographic check ups does not permit any formal conclusion as to the validity of the procedure. The results of this technique seem satisfactory and quite comparable with other non invasive methods used in the study of aorto-coronary grafts.

[Computerized axial tomography in diagnosis of congenital heart diseases. Preliminary report]. / L'examen tomodensitométrique pour le diagnostic de certaines cardiopathies congénitales. Rapport préliminaire.

Transverse sections of the heart and great vessels may be obtained by tomodensitometry using an exposure time short enough to carry out the investigation during apnoea, and an infusion of contrast medium. The definition is good enough for the investigation to be considered as a useful adjunct to the normal investigations in complex congenital cardiac abnormalities. All measurements are instantaneous, including the study of pulmonary density which allows assessment of the pulmonary vascularisation.

[Computed tomography of the heart: anatomical findings in normal subjects (author's transl)]. / Tomodensitométrie cardiaque. Anatomie normale.

Clear images of the chambers of the heart and the vessels can be obtained by rapid scanning with computed tomography, associated with rapid perfusion of a contrast medium. A study in 30 normal subjects demonstrated that it was possible to identify and localize the heart chambers and the large vessels in different planes, and to obtain precise measurements of the various diameters. These results could form the basis for etiological studies of the cardiopathies.

[Radiological diagnosis of ventrycular aneurysms. A report on 36 operated cases (author's transl)]. / Diagnostic radiologique des anévrysmes ventriculaires. A propos d'une série de 36 patients opérés.

The value of different radiological examinations in the diagnosis of left ventricular aneurysms following infarcts is assessed using the results obtained in 36 operated cases. By correlating radiological and surgical findings the orientation value of standard examinations can be determined: almost constant cardiomegaly, irregularity of the borders of the heart, and more rarely, myocardial calcification, are significant signs. The two essential examinations are ventriculography and coronarography. Ventriculography can demonstrate anatomical abnormalities (protrusion), or dynamic changes only (hypokinesia, akinesia, systolic expansion). This remarkably reliable examination showed a predominance of anterior and anterolateral aneurisms (87% of cases), and enables definition of the critical cardiac surface area (about 25%) above which the aneurysm is operable. Coronarography shows that the anterior interventricular artery (A.I.V.) is affected in a large proportion (90%) of aneurysms. These two examinations can be used to select those patients suitable for surgery. Results were good and only one death occurred. In the other cases, the disorders of rhythm were reduced and the manifestations of cardiac insufficiency disappeared.