Malignant external otitis complicated by spinal cord compression: Case report.

Introduction: Malignant otitis externa is a life-threatening infectious pathology that occurs mainly in diabetic patients; in a picture of otorrhea, with facial paralysis. We report the case of a necrotizing otitis externa, treated with antibiotics, which was complicated a few months later by spinal compression. Observation: This is the case of a 60-year-old patient, diabetic, who presented a painful otorrhea associated to left facial palsy.The diagnosis of necrotizing otitis externa was retained after performing a CT scan of the temporal bone.6 months after medical treatment, the patient became has been complicated by tetraparesis with respiratory distress. Discussion: Necrotizing otitis externa is an osteitis of the base of the skull, which occurs in the diabetic patient and which starts in the external ear and spreads by contiguity after infection of the temporal bone.It represented clinically by otalgia and purulent otorrhea.The role of imaging is to confirm the involvement and to specify the extension of the lesions. CT scan is useful to evaluate the bone involvement. MRI is the examination of choice for the study of soft tissues and is essential in advanced forms.Its treatment is based on antibiotic therapy for a minimum of 6 weeks. Conclusion: OEM is an infection occurring in elderly and diabetic patients. Imaging allows to confirm the diagnosis and to carry out the assessment of extension; but also has a great interest in the follow-up of these immunocompromised patients who are subject to complications with insidious evolution.

[Role of computed tomography in bronchial carcinoid tumors for diagnosis and local staging]. / Apport de la tomodensitométrie dans le bilan lésionnel des tumeurs carcinoïdes bronchiques.

PURPOSE: Report radiographic aspects and assess the contribution of computed tomography for the diagnosis and search for extension of bronchial carcinoid tumors. MATERIAL AND METHODS: This retrospective study included 9 patients with a bronchial carcinoid tumor during a four years period. In all patients, the exploration included standard chest radiography, computed tomography (CT) and abdominal ultrasonography. RESULTS: This series included three females and six males, mean age 25 years (age range 20-52 years). The average time between clinical symptoms and diagnosis was 24 months. The important signs were chest pain, dry cough and dyspnea in 7 cases, hemoptysis in 4 cases. Chest radiography has objectified a rounded opacity speculated in 4 cases, opacity systematized in 3 cases and an opaque lung in 2 cases. Computed tomography (CT) revealed an endobronchial process with a endobronchial budding in 5 cases, pneumonia systematized in 4 cases, collapse in 7 cases, a localized dilatation of bronchus in 2 cases, lymph node metastases in 4 cases. Bronchoscopy has the macroscopic diagnosis in all cases. All patients have surgical treatment, the lobectomy in 4 cases, pneumonectomy in 3 cases and bilobectomy in 2 cases. CONCLUSION: CT is indispensable for positive diagnosis, and topographic localization of extension of bronchial carcinoid tumors. The main contribution of CT compared with fibroscopy is to demonstrate exobronchial tumor development and upstream pulmonary complications.

BUT: Rapporter les aspects radiologiques et évaluer l'apport de la tomodensitométrie dans le diagnostic et le bilan d'extension des tumeurs carcinoïdes bronchiques. MATÉRIEL ET MÉTHODE: Etude rétrospective de 9 cas de tumeurs carcinoïdes bronchiques sur une période de 4 ans, portant sur les patients explorés dans le service de radiologie 20 Août, et opérés dans le service de chirurgie thoracique de CHU Ibn Rochd Casablanca. Tous les patients ont bénéficié de radiographies et d'une tomodensitométrie (TDM) thoraciques, ainsi une échographie abdominale. RÉSULTATS: Il s'agissait de 3 femmes et 6 hommes, la moyenne d'âge était de 25ans. Le délai moyen entre la symptomatologie clinique et le diagnostic était de 24 mois. Les signes révélateurs étaient des douleurs thoraciques, une toux sèche et une dyspnée dans 7 cas, une hémoptysie dans 4 cas. La radiographie thoracique a objectivé une opacité centrale arrondie spiculée dans 4 cas, opacité systématisée dans 3 cas et un poumon opaque dans 2 cas. La tomodensitométrie (TDM) thoracique a montré un processus tissulaire avec bourgeon endobronchique dans 5cas, une pneumopathie systématisé dans 4 cas, un collapsus dans 7 cas, une dilatation de bronches localisée dans 2 cas, des adénopathies médiastinales dans 4 cas. La bronchoscopie a permis le diagnostic macroscopique dans tous les cas. Tous les patients ont bénéficié d'un traitement chirurgical fait de lobectomie dans 4 cas, pneumectomie dans 3 cas et bilobectomie dans 2 cas. CONCLUSION: La TDM est indispensable pour le diagnostic positif topographique et dans le bilan d'extension pré-thérapeutique des tumeurs carcinoïdes bronchiques. Son apport principal par rapport à celui de la fibroscopie est de montrer leur éventuel développement exo-bronchique, et les complications pulmonaires d'aval.

[An uncommon cause of dyspnea in children. Plexiform neurofibroma of the larynx]. / Une cause rare de dyspnée: neurofibrome plexiforme du larynx.

Plexiform neurofibroma is a rare benign tumor developed from cells of the sheath of Schwann peripheral nervous system often associated with neurofibromatosis type 1 or Von Recklinghausen disease. Laryngeal involvement in neurofibromatosis is rare and usually presents with obstructive respiratory symptoms. Imaging including CT and MRI provides the diagnosis as well as the staging of this lesion, whose treatment is primarily surgical. We report the case of a plexiform neurofibroma of the larynx found in a 4-year-old child revealing a mass completely obstructing the laryngeal vestibule.

[Diffuse infiltrative lung disease in scleroderma. Analysis of radio-clinical and functional semiology]. / Pneumopathie infiltrante diffuse (PID) de la sclérodermie. Analyse de la sémiologie radioclinique et fonctionnelle.

Scleroderma (SD) is a systemic disease that predominantly affects the skin. Diffuse infiltrative lung disease (DILD) is rare and occurs most often in the course of the disease. We analyzed seven cases of DILO of SD recorded between 2003 and 2010 among 196 PID (3.6%). Functional signs were limited to respiratory dyspnea, it was associated to dysphagia in six cases, dry syndrome in five cases and Raynaud's phenomenon in four cases. Clinical examination found crackles in the bases of the thorax in all cases and specific cutaneous signs in six cases. The chest radiograph showed that interstitial disease predominates at the lung bases in all cases with a large aspect of the pulmonary arteries in two cases. The chest CT scan confirmed the predominance of basal and peripheral damage with signs of fibrosis in six cases. The pulmonary function objectified a severe restrictive ventilatory defect in all cases. Bronchoscopy showed a normal macroscopic appearance in all cases, the broncho-alveolar lavage was predominated by neutrophilic formula in four cases. SCL 70 antibodies were positive in four cases. All patients were treated by steroids with improvement of dyspnea and stabilization of radiographs. A patient had died in an array of acute respiratory failure and one patient was lost to follow-up. DILD in scleroderma is rare and seldom reveals the disease, it affects the patient's prognosis especially when associated with arterial pulmonary hypertension.

[Pott's disease (about 16 cases)]. / Mal de Pott (à propos de 16 cas).

INTRODUCTION: Pott's disease or spinal tuberculosis is rare, but represents the most common form of osteo-articular tuberculosis in endemic countries. MATERIAL AND METHODS: [corrected] From January 2000 to December 2010, we collected 16 cases of Pott's disease. We analyzed clinical and radiological profile, means of confirmation and treatment. RESULTS: Spinal and chest pain were the most frequent signs. Four patients had neurological signs. The diagnosis was made by the detection of bacillus in the pus of paravertebral abscess in six cases, by histological study of vertebral biopsy in five cases, biopsy of another associated lesion in one case and in front of radio-clinical arguments with good clinical evolution under antibacillary treatment in four cases. The antibacillary treatment associating four drugs was indicated and correctly followed by all patients. Surgical drainage was associated in five cases. The evolution was good in all cases. DISCUSSION: Diagnosis of Pott's disease is late when there is no neurological sign. Imaging allows to make early diagnosis with MRI. Prognosis is good when treatment is started early.