[Is mammography useful in Paget's disease of the breast?]. / La mammographie est-elle utile dans la maladie de Paget du sein?

PURPOSE: Interest of the mammogram in Paget's disease of the breast, especially for a therapeutic decision in otherwise asymptomatic women with Paget's disease, who would be candidates for conservative treatment. MATERIALS AND METHODS: 61 women with histological Paget's disease of the nipple, treated by mastectomy, were retrospectively analyzed with clinical, radiological and pathological correlations. RESULTS: An underlying carcinoma was found in 60 cases (98.4%), atypical epithelial hyperplasia in one. In the 24 women without breast palpable mass, 17 (71%) had a normal mammogram, 12 (50%) had carcinoma with an invasive component, 14 (58%) had a cancer at a distance from the nipple, 17 (71%) had a multifocal carcinoma. All 37 women with a palpable mass had a pathological mammogram, 36 of them had carcinoma with an invasive component, 35 (95%) a cancer at a distance from the nipple, 31 (84%) a multifocal carcinoma. CONCLUSION: Mammogram is of limited value in management of Paget's disease of the breast for women without breast palpable mass; it can not predict the site of malignancy, nor the invasive component.

Computed tomography of superior mesenteric vein thrombosis following appendectomy.

During a 5-year period, superior mesenteric vein (SMV) thrombosis was detected with computed tomography (CT) in six patients shortly after an appendectomy. No sign of SMV was present at appendectomy, and a period of more than 2 weeks free of clinical symptoms had elapsed between the appendectomy and the onset of the SMV thrombosis. In four cases, the appendicitis was complicated. These patients had nonspecific signs and symptoms, although two of them had elevation of blood hepatic enzyme levels. In all cases, postcontrast CT demonstrated enlargement of the SMV, with well-defined enhancement of the vascular wall and an intraluminal clot. In one case, CT showed extension of the thrombus to the portal vein with the presence of low-attenuation areas in the liver, consistent with hepatic infarcts. Two patients had predisposing diseases: idiopathic hypersplenism in one case and chronic hepatic disease in the other. SMV thrombosis is a possible complication of appendicitis, and early appendectomy in appendicitis can prevent this complication. Moreover, as in any abdominal surgery, early appendectomy may be complicated by thrombosis of the SMV, thus creating problems of postoperative diagnosis. The complication is more frequent when the initial operation is performed under difficult conditions (peritonitis), or when the patient presents with a coagulopathy. CT is useful in the diagnosis of SMV thrombosis, thus leading to early management with anticoagulant therapy, with a view to avoiding complications such as intestinal ischemia, portal vein thrombosis, and hepatic infarction.

Small bowel obstruction: role and contribution of sonography.

The purpose of this study was to determine whether sonography provides additional clinical information in patients suspected of small bowel (SB) obstruction. During a period of 30 months, in a prospective setting, we evaluated with sonography 123 patients suspected of SB obstruction. Sonographic examinations of the entire abdomen were performed with state-of-the-art, real-time, grey-scale equipment. Fourteen patients were labelled 'gassy' and no added information was provided following abdominal ultrasound. Sonography confirmed the SB obstruction in 82 cases with 5 false positives, resulting in a specificity of 82.1 %. Sonographic examinations were negative in 27 cases with 4 false negatives and a sensitivity of 95 %. The accuracy was 91.7 % when the 'gassy' patients were excluded and 81.3 % overall. The aetiology of the ileus was detected by sonography in 13 cases of paralytic ileus (54.1 %) and in 57 cases of mechanical ileus (71.4 %). It is concluded that ultrasound, which is a non-invasive, portable and even bedside imaging procedure, appears accurate in confirming a SB obstruction and in determining the aetiology of SB obstruction.

[Drug-induced stenosis of the small bowel. Value of enteroclysis]. / Lésions médicamenteuses sténosantes du grêle. Intérêt de l'entéroclyse.

The purpose of this study is to characterize radiographically drug-induced ulcerated stenosis of the small bowel and to determine the contribution of enteroclysis in the diagnosis of this rare entity. The clinical pathologic and radiographic findings of 12 patients with drug-induced stenosis (non steroidal anti-inflammatory drugs or potassium salts) evaluated by enteroclysis were reviewed. Three radiological features of strictures were differentiated: diaphragm like stricture, short stricture and stenotic ulceration with girdle aspect. All formulation of NSAIDS and potassium salts are capable of causing the same radiographic and pathologic patterns. Enteroclysis improves the detection of these lesions since intestinal overdistension and correct filling of the loops increase the visualization of small obstructive stenosis and the detection of superficial ulcers. Thus, any patient who has an abnormality of the small bowel should be asked about use of drugs, especially when diaphragm-like strictures are found.

Carney syndrome: radiologic features.

The Carney syndrome, first described in 1977, is characterized by the association of three rare tumours of different origin: gastric leiomyosarcoma, functioning extra-adrenal paraganglioma and pulmonary chondroma. The authors describe a young woman in whom gastric leiomyosarcoma, retroperitoneal paraganglioma and pulmonary chondroma developed. Radiologists should be aware of the possible association of these three types of neoplasia, because simple radiologic examination of the abdomen and the chest may lead to the correct diagnosis.

Ultrasonography of the ankle and the hindfoot.

High-resolution ultrasonography (US) has proved an excellent noninvasive and inexpensive modality for examining the extremities. This pictorial essay illustrates the US appearance of bony and soft-tissue abnormalities of the ankle and the hindfoot. The role of US as an adjunct technique to complement conventional radiography is stressed. The advantages of US in examining traumatic, inflammatory and infectious lesions and soft-tissue masses are discussed.

Computed tomography (CT) and magnetic resonance imaging (MRI) of pleural masses.

Depending on the location, size, and underlying histologic features, pleural masses may produce a large spectrum of findings. While a number of imaging modalities may be used, plain chest radiographs remain the most common examination in the initial assessment of these patients. In this article, we review the use of two noninvasive techniques: computed tomography and magnetic resonance imaging. For the purpose of this review, localized pleural masses and diffuse pleural masses are discussed separately. Among the various pleural masses, metastatic disease represents the most frequent neoplasm.

[Imaging of acute abdomen. Contribution of new radiological methods and practices]. / Imagerie de l'abdomen aigu. Apport des nouvelles méthodes et pratiques radiologiques.

The acute abdomen is a sudden clinicoradiologic problem that may be resolved promptly by an excellent collaboration between the referring physician and the radiologist. The advent of CT and US has modified the diagnostical approach of acute abdomen. As diagnosis should be assessed in the shortest time with the greatest care and accuracy, it is necessary to choose the appropriate available examinations, reducing the time needed to establish a diagnosis and decreasing the number of examinations required. Thus, this paper is geared toward the determination and the choice of the more accurate procedure for the clinical presentation of acute abdominal emergencies.

[Imaging of HIV+ abdominal involvements]. / Imagerie des atteintes abdominales HIV+.

Abdominal symptoms are among the most frequent complaints of patients with AIDS. Because precise diagnosis from symptoms alone is difficult, the contribution of radiologist is important to fill in evaluating the cause of various illnesses. The review describes common clinical symptoms and lists the most likely causes with discussing the most appropriate imaging evaluation. For diagnosis and treatment, the most frequent and characteristics radiographic findings are described.

Ultrasonography of a bone metastasis.

The authors report a case of cortical bone metastasis presenting as a soft-tissue mass in the thigh. Because of the initial clinical presentation, ultrasonography was performed first; plain radiography and a percutaneous biopsy provided additional diagnostic information. The authors describe the ultrasonographic findings and the role of this imaging technique in the final diagnosis of such lesions.