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Real time ultrasonography of the neck, using a sectorial scanner with an ordinary 5 MHz transducer, was performed on 24 patients with hypercalcemia. 21 of them were suffering from primary hyperparathyroidism and 3 from a severe paraneoplasic hypercalcemia. There were 18 true positive, 3 false positive, 1 false negative and 2 true negative. The sensibility and the negative predictive value of the method are 83%. The specificity and the negative predictive value are 95%. The accuracy is 91%. Real time ultrasonography of parathyroid glands is possible with a sectorial scanner using an ordinary 5 MHz transducer and is systematically done, in our institution, before cervicotomy.

Results are reported of a prospective study of 79 CT scan examinations in 50 patients who had undergone sternotomy for cardiovascular surgery. In 69 cases the examination was conducted during the course of a progressive postoperative mediastinitis treated surgically. Mediastinitis was confirmed in 13 cases, including 12 relapses. In 2 cases the CT scan image was normal (2 false negatives) whereas mediastinal drains had been inserted. The CT scan image of mediastinitis shows mainly hypodense fluid collections (0 to 16 UH) in anterior mediastinum or between sternotomy borders (8 of 13 cases). But this type of image, detected 11 times in the absence of recurrence (favorable course), can result from a residual serous collection after ablation of drains. In 8 cases, a CT scan-guided puncture (7 cases) or one under ultrasound control (1 case) eliminated recurrence. The CT scan imaging also allowed diagnosis of 5 cases of osteitis, confirmed surgically. These findings indicate the definite interest of CT scan imaging in postoperative follow-up review of median sternotomies. It appears to be particularly indispensable for surveillance of surgically treated mediastinitis, because of the serious consequences of relapses and the often clinically silent chronic bone lesion. However, the possibility of residual serous collections emphasizes the importance of the clinical context and should lead to guided puncture investigation in doubtful cases.

The acute effects of extracorporeal shock wave lithotripsy (ESWL) on morphology and function of the kidney were prospectively evaluated by abdominal radiography, ultrasonography and contrast-enhanced computed tomography, in 80 treated kidneys. Two types of complications were demonstrated: 1. Obstruction of the ureter by stone fragments in 25% of cases. Relief procedures became necessary in 5 patients (6% of the 80 cases). 2. Limited injuries of the kidney and perirenal spaces in 44% of cases: parenchymatous abnormalities 17.5%; subcapsular hematoma 12.5%; perirenal fluid collection 24%. No treatment was necessary and morphologic abnormalities disappeared in one or two months post-ESWL. Severe ureteral obstruction after ESWL seems to be related to stone size. No definitive evidence that kidney's injury was related to the number of shock waves applied to the kidney was found.

An ultrasonogram (US) of the pancreatic duct was performed in 59 patients prior to a retrograde pancreatography (ERCP). In 41 patients with normal ERCP, the pancreatic duct in the body of the pancreas was found to be on US less than 2 mm. The diameter measured on ERCP on the same portion of the pancreas was found to be 2,5 larger. On 18 abnormal ERCP, 3 patients had normal US defined by a pancreatic duct less than 2 mm in internal diameter and a normal pancreatic parenchyma. These 3 patients had mild ductal abnormalities of chronic pancreatitis on ERCP, undetectable by US. These 3 false negative cases give to a normal pancreatic US a negative predictive value of 93%. The injection of 5 normal autopsy pancreas, combined with US of the pancreatic duct, showed that neither the radiological magnification nor the pressure of injection accounted for the discrepancy between US and ERCP in the measurement of the pancreatic duct diameter. It is thought to be due to an underestimation of the internal diameter of the duct which may be related to an apparent thickening of its highly echogenic walls.

In ten patients where ampullary carcinoma was proved, ultrasonography has been performed in 9 cases and failed in 1 case. The results reported, could be put into two different groups. In 7 cases out of 9, sonogram did not show any specific signs: In 3 of these cases, it mimicked a pancreatic carcinoma; in the other 4 cases, dilatation of biliary and/or pancreatic ducts has only been evaluated. In the 2 remaining cases (20% of the 10 patients of the series) the diagnosis of ampullary carcinoma could be suggested on sonographic features. It showed the "double duct sign" and a bulging mass filling the lumen of the distal common bile duct. In one of these 2 cases, the mass was also detectable in the second duodenum, previously filled with water. Endoscopy with biopsy is the most reliable procedure in the diagnosis of ampullary carcinoma but the interest of ultrasonography is: 1 degree to show suggestive findings when the tumor bulges in the common bile duct and the duodenum; 2 degrees to evaluate the tumor extension in the pancreatic parenchyma.

The authors report 2 new cases of unilateral ureteral obstruction due to a retroperitoneal fibrosis diagnosed by ultrasound examination. Retroperitoneal fibrosis presents as a hypo-echogenic, homogeneous mass, anterior to the sacral promontary, extending more or less cranially or caudally around the aorta and the iliac vessels where it gets a circumferential appearance. The complete regression of the mass has been followed by ultrasound on one patient. The authors underline the diagnostic problem posed with the R.P.F. secondary to metastatic neoplasm and discuss the place of ultrasound guided fine needle biopsy performed on one patient for the diagnosis of the affection.

The authors report 2 cases of unilateral non functioning hydronephrotic kidney, associated with homolateral bladder tumoral filling defect. Cystoscopy and histology showed a non infiltrating tumor. In one case, sonography showed a diffuse tumoral proliferation from the renal pelvis to the bladder and in the other case revealed a tumor located in the lower ureter prolapsed into the bladder. Both were non infiltrating ureteral tumors on histologic examination. These sonographic features, suggesting that the level of obstruction was not the bladder, accounted for the contradiction between urographic findings and lack of histological infiltration.

Three cases of bone hydatidosis of pelvis with invasion of soft tissues provided data on the effectiveness of CT scan and ultrasound imaging for diagnosis, evaluation of extension and follow up surveillance of this affection. Two of the three patients treated medically were followed up by review CT scan and ultrasound examinations. The two techniques were found to be effective for detecting recurrence and for surveillance of hydatid lesions of soft tissues during medical therapy.

Clinical, ultrasound and CT scan examinations were carried out in 9 patients with secondary muscle lesions. All muscles can be affected but there was a marked predominance of psoas lesions (6 of the 9 cases). Two contrasting clinical pictures are seen. Secondary muscle tumors can occur during evolution of a known treated cancer (5 of the 9 cases), revealed usually by large, rarely painful, mass. CT scan imaging shows a heterogeneous mass taking up contrast and often partially necrotic, the lesions appearing hypoechogenic or heterogeneous on ultrasound examination. Certain lesions can be totally necrotic. In some cases (4 of the 9 patients) the muscle metastases revealed the presence of a tumor. Symptomatology may be atypical and lead to a delay in diagnosis. Fine needle puncture biopsy can detect the secondary origin of the muscle lesion and also the primary tumor site (4 out of 9 cases), bronchopulmonary and colon cancer predominating. Images are however non-specific and in the absence of NMR imaging the muscle or lymph node metastases can be confused, although this has no practice consequences since treatment is identical.

A case relative to an isolated tuberculous lesion of a vertebral arch associated with a paravertebral abscess is reported. The authors insist on the rarity of this location. They underline the role of the computed tomography for the positive diagnosis and the precise extent of lesions and the interest of the biopsy under ultrasonography for the bacteriological and histological diagnosis.

The authors report a new case of intra-peritoneal spontaneous rupture of the bladder, which was observed during a voiding urethro-cystography. Urodynamic studies on this patient showed a neurologic bladder which was due to a diabetic neuropathy.