Search

Background: Gastrosplenic fistula (GSF) is a rare and potentially fatal complication of various diseases. Lymphoma is the most common cause. It can occur spontaneously or after chemotherapy. This rare entity may be misdiagnosed. Treatment modalities include surgical resection, chemotherapy or a combination of both. Actually, more and more are headed towards a chemotherapy regimen only to treat GSF.Case presentation: Here we report two cases of GSF due to diffuse large B cell lymphoma patients. First case is of a 54-year-old woman with a primary enormous spleen diffuse large B cell lymphoma (DLBCL) leading to a spontaneous fistula in the stomach. The second one is of a 48 year-old-male patient with a primary spleen DLBCL which fistula complicating chemotherapy. The evolution was fatal for both of them after undergoing surgeryConclusions: GSF complicating lymphomas is a rare disease entity, our case report and a systematic review of the literature may help physicians to diagnose and to treat it.

Patients with ferromagnetic cardiac devices, particularly cardiac implantable electronic devices (CIED) such as pacemakers or implantable cardioverter defibrillators, are often inappropriately deprived of magnetic resonance imaging (MRI) for safety reasons. This consensus document is written by a multidisciplinary working group involving rhythmologists, interventional cardiologists, echocardiographists and radiologists. Its objective is to establish good practice recommendations to optimize the management of patients with cardiac devices requiring MRI examination, while ensuring their safety and facilitating their access to MRI.

Silent strokes are damagesof brain not accompanied by symptoms suggestive of stroke. Currentepidemiological trends suggesttheirindependent association with atrial fibrillation (AF). However, this association is not yetwelldefined.To assess the prevalence of silent stroke in AF and determine itspredictivefactors.We carried out a cross-sectional study enrolling 37 patients followed for non-valvular AF in the cardiologydepartment. All participants had a clinicalevaluation and brain MRI.The mean age was 66 ± 7 yearswith asex ratio (M / F) of 0.76. The mostcommon class of AF was the persistent form (70%). Oral anticoagulant therapywasprescribedin 32 patients (94.1%). Silent strokewerereported in 9 patients (24.3%). Age ≥72 years and CHA2DS2VASc score ≥ 4 weresignificantlyassociatedwith silent strokes in the univariate study withsensitivities of 77.8% and 62.5% respectively and specificities of 78.6% and 92.3% respectively. In the multivariate study, only CHA2DS2VASc score ≥ 4 wasconsidered to be an independentpredictor of silent stroke in AF (p = 0.004; adjusted OR = 20; CI95%: 2.6-152.6).Our resultsregarding the association between silent strokesand AF confirmedpreviousevidence. Screening for theselesions in AF patients at high thromboembolicriskappears to be a relevant approachgiventheirpoorprognosis.

A cell-free DNA (cfDNA) assay would be a promising approach to early cancer diagnosis, especially for patients with dense tissues. Consistent cfDNA signatures have been observed for many carcinogens. Recently, investigations of cfDNA as a reliable early detection bioassay have presented a powerful opportunity for detecting dense tissue screening complications early. We performed a prospective study to evaluate the potential of characterizing cfDNA as a central element in the early detection of dense tissue breast cancer (BC). Plasma samples were collected from 32 consenting subjects with dense tissue and positive mammograms, 20 with positive biopsies and 12 with negative biopsies. After screening and before biopsy, cfDNA was extracted, and whole-genome next-generation sequencing (NGS) was performed on all samples. Copy number alteration (CNA) and single nucleotide polymorphism (SNP)/insertion/deletion (Indel) analyses were performed to characterize cfDNA. In the positive-positive subjects (cases), a total of 5 CNAs overlapped with 5 previously reported BC-related oncogenes (KSR2, MAP2K4, MSI2, CANT1 and MSI2). In addition, 1 SNP was detected in KMT2C, a BC oncogene, and 9 others were detected in or near 10 genes (SERAC1, DAGLB, MACF1, NVL, FBXW4, FANK1, KCTD4, CAVIN1; ATP6V0A1 and ZBTB20-AS1) previously associated with non-BC cancers. For the positive–negative subjects (screening), 3 CNAs were detected in BC genes (ACVR2A, CUL3 and PIK3R1), and 5 SNPs were identified in 6 non-BC cancer genes (SNIP1, TBC1D10B, PANK1, PRKCA and RUNX2; SUPT3H). This study presents evidence of the potential of using cfDNA somatic variants as dense tissue BC biomarkers from a noninvasive liquid bioassay for early cancer detection.

PurposeGastrosplenic fistula (GSF) is a rare and potentially fatal complication of various diseases, of which lymphoma is the most common cause. We aim through our work to relate two cases of GSF and to review literature. Methods We reviewed two cases treated in our department of GSF and made a research in Pubmed using the keywords “Gastrosplenic fistula” and “Splenic lymphoma”.Results GSF is a rare condition that can occur spontaneously or after initiation of chemotherapy. It arises from the rapid growth of tumour and invasion of surrounding organs. Diagnosis may be difficult to make and confused with splenic abscess. Treatment modalities include surgical resection, chemotherapy or a combination of both. Here we report two cases of GSF due to diffuse large B cell lymphoma patients. The first case is of a 54-year-old woman with a spontaneous fistula in the stomach. The second one is of a 48 year-old- male patient presenting a fistula after chemotherapy. Both patients died after surgery. ConclusionGSF is a rare but dangerous condition in which surgery is currently the preferred treatment.

The purpose of this study was to assess and analyze the radiation doses during head pediatric CT from different CT units within six Tunisian hospitals representing different geographic regions in order to optimize the dose given and minimize the radiology risk to this category of patients and towards the derivation of national diagnostic reference levels. Patient data and exposure parameters were collected for four age groups (

Résumé Les lymphomes pulmonaires primitifs sont des tumeurs rares représentant moins de 1% des tumeurs malignes du poumon. La forme la plus fréquente est le lymphome de type Mucosa-Associated Lymphoid Tissue (MALT). L'atteinte oculaire est aussi rare et elle est dans la plupart du temps localisée dans les glandes lacrymales. Nous rapportons l'observation d'un patient ayant présenté un lymphome pulmonaire de type MALT associé à une atteinte synchrone des glandes lacrymales. Cette observation illustre les aspects cliniques, radiologiques et évolutifs de cette entité qui sont peu spécifiques.

Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.

Resume Objectifs Relever l’ensemble des anomalies cardiaques decouvertes au cours des angioscanners thoraciques realises pour suspicion d’embolie pulmonaire (EP). Patients et methodes Etude retrospective portant sur 780 patients ayant ete explores par angioscanner pulmonaire avec determination des anomalies cardiaques notees associees ou non a une embolie pulmonaire. Resultats Des anomalies cardiaques ont ete notes dans 80 cas, associees dans uniquement 20 % des cas a une embolie pulmonaire. Les anomalies les plus frequentes etaient la dilatation des cavites cardiaques et les calcifications coronaires. Conclusion Il est important de verifier sur un angioscanner pulmonaire s’il existe ou non des anomalies cardiaques pouvant expliquer une symptomatologie thoracique en l’absence d’embolie pulmonaire.

Resume La tuberculose est une maladie infectieuse le plus souvent liee au Mycobacterium tuberculosis. Elle est frequente dans les pays en voie de developpement et son incidence est en hausse dans les pays developpes. L’atteinte pulmonaire est la plus frequente mais d’autres structures thoraciques peuvent etre touchees. La confrontation radioclinique reste la demarche diagnostique habituelle, mais sa confirmation ne peut etre que bacteriologique et/ou histologique. Le role de l’imagerie dans la prise en charge de la maladie est fondamental. Ses manifestations radiologiques varient en fonction de l’âge du patient, de son statut immunitaire et de ses antecedents de tuberculose. La radiographie standard reste l’examen de premiere intention malgre ses insuffisances. Elle permet d’evoquer le diagnostic sur l’aspect et le siege des lesions. La tomodensitometrie s’avere d’un grand interet pour le diagnostic positif en cas de discordance radioclinique grâce a une semiologie bien codifiee. Elle est fondamentale pour le diagnostic des complications parenchymateuses, vasculaires, ganglionnaires, pleurales, parietales ou mediastinales. Elle permet egalement de faire un bilan des sequelles. L’IRM et le PET-scanner ont des indications limitees. Nous nous proposons a travers cet article d’illustrer les differentes formes radiocliniques, les formes particulieres et sequellaires de la tuberculose thoracique ainsi que ses complications en situant la place des differents moyens d’exploration par l’imagerie.

Thymomas are the most common neoplasms of the mediastinum. It is common that thymoma invades neighboring structures in the thorax, but direct polypoid tumor growth into the airway is extremely rare. We report a rare case of invasive thymoma with polypoid endobronchial growth in a 66-year-old woman. Computed tomography demonstrated an anterior mediastinal tumor which extended into the right upper lobe. Endoscopic examination revealed a polypoid tumor which occluded the right upper bronchus. A biopsy specimen obtained from the intraluminal mass was very suggestive of thymoma. The patient had no parathymic syndrome. The tumor was resected with the right upper lobe. The final post-operative tissue findings confirmed a type B2 thymoma of the World Health Organisation classification.

Cardiovascular magnetic resonance (CMR) has become the examination of choice in case of suspicion of acute myocarditis. Late gadolinium enhancement (LGE) imaging is very important to establish this diagnosis. Cine MRI sequences are useful for the study of the myocardial contractility. The purpose is to estimate the value of cine MRI sequences before and after injection for the diagnosis of acute myocarditis compared with late gadolinium enhanced sequences.We prospectively included 40 patients having a high suspicion of acute myocarditis and examined using a 1.5 Tesla CMR. Cine MRI sequences before and after injection were performed. The protocol also include T2-weighted short- tau-inversion-recovery (STIR T2) fast spin echo MRI and LGE imaging eight minutes after injection with visual adjustment of inversion time.Delayed enhancement was found among 23 patients. Fifteen patients (65 %) presented a spontaneous hyper signal detected visually on Cine MRI sequences before injection and 11 patients (48 %) on STIR T2. The hyper signal on Cine MRI sequences after injection of gadolinium was the same topography that the late raising at 23 patients. In addition, we highlighted a significant difference between this hyper signal before injection and the left ventricle ejection fraction (p=0.022) as well as with the telesystolic volume of the left ventricle (LV) indexed by the body mass (p=0.039).Our study suggests that Cine MRI sequences after injection are of equal performance in the diagnosis of acute myocarditis as the LGE sequences and its contibution is important when we want to shorten the examination or when inversion time isn't optimal.

Resume Les tumeurs primitives de la trachee sont tres rares. Chez l’adulte, la majorite d’entre elles sont malignes. Les schwannomes sont des tumeurs benignes, exceptionnelles dans leur localisation tracheobronchique. Nous rapportons le cas d’un patient âge de 37 ans, traite pour asthme depuis 4 ans, hospitalise pour dyspnee d’aggravation progressive resistante au traitement. La tomodensitometrie thoracique et la fibroscopie bronchique mettaient en evidence une image intratracheale se prolabant au niveau de la bronche souche gauche. Une resection chirurgicale a ete indiquee apres echec d’une tentative de desobstruction au laser. Une excision de la base d’implantation de la tumeur a ete realisee, emportant les 2 premiers anneaux de la bronche souche gauche avec retablissement de la continuite. L’analyse histologique de la tumeur affirmait le diagnostic de schwannome sans caractere suspect de malignite. La surveillance ne constatait pas de recidive. Nous concluons a partir de ce cas qu’il faut penser a une masse intratracheale chez les patients presentant une dyspnee ou souffrant d’un asthme refractaire au traitement habituel.

We report the case of a 53- year-old man in whom the diagnosis of small cell lung cancer (SCLC) was made by the biopsy of a mass of the right trapezius muscle. A tumor was revealed on flexible bronchoscopy which pathological study showed tuberculosis (TB). Chest computed tomography (CT) scan revealed findings related to the SCLC associated to micronodules and nodules compatible with pulmonary TB. Cerebral CT scan revealed a nodule of 4.5 mm in diameter presenting enhancement after contrast material injection thought to be a metastasis. The patient was administered antitubercular treatment. Fiveteen days later, the patient started chemoptherapy with etoposid and carboplatin. A control cerebral CT scan realized after the end of the chemotherapy (2 months and a half of antitubercular treatment) revealed numerous cortical and subcortical infracentimetric nodules with contrast enhancement with a tentorial and subtentorial location considered to be in relation with cerebral miliary TB. The nodule discovered on the first cerebral scan was therefore a posteriori considered to have been of tubercular origin. The PS of the patient rapidly worsened. He presented mental confusion and died in some days.

Primary sarcomatoid carcinoma of the lung are rare non small cell lung cancers (NSCLC) recently individualized by the World Health Organization. Their clinical, radiological and evolutive features are not well known but they seem to have bad prognosis with rapid progression and early metastases. Although they are felt to be chemo-refractory they must be treated as the other subtypes of NSCLC.To evaluate clinical, radiological and evolutive features of primary sarcomatoid carcinoma of the lung.We report the cases of five patients presenting sarcomatoid carcinomas and assess their clinical and evolutive data.One patient had stage IIB cancer underwent surgical resection and adjuvant chemotherapy, he is alive 18 months later; another had stage IIIB was treated by radio and chemotherapy and is alive 6 months later; and three other patients had stage IV in whom one had chemotherapy, the two others did not because of they had performance status. They died 1 to 3 months after the diagnosis.Lung sarcomatoid carcinomas are of bad prognosis. Their treatment is nowadays not well established. Much more good studies are therefore needed.

Objectifs pedagogiques Decrire la semiologie IRM du syndrome de Gayet-Wernicke. Connaitre les principales presentations cliniques du syndrome de Gayet-Wernicke. Materiels et methodes Etude retrospective de 8 dossiers de patients ayant presente un syndrome de Gayet-Wernicke durant une periode de 2 ans entre juin 2013 et juin 2015 avec une symptomatologie dominee par des troubles de conscience et des paralysies occulo-motrices. Ils ont ete explores par une IRM cerebrale avec une injection de gadolinium. Resultats L’IRM cerebrale a montre des lesions bilaterales et symetriques des regions peri-aqueductales (5 patients), regions paraventriculaires (4 patients), des thalami (7 patients), des corps mamillaires (7 patients) et du toit du V4 (3 patients) sous forme d’hyperintensites en sequences T2 et fluid-attenuated inversion recovery (FLAIR). Le coefficient apparent de diffusion au stade precoce est eleve. Ces lesions correspondent a un œdeme vasogenique et sont donc generalement reversibles apres un traitement par de la thiamine. Dans trois cas, l’IRM a montre des lesions hyperintenses avec un coefficient de diffusion abaisse en rapport avec un œdeme cytotoxique. Conclusion Le syndrome de Gayet-Wernicke est une complication neurologique grave secondaire a une carence en vitamine B1 et necessitant une prise en charge diagnostique et therapeutique urgente. L’IRM cerebrale doit etre indiquee de premiere intention chez tout patient denutri presentant des troubles oculomoteurs, une ataxie ou des troubles de la vigilance.