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Spinal tuberculosis is a frequent skeletal involvement in tuberculosis. We report 122 cases between 1983 and 1998 of Pott's disease explored by plain radiographies in all cases, CT-scan in 22 cases and MRI in 6 cases. The lesion involved one localization in 98 cases, two localizations in 9 cases and multiple localizations in 15 cases. The usual form associating the discal and vertebral involvement was noted in 70%. Unusual forms were seen in 30% of the cases The localizations were: posterior arch (20 cases), centrosomatic (10 cases), suboccipital (4 cases) and subligamentar (2 cases). In addition, the CT scan noted vertebral lesion with soft tissue abscess in all cases and epidural lesion in 9 cases. MRI performed in 6 cases showed epidural lesions in 4 cases: epiduritis (2 cases) and abscess (2 cases). The disco-vertebral puncture-biopsy, performed in 12 cases, confirmed the diagnosis in 7 cases. The diagnosis of Pott's disease was confirmed biologically in 30 cases. Radiographic exploration of Pott's disease is improved by the contributions of CT and MRI which can identify sequestra, perilesional sclerosis and epidural or soft tissue abscesses. Discovertebral aspiration biopsy provides the key to diagnosis.

Authors report spontaneous necrosis of a sellar hemangiopericytoma, in a 44 year old man, revealed by a right cavernous syndrome. The initial CT scan showed a right sellar and parasellar spontaneous hyperdense process, intensely and homogeneously enhanced by contrast-agent. This process invaded the right cavernous sinus and extended to the sphenoid sinus. Magnetic resonance imaging showed a lesion in isointense on T1-weighted sequence and slightly hyperintense on T2-weighted sequence, with an intense and homogenous enhancement. The follow-up CT scan performed 6 months later, showed a total necrosis of the lesion. Angiography showed a slightly vascularised process, with mass effect on the carotid and sylvian vessels. The sellar and parasellar localization of hemangiopericytoma is rare. The spontaneous necrosis is exceptional, but it enabled us to distinguish it from meningioma.

The authors report a case of an heterotopic pregnancy where the transabdominal US was more useful than endovaginal US. The embryon in this case was located in upper zone of the right iliac fossa, inaccessible to endovaginal US. Both methods are complementary.

Purpose: To report the radiological polymorphism of angiomyolipoma (AML)., Material and Methods: [corrected] A retrospective series of eight cases of AML explored by US and CT scan. The diagnosis was radiological in seven cases and histopathological in one case., Result: Five cases of AML were discovered fortuitously. The tuberous sclerosis of Bourneville disease (TSB) was noted in five cases. The cverage age was 37 years with female predominance noted in seven cases. The AML were multiple in half cases all of thein had TSB. The tumoral size ranged from 0.5 cm and 20 cm. The US showed an homogenous hyperechogenique mass in six cases and heterogenous in two cases. The CT scan showed polymorph parenchymal lesions. The fatty component was detected in seven cases. An intratumoral bleeding was noted in one case., Conclusion: The radiological feature of AML is variable, related to tumoral size. It's typical when a tumor of kidney contains fat. An association with TSB is a supplementary argument of diagnosis.

The authors report a case of bilateral malignant teratoma of the mediastinum in a 40 year old female presenting with chest pain. Two separate bilateral soft tissue masses were noted in the mediastinum at imaging. On the right side, the mass was heterogeneous with large calcification and infiltration of the pericardium. On the left side, the mass was well defined, heterogeneous and without evidence of local invasion. The analysis of samples obtained by US guided puncture biopsy and surgical specimen of the two masses confirmed the diagnosis of pluricellular malignant teratoma. Mediastinal malignant teratomas represent 1 to 5% of all mediastinal tumors. To our knowledge, no case of synchronous bilateral mediastinal teratoma has never been reported.

Purpose: Analysis of imaging features of malignant stromal tumors of the small bowel and review of literature., Material and Methods: 9 cases of malignant stromal tumor of the small bowel with histological proof were imaged at US (8 cases), small bowel series (9 cases) and CT scan (3 cases)., Results: There were 6 cases of leiomyosarcoma and 3 cases of malignant schwannoma. Tumors involved the jejunum in 3 patients, the ileum in 4 patients, and the duodenum in 2 patients. The main clinical presentation was an abdominal mass (8 cases), which appeared heterogeneous and hypoechoic with eccentric lumen at US confirming its GI origin (7 cases). Small bowel series showed a bulky cavitary mass opacified via a thin fistula (7 cases), an ileo-ileal intussusception (1 case) and enlarged duodenal lumen (1 case). CT performed in 3 cases showed an intraperitoneal mass with soft-tissue density. A communication with the GI tract was noted in 1 case, and in another case, it showed an intestinal intussusception. US guided biopsy performed in 3 cases provided diagnosis in 2 cases (malignant schwannoma, leiomyosarcoma). Tumor growth was exophytic in 8 cases and dumbbell-shaped in 1 case., Conclusion: The imaging features of malignant stromal tumors of the small bowel are similar. It varies with the type of tumor growth and its size. The diagnosis may be suggested based on imaging features.

We report a series of 10 cases of centrosomatic tuberculosis of the spine. The mean age of the patients was 36 years. Plain x-rays of the spine showed isolated defects in 3 cases, a defect with wedge fracture in 3 and a wedge fracture alone in 2. A sequestrum was found in 2 cases and bony condensation around the defect in 6. A CT scan performed in 3 cases showed, in addition to the bone lesions, a perilesional bony condensation in all cases. Soft tissue abscess formation was noted in 1 case and epidural involvement in the 2 others. MRI performed in 2 cases evidenced an alteration of the vertebral body signal with localized anterior epiduritis at the site of a small epidural abscess. CT scan and MRI contribute usefully to the radiographic diagnosis of centrosomatic tuberculosis, evidencing sequestra, bony condensation at the periphery of defects, and the presence of soft tissue abscesses and or epidural involvement. When these signs are absent, the differential diagnosis may be difficult with other causes of tumor formation, requiring vertebral biopsy.

We report a case of dermoid cyst arising in the cavernous sinus and parapharyngium areas through the foramen lacerum. A 12-year-old girl was hospitalized in October 1966 for progressive intracranial hypertension. CT before a prior surgical intervention in 1994 showed an intracranial process suggesting a dermoid cyst. CT performed in October 1996 showed a temporal process at the left side measuring 8 cm x 5 cm and well circumscribed with a thin wall. This process extended towards the parapharyngium area through the foramen lacerum. The exocranial part measured 4 cm in diameter. The density of the process strongly suggested a mature dermoid cyst with fatty and calcium components. The histology study confirmed the diagnosis of dermoid cyst. The frequency of intracranial dermoid cysts is 2 to 3 times less than that of epidermoid cysts. This is an uncommon process accounting for 1% of intracranial tumors occurring in children. In the sustentorial spaces, the process occurs more frequently in the parasellar area. To our knowledge, exocranial extension has not been reported to date.

Angiosarcoma of the breast in an uncommon entity. The authors report a well documented case of angiosarcoma. The patient, a 23 years old woman, had a voluminous mass of the left breast without inflammation. The evolution was rapidly fatal. Physical examination revealed a large painful breast mass with purplish discoloration cutaneous area in front of the lesion. The palpation revealed a thrill. The mammography had shown an area of increased density in the left breast. A complementary ultrasound examination detected a well circumscribed voluminous mass with hypoechogenic heterogenous echostructure. The Doppler examination detected a venous blood flow in the tumor. This finding was compatible with vascular tumor as angioma or angiosarcoma. The angioscanner showed a peripheral vascular enhancement and a centripetal diffusion of the contrast product. This vascular kinetic is seen commontly in the angioma. Magnetic resonance imaging in the T1 and T2 relaxation times detected an intermediate signal mass with bleeding areas. The patient had had a mastectomy and the histopathologic examination confirmed the diagnostic of angiosarcoma. The radiological aspacts of angiosarcoma of the breast are discussed depending on the literature data.

Objective: We evaluated arteriographic findings and endovascular treatments of eight patients who had bleeding iliac artery pseudoaneurysms and who had undergone radiation therapy (3000-6500 rad [30-65 Gy]) and surgery for pelvic malignancies., Conclusion: Angiography revealed contrast media extravasation in 75% of patients who had bleeding iliac artery pseudoaneurysms and failed to show the source of bleeding in 25%. The patients who had positive findings at angiography were all successfully treated percutaneously, although two patients required additional bypass surgery. Among embolic materials, coils and balloons were safe and efficient, whereas cyanoacrylate was unsafe and led to complications in two of three patients. A covered stent, which was not available for most of our patients, was used in one patient and may be an effective means of treating pseudoaneurysms.

Unlabelled: Transthoracic needle biopsy is a reliable method for the diagnosis of thoracic lesions, specially when they are peripleral., Aim: The main objective was to evaluate the results of US guidance for thoracic needle biopsy in 159 cases., Result: Overall sensitivity was 83% as tissue was obtained in 132/159 cases. In 24 cases, 2 or 3 biopsies were necessary. In 17 cases, analysis was made on cytology only with a 70.6% sensitivity. One pneumothorax and two cases of hemoptisies were encountered., Commentary: US guidance is a useful method for the diagnosis of peripheral thoracic masses, yielding a high sensitivity and a very low complication rate.

Thyroid disease is a very common disease, essentially affecting women, and raises diagnostic and therapeutic problems. The objective of this study was to specify the value of ultrasonography in the diagnosis and aetiological orientation of these lesions, based on a retrospective study of 100 patients. The results of ultrasonography were compared to the histological results. The aetiologies detected were dominated by benign lesions, particularly adenomas (56 cases), dystrophic goitres (32 cases) and cancers (7 cases). Ultrasonography allowed the detection of clinically impalpable nodules with no isotope scan signs in 11% of cases. The ultrasonographic appearance of benign nodules was variable. Solitary nodules were detected in 63 cases. They were hyperechoic in 15 cases, isoechoic in 8 cases, cystic in 9 cases, and mixed in 31 cases. A peripheral clear halo was revealed in 25 cases and macrocalcifications were present in 17 cases. Malignant lesions were visualized in 7 cases and were solitary in 5 cases. Solitary lesions had a hypoechoic echostructure in 1 case, an isoechoic echostructure in 2 cases and a mixed echostructure in 2 cases. The margins were poorly demarcated in 3 cases, and circumscribed without peripheral halo in 2 cases. Cervical lymphadenopathy was detected in 2 cases. Graves' disease, diagnosed in 2 patients, showed a diffuse hypoechoic appearance of the entire thyroid gland. Ultrasonography is a sensitive morphological method for the diagnosis of thyroid lesions. A detailed and precise analysis of the ultrasound signs of the lesion can suggest that benign or malignant nature of the lesion, which can be completed by Doppler-ultrasound and especially ultrasound-guided needle biopsies.

Appendicular mucocele is a rare lesion presenting a combination of several histological lesions. It generally ruptures into the peritoneum and rarely into the retroperitoneum. The objective of this study was to examine the various radiological appearances of appendicular mucocele and to report three cases of mucocele which ruptured into the retroperitoneum. This retrospective series of 6 cases of histologically confirmed appendicular mucocele was collected by the Central Radiology Department of Ibn Rochd University Hospital in Casablanca. The mean age of the patients was 61.6 years (33 years-77 years) and the sex ratio was 4/2. A plain abdominal X-ray and ultrasonography were performed in all patients. Five patients were examined by CT scan and two underwent a barium enema. Five out of six mucoceles ruptured: into the peritoneal cavity in 2 cases with gelatinous ascites and into the retroperitoneum in 3 cases. The plain abdominal X-ray showed a mass in the right flank, which was calcified in 2 cases. Ultrasonography and CT scan were suggestive of the diagnosis of appendicular mucocele in only two cases. The case of non ruptured mucocele consisted of a clearly delimited, thin-walled collection. A loculated effusion with scalloping on the liver was observed in the two cases of gelatinous ascites. In the three cases of mucocele rupturing into the retroperitoneum, ultrasonography and CT scan showed a loculated retroperitoneal collection. This collection extended into the right psoas in 2 out of 3 cases. Gelatinous ascites is the usual complication of appendicular mucocele; but in rare cases of mucocele of a retrocaecal appendix, the mucus may enter the retroperitoneum.

The authors report an exceptional case of spinal compression following an isolate rib hydatidosis. The CT scan has suspected the diagnosis. The authors recall the anatomoclinic features and specify the radiologic aspects of the osseous hydatidosis, especially the rib's localization which is very rare. MR imaging in addition of its diagnosis role showing a very evocative cyst images, is the exam of choice in order to appreciate the disease's extent and the degree of medular sufferance.

The authors reviewed 135 abdominal collections, collected at the Radiologic Central Service over four years. The average age of the patients was 40 years. The abscesses sit especially in the liver (54 cases) and the psoas muscle (43 cases). The percutaneous management was guided by ultrasonography in all the cases. The results were successful in 74%. Only 15 cases needed surgical therapy. The literature results are similar. The authors underline the percutaneous treatment interests, its efficacy, its complications and their therapy.

The authors report an unusual ultrasonographic aspect of hydatic cyst of kidney. They point out the importance of computed tomography in atypic hydatid cysts. Semiologic analysis of ultrasonographic and scanographic patterns, leads usually to the diagnosis of atypic hydatid cyst, in addition with serologic examination.

Benign renal cysts are usually asymptomatic: They require a minimally invasive treatment if they cause complaints such as flank pain or other compressive complications. During a 6 month period, 14 patients were treated for benign renal cyst using an ultrasound guided puncture. Presenting complaints were flank pain (12 cases), hypertension (1 case), polycythaemia (1 case). Only cyst of 5 centimeters diameter or more were assigned to this treatment. After needle puncture, the cyst was evacuated and then filled with sterile 95% alcohol. Clinical and anatomical results, after 6 months, were good in 9 cases, 2 cases showed good anatomical results with persistence of initial symptoms, and there were 3 failures corresponding to large cysts of 10 cm diameter or more. Percutaneous alcoholization of moderate benign cysts is a safe, simple and reliable method.

Tuberculosis of the spleen is not exceptional. The authors report ten cases which occurred with a predominance in young male adults. All patients had at least one other site of tuberculosis, without any HIV infection. All patients had focal splenic lesions in the form of scattered hypoechogenic and hypodense nodules. These nodules had a pseudo-tumor appearance in one case. CT-guided puncture was performed in one case. Splenic tuberculosis is not as rare as is sometimes thought. The CT-guided splenic puncture is now performed routinely and remains the ideal diagnostic approach.

The abscess of psoas are more often secondary to a loco-regional cause. The authors report a series of 42 abscess of psoas in 30 patients during 3 years. It concerns 16 men and 14 women witch a mean age of 35 years. The abscess was secondary to a spondylodiscis in 25 patients and primary in 5 patients. The size of the abscess was upper 5 cm with a variable ultrasound structure: liquid in 33 cases, hypoechogenic in 9 cases. All patients underwent a percutaneous treatment guided by ultrasonography. A single or multiple evacuation puncture with 16 Gauge needle were performed for 40 abscess. Complementary percutaneous drainage with 14 french drain was used in 3 cases. In 2 other cases, the percutaneous drainage was used firstly. The bacteriological study of puncture liquid isolated the germ in 8 cases. Evaluation has been assessed in only 29 cases. The recovery was reached in 12 abscess on 15 which were treated by a single puncture. In 10 abscess on 13 treated by multiple puncture; and in 4 abscess an 5 managed by drainage. The results demonstrate the accuracy of single or multiple drainage puncture associated with adapted antibiotherapy in the management of abscess.

The authors report a case of aneurysmal bone cyst in a female, revealed by a pelvic mass. Ultrasonography visualised the pelvic mass, its fluid content, internal septations and fluid level and displacement of surrounding structures. Sacral plain radiographs and computed tomography images showed trabeculated osteolysis involving the sacrum, sacro-iliac joint and adjacent iliac wing. The endopelvic component had a liquid-density varying between 15 and 30 HU, with contrast enhancement of its wall and internal septations.

Focal lesions of the spleen are due to multiple causes dominated by malignant lymphoma. The authors study the contribution of sonography in the diagnosis and etiology of these lesions based on a retrospective study of 38 cases, over an eight-year period. Hematological malignancies splenic metastases and splenic hydatid disease are the commonest lesions in this series. Sonography provides an etiologic diagnosis in the presence of highly suggestive features (hydatic cyst, hematomas) without requiring other investigations. The needle biopsy is necessary for any hypoechoic lesion, suggestive of a malignant etiology. CT is essential when a hemangioma is suspected.

The authors report on a retrospective series of 37 liver abscesses treated via the percutaneous route in 34 patients, in order to assess the efficacy of this method. One or more aspiration punctures were undertaken in 24 patients (70.6%), while percutaneous drainage was performed in 10 patients (29.4%). In 27 cases (79.5%), this percutaneous treatment resulted in a cure. Further surgical drainage, carried out in 7 patients (20.5%) was only required in 3 cases, twice due to the inefficacy of percutaneous drainage and once in the presence of three liver abscesses containing particularly thick pus. Ultrasonographic monitoring demonstrated a return to normal in 66.6% of cases, the persistence of a slight residual collection in 26.6% patients and one relapse, two months after percutaneous drainage. Two complications inherent to the percutaneous treatment were noted: a pneumothorax and a case of septicemia, both of which had a favourable outcome.

A retrospective series of 32 cases of hepatic abscess was collected in the radiology department of Ibn Roch University Hospital (Casablanca), over a period of 43 months (May 1989-September 1992). Among these 32 cases, 16 were amebic (based on the dysenteric syndrome and especially positive amebic serology) and 16 had pyogenic causes. All patients underwent ultrasound examinations. Only two cases had CT scan. The confirmation of the hepatic abscess was made by ultrasound guided percutaneous aspiration in 30 cases and laparotomy in 2 cases. The right lobe was concerned in all cases. The pyogenic abscesses were multiple in 62.5% cases, while the amebic abscesses were double in only one case. The amebic abscesses were larger than the pyogenic ones. The average volume was respectively 10.5 cm and 7 cm. Three ultrasound aspects were found. Hypoechogenic aspect was the most frequent (76% of amebic abscesses and 61% of pyogenic abscesses). The heterogenic aspect was found in 21% of amebic abscesses and in 36% of pyogenic abscesses. The anechogenic aspect was found in only one case of pyogenic abscess. A light and regular wall was found in 70% of amebic abscesses and in 51% of pyogenic abscesses. Referring to the literature, the various ultrasound signs of orientation towards an amebic or pyogenic etiology were found in this series, but we emphasize the very important role of ultrasound-guided percutaneous aspiration and amebic serology for the etiological diagnosis of hepatic abscess.

The authors report twenty-eight cases of superior vena cava thrombosis. They try to establish a correlation between the radiological features of thrombosis and the etiology. The etiology was Behçet's disease in 64% of cases, lung cancers in 14%, the mediastinal tuberculosis in 14%, systemic lupus erythematosus in 3.5% and undetermined origin in 7%. A normal meiastinal appearance slight widening of the superior mediastinum is noted in Behçet's disease, systemic lupus erythematosus and tuberculous mediastinal fibrosis. Superior vena cava thrombosis is extensive in Behçet's disease involving the subclavian vein and the azygos vein. An obvious widening of the mediastin is noted in lung cancers and tuberculous mediastinal lymphadenopathy.

The radiological diagnosis of ileo-cecal tuberculosis is based on the analysis of various and polymorph semiological signs. The authors report a series of 31 cases of ileo-cecal tuberculosis. The concomitant involvement of the ileum and the cecum il up to 61.2% of all cases. The associated peritoneal involvement is observed in 35.4% of the cases. The hypertrophic form is the most common (57%) and the ulcero-hypertrophic form in 43% cases. The observation of ileum short stenosis, valve attempt, cecum retraction, and associated peritoneal involvement is in favour of the ileo-cecal tuberculosis origin.

The author reports 13 cases of Behçet's disease with thrombosis of superior vena cava. The thrombosis of superior vena cava achieve to superior cava syndrome. In all cases, the X ray of the chest showed a discreet widening of the superior mediastinum related to collateral circulation confirmed by angiography. The thrombosis interest the brachial veins in 9 cases. The analysis of the results point out to the importance of the chest X ray in orientating the diagnosis. The etiological diagnosis is always clinical.

The diagnosis of Pott's disease is generally easy exception unusual sites whose diagnosis is requires cross-section imaging and needle biopsy. The authors report 14 cases of atypical forms of Pott's disease: 7 cases of centro-somatic forms 4 cases of sub-occipital Pott's disease, 2 cases of posterior arch and one case of sub-ligamentous vertebral tuberculosis. The radiological diagnosis of Pott's disease is suggested by the presence of a paravertebral abscess noted in 12 cases tuberculous spondylitis associated in 3 cases and multifocal involvement in 9 cases.