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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.

Resume La mucormycose est une infection fongique opportuniste, rare et souvent fatale, causee par des champignons de l’ordre des mucorales appartenant a la famille des zygomycetes. La mucormycose pulmonaire isolee est rare, survenant principalement sur des terrains fragilises et, en particulier, chez les diabetiques non controles. Les filaments envahissent les vaisseaux sanguins causant une necrose ischemique. Nous rapportons l’observation d’une adolescente diabetique âgee de 13 ans qui a presente une mucormycose pulmonaire compliquee d’un thrombus intra-auriculaire gauche. Le diagnostic de mucormycose a ete porte sur l’examen histologique des prelevements biopsiques bronchiques. Un traitement associant l’amphotericine B par voie systemique et la chirurgie a permis une evolution favorable. Cette infection, de diagnostic difficile, doit etre envisagee chez les diabetiques presentant une infection pulmonaire resistante au traitement, afin d’appliquer une therapeutique agressive precoce. Le traitement optimal associe un traitement antifongique systemique prolonge, une resection chirurgicale du foyer pulmonaire et la correction du facteur predisposant sous-jacent.

Resume Objectifs Illustrer les aspects de l’atteinte arterielle pulmonaire au cours de la maladie de Takayasu. Patients et methodes Etude retrospective portant sur une serie de 6 patients ayant une atteinte arterielle pulmonaire parmi 28 patients ayant une maladie de Takayasu avec revue de leurs donnees cliniques et angioscanographiques. Resultats L’âge moyen des patients ayant une atteinte arterielle pulmonaire etait de 34 ans. Tous les patients avaient une atteinte arterielle systemique etendue. Le signe angioscanographique le plus frequent etait l’epaississement parietal. Une dilatation du tronc de l’artere pulmonaire etait observee dans un tiers des cas. Conclusion L’atteinte arterielle pulmonaire au cours de la maladie de Takayasu n’est pas rare. L’angioscanner constitue un moyen d’imagerie fiable pour en faire le diagnostic.

Resume Introduction L’amylose est caracterisee par des depots tissulaires de substance amyloide. L’amylose secondaire peut se constituer sur des lesions sequellaires de tuberculose pulmonaire et ce, avec un delai plus ou moins long ; cependant, cela n’a pas ete le cas de notre patient. A travers notre observation, nous avons fait une revue de la litterature, pour essayer d’expliquer l’evolution enigmatique de l’amylose AL chez notre patient tuberculeux. Observation Un patient de 36 ans etait admis dans notre service pour l’exploration d’une hemoptysie. Le diagnostic de tuberculose pulmonaire de premiere atteinte a ete retenu et le patient a ete mis sous traitement antituberculeux. Au deuxieme jour du traitement, l’evolution etait marquee par l’apparition d’un hematome de la plante du pied droit qui s’est etendu jusqu’aux lombes les jours suivants. Le bilan renal a mis en evidence une proteinurie de 24 heures a 9 g/L et l’electrophorese des proteines seriques a revele un taux d’albumine a 11,8 g/L. Le diagnostic d’un syndrome nephrotique pur a ete pose, indiquant la pratique d’une ponction biopsie renale, cependant, devant l’aggravation de l’etat du patient au 14e jour de traitement, celle-ci n’a pu etre pratiquee. L’evolution etait marquee par l’alteration de l’etat de conscience, et le patient a ete alors transfere en reanimation ou il a ete intube et ventile mais il est decede 48 heures plus tard. L’examen anatomopathologique des pieces de biopsies post-mortem pulmonaires et cutanees a objective des depots amyloides en faveur d’une amylose AL. Conclusion Devant l’association d’une tuberculose pulmonaire active et d’une localisation pulmonaire d’une amylose, la relation de causalite n’est pas la seule a evoquer. La coexistence d’une tuberculose pulmonaire active et d’une amylose primitive doit aussi etre consideree, en particulier quand la caracterisation immuno-histochimique des depots amyloides met en evidence une amylose AL.

Objective: Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. Methods: Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magneticresonanceimaging(MRI).Results:Inpatientswithahistoryofabdominalsurgery,theforeignbodywaslocatedintheparenchymaofthe right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textilomainthreeof thefivepatientsbydemonstratinga non-calcifiedhyperechoicmasswithacousticshadow.At CT, thegossypiboma wasa lowattenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. Conclusions:The CTaspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CTsigns helps to have a preoperative diagnosis. # 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Small cell lung carcinoma (SCLC) typically is central in location. It is a very aggressive tumor characterized by its propensity for invasion of mediastinal structures, frequently, the ipsilateral pulmonary artery, multifocal nodal metastases and high frequency of distant metastases at initial presentation. CT is very sensitive and effective for local and regional staging. Combined with other diagnostic modalities, especially PET imaging, it allows whole body imaging for accurate staging, which is mandatory for therapeutic management. The different CT imaging features of SCLC and its more specific imaging characteristics will be reviewed in this article.

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 17 decembre 2013

Resume Introduction Les lymphomes pulmonaires primitifs (LPP) sont des tumeurs rares, dont les aspects radiologiques sont souvent peu connus. Methodes Afin d’illustrer les differentes presentations radiologiques des LPP, nous rapportons une serie retrospective de neuf cas de LPP colliges dans notre service sur une periode de quatre ans, six LPP type MALT, deux LPP-B diffus a grandes cellules et un cas de granulomatose lymphomatoide. Le diagnostic a ete confirme histologiquement, soit par une biopsie bronchique, soit par une biopsie pulmonaire chirurgicale. Resultats En TDM, le LPP type MALT se presentait sous la forme soit d’une ou plusieurs condensations (quatre patients sur six) evoluant sur un mode chronique dans deux cas, soit de nodules pulmonaires associes a des condensations ou a des masses, soit enfin d’un aspect de « verre depoli » diffus. Dans le LPP-B diffus a grandes cellules, l’aspect tomodensitometrique etait celui d’une ou plusieurs masses avec envahissement locoregional, simulant un carcinome bronchopulmonaire primitif. Dans le cas de la granulomatose lymphomatoide, la presentation TDM etait celle d’une pneumopathie infiltrante diffuse fibrosante. Conclusion Les aspects radiologiques des LPP sont tres polymorphes. C’est le LPP type MALT qui pose le plus de probleme diagnostique en raison d’une presentation radiologique faussement rassurante.

We report two observations of unusual mass in the posterior mediastinum: hemangioma, with different imaging features. In one case, it was a sharply marginated mass of the paraspinal region with limited extension into the adjacent foramina. In the second case, it was a posterior mediastinal mass with a large intra-spinal extension. On CT, the two masses did not contain calcifications according to phleboliths. In CT and MRI, they showed moderate enhancement in the first case and intensive enhancement in the second case. On T2 weighted sequences, the two masses showed a very high signal. These imaging features are relatively unspecific but indicative to think about mediastinal hemangioma as important differential diagnosis. Therefore MRI is very important to give the clues for the diagnosis, even if neurogenic tumors are the most frequent masses in this location.

Pseudotumoral mediastinal amyloidosis Purpose Amyloidosis involvement of mediastinal nodes is rare. Isolated pseudotumoral involvement without extra-thoracic disease is a diagnostic challenge and typically raises concern for underlying malignancy. We present 3 cases of pseudotumoral mediastinal amyloidosis. Methods We report the cases of 3 patients presenting with recent onset of respiratory symptoms. Bronchoscopy showed mucosal infiltration suspicious for lymphangitic spread of tumor. The patients underwent chest radiography complemented by CT of the chest and abdomen, and laboratory and immunological work-up. A diagnosis of pseudotumoral mediastinal amyloidosis was confirmed by mediastinoscopic biopsy in all cases. Results CT showed a pulmonary and mediastinal tumor process in 2 cases and pericarinal tumor in 1 case. Diffuse bronchial wall thickening was present in all cases. Review of biopsy material showed tracheobronchial amyloidosis in 1 case. Patient work-up showed no evidence of extra-thoracic amyloidosis. Rapid progression of bronchial obstruction was observed in 1 case. Conclusion The imaging features of mediastinal amyloidosis are non-specific. Pseudotumoral involvement of mediastinal nodes associated with pulmonary amyloidosis accelerates the degree of airway obstruction.

Inflammatory myofibroblastic tumors of the lung: Imaging features Inflammatory myofibroblstic tumors are ubiquitous but most frequently affect the lung. The imaging features are non-specific but the diagnosis may be suggested in the presence of solitary pulmonary nodule or mass in children or young adults. The tumor may appear locally and regionally aggressive suggesting malignancy. Diagnostic confirmation is obtained from histological evaluation of the surgical specimen. Treatment is surgical with oncologic surgical resection.

Mediastinal fibrosis or fibrosing mediastinitis is a rare condition characterized by chronic fibrosis occurring in mediastinal structures, in proliferating fibrous scar tissue. The disease may be secondary or idiopathic. The authors report the case of a 46-year-old woman, without a particular past history, who, in December 2006, presented dyspnoea on exertion and a superior vena cava syndrome. Her chest X-ray showed a right laterotracheal opacity. Fiberoptic bronchoscopy revealed concentric tracheobronchial narrowing, severe hyperemia and mucosal edema. The chest computed tomography documented the obstruction of the superior vena cava, the right main bronchus and the right upper lobe bronchus secondary to a mediastinal mass. Mediastinoscopy revealed a hard and dense mass, surrounding the different structures of the mediastinum. Pathologic examination corroborated mediastinal fibrosis. No cause was determined. Prednisone and anticoagulant were prescribed during 2 years with a regression of dyspnoea and the superior vena cava syndrome and an important regression of radiological lesions. In conclusion, prolonged corticosteroids may be efficient in the treatment of idiopathic mediastinal fibrosis.

Resume But Rapporter les differents aspects tomodensitometriques du kyste hydatique pulmonaire ouvert dans les bronches et etablir une stadification tomodensitometrique. Patients et methodes Nous avons relu retrospectivement les examens TDM de 41 patients porteurs de KHP complique d’ouverture dans les bronches. En se basant sur la classification de D.B. Lewall et S.J. Mc Corkell, les donnees de notre serie et les cas publies, nous avons propose une stadification TDM detaillee, chaque stade correspondant a une etape de l’evolution naturelle du KHP complique. La « rupture communicante » de DB Lewall et SJ Mc Corkell traduit une rupture de l’endokyste et du perikyste avec etablissement d’une communication entre le kyste et la lumiere des bronches. Elle regroupe plusieurs stades qui se succedent dans le temps : – stade I : Aspect en « bague a chaton » ; – stade II : Aspects de « croissant » et de « croissant inverse » ; – stade III : Aspects de « clartes piegees » et « en nid d’abeille » ; – stade IV : Aspects hydro-aeriques : « en double arc », « du nenuphar », « serpigineux », « niveau hydro-aerique » regulier ; – stade V : Aspect de retention seche: « en pelote de laine », « en grelot », « pseudotumoral » ; – stade VI : Aspects sequellaires: Cavite aerique et image cicatricielle. Resultats 73 KHP compliques d’ouverture dans les bronches ont ete inclus dans notre analyse. IB sont repartis de la facon suivante. stade I : (16 %), stade II : (12,7 %), stade III : (42,8 %), stade IV : Aspect « en double arc » (2,7 %), signe du « nenuphar » (10 %), aspect « serpigineux » (8,2%), aspect de « niveau hydro-aerique » regulier (5,4 %), stade V : Aspect « en pelote de laine » (6,8 %), image « en grelot » (15 %), aspect « pseudotumoral » (4 %), stade VI : Cavite aerique (4 %) et image cicatricielle (2,7 %). Conclusion La stadification que nous proposons detaille la classification generale de DB Lewall et S. J Mc Corkell. Elle tient compte d’une part de l’evolution naturelle du kyste hydatique, et d’autre part de la particularite de la localisation pulmonaire.

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.

Resume But Rapporter les aspects radiologiques et evaluer l’apport de la tomodensitometrie dans le diagnostic et le bilan d’extension des tumeurs carcinoides bronchiques. Materiel et methodes Il s’agit d’une etude retrospective de 20 patients porteurs d’une tumeur carcinoide bronchique ayant fait l’objet d’une intervention chirurgicale. L’exploration thoracique de tous nos patients a comporte une radiographie du thorax, une fibroscopie bronchique, et un examen tomodensitometrique (TDM) thoracique. Une imagerie par resonance magnetique (IRM) thoracique a ete realisee chez 2 patients et une echographie abdominale dans le cadre du bilan d’extension chez tous les patients. Resultats Il s’agissait de 11 femmes et 9 hommes. L’âge moyen etait de 40 ans (extremes : 21-71 ans). Les signes radiologiques standards etaient non specifiques avec des atelectasies (75 %), une opacite parenchymateuse isolee (15 %). La TDM a objective, dans 85 % des cas, une masse proximale, qui etait obstructive avec trouble ventilatoire d’aval dans 80 % des cas. La TDM a egalement visualise un trouble ventilatoire secondaire a une obstruction bronchique sans masse individualisable dans un cas (5 %), une masse parenchymateuse isolee dans 2 cas (10 %), et un bourgeon endo-bronchique interessant la bronche souche droite sans trouble ventilatoire d’aval dans un cas (5 %). Des calcifications tumorales ont ete detectees dans 30 % des cas. Les tumeurs etaient reparties histologiquement en 17 carcinoides typiques et 3 atypiques. Celles-ci differaient par leur taille, leur extension locoregionale et a distance. Conclusion La TDM est indispensable pour le diagnostic positif topographique et dans le bilan d’extension pre-therapeutique des tumeurs carcinoides bronchiques. Son apport principal par rapport a celui de la fibroscopie est de montrer leur eventuel developpement exo-bronchique, et les complications pulmonaires d’aval.

Resume La tuberculose bronchopulmonaire pseudotumorale est une entite radiologique rare. La malignite est evoquee soit sur l’aspect radiologique devant une lesion focale parenchymateuse d’allure tumorale soit par la presence a l’endoscopie d’un bourgeon ou d’une infiltration bronchique. Cette suspicion de malignite peut parfois pousser l’escalade des explorations jusqu’a la thoracotomie. Le recours a la tomodensitometrie permet de mieux caracteriser les lesions parenchymateuses et de preciser les signes associes. A travers l’analyse de 25 cas de tuberculose pseudo-tumorale explores par tomodensitometrie, nous illustrons les differents aspects de cette maladie en precisant les difficultes diagnostiques qui peuvent etre rencontrees.

Resume L’atteinte thoracique de la maladie de Behcet est rare et grave. L’angio-Behcet thoracique est en rapport avec le tropisme vasculaire bien connu de la maladie. Elle peut interesser la veine cave superieure, les arteres pulmonaires, l’aorte et les vaisseaux sous claviers. Si le diagnostic de la maladie de Behcet est clinique, celui de l’angio-Behcet repose sur differents moyens d’imagerie en particulier les examens tomodensitometriques (TDM) et d’imagerie par resonance magnetique (IRM). L’imagerie en coupes (TDM et l’IRM) est a l’evidence plus performante que l’angiographie et la cavographie dans le diagnostic positif et dans le bilan d’extension. L’analyse de 22 cas permet de presenter les differentes manifestations vasculaires thoraciques de cette maladie.

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.

Resume L’hemothorax est une manifestation exceptionnelle, grave et trompeuse des sequestrations extra-lobaires. Nous rapportons l’observation d’un patient, âge de 15 ans, qui consultait pour des douleurs thoraciques et une dyspnee d’apparition brutale. La radiographie du thorax montrait un epanchement pleural liquidien. La ponction pleurale ramenait un liquide hematique. L’angio-scanner montrait un epanchement pleural entourant une formation hyperdense sans visualisation d’une artere systemique. La thoracotomie revelait une formation pyramidale intra-pleurale gauche, vascularisee par un pedicule provenant de l’aorte thoracique. Une sequestrectomie etait realisee. Apres un recul de 2 ans, le patient restait asymptomatique. La sequestration extra-lobaire doit faire partie des diagnostics etiologiques de l’hemothorax. L’absence de visualisation d’un vaisseau systemique aberrant par l’imagerie ne doit pas faire eliminer le diagnostic de sequestration et le chirurgien doit prendre des precautions pour eviter une lesion vasculaire.

Resume L’hemosiderose pulmonaire idiopathique (HPI) est une etiologie rare de l’hemorragie intra-alveolaire diffuse, caracterisee par l’accumulation anormale d’hemosiderine au niveau des macrophages alveolaires. Elle predomine chez l’enfant. Sa survenue a l’âge adulte est rare : une dizaine de cas d’HPI de l’adulte ont ete publies au cours de ces 10 dernieres annees. Nous rapportons un cas d’HPI decouvert chez une patiente âgee de 20 ans. Le bilan etiologique, en particulier immunologique, etait negatif. La patiente a bien evolue sous corticotherapie systemique au long cours, durant 4 ans.

Pulmonary hyalinizing granuloma is a rare fibrosing nodular disease of the lung characterized by solitary or multiples pulmonary nodules. This report describes two cases of this rare disorder. MRI was available in one case. For the first case, the stability of the lesions and past history of retroperitoneal fibrosis suggested the diagnosis. For the second case, open lung biopsy was required for diagnosis. When multiple nodules are present, metastatic disease cannot be excluded and biopsy may be required. Evolution is usually benign but follow up is necessary.

Primary tumors of the sternum are rare and account only 0.5% of all primary bone tumors. They are often malignant, osteolytic and aggressive. They often present difficulties in management.to determine clinical, pathological and therapeutic characteristics for primary malignant tumors of the sternum.We report a series of six cases of primary malignant tumors of the sternum, collected in our institution between 1993 and 2009.There were 4 men and 2 women with a mean age of 69, 5 years. Parietal swelling was the most frequent symptom. Imaging showed a sternal lytic lesion. Three tumors were treated surgically. Associated treatments were neoadjuvant chemotherapy (1 case) and postoperative radiotherapy (1 case). A medical treatment (radiotherapy alone or chemotherapy) was performed in 3 cases. These tumors were divided as below: 3 plasmacytoma, 1 chondrosarcoma, 1 osteosarcoma and 1 large B cell lymphoma.The management of primary malignant tumors of the sternum is multidisciplinary. It depends on the histological type, the possibility of surgical treatment and the distant and local aggressiveness.

Angiomyxolipoma is a benign tumor considered as a variant of lipoma and that occurs mainly in the subcutis. The mediastinal location hasn't been previously reported.To describe the radiological features of this tumor in its posterior mediastinal location and to confront them to the pathological features.We report the case of a 49-year-old woman who was admitted for chest wall pain and neurologic disturbance of her two lower limbs. The chest X-ray showed a posterior mediastinal opacity. On CT examination, this mass contained some small areas of fat and enhanced intensely. Microscopic examination of the excised mass confirmed the diagnosis of posterior mediastinal angiomyxolipoma.Mediastinal location of angiomyxolipoma hasn't been previously reported. Clinicians and radiologists should be aware that this diagnosis should be suggested, among others, when there is a posterior mediastinal mass that contains fat and that intensely enhances with a possible spinal cord extension.

Lung cancer is the most common malignancy diagnosed in patients with venous thrombo-embolism (VTE).To investigate clinical, biological, radiological features and survival of lung cancer patients with VTE.Retrospective case-control study investigating biologic, clinical course and survival of 25 patients lung cancers with VTE (Group M) and 50 lung cancers without VTE (group T).The frequency of the VTE was 5.88% with 2.58% pulmonary embolism (PE). The mean age was 58 years ± 9.8 in group M and 57.9 years ± 9.6 in group T. No significant difference concerning medical or surgical history for both groups was found. The dyspnea and chest pain were at equal frequency (63.6%). Regarding the clinical probability of the PE, it was no significant differences between the two groups. A rate of D-dimer0.7μg/l was more frequent among group M (75% vs 20%; p = 0.054). The most common histological type was nonsmall cell lung cancer (88%). A stage IV was significantly more frequent in group M (86.4% vs. 52.3%; p = 0.007). The mean period of survival in Group M was 10.6 ± 1.2 month and 20.2 + 1.8 month in group T; p = 0.38.The VTE associated to lung cancer is under diagnosed. Prospective studies are needed to establish more adapted scores.

Acute pulmonary embolism is a common disease with substantial morbidity and mortality in untreated patients. It requires an urgent positive diagnosis.To assess the prevalence of acute pulmonary embolism and calculate the sensitivity and specificity of multidetector CT for the diagnosis of acute pulmonary embolism in a hospital specialized in cardio-thoracic diseases.This is a prospective study conducted at Abderrahmen Mami Hospital, which included 200 consecutive patients suspected of acute pulmonary embolism and explored by a multidetector CT pulmonary angiography (16 slices).Prevalence of acute pulmonary embolism was calculated at 37.5%. The multidetector CT has enabled an alternative diagnosis in 46 patients (40%). The sensitivity and specificity of multidetector CT were calculated respectively 89.6% and 100%.The prevalence of acute pulmonary embolism, in a hospital specialized in cardio-thoracic diseases, is higher than that found in general hospitals. High sensitivity and specificity of multidetector CT makes it the gold standard for the diagnosis of pulmonary embolism.