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International audience; INTRODUCTION: The entities of non-solid and part-solid pulmonary nodules on CT scan have been recently described.STATE OF ART: Nonsolid and part-solid pulmonary nodules account for between 2.9 and 19% of all pulmonary nodules detected in high-risk patients included in CT screening series for lung cancer. Radio-pathological correlations have shown that the aetiology could be either benign (chronic pneumonia, atypical adenomatous hyperplasia, localized fibrosis) or malignant (broncholoalveolar cell carcinoma, adenocarcinoma, more rarely metastasis). Part-solid or non-solid nodules are more likely to be malignant than solid ones. The doubling time of non-solid nodules can be longer than part-solid ones and even longer than the doubling time of solid nodules. Patient prognosis is related to the proportion of the ground glass component.PERSPECTIVE: The management of these nodules requires prolonged surveillance of nodules less than 10mm in diameter and surgical excision of nodules greater than 10mm persisting on scans between 1 to 3 months after they have been discovered and anti-inflammatory and anti-infectious therapy has been administered.CONCLUSIONS: Nonsolid and part-solid pulmonary nodules found on CT scan warrant a specific diagnostic workup.

Endovascular therapies represent the most efficient treatment of benign or malignant obstructions of the superior vena cava. The indication of stenting in case of malignant obstruction depends on the severity of the superior vena cava syndrome, the histological type of the tumor, and the response to radiotherapy and chemotherapy. Restoration of the superior vena cava patency is obtained in more than 90% of cases, with persistent good mid and long term results. Complications are rare, especially after early treatment. Stenting of benign obstructions, especially in patients who undergo hemodialysis, allows to restore venous accesses. However, indication of treatment may be discussed because the initial and late patencies are lower than in malignant obstructions.

From analyses of strengths and weaknesses of the apprenticeship of radiology in France, of existing pedagogic methods, of time constraints within clinical settings and of scientific theories of teaching and learning, the authors define objectives that teaching should target and propose a new method of instruction problem and practise-based. The method appears applicable in French radiology departments. It should forster early acquisition by residents of professional attitudes and way of thinking, and make them active self-directed learners.

To address prospectively the potential of CT of the abdomen and pelvis to demonstrate deep vein thrombosis in patients suspected of acute pulmonary embolism and investigated with helical CT of the pulmonary arteries.197 patients presenting non-diagnostic scintigraphy and negative Doppler US of lower limbs and IVC were included. They had helical CT of the pulmonary arteries (5mm collimation, 1:1 pitch, reconstruction every 2.5 mm, injection of 120 mL of contrast media at a rate of 3 mL/sec). Ninety seconds after the end of the thoracic acquisition, abdominal and pelvic CT were acquired (7 mm collimation every 12 mm).3 (1.5%) of 197 patients had an unknown thrombosis of the caval system (renal vein, ovarian vein, lilac veins). A fourth patient had an unknown thrombosis of the mesenteric vein. All these patients had a pulmonary embolism (4/40). None of the 157 patients without pulmonary embolism at helical CT showed deep venous thrombosis.In our study, CT of the abdomen and pelvis disclosed an unknown thrombosis of a deep vein of the abdomen and pelvis that can explain the pulmonary embolism in 7.5% of patients.

Diffusion du document : DDAF de l'Isère 42 avenue Marcelin Berthelot BP 31 38040 Grenoble Cedex 9 (FRA); National audience; Le département de l'Isère s'étend sur 788 220 hectares, mais sa surface agricole utilisée (SAU) ne couvre que 313 000 hectares soit 39,7 % du territoire. La surface agricole départementale subit depuis plusieurs décennies une lente et constante régression (- 0,6 % par an depuis 1981). Sur les cinq dernières années, l'agriculture a perdu en moyenne 1 800 hectares par an qui ont surtout été affectés à l'urbanisation et à l'emprise des grands ouvrages linéaires : TGV et autoroutes. Pour mettre en place une agriculture qui participe au développement local en valorisant les terroirs et paysages du département, il faut : privilégier l'installation des agriculteurs pour préserver les potentiels acquis, mieux former les nouveaux agriculteurs, maintenir l'activité dans les zones rurales pour éviter la désertification des zones les plus défavorisées, sauvegarder le milieu naturel pour laisser aux générations futures un héritage aussi riche que celui qui a été transmis par les générations précédentes, et enfin, contribuer aux besoins alimentaires de la planète.

The authors describe a case of partiel anomalous pulmonary venous drainage of the entire right lung in the azygos vein, without cardiac septal defect discovered on a systematic chest X-ray that showed a right paratrachea mass. MR imaging demonstrated the abnormal pulmonary vessel draining into the azygos arch.

Twenty-five cases of thoracic hydatic disease, studied by CT since 1982, are reviewed. Fifteen patients were Maghrebin, 10 were native. The lungs were interested 22 times, the mediastinum 3 times and the heart only once. Complications of hydatic disease were present 8 times. We compare contribution of CT to the other diagnosis criterious. Our results show the accuracy of CT for the diagnosis of non complicated cyst and the lack of specificity for complicated cysts.

High resolution computed tomography (TDM-HR) is now the technique of choice in the diagnosis and management of diffuse infiltrative lung disease (PID). After a brief review of the technique the authors describe the normal appearance; anatomical observations and the in vivo findings have shown that TDM-HR allow for the exploration of details of structure down to the second pulmonary lobule. Thus, through the alterations that are transmitted in the lobular area, and from its contents and its limits, PID has led to the elaboration of a new semeiology. The authors review the basic computed tomographic images and correlate these in each case with the histological evidence. The spatial distribution and the time sequence of the elementary images are the two other terms in the diagnostic equation of PID. The spatial distribution of several elementary images presents in TDM-HR a superior aetiological pointer to that which is furnished by thoracic radiographs; and the time sequence may furnish a useful indication as to the progress of the treated disease. Sarcoidosis, histiocytosis X, idiopathic interstitial fibrosis and lymphangitis carcinomatosis would serve as examples. Nevertheless, the authors point out that it would be dangerous during the period of evaluation to prematurely extend to all cases of PID conclusions which are only possible to make at present in a restricted number of disorders.