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External iliac artery endofibrosis (EIAE) is an uncommon disease that affects a large number of athletes. The pathogenesis of EIAE is unclear. We offer an additional possible cause, with a direct relationship between EIAE and psoas muscle hypertrophy.

Planar pulmonary scintigraphy is still regularly performed for the evaluation of pulmonary embolism (PE). However, only about 50-80% of cases can be resolved by this approach. This study evaluates the ability of tomographic acquisition (single photon emission computed tomography, SPECT) of the perfusion scan to improve the radionuclide diagnosis of PE. One hundred and fourteen consecutive patients with a suspicion of PE underwent planar and SPECT lung perfusion scans as well as planar ventilation scans. The final diagnosis was obtained by using an algorithm, including D-dimer measurement, leg ultrasonography, a V/Q scan and chest spiral computed tomography, as well as the patient outcome. A planar perfusion scan was considered positive for PE in the presence of one or more wedge shaped defect, while SPECT was considered positive with one or more wedge shaped defect with sharp borders, three-plane visualization, whatever the photopenia. A definite diagnosis was achieved in 70 patients. After exclusion of four 'non-diagnostic' SPECT images, the prevalence of PE was 23% (n =15). Intraobserver and interobserver reproducibilities were 91%/94% and 79%/88% for planar/SPECT images, respectively. The sensitivities for PE diagnosis were similar for planar and SPECT perfusion scans (80%), whereas SPECT had a higher specificity (96% vs 78%; P =0.01). SPECT correctly classified 8/9 intermediate and 31/32 low probability V/Q scans as negative. It is concluded that lung perfusion SPECT is readily performed and reproducible. A negative study eliminates the need for a combined V/Q study and most of the 'non-diagnostic' V/Q probabilities can be solved with a perfusion image obtained by using tomography.

Background: To assess the effectiveness and prospects of transcatheter gastroduodenal artery embolization in the control of massive duodenal bleeding and to relate our experience., Methods of Study: The study is based on the retrospective analysis of 165 patients with endoscopically detected bleeding duodenal ulcer who presented between 1991-1998. 28 patients were considered eligible for endovascular treatment either at initial presentation or following hemorrhage recurrence after endoscopic therapy., Results: Technical failure was noted in 3 cases, thereafter treated by surgery. In the other 25 patients, embolization was performed: bleeding recurrence occurred in 7 cases. Four were treated only endoscopically. One was reembolized and the last two were treated by surgery. In 6 cases, a coaxial technique was used (guiding catheter in 2 and 3F microcatheter in 4). No complication related to the catheterization was observed., Conclusion: Transcatheter embolization of the gastroduodenal artery appears to be an efficient procedure even in the absence of active bleeding at the time of the procedure. Failure and recurrence rates can be reduced by using a coaxial technique in the uneasy cases. Embolization seems to have a low recurrence rate and a very low complication rate.

Purpose: This retrospective study evaluates the long-term clinical outcome and the survival of 600 consecutive carotid endarterectomies performed with a temporary shunt. All arteriotomies were closed by vein patch angioplasty., Materials and Methods: Between November 1989 and November 1998, 600 isolated carotid endarterectomies (CEA) were performed in 540 patients by a uniform surgical technique at the University Clinic of Mont-Godinne. An intraluminal shunt and patch closure were systematically used. The mean age was 68 yr (ranging from 41 to 91 yr), 400 patients were men. The risk factors included hypertension in 73%, smoking history in 60%, coronary artery disease in 51% and hyperlipidemia in 35%. The indications were asymptomatic stenosis in 47%, transient ischemic attack in 40%, vertebrobasilar symptoms in 7% and stroke in 6%., Early Results: The combined 30-day stroke and death rate was 0.9%. There were four deaths. The stroke and TIAs rates were 0.2% and 1.5% respectively. The incidence of early carotid occlusion was 0.5%. Cranial or cervical nerve dysfunction was identified in 6.3%. LATE RESULTS: The median follow-up was 49 months with a range of 2-124 months. Cumulative survival rates at 5 and 10 yr were 92+/-1% and 89+/-2% respectively. Thirty-two patients died during long-term follow-up; the death was stroke-related in only three patients., Conclusion: Carotid endarterectomy using an intraluminal shunt and vein patch closure is a safe and effective procedure associated with low morbidity and mortality rates at short and long-term follow-up.

Dissection of the cervical segment of the internal carotid artery may occur spontaneously or after trauma. We report the management of a 53-year-old right-handed man with progressive dizziness and neck pain 6 weeks after a motor vehicle collision. The clinical and neurologic examinations were normal. The CT scan led to the diagnosis of a pseudoaneurysm of the right internal carotid artery near the skull base. We successfully treated this post-traumatic lesion with a covered stent. The patient underwent the endovascular procedure under general anesthesia and transcranial Doppler monitoring. No neurologic event was observed. Obliteration of the pseudoaneurysm with preservation of the carotid artery was achieved. The patient was discharged from the hospital 72 hr later with no complications. Clinical and imaging follow-up at 6 months was unremarkable.

We report paradoxical and ambiguous imaging findings in a patient with transient ischaemic attack (TIA). Perfusion-weighted (PW) MRI obtained 2 hours after symptoms onset showed a hypoperfused area in a region compatible with the focal deficit, while diffusion-weighted (DW) MRI was considered negative. Despite the complete resolution of the symptoms which had already begun at the end of the first MR examination, follow up DW MRI at 3 days showed partial conversion to hyperintensity of the initially hypoperfused area. This case illustrates that PW and DW MRI have to be used in combination and at different time points to correctly diagnose and manage ischaemic stroke because PW MRI is more sensitive than DW MRI for very early detection of ischaemia and delayed DW MRI provides the final signature of brain damage even in case of complete clinical recovering.

The risk of thyroid papillary carcinoma is increased by external radiation particularly in children under 15 years of age as shown by a marked increase in those exposed to radiation after Chernobyl. We were recently confronted in Belgium over a short period with four patients (3 F, 1 M) with papillary thyroid carcinoma who were aged 10 years, 2 months, 2 years and 6 years when the Chernobyl accident occurred. We thus raise the question of a possible relationship. The patients were aged 17, 11, 10, 19 years at presentation. They all presented fortuitously over 3 years which was a very unusual increase in our extensive experience in thyroid surgery (62 cases of thyroid cancer among 1014 thyroidectomies in adults vs 4 cases in 18 children since the Chernobyl accident in 1986). Two out of the four patients had psammoma bodies (identifiable on CT scanning and ultrasound) and thyroglobulin autoantibodies (TgAb). The first patient had positive lymph nodes at the time of surgery. The incidence of thyroid cancers in Belarus and Ukraine rose just 4 years after the Chernobyl disaster; because radioactive clouds passed over Belgium, we wonder whether the occurrence of thyroid cancer in our patients could be related to this irradiation. The mechanism of increased incidence of radiation-induced thyroid cancer is thought to be due to rearrangement of the tyrosine kinase domains of the RET and TTK genes. The other important similarities in our patients are the presence of psammoma bodies that can be visualized on radiological examination and the presence of TgAb that are more frequent in differentiated thyroid cancers. Whether or not these cases reflect an increased incidence in the population as a whole, clinicians must remain vigilant for this rare but curable cancer in young patients, especially if suggestive radiological features or TgAb are present.

Evaluation and treatment of patients with suspected cervical vertebral trauma requires close cooperation between multiple medical disciplines. Recognition of the significant signs of cervical spine injury enables accurate interpretation of the radiograph, and if necessary adequate selection of the best imaging method for further evaluation. When judiciously selected, these imaging techniques result in the expeditious gathering of the diagnostic information required for the management of the traumatized patient.

We present the characteristic imaging findings of hypoplasia of the internal carotid artery (ICA) in two cases, one accompanied by an intracranial aneurysm. Finding of a diffuse luminal narrowing of the ICA on MR angiography or digital subtraction angiography (DSA) could wrongly evoke severe acquired diseases such as dissection or atherosclerosis. Absence of associated wall thickening and flow disturbances on color Doppler sonography (CDS) should suggest carotid hypoplasia. Confirmation of the diagnosis is obtained by CT of the skull showing a small carotid canal. Non-invasive procedures are sufficient to differentiate this rare congenital anomaly from acquired string signs.

Case Report: A case of mediastinal emphysema occurring without etiologic factor except a Valsalva's manoeuvre a few hours before admission in a 15-year-old boy is reported. Symptoms were cervical and chest pain with moderate dysphagia. Diagnosis was confirmed by palpating subcutaneous air in the neck region and mediastinal air on a chest roentgenogram. A CT scan was performed to exclude a concurrent pneumothorax. The patient recovered with bed rest., Conclusion: Spontaneous pneumomediastinum results from nontraumatic, mediastinal air leakage without underlying lung disease. It should be considered in the differential diagnosis of chest pain, especially in healthy adolescents and young adults; it is certainly underdiagnosed in this population.

Unlabelled: An isolated eosinophilic granuloma involving the posterior elements of a lumbar vertebra is reported in a 3-year-old boy presenting with progressive limp. Radiological investigations revealed osteolysis of the L5 right pedicle. MRI showed a well-defined homogeneous mass with nonspecific signal intensity. An unusual feature was the paravertebral muscular location of the largest part of the tumour indicating a possible soft tissue origin. Immunohistochemical studies were typical for Langerhans' cell histiocytosis., Conclusion: A limp can be due to lumbar and paravertebral muscular location of Langerhans' cell histiocytosis.

Computed Tomography (CT) is recognized as a relatively high-dose diagnostic procedure. There is some obscurity in the literature about the doses due to conventional CT, spiral CT and High Resolution Computed Tomography (HRCT) of the chest. Conventional chest CT results in a radiation dose approximately 100 times that of a standard chest film and 10 times that of a mammography; on the other hand, conventional chest CT is safe for the lens and the pelvis (ovaries, testes and uterus). Radiation dose associated with helical CT is potentially lower than the dose associated with conventional CT. HRCT, consisting of 1- to 2- mm thick-sections performed at 10 mm intervals, has an effective radiation dose lower than that of conventional CT, even with high-dose techniques (400 mAs). HRCT scans obtained at reduced milliamperage (40-80 mAs), the so-called "low-dose HRCT technique", may provide satisfactory visualization of lung parenchyma in the majority of cases and is recommended in patients in whom radiation dose is a major concern (pediatric population or young women in order to minimize breast irradiation). The awareness of radiation dose will become increasingly important for both referring physicians and radiologists when determining indications and deciding which types of imaging procedures and specific protocols should be used.

Symptomatic bronchopulmonary disorders have been only occasionally reported in Crohn's disease, although several studies have documented the possibility of latent involvement of the respiratory tract. We report the case of a patient with long-standing Crohn's disease who presented with acute transient chest pain and a recent history of mild dyspnea and nonproductive cough. Chest radiographs were normal, while high-resolution computed tomography demonstrated a mosaic pattern of attenuation that was consistent with a bronchiolar disorder. Pulmonary function tests showed mild airway obstruction and normal diffusion indices. Thoracoscopic lung biopsy demonstrated focal infiltration of the bronchiolar walls by mononuclear cells and non-necrotizing granulomas. To our knowledge, this is the first account of isolated granulomatous bronchiolitis in Crohn's disease. These findings suggest that a granulomatous inflammatory process of the bronchioles could be involved in the development of airway obstruction in patients with Crohn's disease.

The authors describe an unusual case of a complex traumatic fracture-dissociation injury of the craniovertebral junction, which the patient survived with no neurological damage. This case featured the rare combination of an avulsion of both the right occipital condyle and clivus and a fracture of the left lateral mass of the atlas. Because of the craniocervical ligament injury and the slight anterior occipitoatlantal dislocation, the lesion was considered to be unstable and was treated successfully with a cervical collar. The authors emphasize that thin-slice computerized tomography scanning with multiplanar reconstructions is essential to visualize these fractures, whereas magnetic resonance imaging is useful to assess soft tissues.

We report early carotid involvement by retropharyngeal abscess in a 4-year-old boy. MR imaging showed enhancement of the wall and narrowing of the lumen of the internal carotid artery, which were thought to reflect spasm and/or arteritis. Prompt treatment may have prevented hemorrhagic and neurologic complications.

Purpose: To determine with spiral computed tomography (CT) the incidence and caval location of left renal vein (LRV) variants that may affect inferior vena cava (IVC) filter placement, spermatic vein embolization, and adrenal or renal venous sampling., Materials and Methods: Contrast material-enhanced spiral CT scans of 1,014 patients were evaluated for the incidence and configuration of LRV variants and for the distribution of the entrances of these veins into the IVC., Results: In this series, variants detected were as follows: one azygos continuation of the IVC (0.1%), three bilateral IVCs (0.3%), and 102 LRV variants (10%) including 38 retroaortic renal veins (3.7%) and 64 circumaortic venous rings (6.3%). In the retroaortic renal vein group, the distance between the entrance of the LRV into the IVC and the confluence of the iliac veins was +62.5 mm +/- 8.7. In the circumaortic venous ring group, the distance between the entrances of the retroaortic and preaortic limbs into the IVC was -39.0 mm +/- 17.4; the distance between the entrance of the left retroaortic limb into the IVC and the confluence of the iliac veins was +63.2 mm +/- 17.1., Conclusions: Detailed knowledge of these anomalies is crucial for IVC filter placement, spermatic vein embolization, and adrenal or renal venous sampling.

In our hospital, 30% of plain chest radiographs are performed in patients over 70. Somewhat surprisingly, few papers specifically dealing with the aging lung are available in the radiological literature. It is obvious however that the differential diagnosis of a chest lesion is not the same if the patient is 40 or 70. A false positive diagnosis is a frequent potential mistake in aging subjects, for example: chondral calcification versus pulmonary nodule, hyperinflation versus emphysema, "normal aging" bronchial and tracheal calcification versus hypercalcemia, diaphragmatic defect versus tumor, diaphragmatic pseudotumor versus lymph node, false diagnosis of aortic knob dissection, false diagnosis of syphilitic aortitis, inaccurate CT-detection of valvular and coronary calcifications, confusion between valvular and annular mitral calcification. Much work is still needed to exploit CT in its clinical applications for the aging lung.

We report the CT and MR appearance of a nontraumatic hemorrhagic arachnoid cyst presenting with a third nerve paresis in a 37-year-old man. The cyst, located in the left suprasellar area, contained a fluid-blood level with stigmata of subacute hemorrhage on both CT and MR studies.

We describe a case of Castleman's disease in a 8-year-old-boy who presented with a slowly growing mass in the upper neck. MRI showed a well-defined homogeneous mass with nonspecific signal features. Unusual features were a kidney-bean shape and the deep location in the suprahyoid region, the mass originating in the left retropharyngeal space.

Spiral computed tomography (CT) has proved to be a valuable tool by providing three-dimensional (3D) images of the studied structures. We hypothesized that a more realistic depiction of lesions by 3D CT could be of interest for surgeons who are treating blunt abdominal traumas and lead to less inappropriate triage. A good working relationship between surgeons and radiologists allowed us to perform a 3D CT examination in six patients. In the first patient, the 3D CT accurately demonstrated spleen fragmentation without devascularized fragment. The second patient had complete devascularization of the spleen upper pole. Conservative treatment was pursued for both patients. For the third patient, 3D CT helped us to differentiate peritoneal-perisplenic fluid from subcapsular fluid. The fourth patient had minor spleen injury associated with severe lacerations of the left kidney. 3D CT showed a complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. The fifth patient presented a fragmented spleen and transient massive haematuria related to a well-contained laceration of the kidney upper pole that were amenable to nonoperative management. The sixth patient was emergency operated for active bleeding from a fragmented spleen. 3D CT performed 2 months after spleen repair allowed the assessment of the amount of devascularized tissue, as well as the status of the upper abdomen arteries. For haemodynamically stable patients, 3D CT could be a helpful addition to conventional axial CT for quantifying blunt abdominal traumas, for making the choice between nonoperative and operative treatment, but also between emergency and delayed surgical strategy.

We describe the MR findings in a case of chondroma arising from the falx. At MR imaging, the mass appeared well defined, lobulated, hypointense to isointense on T1-weighted images, and very heterogeneous with marked hyperintense areas on T2-weighted images. After contrast administration, this tumor enhanced slightly on delayed images.

In recent years, Extramucosal Fungal Sinusitis (EFS) in immunocompetent hosts have aroused increasing interest from both clinicians and pathologists. Histopathologically, they are characterized by the presence of fungal hyphae in the lumen of the sinus with no tissue invasion. They include two different entities: the mycetoma and the atopical fungal sinusitis (AFS). The mycetoma is the most frequent and best recognized form of EFS. The clinical picture is that of a unilateral symptomatic chronic sinusitis, often painful, unresponsive to appropriate medical treatment. CT scanning is very evocative in most cases. Definitive diagnosis requires histological and bacteriological examinations of the sinus contents. Surgery is the treatment of choice. Additional antifungal therapy is not indicated unless there is fungal tissue invasion. AFS is a distinct form of EFS. It typically occurs in an atopic patient with a long story of either chronic sinusitis or recalcitrant nasal polyposis recurring after adequate medical treatment or previous sinus surgery. Histopathologically, the pathognomonic pattern shows an "allergic mucin" and scanty fragmented fungal hyphae. Culture is the only way to identify the causative agent. Management should include wide radical sinus surgery combined with long-term nasal steroids. In spite of proper medico-surgical management, the prognosis remains variable and recurrences frequently arise.

In recent years, routine endoscopic examination of the nose and advances in medical imaging have led to a better understanding of the pathophysiology of chronic sinusitis and the development of "FESS". The CT san of the sinuses have superseded the conventional standard radiography in the evaluation of the paranasal sinuses as it offers more precise anatomic information to the surgeon on the complex anatomy of the sinus cavities and their drainage pathways, in particularly the ostiomeatal complex. The coronal plane is the best incidence because it most closely correlates with the surgical approach. The utilization of a high resolution bony algorithm is recommended. A window of intermediate type, 2500 with a center of 250 HU, is sufficient for nearly all diagnosis. Complementary direct axial sections are needed by the surgeon to guide the approach to the sphenoid sinus and the posterior ethmoidal cells. MRI plays a limited role in the evaluation of a non complicated sinusitis. But MRI has supplanted the CT scanner in the appreciation of intracranial and orbital complications of sinusitis because it provides better visualisation and differentiation of soft tissues than the CT scan. The injection of contrast is recommended in all cases of complicated sinusitis.

Spiral CT has proved to be a valuable tool by providing various kinds of three-dimensional (3D) images of the studied structures. Such 3D images, which offer a more realistic depiction of the lesions, could be of interest for surgeons who are attempting to treat conservatively blunt abdominal traumas and lead to less inappropriate triage between conservative and operative management particularly for renal trauma. A good working relationship between surgeons and radiologists allowed us to perform an early follow-up 3D spiral CT on a commercially available spiral CT scanner. In the first adult patient, the 3D CT demonstrated minor spleen injury associated with severe lacerations of the left kidney with complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. For the second 12-year-old patient presenting with severe spleen trauma and macroscopic hematuria, the 3D CT accurately documented the spleen and renal lesions that were safely amenable to nonoperative treatment. For hemodynamically stable patients, 3D CT is a potentially helpful addition to conventional axial CT for quantifying blunt renal traumas and for making the strategic choice between nonoperative, emergency or delayed surgical treatment.

Objective: To assess the concordance between conventional duplex scanning and colour Doppler imaging in the grading of extracranial carotid artery stenosis., Patients and Method: A total of 67 carotid bifurcations in 48 patients were studied independently by two observers. First, each observer obtained a conventional duplex scan and recorded peak systolic and diastolic velocities. Then, each observer performed a colour Doppler study in which only the point of maximal colour shift was sampled. The stenosis in each case was subsequently classified, first as one of four classes (mild, moderate, severe or critical) on the basis of percent stenosis and peak systolic and diastolic velocities, and then as one of two groups (less than 70% or 70% or greater, with a peak systolic velocity of 2.3 m/second as the cut-off point)., Results: For the first observer, the two methods disagreed in 10 (15%) of the 67 cases. In five of these cases, colour Doppler imaging indicated a higher class of stenosis, and in the other five cases conventional duplex scanning indicated a higher class of stenosis. For this observer, the mean of the difference between conventional duplex and colour Doppler scanning for peak systolic and diastolic values was not statistically different from 0 (three-way analysis of variance). With colour Doppler imaging observer 1 detected all of the 14 cases of stenosis of 70% or greater that were detected by conventional duplex scanning. For observer 2, the results of the two methods differed in 12 (18%) of the 67 cases. For all 12 cases, conventional duplex scanning indicated a higher class of stenosis. The mean of the difference between the two methods was -23.8 cm/second (standard deviation 46.0) for peak systolic velocity and -10.7 cm/second (standard deviation 24.7) for peak diastolic velocity (both significantly different from 0). With colour Doppler imaging observer 2 did not identify 3 of the 16 cases of stenosis of 70% or greater that were detected by conventional duplex scanning., Conclusion: Discrepancies may exist between conventional duplex scanning and colour Doppler imaging in assessing extracranial carotid artery stenosis.

A pregnant woman presented with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and a single pulmonary arteriovenous malformation (AVM) that had been embolized 5 years previously. Partly due to pregnancy, recanalization of the aneurysm occurred with subsequent hemoptysis. Despite successful therapeutic reembolization of the afferent pulmonary artery, hemoptysis recurred 5 days later. At this time, recanalization of the pulmonary artery was not demonstrated by pulmonary angiography, but a systemic angiogram revealed a bronchial arterial supply to the pulmonary AVM. A systemic supply should always be sought in cases of recurrent hemoptysis after technically successful embolization of the feeding pulmonary artery.

We report a 49-year-old woman with a left parietal lesion, shown on CT and MRI as an isolated ring-enhancing mass. The diagnosis of cerebral Whipple's disease was made by brain biopsy; there were no gastrointestinal symptoms nor periodic-acid Schiff-positive inclusions in the jejunal mucosa. This case illustrates atypical Whipple's disease, confined exclusively to the central nervous system.

The papillary carcinoma is the most common cancer of thyroid but its presentation may be unexpected. In the first case, a 18-year-old girl complained of a painful enlargement of the right thyroid lobe. Upon the basis of a CT scan revealing punctuate calcifications suggesting psammoma bodies and a right-sided cold nodule on thyroid radioiodine scanning, the patient had a thyroidectomy. The second case was a discovery of papillary carcinoma in a 49-year-old woman who had a thyroidectomy for Graves' disease. This association may not be fortuitous. The cancer could be more aggressive in this group of patients, as TSI play a pathogenic role.

Background: Some cases of left-sided appendicitis related to malrotation or situs inversus have been reported. Another type of left-sided appendicitis is reported., Case Report: A 9 year-old boy was admitted suffering from a 2-day history of severe left-sided abdominal pain of the lower quadrant with fever at 38 degrees C. He presented abdominal tenderness and guarding, maximal in the left lower quadrant. His leukocyte count was 22,000/mm3. Ultrasonography showed a digestive tubular structure with thick walls in the left lower quadrant. CT scan revealed a dilated right-sided appendix with localized perforation, whose extremity was located in the left lower quadrant along the lateral wall. The diagnosis was confirmed by median laparotomy., Conclusion: Left-sided appendicitis can also be related to a dilated right appendix with its extremity in the left lower-quadrant near the lateral wall. CT scan can then be helpful for diagnosis when ultrasonography remains unconclusive.

We report the unusual case of a young man with progressive pain in the thoracic wall. The radionuclide bone scan revealed an increased uptake, and the bone roentgenogram, a calcified soft-tissue mass. Based on computed tomography findings, biopsy was avoided, and evolution was favourable for myositis ossificans. Although rare, myositis ossificans is one of the potential causes of thoracic pain, not to be mistaken for a malignant or infectious lesion.

The aim of the present study was to investigate the appearance of bronchioloalveolar lung carcinoma on computed tomography (CT) scans, and to determine the frequency of signs suggestive of this diagnosis. CT features of 42 cases with pathologically proven bronchioloalveolar carcinoma were retrospectively analysed for pattern, size, location and secondary signs suggesting the diagnosis. Bronchioloalveolar carcinoma had one of the following patterns: solitary nodule or mass (16), lobar consolidation (10), multilobar consolidations (13) and diffuse nodules (3). The 16 solitary nodules or masses ranged in size from 2.0 to 9.4 cm (mean +/- SD 3.75 +/- 1.7 cm). Eleven of the 16 nodules or masses were peripheral and five were central: Eight of the 16 tumours had pleural tags, seven had spiculated margins, and three had bubblelike lucencies. The consolidations were peripherally distributed in 13 out of 23 cases; cystic airspaces were observed in 19 out of 23 consolidations; bulging of interlobar fissures in 8 out of 23; and the angiogram sign in 7 out of 23. In conclusion, computed tomography findings of bronchioloalveolar carcinoma have a wide spectrum, showing typically a peripheral nodule or consolidation. Computed tomography has a role in the diagnosis of nodular localized versus other forms, with subsequent therapeutic and prognostic implications.

A case of chronic lung abscess due to Pasteurella multocida presenting as a solitary pulmonary mass with a computed tomographic appearance suggestive of malignancy is described.

Objective: Because of intrinsic limitations of transverse cross-sectional imaging methods, CT sometimes is insufficient for adequate evaluation of complex tracheobronchial anomalies. This article describes a complementary 3D procedure specifically dedicated to the study of the tracheobronchial tree., Materials and Methods: The procedure combines a specific spiral CT acquisition with 2 or 4 mm collimation, 3D surface rendering of the tracheobronchial aerial content, and double obliquity multiplanar reformats directly planned on the 3D virtual object. It was performed in 11 complex cases including 3 stented benign or malignant stenoses and 2 single lung transplantations., Results: Easier understanding of the tracheobronchial status was achieved in all cases. In three cases, the procedure yielded relevant diagnostic information that neither fiberoptic endoscopy nor transverse CT had provided, leading to significant modification of patient management., Conclusion: Three-dimensional spiral CT of the bronchial tree with secondary reformation seems suitable in clinical practice for selected cases.

The purpose of this study was to determine the prevalence of enlargement of the azygos system in the case of lung sequestration and its potential usefulness in the differential diagnosis of lower lobe opacities. Seven consecutive adult cases of pulmonary sequestrations were retrospectively enrolled; 4 sequestrations were proved surgically and all 7 angiographically. A group of 50 consecutive patients with a normal chest CT were used as controls. Another group consisted of 25 consecutive patients identified on the basis of an opacity in a posterobasal location on chest CT. For the 3 groups, the maximum diameter of the azygos and hemiazygos veins was measured, the level of measurement located between the upper poles of the kidneys and the confluence of inferior pulmonary veins into the left atrium. The diameter of the azygos veins (mean 10.4 +/- 5.1 mm) and of the hemiazygos veins (mean 7.1 +/- 3.0 mm) in the sequestration group was significantly larger than the diameter of the azygos and hemiazygos veins in the control group (mean 5.7 +/- 2.5 mm, and 3.4 +/- 2.4 mm, respectively), as well as in the study group (mean 5.9 +/- 2.6 mm and 3.3 +/- 2.6 mm, respectively). Our results suggest that enlargement of the azygos system in association with a posterobasal chest opacity, although nonspecific, may be a useful additional CT sign of sequestration.

The multiplanar capability of spiral CT improves the evaluation of bile duct lesions. In particular, spiral CT after intravenous administration of a cholangiographic agent (spiral CT cholangiography) provides adequate 2D and 3D images of the bile ducts in patients with normal bilirubin levels. Spiral CT cholangiography may be particularly useful as a noninvasive imaging method to detect biliary anatomic variations and bile duct stones before or after laparoscopic cholecystectomy. This technique does not replace retrograde cholangiography which has therapeutic applications, but might help to select patients who need to undergo invasive procedures such as retrograde cholangiography.

We report the case of a 63-year-old patient suffering from myotonic dystrophy, complicated with respiratory insufficiency, who presented a pneumoperitoneum without sign of peritonitis. Diagnosis of pneumatosis cystoides coli was based on CT scan evidence. Given oxygenotherapy and antibiotherapy, the patient rapidly improved. The association between the two affections has, to our knowledge, not been previously described.