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Highlights • Taller-than-wide thyroid nodules are more likely to require surgery. • A taller-than-wide, solid and hypoechoic thyroid nodule is likely a Bethesda 4 or 5. • Taller-than-wide sonographic sign is the strongest in predicting thyroid malignancy., Purpose To develop a Classification and Regression Tree (CART) model in order to recognize the most suspicious sonographic features of thyroid nodules and efficiently guide their management. Methods 791 thyroid fine needle aspiration cytology (FNAC) performed under ultrasound guidance between January 2015 and January 2017 were reviewed. Retrieved data consisted in qualitative (patient’s gender, composition, echogenicity, shape, margins and echogenic foci of the nodule) and quantitative (patient’s age and maximal diameter of the nodule) variables as well as the Bethesda score. Results Patients were 48.5 ± 13.7 years old with female to male ratio of 8:2. The nodules had median size of 2.3 (1.5–3.5) cm with a majority of solid (62.5 %) and isoechoic (50.8 %) features. 700 nodules (88.5 %) had a wider-than-tall shape, 600 (75.9 %) smooth margins and 113 (14.3 %) ill-defined ones. Echogenic foci were absent in 388 nodules (49.1 %) and, when present, largely dominated by punctate foci (32.5 %). Bethesda classes 3, 4 and 5, which require surgery, represented only 10.6 % of cases. They were significantly correlated with the taller-than-wide shape and with solid or predominantly solid features. There was no significant correlation between echostructure and Bethesda scores but we did find more nodules classified Bethesda 4 and 5 in the categories hypoechoic and severely hypoechoic. In the CART model we developed, the sequence leading to most nodules classified Bethesda 4 and 5 is: taller-than-wide shape, solid composition and hypoechoic or severely hypoechoic feature. Conclusions Taller-than-wide, solid or predominantly solid, hypoechoic or severely hypoechoic nodules are likely to require surgery and might benefit from FNAC.

Imaging of a patiеnt undеrgoing cardiac arrеst is not common but thе abnormal hеmodynamics duе to thе pump failurе havе charactеristic imaging fеaturеs on CT-scan. Thе main imaging fеaturеs includе stasis and pooling of blood in thе dеpеndеnt organs of thе body, thе infеrior vеna cava, thе right rеnal vеin, thе right hеpatic vеin and thе right hеpatic parеnchyma. Knowlеdgе of thеsе signs is еssеntial in ordеr to start rеsuscitating thе patiеnt and can havе important survival implications. Wе rеport thе contrast-еnhancеd CT-scan fеaturеs of thе casе of a critically-ill patiеnt having imminеnt cardiac arrеst fеw minutеs aftеr thе еxamination.

We present the case of a 30-year-old female, complaining of thoracic outlet compression symptoms caused by a supernumerary muscle, the subclavius posticus, accompanied by a caudally inserted middle scalenus muscle on the second rib. This rare anatomic variant was clearly shown on CT angiography and MRI images and surgical treatment was successful. As first described by Rosenmuller in 1800, subclavius posticus is a supernumerary muscle originating from the cranial surface of the sternal end of the first rib, running laterodorsally beneath the clavicle, and inserting into the superior border of the scapula. Its role in thoracic outlet syndrome has been seldom demonstrated in living patients nor described in imaging, although it is theoretically easily recognizable on modern imaging modalities. It should be taken into account during workout of patients with thoracic outlet syndrome, since it can be potentially treated.

Objective/Background The use of antithrombotic medication (ATM) frequently is reported in patients with intracranial hemorrhage (ICH) and is associated with increased mortality. Unfortunately, ATMs sometimes are prescribed and/or used inappropriately. We sought to determine the rate of ATM misprescription/misuse among patients with ICH in a single-center retrospective study. Methods All patients admitted with ATM-related ICH in 1998−2014 were included. Charts were reviewed and demographic, clinical, and radiologic variables were recorded. The type of ATM, dose, and duration of treatment were analyzed critically. The adequacy of ATM prescription/use was assessed in light of the recommendations and guidelines of the American Heart Association, American Stroke Association, and French National Authority for Health, in effect at the time of admission. Results A total of 106 patients with mean age 68 years were identified. Aspirin (53.8%) was the most commonly used drug, followed by oral anticoagulants (31.1%) and clopidogrel (22.6%). In only 80 patients (75.5%), the use of ATM was in line with contemporary guidelines. In the remaining 26 (24.5%), the use of ATMs was inappropriate, including bad drug combination, wrong dose, poor indication, wrong drug class, and/or incorrect treatment duration. Conclusions In this Lebanese cohort of patients with ICH, the 24.5% rate of ATM misprescription and/or misuse is highly alarming and the origin of this problem is likely multifactorial. Immediate measures should be undertaken, and efforts should be focused on regaining tight control of ATM prescription and fulfillment, ensuring good patient education, and offering more vigilant oversight on physician licensure.

Resume L’hydatidose est une maladie parasitaire retrouvee dans le monde entier, notamment dans les pays mediterraneens. Elle est generalement due a une infection par Echinococcus granulosis et l’homme constitue l’hote intermediaire, accidentel, dans le cycle de ce parasite. L’embolie arterielle pulmonaire hydatique est extremement rare, prenant origine le plus souvent du cœur ou du foie. Nous rapportons un cas d’embolie pulmonaire hydatique evalue au scanner multidetecteur et a l’IRM, et confirme histopathologiquement sur piece operatoire. A notre connaissance, il s’agit du premier cas d’embolie arterielle pulmonaire hydatique inaugurale decouverte au scanner posant le diagnostic de la maladie chez un patient n’ayant pas d’autre localisation.

Meningeal melanocytoma is a rare benign CNS tumor derived from the leptomeningeal melanocytes. Although unusual, malignant transformation with leptomeningeal seeding into the brain or spinal cord may occur years after the initial diagnosis. The authors report a unique case of multifocal benign meningeal melanocytoma involving both cerebellopontine angles and the thoracic spinal cord, with associated diffuse leptomeningeal hyperpigmentation. They review the literature relevant to this topic and discuss the radiological and pathological features of this disease as well as its treatment options.

To analyze the impact of the lunar cycle and season on the incidence of aneurysmal subarachnoid hemorrhage (SAH).The medical records of 111 patients who were admitted over a 5-year period to our department because of aneurysmal SAH were retrospectively reviewed. The date of aneurysm rupture was matched with the corresponding season and moon phase.An incidence peak for aneurysm rupture (28 patients) was seen during the phase of new moon, which was statistically significant (p0.001). In contrast, no seasonal variation in the incidence of SAH was observed.The lunar cycle seems to affect the incidence of intracranial aneurysm rupture, with the new moon being associated with an increased risk of aneurysmal SAH.

The use of iodinated contrast agents (IC) has become common practice nowadays in the daily diagnostic and therapeutic procedures in radiology. Immediate hypersensitivity reactions occurring up to the first hour after injection of IC, can be of serious consequences, occasionally leading to death. This justifies the establishment of a prevention algorithm, including a sharp identification of those at risk and the implementation of premedication with corticosteroids. A history of previous reaction to IC is the major risk factor of a new reaction. Other risk factors include asthma, atopy and cardiomyopathy. The factors that influence the severity of the hypersensitivity allergic reactions are female gender, age, and taking beta blockers or ACE inhibitor drugs.

CT-guided transthoracic lung biopsy is widely used in pulmonary lesions diagnosis. This technique rarely entails severe complications such as pneumothorax and pulmonary hemorrhage which call for adequate candidates screening. The aim of our study is to statistically assess risk factors related to these two main complications, and determine the best diagnostic workup.This retrospective study includes 110 patients who underwent CT-guided transthoracic biopsy of a pulmonary lesion. Rates of pneumothorax and pulmonary hemorrhage, as well as their severity, were evaluated, and a correlation with factors related to patients, lesions and biopsy technique were statistically analyzed.Higher rates of complications are significantly found with multiple punctures (pneumothorax risk multiplied by 7.4), longer intra-parenchymal needle tract (5 and 7% higher risk of pneumothorax and hemorrhage for every 1 mm increase in depth), and with smaller lesions (2 and 5% lower risk respectively for pneumothorax and hemorrhage for every 1 cm increase in lesion size). The presence of an interposing rib is associated with a higher rate of hemorrhage.Transthoracic lung biopsy is a minimally invasive technique. However, the presence of associated risk factors must lead to consider another diagnostic method.

To assess the value of ultrasound as an adjunct to radiography in minor musculoskeletal pediatric trauma.Fifty children with 53 suspected fractures were referred for upper and/or lower limbs X-rays, followed by ultrasound. On radiography, we noted presence of fracture, of soft tissue thickening, or absence of any lesion. On ultrasound, we noted presence of fracture, of soft tissue lesion, or absence of lesions.A fracture was seen on both examinations in 25 patients with 28 fractures.In 4 patients where only soft tissue thickening was seen on radiography, ultrasound showed fracture in 1 patient, hematoma in 1 patient and was normal in 2 patients. In another patient with a doubtful diagnosis of fracture on radiography, ultrasound was normal. In 20 patients with normal X-rays, ultrasound showed fracture in 6 patients, hematoma in 7 patients and was normal in 7 patients.Ultrasound was helpful as an adjunct to radiography, it yielded additional bone (7/50 patients) and soft tissue (8/50 patients) diagnostic information in 30% of patients. However, ultrasound remains operator-dependent and can be used only in particular circumstances, especially in children with normal X-rays and a high index of clinical suspicion for an occult or subradiological fracture.

Knowledge of axial anatomy of the different laryngeal structures, identification of the plan of the cords, and relations between the true and false vocal cords is essential for laryngeal surgery where anatomical and radiological correlation is necessary for optimal orientation and guidance. This review constitutes an atlas of axial anatomy of the larynx obtained from a multidetector CT scan, describing the skeletal cartilage, the different folds constituted by laryngeal ligaments covered by mucosa, and the fatty laryngeal spaces. It shows that CT scan and the different reconstructions specifically virtual endoscopy are a valuable adjunct in laryngeal exploration.

Imaging techniques are in permanent evolution and so are their respective sensitivities. We present a case of a patient who had three abdominal CT scans over 10 years for the detection of pancreatic insulinomas. The first was made on an incremental CT and showed no lesion, the second on a single-slice helical CT which revealed a single centimetric tumor of the head of the pancreas, and the third on 64-slice CT which revealed 5 infracentimetric tumors. We do not know if all were present at the first scan but it is possible that these small tumors could have been missed on thick CT scan slices with overlap. The ideal imaging technique for the detection of endocrine pancreatic tumor is not known yet. The detection rates in the latest publications are 80% for CT scans and 70% for MRI, but there is a slight preference for CT scan because of its larger availability and higher resolution.

Osteoarticular ultrasound, a well established technique in adults, appears to be very useful also in children because of the non ossification of cartilaginous structures, the possibility to avoid sedation and irradiation, and hence the use of scanner and MRI will be reduced. This is a review of the clinical applications of musculoskeletal ultrasound in the pediatric population. Pictorial examples of cases collected between January 2003 and December 2006 of different pathologies encountered in Lebanon are displayed with a discussion of congenital malformations, traumatic lesions, inflammatory and infectious lesions, bone dystrophy and dysplasia, metabolic and tumoral lesions.