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Resume Introduction Dans la sarcoidose pulmonaire, ĺatteinte vasculaire est habituellement limitee aux vaisseaux de petit et moyen calibre. Les adenopathies sont typiquement bilaterales et non compressives. Observation Nous rapportons ici un cas de dyspnee chez un patient porteur d’une sarcoidose pulmonaire avec pour seule anomalie thoracique des adenopathies hilaires tres volumineuses comprimant les arteres pulmonaires en proximal et responsables d’une elevation segmentaire de la pression arterielle pulmonaire. Une corticotherapie efficace a permis la regression des adenopathies et parallelement l’amelioration clinique. Conclusion Les adenopathies hilaires rencontrees au cours de la sarcoidose peuvent etre responsables d’une compression symptomatique sur les arteres pulmonaires. Le pronostic vital a court terme peut etre menace en l’absence de traitement.

Pulmonary veno-occlusive disease (PVOD) is a rare cause of pulmonary arterial hypertension that affects predominantly post-capillary pulmonary vessels. A major concern with PVOD is the poor response to available therapies and the risk of pulmonary oedema with continuous intravenous epoprostenol. The present authors hypothesised that alveolar haemorrhage may be a characteristic feature of pulmonary veno-occlusive disease, as compared with other forms of pulmonary arterial hypertension that predominantly involve pre-capillary pulmonary arteries. This paper reports a series of 19 patients with either PVOD (n = 8) or idiopathic pulmonary arterial hypertension (IPAH; n = 11) who underwent bronchoalveolar lavage. Cytological analyses were performed and differential counts were made on Perls-stained preparations. The Golde score was used to assess alveolar haemorrhage. As compared with IPAH, PVOD was characterised by a higher percentage of haemosiderin-laden macrophages (40+/-37 versus 3+/-6%), resulting in elevated Golde scores (81+/-88 versus 4+/-10). It was concluded that occult alveolar haemorrhage is a common feature of pulmonary veno-occlusive disease. Detecting occult alveolar haemorrhage may be of interest in the diagnostic approach of pulmonary veno-occlusive disease.

To correlate pretherapeutic thin-section computed tomographic (CT) findings in patients with pulmonary hypertension with the risk of fatality with treatment with epoprostenol.Seventy-three consecutive patients with severe pulmonary hypertension treated with epoprostenol were retrospectively separated into two groups. The first group included 12 patients who had a fatal outcome with epoprostenol therapy. The second group (n = 61) was a reference group of patients with epoprostenol-induced clinical improvement. Pretherapeutic thin-section CT scans of each patient were reviewed.Poorly defined nodular opacities (P =.003), septal lines (P =.04), pleural effusion (P =.01), and adenopathy (P =.009) strongly correlated with a risk of clinical worsening with treatment. In six patients in group 1, postmortem examination of the lung revealed either pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis.On pretherapeutic thin-section CT scans, poorly defined nodular opacities, septal lines, pleural effusion, and adenopathy should raise suspicion for pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis and provoke possible further evaluation before epoprostenol therapy.

To determine whether computed tomography (CT) can depict liver hemodynamic changes caused by occult hepatic micrometastases in rat.Liver micrometastases (mean diameter, 500 micrometer +/- 300) were produced in seven BD IX rats by injecting 10(7) DHDK12 PROb colorectal carcinoma cells into the spleen. Macrometastases (mean diameter, 7 mm +/- 3) were produced in four other rats. Five normal rats were studied as controls. CT images were obtained every 300 msec for 30 seconds during the injection of 1 mL per kilogram of body weight of contrast medium. The time-attenuation curves of the aorta, portal vein, and liver were used to calculate liver perfusion with a deconvolution model designed for the dual blood supply.Micrometastases in an apparently normal liver caused a 34% decrease in portal blood flow and a 25% increase in the mean transit time for the blood to pass through the liver. These findings suggest increased resistance in the sinusoidal capillaries. Similar but greater changes were found in the macrometastases.Occult liver micrometastases in rats generate changes in liver perfusion that can be detected with CT.

Monsieur SL âge de 38 ans se presente aux urgences pour des douleurs abdominales epigastriques brutales. L’examen retrouve une douleur diffuse epigastrique avec defense. Ses antecedents comportent un reflux gastro-œsophagien traite et une intoxication alcoolo-tabagique non sevree. Une gastroscopie realisee peu avant l’episode actuel retrouvait une oesophagite de grade I, un ulcere bulbaire et un aspect de compression extrinseque du bulbe duodenal. Un scanner abdomino-pelvien avec injection est realise et les cliches sont presentes ci-dessous.

In pulmonary sarcoidosis, vascular involvement is usually limited to the small and medium-sized vessels. Enlarged hilar lymph nodes are usually considered to be soft and hence unlikely to cause pressure on adjacent bronchi or blood vessels.We report a rare symptomatic compression of a major pulmonary artery by lymphadenopathy in a case of sarcoidosis. Our patient presented with exertional dyspnoea, with enlarged hilar lymph nodes responsible for segmental pulmonary arterial hypertension, without other thoracic abnormalities. The symptoms and lymphadenopathy regressed with corticosteroid therapy.Enlarged hilar lymph nodes can compress major pulmonary arteries and cause segmental pulmonary hypertension. The prognosis can be grave in the absence of treatment.

International audience; This study was carried out to compare ultrasonographic findings on patients after transobturator tape (TOT) and tension-free vaginal tape (TVT) procedures to evaluate displacement of tapes up to a 2-year follow-up and to test the correlation between bladder outlet obstruction and the tape position. Forty-nine patients had a transvaginal ultrasonographic evaluation after TOT (n=31) or TVT (n=18) procedures. Twenty-one patients from the TOT group and 12 from the TVT group had ultrasonographic evaluation both at 1 and 2 years follow-up. Tape position was evaluated with a complete sagittal view, and the width of the tape and the distance between the middle of the tape and the bladder neck were measured. Statistical analysis was performed using a t test. After clinical evaluation, stress test, and uroflowmetry with residual measurement, the tapes were compared on ultrasound with regard to clinical and urodynamic results: success in stress incontinence vs failure, bladder outlet obstruction vs no obstruction, and de novo urgencies vs no urgencies. No difference was found between TOT and TVT in the midurethral tape placement. The distance between the middle of the tape and the bladder neck at rest was similar at both 1 and 2 years after both TOT and TVT and was unchanged after coughing or Valsalva. The width of the tape was similar after TOT and TVT at both 1 and 2 years after the procedure. There was no difference in the distance between the middle of the tape and the bladder neck between cured patients, failure, bladder outlet obstruction, and de novo urgencies after both TOT and TVT. Transvaginal ultrasound examination showed no significant difference in the tape position between TOT and TVT. No correlation was found between ultrasonographic findings and postoperative voiding troubles for both techniques.

To describe the CT findings of pulmonary veno-occlusive disease.Pre-therapeutic CT of 15 patients suffering from pulmonary veno-occlusive disease were retrospectively reviewed. Pathologic evaluation of pulmonary veno-occlusive disease was obtained after post mortem examination or pulmonary transplantation. CT protocol always included intravenous helical CT and high resolution CT.The most frequent CT-findings in pulmonary veno-occlusive disease were the following: ground glass opacity with poorly defined nodular opacities (73%), septal lines (93%), and adenopathy (80%). Pericardial (60%) and pleural effusions (27%) were also noted. Other parenchymal findings were unusual.HRCT must be systematically included in the initial CT evaluation of pulmonary hypertension. Combination of poorly defined nodular opacities, septal lines, and adenopathy are indicative of pulmonary veno-occlusive disease.

To determine the fetal and maternal exposure to radiation by use of thermoluminescent dosimeters in order to compare conventional and CT-scan X-ray. Materials and methods. Dosimetry was performed with an anthropomorph phantom. Thermoluminescent dosimeters were positioned on the surface and in the depth of the phantom. Digital radiography of the pelvis was performed according to a standard technique. CT-scan of the pelvis was performed according to the Buthiau's technique.With CT, the dose reached 0.31 to 4.95 mGy, with a dose of 2.32 mGy for the fetal gonads. With standard technique, the doses reached 0.03 to 0.39 mGy, with a dose of 0.39 mGy for the fetal gonads.With CT the fetus and the mother were exposed to 1/10th of the total dose delivered using conventional X-rays and the dose distribution was more homogenous.

We present a case of pulmonary embolism which resulted from the migration of an oesophageal variceal sclerosing agent. Despite its frequency, this complication is rarely described in the literature.

Objectifs Comparer angioscanner (CTA) et angiographie numerisee (DSA) dans le bilan pre-operatoire du cœur pulmonaire post-embolique (CTED). Materiels et methodes Etude retrospective sur 27 patients traites consecutivement par thromboendarterectomie. Tous ont eu CTA et DSA dans le mois precedant l’intervention. L’etude a evalue (1) l’operabilite des patients definie radiologiquement par l’existence de thrombi proximaux avant la naissance des arteres segmentaires. Les CTA et DSA ont ete relus par 2 groupes de radiologues differents sans connaissance des resultats operatoires. (2) L’obstruction distale des 540 arteres segmentaires a ete evaluee en CTA, compare a la DSA consideree comme reference (test de Spearman). Resultats Concernant l’operabilite, les sensibilites et specificites sont de 98 % et 50 % pour la DSA, et de 96 % et 75 % pour le CTA L’association des deux examens conduit a une specificite de 100 %. Le scanner ne permet pas dans cette etude d’estimer correctement l’obstruction distale (p = 0,22). Conclusion CTA et DSA ont une bonne sensibilite pour determiner l’operabilite du CTED. Neanmoins, la specificite est mediocre. Il apparait indispensable d’associer ces deux examens en pre-operatoire pour eviter d’operer des patients a tort.

A 66-year-old man with a history of primary hypertension and peripheral arteritis was admitted to the intensive care unit with multiple organ failure including shock, lactic acidosis, Escherichia coli bacteriemia, acute renal failure, respiratory failure, and confusion after 12 hours of abdominal pain and diarrhea. Owing to the severity of the clinical picture, a computed tomographic scanning of the abdomen with intravenous contrast medium was performed. This showed gas in the intrahepatic portal venous system (Fig. 1), in the portal vein (Fig. 2), in the mesenteric vein, and in the wall of the small bowel (Fig. 3), demonstrating the presence of diffuse acute enteritis. The patient was considered too seriously ill to undergo surgery and died a few hours later. No postmortem examination was performed. Non-occlusive ischemic enterocolitis was consistent with the patient’s presentation, despite the associated risk factors. Indeed, the patient did not have a previous history of intestinal angina. The role of severe hypovolemia, vasoconstriction, shock, and systemic sepsis can be suspected. Intramural gas, either linear or bubble shaped, and gas in the portal venous system—an ominous sign—are the radiographic hallmarks required for the diagnosis in adults of ischemic bowel disease and in the premature newborn of necrotizing enterocolitis [1]. In general, plain radiography of the abdomen and ultrasonography may be sufficient for premature

Objectifs L’objectif de ce poster est d’exposer de facon didactique l’aspect semiologique des principales pathologies biliaires en IRM. Materiels et methodes Presentation des principales pathologies biliaires a partir d’une analyse retrospective des cholangio-RM effectuees ces 15 derniers mois dans notre service, totalisant une centaine d’examens. Ces examens ont ete realises selon un protocole standardise sur un imageur 1,5 T (Siemens), a l’aide d’une antenne en reseau phase, apres ingestion de jus d’ananas (sequences axiale et coronale HASTE, axiale TrueFISP, monocoupes 2D RARE et acquisition volumique 3D RARE avec reconstruction multiplanaire). Resultats Apres un rappel de l’anatomie normale des voies biliaires, description des principales pathologies biliaires a connaitre, primitives ou iatrogenes, en insistant sur les images pieges grâce a leur correspondance en TDM ou en echographie. Conclusion La semiologie des pathologies des voies biliaires en cholangio-RM necessite d’etre connue de tout radiologue en raison de sa place grandissante du fait de son innocuite face aux explorations endoscopiques.

Objectifs Place et aspects semiologiques des differentes modalites d’imagerie dans la prise en charge du cœur pulmonaire chronique post-embolique (CPCPE). Materiels et methodes Le CPCPE est une complication rare (4 %) mais grave de l’embolie pulmonaire, l’obstruction arterielle etant responsable d’une hypertension pulmonaire severe rapidement fatale en absence de traitement. Nous sommes centre de reference de l’hypertension pulmonaire et une centaine de patients nous est adressee chaque annee pour confirmer le diagnostic de CPCPE et evaluer les formes accessibles a un traitement chirurgical curatif par thromboendarteriectomie (50 %). Chaque patient beneficie systematiquement d’un angioscanner 64 detecteurs, le plus souvent complete par une angiographie et une IRM morphologique et fonctionnelle. Resultats Nous rapportons notre experience sur la semiologie radio-logique du CPCPE, en insistant particulierement sur les aspects angiographiques, scanographiques et IRM (angioIRM, cineIRM et contraste de phase). La place des ces techniques est egalement discutee pour le diagnostic, la decision operatoire et l’evalution du succes operatoire. Conclusion Bien que l’angiographie soit le « gold standard », V angioscanner multidetecteur prend une place preponderante dans l’evaluation du CPCPE. L’IRM des arteres pulmonaires, encore du domaine de la recherche, devrait rapidement devenir une technique incontournable par son apport fonctionnel.

Objectifs Illustrer les aspects IRM de l’envahissement digestif souvent meconnu dans l’endometriose. Materiels et methodes Etude retrospective de 12 cas d’endometriose infiltrante ayant beneficie d’une resection digestive entre 1999 et 2004. Une analyse detaillee de l’atteinte digestive, par deux radiologues, est correlee aux donnees chirurgicales et anatomo-pathologiques. Resultats L’endometriose est souvent floride. On illustre deux formes d’atteinte digestive. Une premiere se presente sous forme de nodules, souvent en hypersignal Tl et T2, enclaves dans la paroi digestive ou en contact etroit avec celle-ci. Une deuxieme, semblant plus frequente mais de detection plus difficile, correspond a un epaississement retractile en plage attirant les structures digestives. Cette forme est souvent en hyposignal Tl et T2, accompagnee d’un epaississement focalise irregulier de la paroi digestive. Deux cas de faux positifs et un cas de faux negatif illustrent la difficulte de l’analyse IRM de l’envahissement digestif. Conclusion Parmi les aspects de l’envahissement digestif dans l’endometriose, la connaissance de la forme retractile, en hyposignal Tl et T2, permet d’en ameliorer la detection et donc de prevoir une prise en charge pluri-disciplinaire.