A case of pseudocyst of adrenal gland is reported. The first findings have been acute pain and falling hematocrit. Then hepatomegaly is present. All the investigations--ultrasonography, radionuclidescan, arteriography--failed to demonstrate the origin and saided liver cyst. The diagnosis is operative. The pseudocyst hemorrhagic are 32% of adrenal cysts. We think the computer tomography will be an important contribution for the diagnosis of false hepatomegaly.
By using rigourous examination techniques and interpretive criteria, ultrasonography of the pancreas can, in many cases, confirm the etiological diagnosis of solid pancreatic masses. Factors influencing diagnosis are the volume and shape of the pancreas, the ultrasound structure, the attenuation of ultrasounds, the outline of the pancreas, and the effect on neighbouring structures. The association of signs is often characteristic and can differentiate benign from malignant masses.
A man of 37 years of age developed portal hypertension which was observed on radiological examination as a mediastinal opacity having the appearance of a tumor. No oesophageal varices were seen on barium meal examination or by endoscopy. A smooth liver was seen during laparoscopy. Pre-operative hemodynamic studies showed that there was no sinus block. Thoracotomy revealed an aneurysm of the azygos veins. Exploratory laparotomy after coelio-mesenteric arteriography confirmed the diagnosis of diffuse nodular hyperplasia of the liver, cirrhosis, and portal hypertension. The findings in 16 cases of mediastinal opacity from portal hypertension reported in the published literature are discussed.
A new radiological technique is described for opacification of the thoracic aorta in neonates and babies weighing less than 10 kg. The exploration method is described: injection of a contrast medium after retrograde carotid puncture, and increased endothoracic pressure. The results obtained in 21 babies aged from 3 to 157 weeks, and weighing 3.3 to 10 kg are discussed. Radiographic results were excellent in 17 cases, satisfactory in 3 cases, and only moderate in 1 case. The procedure was perfectly well tolerated, and enabled visualization of an arterial canal in 4 cases, stenosis of a Blalock-Taussig anastomosis in 1 case, aortic stenosis in 7 cases (2 tubular hypoptasias, 1 coarctation, 3 segmentary interruptions, 1 recoarctation), coronary-cardiac fistula in 1 case, and a normal aorta in 9 cases. The authors review the advantages, inconveniences, and risks of the other methods of opacification of the thoracic aorta in neonates and babies. They conclude that when right cardiac catheterization cannot give, in babies under 10 kg of weight, a satisfactory radiological assessment of the thoracic aorta in the following clinical conditions: coarctation syndrome, badly tolerated left-right shunt, or possible abnormality of the aortic arch or coronaries, the technique of opacification of the thoracic aorta by retrograde puncture of the common carotid is the best radiological method for establishing a definite diagnosis.
A child aged 4 1/2 years was found to have secondarily infected retained secretions in the vagina from a vaginal membrane. The authors underline the value of intravenous urography coupled with rectal insufflation, which is essential in order to confirm the diagnosis of colpos and to eliminate any associated urinary malformation.
About an experience of 7,757 investigations and after study of the published series in the literature, it appears the frequency of the accidents following vascular roentgenology has not really changed since ten years. -- 0,5% complications; 0,07% death in aortographies; -- 0,4% complications; 0,09% death in femoral artery catheterization; -- 3% complications; no death in axillary artery catheterization. The authors use the term "complications" when a surgical operation is necessary or after effects are present in the evolution. The study of the recent literature proves no significant amelioration in comparison with the last ten years. The accidents are analysed in aortography, in arterial catheterization using femoral or axillary arteries: the latter is the most dangerous. The considerable increment of the number of investigations suppressed the progresses provided by the material improvements. An explanation: in hospitals, it is necessary to train the students for roentgenology.
Clear images of the chambers of the heart and the vessels can be obtained by rapid scanning with computed tomography, associated with rapid perfusion of a contrast medium. A study in 30 normal subjects demonstrated that it was possible to identify and localize the heart chambers and the large vessels in different planes, and to obtain precise measurements of the various diameters. These results could form the basis for etiological studies of the cardiopathies.
The authors review 69 cases of infections due to mycoplasma pneumoniae in children, including the clinical, biological, and radiological aspects, and compare their results with those in the published literature. Clinical and radiological signs and non-specific, and diagnosis is made exclusively by serological tests.
Standard radiological examinations in a woman of 40 years of age with a pneumothorax and chylothorax revealed the presence of a posterior mediastinal mass compressing the oesophagus, and an interstitial syndrome. Retroperitoneal and mediastinal cystic lymphangiomas were found on lymphography. These findings are in accordance with the lymphangiomyomatosis described by Cornog and Enterline in 1966. The similarity between this disease and tuberculous sclerosis is underlined in present-day publications.
Definition and technique of the Dulac 7 incidence. Diagrams 1 and 2 give details of the anatomical orientations which define this incidence. It is:--centered on the head of the malleus,--orientated in the plane of the ossicules or in the neighbouring plane of the ear-drum,--parallel to the general axis of the ossicules,--close to the perpendicular to the tegment tympani. This incidence is easy to obtain with our technique, using a fixed intracranial centering point, The transversal linear scanning is very effective and can be completed in a very short period. It should be noted, however, that in obese subjects with short necks, the entry point of the incidence is difficult to obtain as there is interposition of the neck muscles. Under these conditions, one should try to be as close to this entry point as possible, knowing that the results are still valid. Tomographic anatomy. A close examination of the text of figures 6, 7, and 8 will familiarize the reader with the tomographic anatomy of this incidence. To summarize the important information obtained from the Dulac 7 incidence we should note that in tomographies of normal petrous bones:--the attic is always perfectly visible, expecially its internal and external walls throughout their total length, and more especially the anterior wall;--the ossicles (head of the malleus, body of the incus, and their articulation) are always perfectly visible and distinct;--the inferior processes of the malleus and incus are always visible;--the external wall of the attic is visible throughout its length, more especially the anterior and posterior portions;--the anterior and posterior contours of the external auditory canal are particularly well-defined. Finally, this incidence also gives clear images of the temporo-mandibular joint, the antral region, the superior canal, and the internal auditory canal. A large experience of this incidence is required before interpreting the image of the foramen ovale. Tomographic pathognomonic signs. The texts of figures 9 to 24 are sufficiently demonstrative of the richness of the pathological data obtained from this incidence, without needing to repeat them here. We would only add that the degree of calcification of the ossicles and the anterior wall of the attic can be precisely determined. This incidence, therefore, gives valuable information in almost all middle ear affections. It is also necessary in order to study the external auditory canal.
Meconium ileus equivalent is a late intestinal occlusion occurring in patients suffering from mucoviscidosis. Three cases are reported in children aged, respectively, 3 years, 6 years and 10 years. In one of the observations (three year old girl), the intestinal obstruction with feces was first manifestation of a mucoviscidosis that was previously undetected. The radiological signs are identical to those found in cases of neonatal meconium ileus: intestinal obstruction and accumulation of closely spaced matter in a distended ileum (terminal part). As in cases of meconium ileus without complications, treatment consisted of enemas with water-soluble products. The high osmotic pressure of these products made it possible to remove the obstruction.
Neurological and clinical examinations were found to be normal in a woman aged 40 years who had had a single generalized epileptic seizure. Rediological examinations demonstrated a spiral-shaped calcification above and laterally to the left sella turcica. This corresponded to changes in the C 1 segment of the left carotid sinus, which was partly stenosed distally, with left unilateral abnormalities of the circle of Willis and multiple distal stenoses of the left sylvian and vertebro-basilar arteries. Scanning demonstrated that these had been present for a long time, but it is not possible to establish the diagnosis on an etiological basis as no similar radiological findings have been published.
In two series amounting to 266 cases, the overall success rate of ultrasonic diagnosis, in pancreatic lesions was 94%. Since most of pancreatic lesions, when clinical symptoms are present, are already rather large, imaging improvements did not enhance accurary, except for small lesions. The tenative analysis of small abnormalities can be responsible, with last generation machines, for an increase of false positive diagnoses.
