Nous reportons le cas d’un patient de 68ans, pris en charge dans notre service pour un quadruple pontage coronarien. La stratégie initiale consistait à prélever l’artère thoracique interne gauche et l’artère radiale gauche en vue de les anastomoser sur les artères coronaires. Mais le prélèvement radial gauche a échoué en raison d’une rare variation anatomique de l’artère radiale, qui était formée d’une confluence de deux branches : une artère radiale superficielle et une profonde au tiers proximal de l’avant-bras, à environ 10cm sous le coude.

We report the case of a 68-year-old patient, operated on in our department of a quadruple coronary bypass grafting. The grafting strategy consisted initially on harvesting the left internal thoracic artery and the left radial artery. The harvest of this latter failed because of a rare anatomical variation of the radial artery, which rose from the confluence of two branches: a superficial and a deep radial artery at the proximal third of the forearm approximately 10cm below the elbow.

The purpose of this study was to assess the inter-observer and intra-observer reproducibility of the interpretation of CT arthrography and plain X-rays for scapholunate advanced collapse (SLAC), scaphoid non-union advanced collapse (SNAC) and scaphoid chondrocalcinosis advanced collapse (SCAC) wrist conditions, as well as the clinical relevance of these imaging modalities. The CT and X-rays images were reviewed twice in a blinded and randomized manner by two experienced orthopedic surgeons specialized in hand surgery, two orthopedic surgery residents and two experienced radiologists specialized in bone and joint imaging. Cohen's kappa and Fleiss' kappa coefficients were used to analyze the reproducibility of interpretation of the radiological examinations. With CT arthrography, the overall diagnosis was often a problem, in terms of both inter- or intra-observer reproducibility. The assessment of the joint line appeared to be fairly reproducible for each observer but was poorly reproducible between different observers. Plain X-rays are not sufficient to assess cartilage quality in degenerative wrist disease. CT arthrography is a reliable examination, but its interpretation is not always standardized. Diagnostic arthroscopy may be justified in doubtful cases.

Despite being associated with a very poor prognosis, long-term survivors across all series of Desmoplastic Small Round Cell Tumor (DSRCT) have been reported.To analyze patients ‘characteristics associated with a prolonged survival after DSRCT diagnosis.All consecutive patients treated for DSRCT in nine French expert centers between 1991 and 2018 were retrospectively analyzed. Patients with a follow-up of less than 2 years were excluded and cure defined as being disease-free at least 5 years.100 pts were identified (median age 25 years, 89% male). 27 had distant metastases at diagnosis and 80 pts underwent upfront chemotherapy (CT). 71 pts were operated, 20 pts without prior CT). Surgery was macroscopically complete (CC0/1) in 50 pts. Hyperthermic intraperitoneal Chemotherapy (HIPEC) was administered during surgery in 15 pts 54 pts had postoperative CT and 26 pts had postoperative whole abdomino-pelvic RT (WAP-RT). After a median follow-up of 103 months (range 23–311), the median overall survival (OS) was 25 months. The 1- year, 3-year and 5-year OS rates were 90%, 35% and 4% respectively. 5 patients were considered cured after a median disease-free interval of 100 months (range 22–139). Predictive factors of cure were female sex (HR = 0.49, p = 0.014), median PCI<12 (HR = 0.32, p = 0.0004), MD Anderson stage I (HR = 0.25, p < 0.0001), CC0/1 (HR = 0.34, p < 0.0001), and WAP-RT (HR = 0.36, p = 0.00013). HIPEC did not statistically improve survival.Cure in DSRCT is possible in 5% of patients and is best achieved combining systemic chemotherapy, complete cytoreductive surgery and WAP-RT. Despite aggressive treatment, recurrence is common and targeted therapies are urgently needed.

Background: The differential diagnosis of non-traumatic lower extremity pain and swelling runs the gamut from simple musculoskeletal injury to a possibly life-threatening deep venous thrombosis (DVT). Although evaluation and management are often guided by physical examination and history, a diagnostic study is often required. Institutional factors surrounding diagnostic imaging often lead physicians to empirically treat these patients for DVT with a plan for definitive diagnosis at a later time. Objectives: We discuss plantaris tendon rupture, the ability of the clinician to differentiate DVT from musculoskeletal injury, and the risks of anticoagulation in the setting of an undifferentiated, painful, swollen lower extremity. Case Report: We report the case of a 57-year-old transgendered woman who presented with left lower extremity pain and swelling and was found to have a rare cause of tennis leg: plantaris tendon rupture. Conclusions: Frequently, clinical examination and history are insufficient to distinguish DVT from musculoskeletal injury. In these instances, anticoagulation carries a risk of compartment syndrome and hemorrhage with uncertain benefit to the patient. A definitive diagnosis should be sought before initiation of anticoagulation of the swollen, painful lower extremity.

A 24-year-old woman presented with sudden right-sided weakness and aphasia.Brain MRI was performed 5 hours after symptoms onset.On diffusion-weighted imaging (DWI), the lesion showed a marked increase in signal intensity and an approximatively 70% mean apparent diffusion coefficient (ADC) decline as compared with the contralateral hemispheric white matter (figure).The patient met diagnostic criteria for multiple sclerosis and other etiologies were excluded.ADC decline in acute multiple sclerosis lesions, suggesting a diagnosis of ischemic stroke, has been previously reported. 1,2However, the decline in ADC values (22% to 40% decrease) was not as pronounced as our observation.Thus this fourth case of reduced ADC in acute demyelinating lesion indicates that the ADC drop may be important and close to that observed in the core of an acute brain infarction.

Comparer les performances de l’échographie à l’arthroscanner pour l’évaluation des lésions cartilagineuses de la trochlée fémorale. Etude prospective chez 30 patients addressés pour réalisation d’un arthroscanner du genou aux indications cliniques diverses. L’échographie était effectuée avant l’arthroscanner considéré comme examen de référence pour les lésions ouvertes. La classification de Broderick et Cool a été utilisée pour la description des lésions. L’échographie a détecté 7 lésions de grade 2,8 lésions de grade 3 et 5 lésions de grade 4 contre 8 lésions de grade 2,14 lésions de garde 3 et 8 lésions de grade 4 en arthroscanner. Nous avons retrouvé pour la détection des lésions de grade 2 à 4 par rapport à l’arthroscanner : une sensibilité de 67 %, une spécificité de 97 %, une valeur prédictive positive de 90 % et une valeur prédictive négative de 87 %. L’échographie visualise correctement le cartilage de la trochlée fémorale et 2/3 des lésions sont identifiables. L’analyse systématique du cartilage trochléen doit faire partie de chaque examen échographique du genou réalisé pour explorer les douleurs antérieures.

Connaître la sémiologie radiologique des lésions ostéoarticulaires classiques de l’hyperparathyroïdie primitive (HPTlve). Savoir évoquer le diagnostic devant une hypercalcémie et des lésions lytiques ou atypiques. Connaître l’imagerie des complications ostéoarticulaire de l’HPTlve. Les premiers signes radiologiques d’HPTlve sont dus à une résorption osseuse. Les tumeurs brunes (ostéites fibrokystiques) sont aujourd’hui rares lors du diagnostic (5 %). Une chondrocalcinose et des calcifications des parties molles peuvent exister. L’association lésions lytiques et hypercalcémie pose le problème du diagnostic différentiel avec une pathologie maligne (métastases, myélome). Le dosage de la calcémie ionisée et de la PTH 1-84 redressera le diagnostic.

We report a case of calcified aortic stenosis revealed by an ischemic stroke. An 81-year-old man with hyperlipidemia, hypertension and renal function impairment presented with acute onset of right-sided hemiparesis and aphasia. Head CT scan revealed a rounded calcified high-density mass within the distal segment of the left anterior cerebral artery, consistent with a calcified cerebral embolus, and an infarct in the left paracentral lobule. Transesophageal echocardiography demonstrated a sclerotic aortic valve. The patient was discharged from hospital on aspirin and atorvastatin, and the outcome was favorable. Calcified embolus remains a rare event and it has been not yet reported in the territory of anterior cerebral artery. It may be observed in aortic and mitral valve diseases, calcified plaques of the internal carotid artery and aortic arch. Renal failure promotes their development and is the cause of cardiovascular diseases. To date, aortic valve calcification is not considered as a marker of stroke risk, except when associated with severe stenosis or left ventricular hypertrophy.

PURPOSE OF THE STUDY:We aimed to highlight a rare anatomical variation involving the recurrent laryngeal nerve, and to emphasise its implications for thyroid surgery.MATERIALS AND METHODS:Over a period of 13 years, 993 patients underwent thyroid surgery; 1557 recurrent laryngeal nerves (887 on the right side) were exposed.RESULTS:Three non-recurrent laryngeal nerves were found on the right side, associated with a retro-oesophageal subclavian artery. One case was suspected before surgery.DISCUSSION:Several variations in the path and branches of the recurrent laryngeal nerve have been reported in the literature. The frequency of occurrence of a non-recurrent laryngeal nerve is about 1 per cent, for patients undergoing thyroid surgery. Other surgically relevant anatomical variations of the recurrent laryngeal nerve include associations with the inferior thyroid artery and the presence of nerve branches.CONCLUSION:The recurrent laryngeal nerve must be carefully dissected and totally exposed during thyroid surgery in order to best preserve its function. Moreover, the thyroid surgeon must be aware of the existence of anatomical variations, which are not as rare as one may think.

Connaître les principales localisations osseuses de l’histiocytose langerhansienne. Connaître la séméiologie de sa lésion élémentaire. Connaître les diagnostics différentiels des lésions osseuses de l’histiocytose. Connaître l’impact des différents examens d’imagerie dans la démarche diagnostique et étiologique. L’histiocytose langerhansienne est une pathologie rare, de localisations viscérales multiples. Au niveau osseux, elle se caractérise par des lésions lyriques d’agressivité variable. L’ensemble des techniques d’imagerie (radiographies standard, TDM, scintigraphie et IRM) concourt à l’élaboration du diagnostic. L’IRM est utile à la recherche d’une atteinte des parties molles. L’étude histologique reste indispensable au diagnostic final.

Recanalization of cerebral venous thrombosis within 24 hours A case reportCerebral venous thrombosis represents 1% of acute strokes.Its recanalization rate is variable according to the series but averages around the 4 first months. 1We report a 22-year-old woman with sudden headache and vomiting due to cerebral thrombophlebitis documented by cerebral CT angiography (figure , A andB) 2 recanalized within 24 hours owing to IV heparin therapy with amendment of clinical signs and recanalization of cerebral venous sinuses demonstrated by MRI (figure , C andD).This case illustrates the need for early positive diagnosis of cerebral thrombophlebitis to avoid false negatives and allow treatment with anticoagulation therapy as soon as possible, to prevent recurrences.

Connaître les principales tumeurs osseuses malignes primitives. Savoir sur quels critères elles sont diagnostiquées. Décrire l’imagerie de ces tumeurs. Comprendre le rôle de chaque technique d’imagerie. Les plus fréquentes tumeurs osseuses malignes primitives sont l’ostéosarcome, le sarcome d’Ewing et le chondrosarcome. La radiologie standard demeure l’examen de première intention. La tomodensitométrie peut compléter le bilan et permettre dans certains cas d’orienter le diagnostic. L’IRM tient pricipalement son rôle dans le bilan d’extension et le suivi de l’évolution de la lésion sous traitement. Le diagnostic formel repose sur l’étude histologique.