Ahmed Zrig

Lipoblastoma: a rare lesion in the differential diagnosis of childhood mediastinal tumors.

Lipoblastoma is a rare, benign, fatty tissue tumor that occurs in childhood. The location of this tumor in the mediastinum and extension to the chest wall is uncommon. We describe a 12-month-old male infant with a mediastinal lipoblastoma discovered because of a chest wall swelling. Computed tomography showed the deep component and fatty content of the lesion suggestive of the diagnosis. Total excision of the mass was carried out. The histologic examination of the lesion confirmed the diagnosis of lipoblastoma. Mediastinal lipoblastoma should be considered among the possible diagnoses of a fatty mediastinal tumor in childhood.

Abcès du muscle iliopsoas : complication rare de la sacro-iliite à pyogène chez l’enfant

Pyogenic sacroiliitis is a rare entity in children. Diagnosis is often delayed because of its variable clinical presentation, low suspicion by the examining physician, and rare findings on radiographs. Delayed diagnosis, however, results in complications such as iliopsoas abscess. We report the case of a 12-year-old girl hospitalized with a 21-day history of fever, pain in the left iliac fossa, and flexion contracture of the hip. On examination, she had fever (38.9 degrees C), psoitis, localized tenderness at the left sacroiliac joint, and pain elicited by lateral compression of the pelvis. The abdominal examination was normal. The erythrocyte sedimentation rate was 130 mm in the first hour, C-reactive protein was 186 mg/l, and the white blood cell count was 18,400/mm(3), with 79% neutrophils. Urinalysis was normal. Blood cultures were negative. Radiographs of the pelvis showed irregular left sacroiliac borders. The CT scan provided the diagnosis of sacroiliitis complicated by an ilioapsoas abcsess. Treatment was based on antibiotic therapy associated with surgical drainage. Bacteriologic investigation revealed Staphylococcus aureus. The patients temperature returned to normal on the second day. Antibiotics were continued for 3 months, leading to full recovery.

Perinatally discovered complete tubular colonic duplication associated with anal atresia.

Complete tubular colonic duplication (CTCD) is exceedingly rare. The association of CTCD with an anorectal malformation is unusual. This malformation may be found unexpectedly at laparotomy. We present 3 cases of surgically proven neonate CTCD discovered at laparotomy for anal atresia. We reviewed the mode of clinical presentation, the imaging, and laparotomy findings. Our series illustrates that this rare disease presents perinatally in association with anal atresia, with or without other associated anomalies.

Imaging of complicated frontal sinusitis

Complications occur in 3% of the cases of frontal sinusitis. These are mainly oculo-orbital, intracranial and osteomyelitis. Our aim is to describe the contribution of different imaging modalities in the diagnosis of these complications and their post-treatment monitoring. within a 15 years period (2000-2014), 10 patients with complicated frontal sinusitis were included into this retrospective study. 10 patients (9 males) aged 9 to 70 year old (mean 28). Two of these patients (20%) had a history of craniofacial trauma. Frontal headache was present in all cases (100%), frontal swelling in 8 cases (80%) and unilateral palpebral edema in 3 cases (30%). A CT scan of the face and brain was performed in all cases and revealed frontal osteomyelitis in 6 cases (60%), extradural empyema in 3 cases (33%), intracranial frontal abscess in 2 cases (20%) and occulo-orbital complications in 3 cases (30%). Magnetic resonance imaging was performed in one patient and demonstrated thrombosis of the upper longitudinal sinus. 40% of our patients associated 2 complications. Cross-sectional imaging is important in early and accurate diagnosis of complicated frontal sinusitis.

An unusual cause of neonatal respiratory distress: neurenteric cyst

Houda El Mhabrech, Ahmed Zrig, Habib Besbes, Amine Ksia, Karim Ben Ameur, Aouatef Hajjeji and Chiraz Hafsa Department of Radiology B, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia; Department of Radiology A, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia; Department of Pediatric Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia; Departments of Neonatology, Maternal and Fetal Unit, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia; Departments Obstetrics and Gynecology, Maternal and Fetal Unit, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia

ORL-WS-34 Imagerie des infections fongiques invasives du massif facial

Objectifs Rapporter les aspects tomodensitometriques (TDM) et en imagerie par resonance magnetique (IRM) qui permettent d’evoquer le diagnostic d’infection fongique invasive precocement afin d’ameliorer le pronostic en instaurant un traitement rapide et adapte. Materiels et methodes Etude retrospective de 6 dossiers radiocliniques d’infection naso-sinusiennes fongiques invasives confirmees par des etudes mycologiques et ou anatomopathologiques. Tous nos patients etaient explores par TDM. Deux patients ont beneficie d’une IRM crânio-faciale. Resultats L’âge moyen de nos patients etait de 52 ans, quatre sont de sexe feminin et deux de sexe masculin. Les signes cliniques etaient une obstruction nasale, des algies de l’hemiface gauche et une rhinorrhee chronique. Outre le comblement sinusien, non specifique, la TDM a permis de monter les osteolyses agressives et les extensions intra-orbitaires et aux espaces profonds de la face. L’IRM est largement superieure a la TDM dans l’evaluation des extensions endocrâniennes, aux orbites et aux espaces profonds. Le traitement etait chirurgical complete par un traitement medical par voie generale dans tous les cas. Un de nos patients a beneficie d’un traitement par amphotericine en intra-orbitaire. Conclusion Les infections fongiques nasosinusiennes invasives sont des atteintes graves dont le pronostic depend de la precocite du diagnostic et du traitement. La TDM et l’IRM cranio-faciales sont des techniques complementaires dans l’analyse des atteintes osseuses et des extensions endocrâniennes et aux parties molles profondes. Le diagnostic de certitude est histologique.

RP-WS-36 Demarche diagnostique devant une boiterie de l’enfant

Objectifs Rappeler et illustrer les principales etiologies d’une boiterie de l’enfant et presenter la demarche diagnostique en imagerie en fonction de l’âge et du contexte clinique. Materiels et methodes Revue des radiographies standard, des echographies et des examens TDM et IRM realises dans notre institution pour des enfants examines pour boiterie entre 2000 et 2009. Resultats La boiterie de l’enfant est un motif frequent de consultation. Elle est le plus souvent douloureuse. La hanche est la principale localisation. La synovite transitoire de la hanche est la cause la plus frequente mais reste un diagnostic d’elimination. Entre 1 et 3 ans, les etiologies infectieuses sont frequentes avec des radiographies souvent normales. Entre 3 et 9 ans, une osteochondrite primitive de hanche devra etre systematiquement evoquee. Chez l’adolescent, toute boiterie est une epiphysiolyse jusqu’a preuve du contraire. Conclusion Toute boiterie de l’enfant doit etre exploree. L’imagerie orientee par l’examen clinique tient une place centrale dans la demarche diagnostique. Une bonne connaissance de la semiologie radiologique des differentes pathologies en cause est indispensable pour poser le diagnostic etiologique.

ORL-WS-37 Hyperparathyroidie primaire : du diagnostic au traitement a propos de 20 cas

Objectifs Preciser le role de l’imagerie et les differentes modalites diagnostiques et therapeutiques des parathyroidiens primaires. Materiels et methodes Revue retrospective des examens radiologiques incluant l’echographie et pour certains le scanner, l’IRM et la scintigraphie de vingt patients presentant une hyperparathyroidie primaire. Resultats II s’agit de 15 femmes et 5 hommes avec un âge moyen de 52 ans. Un adenome ectopique a ete detecte dans un cas, un cas de multiples adenomes cervicaux et le reste des adenomes solitaires, en majorite operes sous anesthesie locale. Conclusion Les adenomes parathyroidiens primitifs sont la cause frequente d’hyperparathyroidie. Ils peuvent etre multiples ou ectopi-ques. L’imagerie joue un role primordial dans le diagnostic pre-operatoire et l’approche chirurgicale.