Alain Nchimi

Incidence and distribution of lower extremity deep venous thrombosis at indirect computed tomography venography in patients suspected of pulmonary embolism

Indirect computed tomography (CT) venography reportedly provides high accuracy for detection of venous thrombosis in patients suspected of pulmonary embolism (PE). Nevertheless, the extent of the scanning range for lower limb and abdominal veins remains to be determined. It was the objective of this study to investigate the distribution of venous thrombosis in order to identify the most appropriate extent of scanning range when using CT venography. We reviewed 1,408 combined CT pulmonary angiographies (CTPA) and indirect CT venographies of the lower limbs, performed in patients suspected of PE. Percentage of venous thromboembolism (VTE), which includes PE and/or venous thrombosis was calculated. Location and the upper end of clots were recorded in 37 venous segments per patient from calf to diaphragm. PE, venous thrombosis and VTE, were found respectively in 272 (19.3%), 259 (18.4%) and 329 (23.4%) patients. Addition of CT venography to CTPA increased depiction of VTE in 17.3%. The upper end of venous thrombosis was located below the knee in 48%, between knee and inguinal ligament in 36% of the patients, and above the inguinal ligament in 15%. Ninety-six patients had thrombosis in a single vein, of which none occurred above the iliac crests in a patient without PE at CTPA. In conclusion, when added to CTPA, optimal scanning of CT venography should extent from calves to the iliac crests in patients suspected of VTE.

Relationship between the extent of deep venous thrombosis and the extent of acute pulmonary embolism as assessed by CT angiography.

The aim of our study is to investigate prospectively the quantitative relationship between deep venous thrombosis (DVT) and acute pulmonary embolism (PE). 110 patients clinically suspected of having venous thromboembolic disease underwent combined CT pulmonary angiography (CTPA) and venography of lower limb veins. 44 patients presented with clinical signs of DVT and positive ultrasonography or ascending venography, but no clinical sign of PE (Group 1). 66 patients presented with clinical signs of PE and positive CTPA (Group 2). Clot load in lower limb veins and pulmonary arteries were scored by two independent readers, each using two separate systems for DVT and two for PE. 27 (61%) patients in Group 1 also had PE, and 55 (83%) patients in Group 2 also had DVT. Correlations between PE and DVT scores were weak but statistically significant in Group 2 (r(s) ranging from 0.470-0.520; p< or =0.001), but only some were significant in Group 1 (r(s) ranging from 0.253-0.318; p-values ranging from 0.035-0.097). In conclusion, although PE occurs in a majority of patients with DVT, and vice versa, the amount/burden of clot load in one condition does not necessarily indicate - or indicates only weakly - the degree of burden in the other condition.

Ultrasound appearance of bowel wall in Wolman's disease.

Sir,Wolman’s disease (WD) and cho-lesteryl ester storage disease are, indecreasing order of severity, the twophenotypic expressions of an inbornerror of lipid metabolism, charac-terised by acid lipase deficiency [1].Diffuse bowel thickening with dila-tation, because of infiltration of thelamina propria by foamy histiocytes,is a well-established feature of WD[2]. However, there is little correla-tion of the pathological and imagingfindings in the literature.We investigated a 5-week-old boywho presented with crying, vomitingand diarrhoea. Clinical examinationshowed wasting, thin arms and legs,bloated abdomen and hepatomega-ly. The diagnosis of acid lipase defi-ciency was eventually made oncultured skin fibroblasts. AbdominalCT and US revealed an enlargedfatty liver, normal spleen and bilat-eral foamy peripheral calcificationsin the adrenals. During the US ex-amination, the bowel wall was foundto be diffusely thickened, these

RP41 Leiomyomatose œsophagienne : a propos d’un cas clinique

Objectifs La leiomyomatose œsophagienne (L. O) est une tumeur benigne rare. Dans 30 % des cas il s’agit d’un syndrome d’Alport associant une nephropathie. Materiels et methodes Lise (2,5 ans) souffre d’infections respiratoires a repetition. La radiographie pulmonaire et le transit baryte montrent un megaœsophage. Resultats Un important epaississement parietal (15xa0mm) diffus est objective par l’echographie et la tomodensitometrie. Une hematurie microscopique et une proteinurie moderee a caractere familial sont relevees. L’ensemble du tableau radiologique, clinique et genetique suggere le diagnostic d’un syndrome d’Alport. Conclusion Chez l’enfant la L. O a predominance feminine en bas âge est souvent multifocale diffuse. Le caractere familial est retrouve chez 50 % des enfants. Federici (1998) recense dans la litterature 24 cas pediatriques. La clinique est dominee par les troubles respiratoires et digestifs. L’imagerie est capitale dans l’evocation du diagnostic. L’epaississement parietal œsophagien pourrait etre objective par echographie, TDM, ou RMN. La leiomyomatose est soit isolee a l’œsophage, soit interesse plusieurs organes, ou correspond a un syndrome d’Alport ou s’associe une atteinte renale et genitale. A terme la malnutrition et la compression tracheo-bronchiques sont a craindre. Dans la forme diffuse l’œsophagectomie est la seule perspective therapeutique efficace.

Arterial Embolization as a Treatment of Chronic Edema Following Free Cutaneous Flap Transfer to the Lower Limbs

AbstractPersisting chronic edema following postoperativenfree flap transfer is a common complication. We report 3 cases ofnsuccessful treatment by selective arterial embolization of the feedingnarterial branches without side effect. One session embolization isnadvocated as a first line treatment of this condition.