Chiraz Hafsa

Kyste hydatique du massif facial

OBJECTIVE A maxillofacial location of a hydatid cyst is rare, accounting 2% of cases. The purpose of this study was to review clinical and radiological features by emphasizing diagnostic difficulties. MATERIALS AND METHODS Two observations of hydatid cyst with a maxillofacial location are presented. Two cases were investigated by panoramic dental radiography, an ultrasound and CT scan. MRI was done in one case. RESULTS The first observation reports a 23-year-old woman who consulted for jugal tumefaction with pharyngeal extension evolving in spurts. The second observation was a 16-year-old girl, which consulted for a genian and masseter tumefaction with a tight trismus. In both cases, the imaging studies suggested the diagnosis of the hydatid cyst confirmed by the anatomopathologic exam. CONCLUSION The hydatid cyst is an endemic parasitic pathology involving most often the lung and the liver. The maxillofacial location is exceptional. In cases of a cyst mass in an endemic zone, the diagnosis of the hydatid cyst must be entertained. CT scan and MRI provided a complete lesion workup. Treatment is surgical.

An unusual case of Behçet's disease presenting with postpartum ovarian iliac vein thrombosis and pulmonary embolism

Thrombosis of the ovarian vein is a rare complication which arises classically in the postpartum. We report a case of 24-year-old woman with a history of Behçets disease, who presented with pelvic and thoracic pain, tachycardia, dyspnea and fever occurring 2 weeks after delivery. Computed tomography revealed an ascending thrombosis of the iliac and right ovarian veins complicated by bilateral pulmonary embolism. The patient responded well to the combination of anticoagulants and immunosuppressive agents. Behçets disease should also be considered as an etiologic factor for ovarian vein thrombosis.

Mucinous Breast Carcinoma: Anatomo-Clinical Radiological and Therapeutic Features

Introduction: Mucinous carcinoma of the breast constitutes 1% to 4% of all breast cancers. Two different forms of presentation are distinguished: pure mucinous carcinoma and mixed mucinous carcinoma. The purpose of our work was to clarify the anatomo-clinical and radiological particularities of this rare form of breast cancer. Materials and methods: This was a retrospective study of a series of 14 cases of mucinous carcinoma of the breast, including 8 pure mucinous carcinomas and 6 mixed mucinous carcinomas treated at the Maternity and Neonatal Center of Monastir between January 2009 and December 2017. Results: The frequency of mucinous carcinoma of the breast in our study period was 1.9%. The average of the patients was 55 years old. The average tumor size was 40 mm. Mucinous carcinoma of the breast was pure in 8 cases, mixed in 6 cases. The clinical size of pure CM was smaller than that of mixed CM (41 mm vs 45 mm) [p = 0.12]. Axillary adenopathies were found in 28.5% of patients. Mammography detected a total of 19 masses with three cases of multifocality. The average size was 27 mm, there was no significant difference between subtype sizes. Pure CMs had an oval shape in 83% of the cases with microlobulated contours in half of the cases, mixed CM rather had an irregular shape (71%) with indistinct contours (85%) (p = 0.01/p = 0.04). On ultrasound, pure CMs had a homogeneous hypoechogenic oval mass appearance with microlobulated contours enhancing ultrasound. The mixed CMs had an irregular shape of non-geometric contours and heterogeneous hypoechogenic appearance with posterior ultrasound attenuation (p = 0.06). Microcalcifications were present in 37% of pure CM and 60% of mixed CM (p = 0.13). Ganglionic invasion was noted in 28% of cases. The extension assessment was negative in all cases. The tumors were of low histological grade with predominance of SBR I and II grades. They expressed hormone receptors in 85% of cases. Overexpression of the HER2 gene was noted in only one case. Conclusion: It is important to distinguish between the two pure and mixed forms, because the therapeutic attitude and the prognosis depend on it. The pure form remains a favorable prognosis, whereas that of the mixed form matches that of infiltrating ductal carcinomas.

Anterior Urethral Valve: Uncommon Association with Renal Duplicity

Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

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

Imaging of neck masses in the neonate

INTRODUCTION Neck masses occurring in the neonatal period and early infancy consist of vascular tumors, vascular malformations, benign and malignant soft tissue tumors and other developmental lesions. Although some lesions can be diagnosed on clinical grounds, others can only be diagnosed by imaging. Beyond diagnosis, imaging plays a significant role in evaluating the location and extent of a lesion for possible intervention. METHODS AND MATERIALS Clinical series descriptive study with a retrospective examination of neonates with masses of the neck. US were performed in all patients, CT in 3 cases and magnetic resonance imaging (MRI) in 4 cases. RESULTS Cervical teratoma was found in 4 cases, neuroblastoma in 2 cases and cystic lymphangioma in 2 cases. Prenatal diagnosis was performed in 2 cases. Fine-needle biopsy confirmed diagnosis in the two cases of neuroblastoma. CONCLUSION Imaging is essential for accurate diagnosis and pretreatment planning of neck masses. Ultrasound is often used for initial evaluation. Computed tomography (CT) provides additional information with regard to the extent and internal composition of the mass. Magnetic resonance imaging may be needed in some cases for preoperative assessment.

PO-0739 An Unusual Case Of Neonatal Respiratory Distress : Case Report

Background Neurenteric cysts are the association of an endodermal cyst with a vertebral dysplasia. This congenital malformation can be asymptomatic or manifest itself through respiratory signs due to airway compression. Case report A male newborn, from normal vaginal delivery at 40 weeks of gestation, weighing 4000 g with Apgar score of 8 and 9 at 1 and 5 min was referred to the neonate intensive care unit. The clinical findings showed tachypnea, mild intercostals retraction and there was diminished air-entry on the right side. The chest X-ray showed vertebral anomalies in the midthoracic region, there was an hydric opacity occupying the 2:3 of the right side with deviation of the mediastinum to the left side. The CT scan of the chest revealed butterfly and hemi-vertebrae of the upper thorax. There was a large posterior mediastinal cystic mass partitioned by multiple septa on the inferior right side. On fifth day, the patient underwent a right thoracotomy. A large cystic mass attached to the oesophagus wall was exised, Histopathology favours the diagnosis of neurenteric cyst. Postoperatively outcomes were poor, the operation was complicated by bilateral chylothorax diagnosed on 10 th post-operative day and increasing oxygen needs. The newborn died on the 16 th postoperative day in a severe sepsis. Conlusion Antenatal diagnosis of this malformation is not easy but possible. In post-natal, the radiological approach based on chest x-ray and CT scan, is helpful for establishing the diagnosis and lead to a prompt curative surgery.

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.

RP-WS-17 Emphyseme lobaire geant versus emphyseme compensateur

Objectifs Illustrer les manifestations radiologiques de l’emphyseme lobaire geant (ELG). Discuter les aspects radiologiques et anatomo-pathologiques de l’ELG versus l’emphyseme compensateur (EC). Materiels et methodes Etude retrospective de 30 observations d’enfants examines pour detresse respiratoire. Chez tous les patients, une radiographie de thorax et une TDM thoracique ont ete realises. Resultats La radiographie du thorax a montre une hyperclarte de l’hemichamp pulmonaire gauche dans 19 cas et de l’hemichamp pulmonaire doit dans 11 cas associes a une deviation mediastinale du cote controlateral. La TDM a conclu a un ELG devant l’hyperclarte parenchymateuse et la rarefaction des structures vasculaires parenchymateuses interessant le lobe superieur gauche dans 16 cas, le lobe superieur droit dans 2 cas et le lobe moyen dans 4 cas. Dans 2 cas, l’emphyseme etait bi lobaire (lobe moyen + lobe superieur droit). Dans les six autres cas, un EC a ete retenu. Les 24 patients ont ete operes et l’examen anatomopathologique a confirme le diagnostic d’ELG dans 21 cas. Conclusion Bien que la TDM joue un role important dans l’elimination d’emphysemes secondaires, la differenciation entre un ELG et un EC reste difficile a l’imagerie et meme a l’examen anatomopathologique.

RP-WS-18 CD ROM d’autoapprentissage de la radiographie thoracique du nourrisson et du nouveau-ne

Objectifs Fournir une aide a l’apprentissage des particularites techniques, anatomiques et physiologiques necessaires a la comprehension et a l’interpretation semiologique de la radiographie thoracique chez le nourrisson et le nouveau-ne. Materiels et methodes Il s’agit d’un support pedagogique confectionne sur CD ROM, destine aux etudiants de medecine. Dans ce cours, les auteurs exposent une selection de radiographies de thorax de face et de profil pratiquees chez des nourrissons et des nouveaux-nes. Ces radiographies sont selectionnees parce qu’elles mettent en exergue les particularites techniques de la radiographie thoracique a cette tranche d’âge, rappellent ses criteres de qualite et ses particularites semiologiques emanent d’une anatomie et d’une physiologie differente de celle de l’adulte. A la fin du cours les auteurs presentent des quizz radiologiques. Resultats Ce cours permet d’acquerir une demarche d’interpretation de la radiographie de thorax specifique aux nourrissons et aux nouveaux-nes integrant toute les particularites techniques, anatomiques et physiologiques specifiques de cette tranche d’âge. Conclusion La radiographie de thorax reste largement prescrite chez le nourrisson et le nouveau ne malgre les avancees techniques. Son interpretation reste cependant difficile puisque certaines particularites semiologiques peuvent etre prises a tort pour des images pathologiques.