I. Baccouche

Imaging of thoracic textiloma

OBJECTIVE Intrathoracic textiloma or gossypiboma, a retained surgical sponge in the thoracic cavity, is an exceptional but serious complication following thoracic or abdominal surgery. The purpose of this work is to highlight the topographic features of thoracic textiloma and to describe imaging aspects, and, particularly, computed tomography (CT) features. METHODS Eight patients have been operated in our thoracic surgery department for thoracic gossypiboma. In the past, three patients had undergone hepatic surgery and the five others had a history of thoracic surgery. All the patients had a chest radiograph, five of them had a thoracic ultrasonography, all had a chest CT, and one patient had a chest magnetic resonance imaging (MRI). RESULTS In patients with a history of abdominal surgery, the foreign body was located in the parenchyma of the right lower lobe. In the other patients, the foreign body was either intrapleural or mediastinal. Ultrasonography suggested the diagnosis of textiloma in three of the five patients by demonstrating a non-calcified hyperechoic mass with acoustic shadow. At CT, the gossypiboma was a low-attenuating mass containing trapped gas lucencies in six patients and it was a high-attenuating mass in two patients. MRI showed a diaphragmatic defect in one patient with an intrapulmonary gossypiboma that migrated from the abdomen. CONCLUSIONS The CT aspect of thoracic gossypiboma may be different according to pleural or parenchymal location. The spongiform appearance, characteristic in abdominal gossypiboma, is not the only CT presentation of thoracic gossypiboma. The confrontation of the surgical history with the CT signs helps to have a preoperative diagnosis.

Kyste hydatique du poumon ouvert dans les bronches : apport de la tomodensitometrie

Resume But Rapporter les differents aspects tomodensitometriques du kyste hydatique pulmonaire ouvert dans les bronches et etablir une stadification tomodensitometrique. Patients et methodes Nous avons relu retrospectivement les examens TDM de 41 patients porteurs de KHP complique d’ouverture dans les bronches. En se basant sur la classification de D.B. Lewall et S.J. Mc Corkell, les donnees de notre serie et les cas publies, nous avons propose une stadification TDM detaillee, chaque stade correspondant a une etape de l’evolution naturelle du KHP complique. La « rupture communicante » de DB Lewall et SJ Mc Corkell traduit une rupture de l’endokyste et du perikyste avec etablissement d’une communication entre le kyste et la lumiere des bronches. Elle regroupe plusieurs stades qui se succedent dans le temps : – stade I : Aspect en « bague a chaton » ; – stade II : Aspects de « croissant » et de « croissant inverse » ; – stade III : Aspects de « clartes piegees » et « en nid d’abeille » ; – stade IV : Aspects hydro-aeriques : « en double arc », « du nenuphar », « serpigineux », « niveau hydro-aerique » regulier ; – stade V : Aspect de retention seche: « en pelote de laine », « en grelot », « pseudotumoral » ; – stade VI : Aspects sequellaires: Cavite aerique et image cicatricielle. Resultats 73 KHP compliques d’ouverture dans les bronches ont ete inclus dans notre analyse. IB sont repartis de la facon suivante. stade I : (16 %), stade II : (12,7 %), stade III : (42,8 %), stade IV : Aspect « en double arc » (2,7 %), signe du « nenuphar » (10 %), aspect « serpigineux » (8,2%), aspect de « niveau hydro-aerique » regulier (5,4 %), stade V : Aspect « en pelote de laine » (6,8 %), image « en grelot » (15 %), aspect « pseudotumoral » (4 %), stade VI : Cavite aerique (4 %) et image cicatricielle (2,7 %). Conclusion La stadification que nous proposons detaille la classification generale de DB Lewall et S. J Mc Corkell. Elle tient compte d’une part de l’evolution naturelle du kyste hydatique, et d’autre part de la particularite de la localisation pulmonaire.

Imagerie des tumeurs myofibroblastiques inflammatoires du poumon

Inflammatory myofibroblastic tumors of the lung: Imaging features Inflammatory myofibroblstic tumors are ubiquitous but most frequently affect the lung. The imaging features are non-specific but the diagnosis may be suggested in the presence of solitary pulmonary nodule or mass in children or young adults. The tumor may appear locally and regionally aggressive suggesting malignancy. Diagnostic confirmation is obtained from histological evaluation of the surgical specimen. Treatment is surgical with oncologic surgical resection.

Bilateral persistent sciatic artery diagnosed by multidetector-row CT angiography

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 17 decembre 2013

Interstitial lung diseases: Imaging contribution to diagnosis and elementary radiological lesions

Interstitial pneumonias comprise a heterogeneous group of disorders in which a multidisciplinary approach is important for accuracy in diagnosis; indeed, one might say, even mandatory. The team of collaborators should include radiologists, because high resolution computed tomography (HRCT) of the thorax is the first, and most of times, the only imaging examination to be prescribed after chest X-ray. Elementary lesions of the interstitium can be accurately described with HRCT, inasmuch as lung windowing with sharp filtering in this technique reproduces the microscopic features of the lung. Guidance of bronchoalveolar lavage and biopsy procedures is also possible with HRCT.

Angiofibrolipoma of posterior mediastinum with transforaminal extension

Angiofibrolipoma is a histological variant of lipoma, which commonly occurs in subcutaneous tissues. In the present report we illustrate the case of an angiofibrolipoma of the posterior upper mediastinum in a 75-year-old man presented with progressive chest pain. Xray chest showed a homogeneous opacity vertically oriented along the right lateral aspect of thoracic vertebrae with an obtuse angle to the mediastinum. The upper extremity of the mass extended above the superior clavicle, suggestive of a posterior mediastinal lesion. Thoracic magnetic resonance imaging revealed a posterior mediastinal mass, in keeping with a nonaggressive lesion, with particular endocanalar extension and heterogeneous signal and enhancement patterns that was highly suggestive of a mixed mesenchymal tumor. The tumor was incompletely removed by right postero-lateral thoracotomy with final diagnosis of angiofibrolipoma. To the author’s knowledge, such a case of angiofibrolipoma located in the posterior mediastinum has not been previously reported in the literature.

Atypical Pleuropulmonary Tuberculosis Mimicking a Malignant Disease

Figure 1. Plain chest radiograph showing multiple bilateral nodules (arrows) and right hilar lymphadenopathies (dashed arrow). To the Editor: Pseudotumoral tuberculosis is considered to be among the most important differential diagnoses of lung and pleural malignancies. This form of tuberculosis is rare and occurs in 3.5% to 4.5% of immunocompetent patients. It is more frequent in those with immunocompromised status and is diagnosed with a delay of 30 to 70 days. We report the case of a 47-year-old women with a history of diabetes who consulted for cough with purulent sputum, weakness, and fever. A plain chest radiograph showed multiple bilateral nodules and right hilar lymphadenopathies (Fig 1). An atypical pneumonia was suspected. Antibiotics were administered. However, the patient clinically worsened. Enhanced computed tomography was performed. It showed subcarinal as well as right hilar and bilateral bronchial lymph node enlargement. There were bilateral lung nodules—especially in the lower lobes. The pleura exhibited bilateral nodular enhanced thickening that was more obvious in the lower regions. Pleural effusion was absent (Fig. 2). Metastatic involvement of the lungs and pleura was suggested. Transbronchial biopsy and cytologic examination of the bronchial fluid showed inflammation with no signs of malignancy. Bronchoalveolar lavage fluid analysis showed no malignant cells. The results of screening for Mycobacterium tuberculosis in the sputum and bronchial fluid were negative. The patient underwent a surgical pleural and parenchymal biopsy. Anatomopathological examination resulted in a diagnosis of caseofollicular tuberculosis. The patient received combined antibacillary medication. One month later, a second chest computed tomography scan showed improvement of the pulmonary and pleural lesions (Fig. 3). This case illustrates how confusing pseudotumoral tuberculosis can be. Generally, typical features of postprimary pulmonary tuberculosis include centrilobular branching 2to 4-mm nodules with a tree-in-bud

Aspects tomodensitométriques du carcinome bronchique à petites cellules

Small cell lung carcinoma (SCLC) typically is central in location. It is a very aggressive tumor characterized by its propensity for invasion of mediastinal structures, frequently, the ipsilateral pulmonary artery, multifocal nodal metastases and high frequency of distant metastases at initial presentation. CT is very sensitive and effective for local and regional staging. Combined with other diagnostic modalities, especially PET imaging, it allows whole body imaging for accurate staging, which is mandatory for therapeutic management. The different CT imaging features of SCLC and its more specific imaging characteristics will be reviewed in this article.

Amylose ganglionnaire médiastinale pseudotumorale

Pseudotumoral mediastinal amyloidosis Purpose Amyloidosis involvement of mediastinal nodes is rare. Isolated pseudotumoral involvement without extra-thoracic disease is a diagnostic challenge and typically raises concern for underlying malignancy. We present 3 cases of pseudotumoral mediastinal amyloidosis. Methods We report the cases of 3 patients presenting with recent onset of respiratory symptoms. Bronchoscopy showed mucosal infiltration suspicious for lymphangitic spread of tumor. The patients underwent chest radiography complemented by CT of the chest and abdomen, and laboratory and immunological work-up. A diagnosis of pseudotumoral mediastinal amyloidosis was confirmed by mediastinoscopic biopsy in all cases. Results CT showed a pulmonary and mediastinal tumor process in 2 cases and pericarinal tumor in 1 case. Diffuse bronchial wall thickening was present in all cases. Review of biopsy material showed tracheobronchial amyloidosis in 1 case. Patient work-up showed no evidence of extra-thoracic amyloidosis. Rapid progression of bronchial obstruction was observed in 1 case. Conclusion The imaging features of mediastinal amyloidosis are non-specific. Pseudotumoral involvement of mediastinal nodes associated with pulmonary amyloidosis accelerates the degree of airway obstruction.

THO-WS-29 Rentabilite diagnostique des biopsies trans-thoraciques en fonction du type d’aiguille

Objectifs L’objectif de ce travail est de comparer la rentabilite diagnostique des aiguilles a guillotine a celle des aiguilles a fragment cylindrique dans les biopsies des masses mediastinales et pulmonaires. Materiels et methodes Sur une periode de 20 mois allant de juin 2007 a fevrier 2009, nous avons realise 106 biopsies transparietales sous guidage tomodensitometrique chez 100 patients, 8 porteurs d’une masse mediastinale et 92 d’une masse pulmonaire ou parietale. Nous avons realise 84 biopsies avec des aiguilles de calibre 18 Gauge (G), 48 biopsies a l’aide d’aiguilles a guillotine et 36 a l’aide d’aiguilles a fragment cylindrique. Pour les 22 biopsies restantes, 13 etaient realisees avec des aiguilles a guillotine 16G et 9 avec des aiguilles a guillotine 20G. Un a deux passages trans-parietaux ont ete juge necessaires. Resultats Les aiguilles a guillotine ont permis un diagnostic histologique precis dans 77% des cas (54 sur 70). Cette precision diagnostique pour les aiguilles de calibre 18 G etait de 79% (38 sur 48) pour les aiguilles a guillotine contre 92% (33 sur 36) pour les aiguilles a fragment cylindrique. Pour le diagnostic de carcinome, l’efficacite des aiguilles a guillotine 18G etait de 81% (34 sur 42) alors qu’elle etait de 94% (31 sur 33) pour les aiguilles a fragment cylindrique. Le geste etait complique de pneumothorax de faible abondance dans 4 cas et d’une hemoptysie de faible abondance dans 5 cas. Conclusion Les aiguilles de biopsie transparietale thoracique a fragment cylindrique presentent une meilleure precision diagnostique que les aiguilles a guillotine notamment pour le diagnostic de carcinome bronchopulmonaire.