J.P. Senac

CT-guided percutaneous treatment of inoperable pulmonary aspergillomas: a study of 40 cases

OBJECTIVE To treat symptomatic pulmonary aspergilloma in patients who were not considered to be operable. MATERIAL AND METHODS Forty patients were treated by CT-guided percutaneous injection of amphotericin paste, the aim being to fill the cavity completely and create an anaerobic environment for the aspergillus. The aspergillomas had developed after bacillary infection and pulmonary fibrosis. Surgery was contra-indicated in these patients because of severe respiratory failure. The authors detail the method of preparation of the paste and the technique of percutaneous injection. RESULTS Hemoptysis ceased in all 40 patients, with a follow-up ranging from 6 to 28 months; six patients were also treated with bronchial embolization. In 26 patients, the aspergilloma disappeared and serum tests for aspergillus became negative. Complete disappearance of both the aspergilloma and the cavity was obtained in three patients. CONCLUSION This technique appears to be a valuable contribution to non-surgical treatment of inoperable patients with pulmonary aspergilloma, but study should be continued in a larger series to define the exact indications and the interaction with other treatments which have recently been introduced.

Reversible amiodarone-induced lung disease: HRCT findings.

Abstract. The aim of this study was to describe thoracic high-resolution computed tomography (HRCT) findings of reversible amiodarone-induced lung disease (AILD). The thoracic HRCT of 20 symptomatic patients who were considered as having reversible AILD by the medical staff of our institution were retrospectively reviewed. The patient-selection criteria used were the development of new respiratory symptoms while receiving amiodarone, the exclusion of other respiratory and cardiac diseases, and the decrease of both respiratory symptoms and radiological abnormalities after cessation of amiodarone and corticotherapy. The CT data recorded were those usually sought infiltrative lung diseases. The radiological findings using chest film (n=20) and HRCT (n=4) follow-up was noted. All patients had ground-glass opacities, associated with consolidations (n=4), thin intralobular reticulations (n=5), or both (n=11), with a subpleural (n=18) or central (n=2) location. Eight patients had high-density areas and 13 had pleural thickening (n=13). Bronchial abnormalities included dilation (n=16) and wall thickening (n=19). After therapeutic management, the radiological follow-up showed complete (n=17) or incomplete (n=3) improvement. Ground-glass opacities associated with thin intralobular reticulations and/or subpleural consolidations and bronchial abnormalities are common HRCT findings in reversible AILD.

Wall Mechanics of the Stented Extracranial Carotid Artery

Background and Purpose— Abrupt compliance changes and concomitant nonlaminar flow patterns may contribute to endothelial dysfunction and subsequent neointimal thickening. The aim of this study was to test the feasibility of wall mechanics measurement using B-mode ultrasound image analysis by dedicated software in the stented human carotid artery. Methods— Carotid Wallstents (Schneider) were placed in the extracranial carotid arteries of 15 patients. B-mode ultrasound examination was performed with a 7.5-MHz probe on the carotid artery upstream; at the proximal, mid, and distal stent levels; downstream from the stent; and on the contralateral internal and common carotid arteries. Carotid diameter (d) and systolic diameter changes (&Dgr;d) were measured with a dedicated image processing system (IÔ version 3.1, IÔDP), while pulse blood pressure (&Dgr;P) was measured. Diameter compliance (Cd) and distensibility coefficient (DC) were calculated as Cd=2&Dgr;d/&Dgr;P and DC=2&Dgr;d/&Dgr;P/d and compared between measurement sites. Results— The evaluation could be completed in 8 of 15 patients. Compliance was significantly lower at the proximal, mid, and distal stent levels (27.77±1.11, 27.38±1.08, 27.38±1.09×10−3 mm · kPa−1) than upstream (103.3±36.7×10−3 mm · kPa−1), downstream (91.5±41.3×10−3 mm · kPa−1), or on the contralateral internal (87.6±28×10−3 mm · kPa−1) and common (149.3±47.6×10−3 mm · kPa−1) carotid arteries. Conclusions— Stenting of the extracranial carotid artery induces a compliance mismatch between the native and the stented artery.

Dissection of the Abdominal Aorta in Blunt Trauma: Management by Percutaneous Stent Placement

Abstract We implanted stents in three patients who had traumatic abdominal aortic dissections, complicated by right limb ischemia in one case. The circulating false channel extended to the left iliac artery in one case and to both iliac arteries in the last case. Diagnosis and radiological follow-up included ultrasound, computed tomography, and arteriography. Two patients were treated with Wallstents, one with a Palmaz stent. The occlusion of the false channel was obtained in all patients without any significant residual stenosis. No early or late complication was noted in any of the patients. The longest follow-up was 2 years.We conclude that stent placement is an efficient method for the treatment of noniatrogenic inframesenteric aortic dissections.

Early Postoperative Assessment of Coronary Artery Bypass Graft Patency and Anatomy: Value of Contrast-Enhanced 16-MDCT with Retrospectively ECG-Gated Reconstructions

OBJECTIVE The objective of our study was to assess early postoperative patency and anatomy of off-pump coronary artery bypass grafts (CABGs) using retrospectively ECG-gated MDCT. CONCLUSION Retrospectively ECG-gated MDCT is a promising noninvasive technique with which to assess early postoperative patency and anatomy of CABGs.

Wall mechanics of the stented rabbit aorta: long-term study and correlation with histological findings.

Purpose: To evaluate long-term changes in arterial wall mechanics induced by stenting of the rabbit aorta. Methods: Eighteen New Zealand white rabbits had initial stent deployment (3×8 mm Multilink) at 110% of the pre-stenting abdominal aortic diameter. Group A (n=10) had no post-deployment stent expansion and group B (n=8) had 30% overdilation of the stent. A noninvasive B-mode ultrasound examination coupled with image processing allowed measurement of diameters at systole and diastole and the calculation of diameter compliance. Measurements were performed before stenting and compared to those recorded immediately after stenting and at 3 months at 3 locations: upstream from the stent, at the stent level, and downstream from the stent. Measurements were also compared among measurement sites. The pathological study included measurement of intimal thickening and calculation of an injury score. Results: At the stent level, diameter compliance was significantly lower after initial stenting and at 3 months than before stenting (group A: p<0.005; group B: p<0.001) and than downstream or upstream from the stent (group A: p<0.0001, group B: p<0.005). No significant difference in diameter compliance was found between groups A and B. In group B, intimal thickening and the injury score were greater than in group A (p<0.05 and p<0.0001, respectively). Conclusions: Endovascular stenting of the rabbit aorta impairs wall mechanics. Performing 30% overdilation of the stent does not worsen this impairment but induces greater in-stent intimal hyperplasia.

Bronchial aneurysms mimicking aortic aneurysms: endovascular treatment in two patients.

Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.

Validation of a newly developed B-mode image-processing technique versus wall-tracking ultrasound for the study of wall mechanics in small-calibre arteries

Purpose: To validate a newly developed image‐processing technique for the assessment of arterial wall compliance and distensibility from non‐invasive B‐mode ultrasound compared with the invasive wall‐tracking technique.

Interventional chest radiology.

The authors review the various interventional radiology techniques currently used in 1996 by a Medico-Radio-Surgical team. CT guided needle biopsy has an important place in the diagnostic approach to parenchymal as well as mediastinal tumours. But CT guidance allows also routine drainage of thoracic collections and sometimes thoracic sympatholysis. Superior vena cava and tracheobronchial stenting are palliative treatments as the percutaneous aspergilloma treatment. Embolization of bronchial and thoracic systemic arteries are also palliative but effective therapeutic procedures as well as vasoocclusion for arterio-venous fistulae.

La lymphographie, modalité thérapeutique d'une plaie chirurgicale du canal thoracique : à propos d'un cas

e chylothorax est défini par la présence de chyle dans la cavité pleurale. La chirurgie et les traumatismes sont responsables pour moitié des chylothorax rencontrés en pratique clinique. L’autre moitié est liée à des étiologies médicales ; c’est-à-dire sans lésion du canal thoracique ; principalement représentées par des pathologies lymphoïdes dont notamment les lymphomes (1) et des pathologies mal connues de drainage du système lymphatique comme le syndrome des ongles jaunes et la lymphangioleïomyomatose (tableau I). Nous rapportons l’évolution d’un chylothorax post-chirurgical qui a régressé après lymphographie.