Jean-Paul Trigaux

CONGENITAL ANOMALIES OF THE INFERIOR VENA CAVA AND LEFT RENAL VEIN : EVALUATION WITH SPIRAL CT

PURPOSE To determine with spiral computed tomography (CT) the incidence and caval location of left renal vein (LRV) variants that may affect inferior vena cava (IVC) filter placement, spermatic vein embolization, and adrenal or renal venous sampling. MATERIALS AND METHODS Contrast material-enhanced spiral CT scans of 1,014 patients were evaluated for the incidence and configuration of LRV variants and for the distribution of the entrances of these veins into the IVC. RESULTS In this series, variants detected were as follows: one azygos continuation of the IVC (0.1%), three bilateral IVCs (0.3%), and 102 LRV variants (10%) including 38 retroaortic renal veins (3.7%) and 64 circumaortic venous rings (6.3%). In the retroaortic renal vein group, the distance between the entrance of the LRV into the IVC and the confluence of the iliac veins was +62.5 mm +/- 8.7. In the circumaortic venous ring group, the distance between the entrances of the retroaortic and preaortic limbs into the IVC was -39.0 mm +/- 17.4; the distance between the entrance of the left retroaortic limb into the IVC and the confluence of the iliac veins was +63.2 mm +/- 17.1. CONCLUSIONS Detailed knowledge of these anomalies is crucial for IVC filter placement, spermatic vein embolization, and adrenal or renal venous sampling.

3D spiral CT of the tracheobronchial tree.

Objective Because of intrinsic limitations of transverse cross-sectional imaging methods, CT sometimes is insufficient for adequate evaluation of complex tracheobronchial anomalies. This article describes a complementary 3D procedure specifically dedicated to the study of the tracheobronchial tree. Materials and Methods The procedure combines a specific spiral CT acquisition with 2 or 4 mm collimation, 3D surface rendering of the tracheobronchial aerial content, and double obliquity multiplanar reformats directly planned on the 3D virtual object. It was performed in 11 complex cases including 3 stented benign or malignant stenoses and 2 single lung transplantations. Results Easier understanding of the tracheobronchial status was achieved in all cases. In three cases, the procedure yielded relevant diagnostic information that neither fiberoptic endoscopy nor transverse CT had provided, leading to significant modification of patient management. Conclusion Three-dimensional spiral CT of the bronchial tree with secondary reformation seems suitable in clinical practice for selected cases.

Pseudoaneurysm of the internal carotid artery : Treatment with a covered stent

Dissection of the cervical segment of the internal carotid artery may occur spontaneously or after trauma. We report the management of a 53-year-old right-handed man with progressive dizziness and neck pain 6 weeks after a motor vehicle collision. The clinical and neurologic examinations were normal. The CT scan led to the diagnosis of a pseudoaneurysm of the right internal carotid artery near the skull base. We successfully treated this post-traumatic lesion with a covered stent. The patient underwent the endovascular procedure under general anesthesia and transcranial Doppler monitoring. No neurologic event was observed. Obliteration of the pseudoaneurysm with preservation of the carotid artery was achieved. The patient was discharged from the hospital 72 hr later with no complications. Clinical and imaging follow-up at 6 months was unremarkable.

Dynamic CT in pancreatic lymphoma

We retrospectively reviewed the dynamic CT examinations of eight patients with pancreatic lymphoma. Four tumors were rounded masses with well-defined contours, four were more infiltrating lesions. The median cross-sectional diameter of the tumors was 6 cm (range 2.5–12 cm). At dynamic CT, the tumors were hypodense (n = 8) and somewhat heterogeneous (n = 6). Additional features were enlarged lymph nodes, 1–3 cm in diameter (n = 5), dilatation of the biliary tract and pancreatic duct (n = 5), abnormalities in the fat around the celiac trunk and/or the superior mesenteric artery (n = 4), and venous stenosis or occlusion (n = 7). The CT findings of pancreatic lymphoma are more various than has been previously reported. Findings such as small tumor size, well-defined contours, tumor heterogeneity, pancreatic duct dilatation, and venous invasion may be seen. Pancreatic lymphoma cannot be reliably distinguished from pancreatic carcinoma by CT findings alone.

Foregut cyst of the mediastinum: fluid re-accumulation after transbronchial needle aspiration

Cysts arising from embryonic remnants of the primitive foregut include bronchogenic cyst, oesophageal duplication and neurenteric cyst (Kirwan et al, 1973). The place of computed tomography (CT) and needle biopsy in the diagnosis and the management of foregut cysts of the mediastinum has been demonstrated (Schwartz et al, 1985, 1986; Kuhlman et al, 1988). We report a case of a foregut cyst diagnosed and treated by these methods, but without long-term symptomatic relief inasmuch as symptoms recurred 3 years later with re-accumulation of fluid. In 1986, a 27-year-old man complained of vague right thoracic pain. A right mediastinal mass was discovered on chest radiographs (Fig. la, b). A CT scan showed a tubular cystic mass (internal density + 30 HU). This had regular and smooth borders and was located on the right side of the entire thoracic oesophagus (Fig. lc, d). There was no subdiaphragmatic extension and a CT scan of the upper abdomen did not show any abnormality. In particular, no pancreatic lesion wa...

Systemic supply to a pulmonary arteriovenous malformation: Potential explanation for recurrence

A pregnant woman presented with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and a single pulmonary arteriovenous malformation (AVM) that had been embolized 5 years previously. Partly due to pregnancy, recanalization of the aneurysm occurred with subsequent hemoptysis. Despite successful therapeutic reembolization of the afferent pulmonary artery, hemoptysis recurred 5 days later. At this time, recanalization of the pulmonary artery was not demonstrated by pulmonary angiography, but a systemic angiogram revealed a bronchial arterial supply to the pulmonary AVM. A systemic supply should always be sought in cases of recurrent hemoptysis after technically successful embolization of the feeding pulmonary artery.

External iliac artery endofibrosis: a new possible predisposing factor

External iliac artery endofibrosis (EIAE) is an uncommon disease that affects a large number of athletes. The pathogenesis of EIAE is unclear. We offer an additional possible cause, with a direct relationship between EIAE and psoas muscle hypertrophy.

Focal Nodular Hyperplasia in Association With Spontaneous Intrahepatic Portosystemic Venous Shunt

We report a case of focal nodular hyperplasia in an adolescent with a spontaneous intrahepatic portosystemic venous shunt. Diagnosis was established by duplex and color Doppler ultrasound, computed tomography, magnetic resonance imaging, and histology. This association further supports the hypothesis that focal nodular hyperplasia is a response to a preexisting vascular abnormality.

Anatomical variations of the carotid bifurcation: implications for digital subtraction angiography and ultrasonography.

Intravenous digital subtraction angiography was used to determine prospectively the positional variations of the common carotid bifurcation in 100 consecutive patients with clinically suspected arteriosclerotic disease. The most common position (97/200, 48.5%) of the external carotid artery was anteromedial to the internal carotid artery. Position of the external carotid artery anterolateral to the internal carotid artery was noted in 26/200 (13%) bifurcations, but this anatomical variant was more common on the right (21/100) than on the left (5/100) (p less than 0.01). Practical implications may be drawn from this study. For digital subtraction angiography, the left anterior oblique view has to be considered the projection of choice and the right common carotid bifurcation is less likely to be adequately displayed than the left one; for duplex ultrasonography, optimal visualization is obtained from a posterolateral orientation of the transducer.

Whipple's disease confined to the central nervous system.

We report a 49-year-old woman with a leaft parietal lesion, shown on CT and MRI as an isolated ring-enhancing mass. The diagnosis of cerebral Whipples disease was made by brain biopsy; there were no gastrointestinal symptoms nor periodic-acid Schiff-positive inclusions in the jejunal mucosa. This case illustrates atypical Whipples disease, confined exclusively to the central nervous system.