Khaled Bouzaidi

Contribution of imaging in the initial management of ballistic trauma.

INTRODUCTION The purpose of this study is to specify the role of imaging in the initial management of ballistic traumas. METHODS This is a retrospective study that colligated 83 victims of a gunshot wound during demonstrations, treated in our trauma centre between 12 January and 3 February 2011. All of the patients were haemodynamically stable and examined by conventional radiography and/or ultrasound and/or 16-slice CT-scan (CT). RESULTS The mean age of the victims was 26years with a sex ratio of 0.02. All wounds were unique. Injury to the limbs was most common in 75.5% of the cases (n=64) followed by that of the torso in 19.5% of the cases (n=16). Wounds in the spine (n=2), brain (n=2) and facial skeleton (n=1) were observed. Conventional x-rays objectified 32 cases of open fractures 95% of which were in the legs. Twenty-one of the victims of gunshot wounds had a CT-scan that objectified the path of the bullet and an assessment of the wound was made in all cases. The confrontation of the data from the CT-scan and that noted during surgery and during the monitoring demonstrated that the CT-scan is very efficient in the diagnosis of pleural effusion, vascular wounds, thoracic parenchymatous wounds and wounds of the solid organs and brain lesions and the facial skeleton. However, the sensitivity is low for the diagnosis of hollow organs. CONCLUSION The CT-scan is very useful in the initial care of stable patients with gunshot wounds as regards the haemodynamics and helps objectify the path of the bullet and obtain a precise assessment of the damage. Conventional x-rays are unavoidable for wounds to the legs and spine.

Unusual radiologic and histologic manifestations of primary pulmonary lymphoma.

Pulmonary parenchymal involvement in lymphoma is unusual and is reported more commonly in Hodgkins disease than non-Hodgkins lymphoma. Radiological appearances are manifold and may mimic other pulmonary diseases. We report the case of a patient with Hodgkins disease who demonstrated multiple cavitating lung lesions with aberrant immunophenotypic expression of T-cell antigens.

Intracardiac metastasis of primary synovial sarcoma of the lung.

Computed tomography in a 53-year-old woman with a 6-month history of increasing shortness of breath, cough, and hemoptysis, demonstrated a large necrotic mass occupying most of the left hemithorax. Needle biopsy revealed synovial sarcoma. The entire tumor along with the lung was removed completely (Figure 1), with lymph node dissection. Histopathology showed synovial sarcoma with negative bronchial and vascular margins. The patient made an uneventful recovery and was discharged with follow-up adjuvant radiotherapy. Nine months later, computed tomography revealed an 18-mm mobile mass at the level of the apex of the right ventricle (Figure 2). Biopsy by right catheterization confirmed synovial sarcoma (Figure 3). Abdominal echography showed multiple nodular images, so curative resection was not considered, and palliative chemotherapy was recommended.