M. Maatouk

Inverted Takotsubo syndrome in Androctonus australis scorpion envenomation

Abstract Context: The nature of scorpion-related cardiomyopathy is still a matter of debate where specific toxin-induced cardiomyopathy, ischemic, or catecholaminergic cardiomyopathy is advocated as well. We report two cases of Takotsubo syndrome following envenomation by Androctonus australis, bringing new evidence for the fundamental role of catecholamines in the pathogenesis of this cardiomyopathy. Case 1: A woman aged 36 presented with pulmonary edema and shock following scorpion envenomation. Echocardiography-Doppler showed a LVEF at 30%. Cardiac magnetic resonance (CMR) imaging showed a basal ballooning of the left and right ventricles suggestive of an inverted biventricular Takotsubo syndrome. A second CMR performed after recovery was normal. Case 2: A woman aged 45 was admitted for pulmonary edema and shock consecutive to scorpion envenomation. Echocardiography showed a LVEF at 35%. CMR showed a basal ballooning. The patient was discharged four days following admission with a normal LV function on repeat echocardiography examination. Conclusions: Cardiomyopathy in these cases, following scorpion envenomation by Androctonus australis, fulfills the criteria of Takotsubo syndrome. These observations contribute to our understanding of the mechanism, prognosis, and treatment of scorpion-related cardiomyopathy.

L'ostéogenèse imparfaite, cause rare de surdité chez l'enfant

We report a case of bilateral hearing loss in a child, caused by osteogenesis imperfecta and we evaluate CT scan findings. A 12-year-old child consulted for bilateral hearing loss. A computed tomography scan of the petrous temporal bone showed bilateral extensive unmineralized bone involving the cochleae, vestibules, and semicircular canals extending to the internal auditory canals. Osteogenesis imperfecta of the temporal bone is a genetic connective tissue disorder with increased bone fragility, low bone mass, and other extraskeletal manifestations. Hearing loss is rare in the first 2 decades of life, but it is one of the frequent features of this disorder in adult patients. Thin-section CT scans of the temporal bone show a remarkable proliferation of unmineralized bone involving the otic capsule. This demineralization is similar to that observed in the cochlear form of otospongiosis.

Dural metastasis of Ewing’s sarcoma

Background: Metastatic Ewing’s sarcoma to the central nervous system is an uncommon condition and debate concerning the true origin of its metastases is still up to date. To the best of our knowledge, only two cases of dural metastatic Ewing’s sarcoma have been published in the English medical literature. We present an additional case in a 24-year-old female and discuss the pathogenesis of these unusual tumors with review of the relevant literature concerning their treatment and outcome. Case Description: A 24-year-old female with previous history of pelvis Ewing’s sarcoma and recently discovered lung metastases, presented with moderate headache for the past 2 weeks and weakness in her left leg for the past 2 days. Computed tomography scan and magnetic resonance imaging revealed an extra-axial right frontoparietal mass invading the superior sagittal sinus but with clear delineation with brain parenchyma. Imaging features were suggestive of a meningioma as no abnormalities in the skull abutting to the tumor were noted. The patient underwent surgical removal of her tumor. Near total resection was achieved and histological examination showed evidence of metastatic Ewing’s sarcoma. Postoperative adjuvant radiation and chemotherapy were administered. The patient improved well postoperatively with full recovery of her motor weakness. She is symptom free with no signs of progression, at most recent follow-up, 8 months after surgery. Conclusion: Despite its rarity, metastatic Ewing’s sarcoma must be considered in the differential diagnosis of extra-axial dural masses particularly meningiomas.

A rare etiology of failed epidural anesthesia and paraparesis: Primary intracanalar hydatid cysts

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 12 octobre 2015

SFIPP P-09 - Imagerie de la dilatation kystique du cholédoque

Objectif Preciser la place de l’imagerie dans le diagnostic et la prise en charge des dilatations kystiques du choledoque. Materiel et methodes Etude retrospective de 13 observations de dilatation kystique du choledoque colligees dans les services de chirurgie pediatrique et de radiologie du CHU de Monastir entre 2000 et 2013. Nos enfants ont ete explores par une echographie abdominale et une tomodensitometrie abdominale. Une cholangiopancreatographie par resonance magnetique (CPRM) a ete pratiquee chez trois enfants. Resultats L’echographie abdominale et la TDM ont permis de montrer une formation kystique en continuite avec la voie biliaire chez 9 enfants. Dans 3 cas, l’origine biliaire de cette lesion n’a pu etre precisee. Une dilatation des voies biliaires intra hepatique a ete retrouvee dans 7 cas. La CPRM a permis de visualiser la dilatation du choledoque et de preciser sa morphologie et son type. Tous les enfants ont ete operes, l’acte consistait en une resection totale de la dilatation et d’une derivation bilio-digestive par montage d’une anse jejunale en Y. Conclusion L’imagerie joue un role important dans la prise en charge des dilatations kystiques du choledoque en permettant le diagnostic et en precisant le type et le retentissement sur l’arbre biliaire.