S. Hantous-Zannad

Imaging of thoracic textiloma

OBJECTIVEnIntrathoracic 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.nnnMETHODSnEight 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).nnnRESULTSnIn 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.nnnCONCLUSIONSnThe 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.

Le granulome pulmonaire hyalinisant : à propos de deux cas

Resume Les granulomes pulmonaires hyalinisants sont des lesions nodulaires fibrosantes du parenchyme pulmonaire, uniques ou multiples. Les auteurs rapportent deux nouveaux cas de cette affection rare, dont l’un a ete explore par une imagerie par resonance magnetique (IRM). Le diagnostic a ete retenu chez le premier patient sur la stabilite des lesions avec un recul de 6 ans et l’association a une fibrose retro peritoneale et chez le second patient sur les donnees d’une biopsie chirurgicale. Le granulome pulmonaire hyalinisant pose dans sa forme multiple, des problemes de diagnostic differentiel avec des lesions secondaires souvent resolus par la biopsie chirurgicale. L’evolution est en general benigne mais la surveillance est de mise.

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.

Imagerie des tumeurs carcinoïdes bronchiques: Vingt cas

Resume But Rapporter les aspects radiologiques et evaluer l’apport de la tomodensitometrie dans le diagnostic et le bilan d’extension des tumeurs carcinoides bronchiques. Materiel et methodes Il s’agit d’une etude retrospective de 20 patients porteurs d’une tumeur carcinoide bronchique ayant fait l’objet d’une intervention chirurgicale. L’exploration thoracique de tous nos patients a comporte une radiographie du thorax, une fibroscopie bronchique, et un examen tomodensitometrique (TDM) thoracique. Une imagerie par resonance magnetique (IRM) thoracique a ete realisee chez 2 patients et une echographie abdominale dans le cadre du bilan d’extension chez tous les patients. Resultats Il s’agissait de 11 femmes et 9 hommes. L’âge moyen etait de 40 ans (extremes : 21-71 ans). Les signes radiologiques standards etaient non specifiques avec des atelectasies (75 %), une opacite parenchymateuse isolee (15 %). La TDM a objective, dans 85 % des cas, une masse proximale, qui etait obstructive avec trouble ventilatoire d’aval dans 80 % des cas. La TDM a egalement visualise un trouble ventilatoire secondaire a une obstruction bronchique sans masse individualisable dans un cas (5 %), une masse parenchymateuse isolee dans 2 cas (10 %), et un bourgeon endo-bronchique interessant la bronche souche droite sans trouble ventilatoire d’aval dans un cas (5 %). Des calcifications tumorales ont ete detectees dans 30 % des cas. Les tumeurs etaient reparties histologiquement en 17 carcinoides typiques et 3 atypiques. Celles-ci differaient par leur taille, leur extension locoregionale et a distance. Conclusion La TDM est indispensable pour le diagnostic positif topographique et dans le bilan d’extension pre-therapeutique des tumeurs carcinoides bronchiques. Son apport principal par rapport a celui de la fibroscopie est de montrer leur eventuel developpement exo-bronchique, et les complications pulmonaires d’aval.PURPOSEnReport radiographic aspects and assess the contribution of computed tomography for the diagnosis and search for extension of bronchial carcinoid tumors.nnnMATERIAL AND METHODSnThis retrospective study included 20 patients with a bronchial carcinoid tumor. The thoracic exploration included standard chest x-ray, bronchial fibroscopy, computed tomography (CT), and magnetic resonance imaging (MRI) in two patients as well as abdominal ultrasonography to search for extension, performed in all patients.nnnRESULTSnThis series included eleven females and nine males, mean age 40 years (age range 21-71 years). Signs on the plain chest x-ray were non-specific: atelectasis (75%), isolated parenchymatous opacity (15%); CT revealed a proximal mass in 85% which was obstructive leading to ventilatory disorders in 80%. CT revealed secondary ventilatory disorders with no individualized mass in one patients (5%), an isolated parenchymatous mass in two (10%) and a endobronchial budding at the origin of the right bronchus with no noted ventilatory disorder in one patient (5%) Tumor calcifications were detected in 30% of patients. Histological there were 17 typical carcinoid tumors and three atypical tumors which were different by their size, locoregional and distant metastatic spread.nnnCONCLUSIONnCT is indispensable for positive diagnosis, and topographic localization of extension of bronchial carcinoid tumors. The main contribution of CT compared with fibroscopy is to demonstrate exobronchial tumor development and upstream pulmonary complications.

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.

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

THO-WP-31 Approche diagnostique des condensations pulmonaires chroniques

Objectifs pedagogiques Connaitre les presentations morphologiques des condensations pulmonaires chroniques. Savoir adopter une approche etiologique en fonction des differentes caracteristiques semiologiques tomodensitometriques et du contexte clinico-biologique. Messages a retenir Les condensations chroniques peuvent etre en rapport avec une pathologie inflammatoire ou tumorale maligne. L’analyse des caracteristiques tomodensitometriques des condensations, de leur distribution, et des lesions parenchymateuses associees, confrontee aux donnees cliniques, biologiques et du lavage bronchoalveolaire, permet d’approcher le diagnostic etiologique.

THO-WP-32 Metastases pulmonaires : semiologie tomodensitometrique

Objectifs pedagogiques Connaitre les differents aspects tomodensitometriques des metastases pulmonaires. Connaitre les differents aspects tomodensitometriques selon les localisations primitives les plus frequentes. Savoir orienter le diagnostic etiologique en fonction de l’aspect tomo-densitometrique et du contexte clinique. Messages a retenir Les metastases pulmonaires se revelent sous cinq aspects tomodensitometriques differents : le syndrome nodulaire avec ses variantes semiologiques (nodules excaves et les nodules calcifies), la lymphangite carcinomateuse, l’embolie tumorale, les metastases endobronchiques et les metastases pleurales. La decouverte de metastases pulmonaires change le pronostic et la conduite therapeutique d’une tumeur primitive connue. La connaissance des aspects semiologiques des metastases pulmonaires peut orienter vers un primitif non encore connu.

THO-WP-27 Verre depoli : Semiologie tomodensitometrique et approche diagnostique

Objectifs pedagogiques Connaitre les differentes etiologies des hyperdensites parenchymateuses pulmonaires en « verre depoli » diffuses et localisees et les correlations anatomo-radiologiques. Proposer le ou les diagnostics etiologiques en fonction de l’aspect et de la distribution des lesions, des signes associes et du contexte clinico-biologique. Messages a retenir Les hyperdensites parenchymateuses pulmonaires en « verre depoli » peuvent etre de nature fibrotique, inflammatoire, infectieuse ou tumorale. L’interrogatoire du patient et le bilan biologique, notamment le lavage broncho-alveolaire, constituent une etape primordiale pour le diagnostic etiologique des hyperdensites en « verre depoli ».