Biomedical subjects
Publications and source records attributed to D Lardé.
Two cases of a rare anomaly of the trajectory of the left brachiocephalic venous trunk were detected by CT scan imaging. In both patients the trunk passed under the aortic arch before emptying into the superior vena cava. One patient presented, in addition, a complex anomaly of the aortic arch.
The role of computerized tomography in the diagnosis and treatment of late complications of acute pancreatitis was evaluated in 25 patients with acute pancreatitis. The clinical severity of the pancreatitis was assessed by Ranson's criteria. In each patient. the scan showed abnormalities of the pancreatic and at least one intraabdominal extrapancreatic extension of the disease. The scan precisely locates the intraabdominal extensions secondary to acute pancreatitis, and thus can guide surgical drainage, but it is less accurate in differentiating solid infiltration of fat planes from necrotic collections. However, in most of our patients, the association of general signs of sepsis with a collection shown on computerized tomographic scan indicated necrosis requiring surgical drainage.
Forty hepatic abscesses were examined with dynamic computed tomography (CT). A "double target sign," consisting of a hypodense central area surrounded by first a hyperdense ring and then a hypodense zone, seems to be highly suggestive of abscess formation. In 12 cases, the hepatic parenchyma surrounding the lesion demonstrated transient hyperdensity after contrast injection, possibly due to localized hepatic venous obstruction secondary to acute hepatic inflammation. This is similar to the appearance of an arterioportal fistula.
Fifty four computed (CT) examinations were performed on patients with bladder carcinoma. A pathological assessment was obtained in 24 cases and the accuracy of CT in local staging was 91%. The accuracy of CT in detecting lymph nodes invasion was also 91%. Moreover, CT is helpful in the follow-up of patients under treatment. As it provides a correct pre-therapeutic evaluation in 83% cases, CT appears as an effective examination to perform in the evaluation of bladder carcinoma.
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The authors report three cases of osseous hydatid disease (echinococcosis) in which examination by computed tomography (CT) was found to be helpful in establishing the diagnosis. Recognition of this rare bone infection in orthodox radiographs is notoriously difficult, but is aided by knowledge of the patient having lived in an area in which the disease is endemic. In two instances, one involving the shoulder and the other the thoracic spine, radiological abnormalities had been attributed at first to tuberculosis. In the third case, in which a destructive lesion in the sacrum had been interpreted correctly, CT studies provided confirmation of a recurrence. CT has proved to be an effective and sensitive method of demonstrating these destructive lesions in bone, of determining their spread, and of establishing the presence of other hydatid cysts in adjacent soft tissues. This technique has been found to be of value in preoperative planning of the surgical approach to hydatid lesions of the skeleton.
We describe a case of dissecting aneurysm that occurred in a 33-year-old woman suffering from acute myocardial infarction, which was discovered by coronary angiography. Angiographic diagnosis of dissections is rare with only six such cases previously reported. Sixty cases in the literature are reviewed to ascertain the main characteristics of this rare entity. The distinct predominance of this disease among women, particularly post partum, suggests an hormonal influence on its pathogenesis.
The authors conducted a retrospective examination of 62 hepatocellular carcinomas, taking dynamic CT scans of selected sections after an intravenous contrast bolus. The proximal portal vein was involved in 40% of cases and the distal segment in 16%. Angiographic correlation was available in 23 patients. CT signs of main or lobar portal vein involvement included (a) hypodensity and enlargement, (b) periportal arterial hypervascularization surrounding the hypodense intraluminal region, (c) nonvisualization of the lobar portal vein, (d) arterioportal shunting, and (e) differences in lobar attenuation. The characteristic appearance of tumor within the portal vein was noted in many cases; in others, distinction between tumor and bland thrombus could not be made. Peripheral portal vein obstruction was suggested when a small, hypervascular tumor became hypodense during the portal phase of CT. The frequency and significance of these CT signs of portal vein involvement are discussed.
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Peripheral arterioportal fistulae are a relatively frequent complication of hepatic biopsies and transhepatic catheterizations. Three cases were revealed by dynamic computed tomography (CT) and confirmed by angiography. The morphologic and densitometric characteristics of these arteriovenous fistulae on CT in most cases indicate the causal mechanism and eliminate consideration of tumor.
The computed tomographic findings of a case of hepatic angiosarcoma are presented. Although many findings are similar to hemangioma, some features can suggest the diagnosis of angiosarcoma.
Hepatic angio-CT was performed according to a standardized schedule in 100 healthy subjects and 260 patients with a liver tumor. In normal subjects, it was possible to determine an arterial phase (15 s), a parenchymatous arterial phase (30 s), a parenchymatous portal phase (45 s) followed by a progressive return to liver densities observed before injection. a) Among the 62 cases of hepatocellular carcinoma, 56 were characterized by hypodensity, 3 cases by hyperdensity and 3 cases by isodensity before injection. After injection, slices obtained at the tumor level showed heterogeneous hypervascularisation in 34 cases, and an early homogeneous hypervascularisation (15th-30th s) in 7 small carcinomas (diameter less than 3 cm); a lesion was disclosed in the other hepatic lobe in 12 cases. Slices obtained at the level of the portal vein allowed to assess tumoral involvement in 61 p. 100 of cases. b) Out of 150 cases of hepatic metastases, a hypodense lesion surrounded by hypervascularisation just after injection was the most frequent aspect. c) Out of 40 cases of hemangiomas, lesions were hypodense and well limited in 37 cases; at the 15th s after injection, contrast medium accumulated at the periphery, then diffused to the center of the lesion. d) Adenomas and focal nodular hyperplasias appeared as hypodense lesions with precocious and fugacious hypervascularisation, and were characterized, although inconstantly, by the presence of fat and vessels in the hypodense central zone, respectively. These results provide a rational basis for a better diagnostic approach of liver tumors.
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The importance and role of computed tomography (CT) are discussed on the basis of 36 cases of vertebral osteomyelitis. The bone images themselves, the detection of lumbar disk hypodensity, and the exploration of soft paraspinal regions in the search for an abscess are factors that contribute to the superiority of this method in difficult cases. In cases where the diagnosis is already known, CT offers an excellent method to assess the extent of the lesions. Its accuracy, coupled with its rapidity and noninvasive nature, affects the role of conventional tomography, a method that is incomplete and involves higher radiation doses. CT offers an excellent method for follow-up after treatment of vertebral osteomyelitis.
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Transfemoral ascending lumbar catheterization of the epidural veins is a new radiological method in lumbar disk disease. The technique and interpretation of the venogram offer some problems: Origin of ascending lumbar vein and internal vertebral venous structures are variable. The authors use 11 corrosion preparations and 18 venograms for the study of the ascending lumbar vein and internal vertebral venous system.