[Pseudo-sepsis of the hip revealing Lyme arthritis in an adult].
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Biomedical subjects
Publications and source records attributed to H Rosier.
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In patients with blunt chest trauma, early diagnosis of mediastinal hematoma is important, because it could be associated with thoracic vessel injury. Mediastinal hematoma is generally evoked because of a widened mediastinum on chest radiograph, but radiologic diagnosis may lead to excessive angiography being performed. Transesophageal echocardiography (TEE) provides accurate views of the mediastinum and can be rapidly performed at the bedside. Thus, we conducted a prospective study to define TEE signs of mediastinal hematoma. TEE was performed in 22 thoracic trauma patients (trauma group) and in 20 brain-dead patients without thoracic trauma (control group). The positive diagnosis of mediastinal hematoma was made using thoracic surgery or computed tomographic scan. The specificity of TEE was 75 percent and sensitivity was 100 percent. In the trauma group, there was only one false positive but angiography discovered a traumatic aneurysm of the proximal right subclavian artery. No false negative was noted. We described three different TEE signs of mediastinal hematoma: (1) an increased distance between the probe and the aortic wall; (2) a double contour of the aortic wall; and (3) visualization of the ultrasound signal between the aortic wall and the visceral pleura. The distance between the esophageal probe and the aortic wall was the most accurate sign because it could be easily obtained; the threshold value for this distance was 3 mm. TEE appears to be an accurate method to diagnose traumatic mediastinal hematoma.
We know that the contrast of MR images can be better than that of CT scans. In the spin echo mode, sequences with long TR and long TE provide great contrast, while, conversely, sequences with short TR and TE produce images with a greater anatomical fidelity. This dual performance, a notion that had never been expressed as explicitly in imaging, has led to distinguishing between the roles of MRI for detection and tissue characterization (diagnosis and nature). While the choice of an appropriate sequence for characterization has apparently been made immediately with a modulation of T2 weighting, the selection of a detection sequence is less easy. The number of parameters involved (signal-to-noise and contrast-to-noise ratios, spatial resolution, artifacts, imaging time) and the compromise arrangements needed to take them into account explain the lack of consensus as to the optimal sequence for detection. Instead of becoming simpler with time, the issue is increasingly complex, as now fast imaging has been developed in addition to conventional spin echo imaging, and may even supersede it.
Among all noninvasive techniques, high-resolution ultrasonography used alone has rarely been used for the diagnosis of thrombosis in the calf. Nineteen patients with suspected AVT were examined with ultrasonography and phlebography during 4 months. For each patient, a sonogram and a phlebogram were taken within less than 24 hours and interpreted independently. The sonographic exploration with a high-resolution (5 MHz) transducer covers all deep trunks and muscular veins (soleus or gastrocnemius muscles). The positivity criterion is the persistence of a hypoechogenic endoluminal image under moderate compression. According to the phlebographic data, 65% of the patients present with thrombosis. Ultrasonography has a sensitivity of 95% and a specificity of 99% for the study of the deep trunks. Ultrasonography screens more thromboses than phlebography (23 cases versus 17). On a whole, ultrasonography seems to be more sensitive than phlebography for the diagnosis of recent sural thrombosis.
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