Biomedical subjects
Publications and source records attributed to J Giron.
Pulmonary metastasis of non small cell lung carcinomas are commonly nodular. The isolated nodular form must be diagnosed from double location carcinomas. The lymphangitic carcinomatosis semiology is best demonstrated with HR-CT-Technic. Endobronchic, alveolar and multi-micro angiopathy with emboli are less common.
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Syndromes presenting with interstitial radiological signs are often difficult to diagnose aetiologically. Surgical biopsy prevents certain rare cases being neglected notably when there are atypical manifestations. We describe a case of bronchiolitis obliterans with an organising pneumonia which was classical as regards the histology and its response to treatment but unusual as regards the clinical presentation and the aetiology.
The authors report five cases of pleural involvement in patients with thymoma. In 3 cases these sites were not directly related to the primary and in 1 case they constituted the first event in the disease. CT and MRI allow effective assessment of these pleural lesions ... provided this phenomenon, reported in the literature, is well known by the radiologist.
The authors report a standardised comparison between MRI, CT and Tomography, in 30 cases of tracheal lesions (postintubation, tumors, external compressions and invasions). They conclude on the superiority of MRI because of its multiplanar visualisation, its soft-tissue contrast resolution and its capability to differentiate inflammatory granuloma.
The primordial role of MRI in the staging of primary or secondary bone tumors has been clearly established. The authors report a study of 16 patients with NHL with suspected bone involvement, investigated by conventional radiography, bone scan, CT, bone marrow biopsy and MRI. The authors believe that, in the future, MRI will have an important role in the staging and follow-up of treatment of bone lymphomas. Better than any other techniques, MRI provides a precise assessment of tumor extension. It also represents a valuable method for monitoring patients during treatment by visualising the course of the disease.
The authors report a case of bronchiolitis obliterans with organizing pneumonia (BOOP) pathologically proved. They give an analysis of the radiological semiologic findings on plain-film and high-resolution CT (HR-CT). In 1985, Epler proposed a nosologic status but the review of the literature and the findings of their own case give to the authors, the opportunity to discuss the entity on the clinical, evolutive, radiological and pathological point of view.
The authors have studied the files of 50 consecutive patients (1987-89) operated for abdominal aortic aneurysm (AAA) and examined with CT. The criteria for inclusion were surgical features. CT can be made more accurate for the study of AAA: Thus the location of the neck of the aneurysm relative to the renal arteries was defined in 94% of all cases. In addition, CT yields information about the wall of the aneurysm, whether it be thickened (3 inflammatory aneurysms were properly diagnosed) or, mor importantly, weakened (solution of continuity in the wall in the "prior-to-rupture" appearance). Owing to the quality of its performances and to its noninvasive character, the authors regard CT with contrast injection as an essential technique for the preoperative assessment of abdominal aortic aneurysm in most cases. The examination must be carried out strictly, especially for the contiguous sections of the renal arteries and their extension to the crural arch. As it demonstrates weakened areas more easily, a more accurate study of the aneurysmal wall with CT might increase the surgical indications for some smaller aneurysms, the potential evolution of which does not seem to be associated with their diameter only.
The authors present the results of a comparative prospective study of the staging 202 bronchogenic carcinomas (T and N) before surgery. The results of CT (202 cases) and MRI (64 cases) were compared with surgical evaluation and pathologic findings. CT and MRI were part of the decisive criteria for therapeutic-surgery choice and were interpreted before surgery. The results showed poor sensitivity for the T and N but better specificity. MRI is superior to CT with the 3 dimensional demonstration and T1 T2 weighted sequences, but its utility remains limited. The authors give their preferred indications for MRI investigation after CT staging. Staging by CT (and MRI) is of great value to avoid impossible thoracotomy and to confirm the findings of mediastinoscopy (suspected N2 and even more N3).
The authors report a case of hepatic angiosarcoma revealed by massive haemoperitoneum. They analyse the CT and MRI features of this rare tumour and recall the difficult diagnostic problems raised by cavernous angiomas. The new MRI diagnostic criteria must be recognized, but do not constitute formal proof of the diagnosis.
The authors report a prospective and comparative study of the pre-operative staging of 90 laryngeal carcinomas by CT and MRI, with blind analysis of each examination. The radio-anatomic correlations and the inter-method correlations (CT versus MRI) are reported. According to the authors MRI seems to be the method of choice because of its capabilities in soft tissues differentiation and because of its multiplanar representation. The motion artefacts are resolved by the fast imaging technique and the spatial resolution is optimized by special surface coils.
A case of aneurysm of the pulmonary artery diagnosed by CT scan and MRI and confirmed by angiography is reported. The discussion considers the literature review.
The authors studied the value of high resolution computed tomography in twelve patients with pulmonary histiocytosis X. The aim of this study was to define the CT signs. More or less thin-walled air-filled cysts were observed in all but one case, although the subsequent follow-up of this case revealed the development of such cysts 6 months later. Nodules were also present in all but two cases. They sometimes consisted of excavated nodules. Reticulations, "frosted glass" appearance and irregularities of interface--all signs of a classical interstitial syndrome--were observed less frequently. The lesions were always diffuse, cortical and medullary. The predominance for the upper lobes was only observed in 50% of cases. The case examined on 2 occasions during the course of the disease at an interval of 6 months suggested the progression of small solid nodules towards larger, excavated nodules, finally resulting in thin-walled cysts which may eventually coalesce to force a "lacework" appearance. The pathophysiology of this progression of the lesions and therefore of the pulmonary eosinophilic granuloma is discussed by the authors.
A case of pneumoblastoma concerning a 33 year old man, incidentally discovered on a systematic chest X Ray, is reported. The radiologic findings include a voluminous and peripherical mass with necrotic zones. The pathologic findings in optic microscopy and the special technics consist in the three cellular contingents which form the pneumoblastoma: clusters of indifferentiated cells, epithelial cells and spindle cells. All the features show clearly a blastomatic character very similar to a foetal lung which allows to differentiate the pulmonary blastoma from carcinosarcoma. The authors, through a review of the literature, demonstrate the rarity (less than 100 cases reported), the malignant evolution which metastasis and the age (strong majority of adults) which characterize this pathology.
With the use of CT guidance, thoracic (pulmonary and mediastinal) biopsy is a very accurate procedure. The authors obtained 86% of good results in a series of more than 1,200 procedures. Aspiration-biopsy therefore occupies an important place in the diagnostic process and in pretreatment assessment when fibroscopy is negative. The authors describe their technique and demonstrate the value of minimally traumatic biopsy equipment: fine millimetric needles. The use of CT and fine needles dramatically decreases the risk of pneumothorax and blank aspiration. A personalised collaboration between radiologists and pneumocytologists is an essential prerequisite. The authors discuss the indications for this technique and propose a decisional flowchart.
The authors report a case-report of tracheo-bronchopathia chondro-osteoplastica with High-Resolution CT scan examination. They emphasize the rarity of this disease, its long clinical latency and the radiologic patterns of tracheal stenosis and calcificated in ward projecting formations from the tracheal wall. The radiologic diagnosis is discussed. Endoscopy and histology are the diagnosis. The etiology, prognosis and specific treatment remain unknown.
The authors report a case of chronic interstitial pneumonia with a very unusual appearance (on plain films and CT); in fact such ribbon-like linear opacities with concentric and pseudo-cavitary disposition have not been previously described. They are comparable but different from the linear opacities described by Carrington in some cases of chronic eosinophilic interstitial pneumonia, which are vertical and peripheral. They are also different from the curvilinear sub-pleural opacities reported in some cases of asbestosis. On the basis of the anatomic findings they discuss the specificity of such radiologic patterns or their sole value as an evolutive state.