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At least 37 records · Page 2Linked to original sources
PubMed1999

Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis.

STUDY OBJECTIVES: Bronchial artery embolization (BAE) has been established as an effective technique in the emergency treatment of life-threatening hemoptysis, but few data concerning long-term results and complications of the procedure are available. The aim of this study was to analyze retrospectively the experience of BAE in our center with particular emphasis on medium-term and long-term results and on morbidity. SETTING: University hospital. PATIENTS: Fifty-six patients underwent bronchial arteriography from 1986 to 1996 in our center for the management of life-threatening hemoptysis. Of them, BAE was performed in 46 patients. Their mean age was 51 years (range, 19 to 89 years). The most frequent etiologies of hemoptysis were active or inactive tuberculosis, bronchiectasis, or idiopathic hemoptysis. RESULTS: BAE resulted in an immediate cessation of hemoptysis in 43 of the initial 56 patients (77%). During the first month after BAE, four patients who died from causes other than hemoptysis or who were referred to surgery were excluded from follow-up and in the 39 remaining patients, a complete cessation of hemoptysis was observed in 32 patients. A remission was noted in 28 of the 29 patients followed up between 30 and 90 days after BAE. Long-term control of bleeding was achieved in 25 of the initial 56 patients (45%) followed up beyond 3 months after BAE (median follow-up of 13 months; range, 3 to 76 months). Overall, complications of BAE consisted of two episodes of mediastinal hematoma and three episodes of neurologic damage, two of which improved without permanent sequelae. CONCLUSION: We conclude that BAE may result in long-term as well as immediate control of life-threatening hemoptysis but that complications are not unusual.

Adult↗
PubMed1999

Helical CT assessment in hilar cholangiocarcinoma: correlation with surgical and pathologic findings.

OBJECTIVE: Our goal was to assess the usefulness of helical CT in the presurgical evaluation of hilar cholangiocarcinoma. CONCLUSION: Helical CT aids in tumor localization and in assessment of parenchymal, biliary intrahepatic, and portal involvement in hilar cholangiocarcinoma. However, helical CT is not effective in the assessment of biliary extrahepatic, arterial, and lymph node involvement.

Adult↗
PubMed1999

[Imaging of the cerebello-pontine angle and skull base].

Lesions of the internal auditory meatus, cerebello-pontine angle and skull base have benefited greatly from the progress made in imaging techniques. There are now three methods of examination at our disposal. MRI scan is the primary method of choice, and includes T1 spin echo sequences without and with the injection of contrast, and the T2-weighted sequence (with spin echo or gradient echo CISS-3DFT); other sequences, such as angio-MRI and FLAIR, are used more rarely. CTscanning is complementary to MRI, but gives a better definition of bony structures. Arteriography is more rarely indicated. Imaging usually allows a diagnosis of the type of lesion encountered. The typical features on MRI and CT scan of the various pathological lesions of the internal auditory meatus, cerebello-pontine angle and skull base are discussed, together with the fact that by far the commonest among them is the vestibular neuroma.

Cerebellopontine Angle↗
PubMed1999

Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours.

Liver metastases, in patients with gastroenteropancreatic endocrine tumours, are present in 25-90%, depending on the nature of the primary tumour. Surgical resection is indicated only for localised liver metastasis, whereas in most cases with diffuse liver involvement other therapeutic modalities such as intravenous chemotherapy, embolization or hepatic arterial chemoembolization, ligation or intra-arterial chemotherapy are currently available. Hepatic arterial chemoembolization is specifically indicated for progressive tumours (mainly carcinoids) confined to the liver especially after unsuccessful systemic chemotherapy. A mixture of cytotoxic drug and iodised oil followed by gelatine sponge particles are injected in the branches of the hepatic artery supplying the tumours. 66-100% positive results of this treatment have been reported in the carcinoid syndrome with a 50-91% decrease in 5-HIAA secretion. Variation of tumour size (WHO criteria) has been reported in 33-80% of the cases, even if no direct comparison between chemoembolization and other therapeutic modalities are currently available. Extensive follow-up of the treated patients and additional studies will clarify the role of chemoembolisation in advanced digestive neuroendocrine tumours.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Thickening of the wall of the bile duct due to intramural collaterals in three patients with portal vein thrombosis.

OBJECTIVE: We report three cases of a rare form of cavernoma developed within the wall of the common bile duct. CONCLUSION: To our knowledge, this kind of portal cavernoma has not been described in the literature. Because the cavernoma may be easily confused with other causes of bile duct wall thickening, color Doppler sonography is mandatory for a correct diagnosis.

Adult↗
PubMed1997

[Ultrasonographic anomalies of intrahepatic biliary ducts: contribution of the comet-tail image].

OBJECTIVES: The aim of this study was to evaluate the sensitivity and specificity of the ultrasound intrahepatic bile duct wall comet-tail artifact for the diagnosis of biliary disease. METHODS: All subjects who underwent upper abdominal ultrasound examination were included in the study over an 18-month period. The presence or absence of the comet-tail artifact (that is hyperechoic pattern with several parallels lines, constant, lining on the intrahepatic biliary ducts) was noted. RESULTS: Fourteen thousand four hundred and ninety-eight patients were included. The comet-tail artifact was only found in 10 of the 14 211 patients without biliary tract disease (99.9% specificity), but in 35 of the 287 patients with biliary disease (12.2% sensitivity). The positive predictive value for the diagnosis of biliary tract disease was 77.7%. The artifact was associated with an angiocholitis in 83% of the patients. CONCLUSION: Despite its low sensitivity, the sonographic comet-tail artifact of the intrahepatic bile duct wall was strongly correlated with the presence of biliary disease. This artifact may be related to an enlargement of the bile duct wall.

Bile Duct Diseases↗
PubMed1997

[Comparison between spiral x-ray computed tomography and endosonography in the diagnosis and staging of adenocarcinoma of the pancreas. Clinical preliminary study].

OBJECTIVE: To determinate in a retrospective clinical study the benefit of helical-CT for the diagnosis and staging of pancreatic carcinoma compared with endoscopic ultrasonography. METHOD: Results of helical-CT and endoscopic ultrasonographic investigations relative to 24 cases of histologically proved adenocarcinoma were reviewed. The criteria studied were: a) existence of a pancreatic mass, b) diagnosis of malignancy, c) existence of vascular involvement, d) lymph node involvement. Statistical analysis (binomial test) was performed in 24 patients for the assessment of mass and malignancy and in 10 patients for the assessment of vascular involvement (9 patients who underwent surgery and one patient with a positive arteriography). RESULTS: For diagnosis of pancreatic mass both methods were equivalent: 91.5% (22 cases out of 24) for helical-CT and 87.5% (21 cases out of 24) for endoscopic ultrasonography. Two pancreatic masses were seen only with endoscopic ultrasonography. Their size was under 3 cm. Two of the 3 masses not seen with endoscopic ultrasonography were infiltrative lesions measuring more than 3 cm. Helical-CT was significantly superior to endoscopic ultrasonography for the diagnosis of malignancy (96% vs 71%) (P = 0.035). The accuracy of helical-CT for vascular involvement was significantly superior to endoscopic ultrasonography (90% vs 40%) (P = 0.031). Endoscopic ultrasonography underestimated vascular involvement in 5 cases: mesenterico-portal confluence (3 cases), superior mesenteric artery (2 cases). In the 6 cases with histologically proved lymph node involvement, endoscopic ultrasonography (6 correct assessments) was superior to helical-CT (3 correct assessments). CONCLUSION: This study confirms the complementarity of helical-CT and endoscopic ultrasonography for the diagnosis of pancreatic carcinoma. It suggests that helical-CT is superior to endoscopic ultrasonography for diagnosis of malignancy and assessment of vascular involvement and endoscopic ultrasonography is superior to helical-CT for diagnosis of lymph node involvement. These preliminary results have to be confirmed by a prospective study including a large number of patients with surgical correlation.

Adenocarcinoma↗
PubMed1997

[Congenital cystic dilatation of the common bile duct. Radio-anatomical correlations in 14 patients].

OBJECTIVES: The aim of this study was to compare imaging and pathological results of congenital cystic enlargement of the biliary tract to determine the best preoperative management strategy. PATIENTS AND METHODS: Radiological findings of 14 cases treated by surgery were reviewed. Radiological examinations were reviewed: ultrasound (n = 20), computed tomography (n = 13), endoscopic ultrasound (n = 8), endoscopic retrograde cholangiopancreatography (n = 10), percutaneous transhepatic cholangiography (n = 3), peroperative cholangiography (n = 11). Imaging and surgical or pathological correlations were obtained with regard to topographical type using Todani's classification, pancreatobiliary junction, and associated diseases, especially biliary malignancies (cystic wall and gallbladder). RESULTS: Cystic enlargement of the biliary tract was type Ia in 2 patients, type Ib in 1, type Ic in 4, type IVa in 5, and type IVb in 2. The radio-pathological correlation was excellent for the topographical type, and quite good for intrahepatic extension. An abnormal pancreatobiliary junction was identified in 5 cases, and visualized before surgery in I case. This junction was not opacified pre- or pre-operatively in 7 cases. Gallbladder stones were present in 2 cases, choledocal stones, in 2 cases, and intrahepatic stones in one cases, always seen on ultrasound. Malignant degeneration was present in the cyst in one case in the pathological specimen, but was not visualized by imaging procedures or peroperatively; one intrahepatic degeneration was visualized on CT and histologically proven in the surgical specimen. CONCLUSION: Ultrasound and CT allow positive diagnosis of cystic enlargement of the biliary tract, and diagnosis of intrahepatic cyst and associated diseases. The bifurcation extension and the study of pancreatobiliary junction require peroperative or retrograde cholangiography.

Adolescent↗
PubMed1997

[Comparison of scanners and porto-scanners, both in helical mode, for the study of hepatic metastases. Prospective study in 12 patients].

PURPOSE: The aim of this study was to compare helical CTAP and helical CT-scan in the preoperative assessment of liver metastases. METHODS: A prospective unicentric study in 12 patients was performed with helical CTAP and helical CT-scan. All patients underwent partial hepatectomy with intraoperative palpation and sonography within 19 days (mean: 9 days). RESULTS: Examination of resected liver specimens found 38 metastases, from colorectal cancer in 36 cases. The sensitivity was 92.1% for helical CTAP and 79% for helical CT-scan. This sensitivity was 85% for helical CTAP and 60% for helical CT-scan for nodules 1 cm or less in diameter (P = 0.08). CONCLUSION: In the preoperative screening of liver metastases, helical CT-scan should be performed as the first choice examination. When hepatic lesions seem to be curable by resection based on helical dynamic CT-scan results, helical CTAP should be performed to increase the sensitivity of detection of lesions 1 cm or less in diameter.

Adult↗
PubMed1997

[Imaging of atypical cysts of the liver. Study of 26 surgically treated cases].

OBJECTIVES: Differential diagnosis between a benign cystic hepatic lesion, biliary cyst, and a potentially malignant lesion or biliary cystadenoma, is difficult. The aim of this study was to evaluate imaging features of atypical cystic liver lesions and the role of imaging techniques in determining a specific diagnosis. METHODS: Twenty-six patients with atypical cystic hepatic lesions were included in this study. All patients underwent surgery and pathological diagnosis was atypical hepatic cyst (n = 18), biliary cystadenoma (n = 4), hydatic cyst (n = 3), and ciliated hepatic foregut cyst (n = 1). We systematically reviewed US (n = 24), CT (n = 24), and MRI (n = 8) examinations. RESULTS: Septum were seen in both cystadenomas (US: n = 4, CT: n = 1) and hepatic cysts (US: n = 11, CT: n = 6). No mural nodules were seen. A thin wall was noted in both hepatic cysts (n = 2) and cystadenomas (n = 3). The intrahepatic biliary tract was dilated in 3 patients with hepatic cysts, 1 patient with cystadenoma, and 2 patients with hydatic cysts. Calcifications were noted in 1 patient with hepatic cyst, 3 patients with hydatic cysts, and in the case of ciliated hepatic foregut cyst. We found an associated typical hepatic cyst in 77% of cases (14/18) with atypical hepatic cysts; this was never found in other atypical cystic lesions (P < 0.01). CONCLUSION: In this series, no imaging features provided a differential diagnosis of atypical hepatic cysts and cystadenomas. The presence of associated typical hepatic cysts is helpful in suggesting the diagnosis of hepatic cyst.

Adult↗
PubMed1996

Calcification in focal nodular hyperplasia: a new problem for differentiation from fibrolamellar hepatocellular carcinoma.

PURPOSE: To describe calcification in focal nodular hyperplasia (FNH) of the liver, which poses a new problem for the differentiation of FNH from fibrolamellar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ultrasound, computed tomography, and magnetic resonance imaging findings of 357 FNH lesions diagnosed in the past 5 years in 295 patients (274 female, 21 male; aged 14-72 years) were retrospectively reviewed with emphasis on intralesional calcification. RESULTS: Calcifications were seen in five FNH lesions (1.4%) as small, solitary spots located centrally or peripherally within the lesions. Morphologic features of these calcifications were similar to those of calcifications in two of six fibrolamellar HCCs in the same period. CONCLUSION: Calcification in FNH is a rare and atypical finding that poses further difficulty for differentiation from fibrolamellar HCC.

Adult↗
PubMed1996

[Imaging of ciliated hepatic or biliary cysts. 4 cases].

Four patients with ciliated hepatic cysts, a rare and benign lesion, were examined between 1990 and 1994. Imaging features were compared to 12 previous cases. All lesions were revealed by US, and were hypoechoic in 3 cases, and anechoic in 1 case. All lesions were less than to 4 cm in diameter, and were well-defined, unilocular, isolated, and located in subcapsular areas, usually in the medial segment of the left lobe of the liver (3 cases). In one case, the cyst was found in the gallbladder wall. The lesions were low density on pre- and post-contrast CT scan (performed in 2 cases), strongly hyperintense on T2-weighted MR images (2 cases), and had a variable signal intensity on T1-weighted MR images. One patient underwent percutaneous guided biopsy but no diagnosis was obtained. None of the patients had preoperative diagnosis and all underwent surgery. Diagnosis was confirmed by histopathologic examination of the resected specimen. Ciliated hepatic cysts may be suspected in this study and in the literature. Diagnostic criteria are as follows: hypoechogenic mass less than 4 cm in diameter, located in the subcapsular area of the medial segment of the left lobe of the liver.

Adult↗