Journal De Radiologie最新文献

Purpose

To describe the imaging features of pancreatic metastases from renal cell carcinoma.

Patients and methods

Retrospective study of 17 patients with isolated metachronous pancreatic metastases from renal cell carcinoma with surgical and pathological correlation.

Results

The preoperative diagnosis was made on ultrasound in 13 cases. Contrast-enhanced CT showed intense tumor enhancement at the arterial phase, mostly homogeneous but sometimes heterogeneous. There were multiple lesions in six cases. Following complete surgical resection, survival was fairly good.

Conclusion

Long-term follow-up with CT obtained in the arterial and portal venous phases is mandatory. The arterial phase acquisition is essential for the diagnosis of pancreatic metastases from renal cell carcinoma.

Acute mesenteric ischemia (AMI) is a life-threatening emergency with prognosis directly correlated with the delay in diagnosis and treatment. Clinical and laboratory findings are nonspecific and it is imperative to look for findings of AMI on CT and ultrasound examinations performed in patients with acute abdomen. Arterial and venous ischemia are different entities with different clinical and imaging features, treatment and prognosis. The main causes of AMI are arterial thromboembolic disease and low-flow state. Venous ischemia is less frequent. Due to its high reported sensitivity (90%), CT should be performed as a firstline imaging modality when AMI is suspected. CT and ultrasound imaging features of AMI include: bowel wall thickness and enhancement abnormalities, pneumatosis, portal venous gas, demonstration of intravascular thrombus, bowel dilatation and ascitis.

Skull base osteomyelitis is a rare but serious infection. It typically afflicts immunosuppressed patients and should be suspected in patients with persistent otitis complicated by cranial nerve palsy (VII, IX and XII). The most frequent germ is pseudomonas aeruginosa. Contiguous spread of infection occurs along neurovascular structures and weaker regions of the skull base, then into the soft tissue compartments of the face and nasopharynx. Diagnosis and treatment should be made early for this disease with poor prognosis and high mortality.

Endoscopic sinonasal surgery is the main procedure in sinonasal pathology. Complications are rare but potentially severe given the close relationship between the nasal cavities and sinuses and the orbit, skull base and carotid arteries. The different types of surgeries along with the mechanisms of injury, presenting signs and symptoms, and imaging features of the different surgical complications will be reviewed. We will also review the anatomical variants increasing the surgical risk that radiologists should describe on preoperative imaging studies.

Imaging evaluation of the temporal bone often is neglected at the acute phase in patients with head trauma due to the urgent need to evaluate the brain. It should nonetheless be an integral part of this evaluation by the addition of thin dedicated CT images. Knowledge of the mechanisms of traumatic injuries combined to multiplanar reconstructions of the acquisition volume lead to accurate depiction of temporal bone injuries, including lesions of ossicles and footplate, structures measuring 2 or 3 mm. This comprehensive work-up will then allow prompt optimal ENT management and may improve the functional outcome.

Vertigo and dysequilibrium are a frequent cause of medical consultation. Clinical evaluation is essential. Some cases of vertigo are diagnosed clinically while others require imaging, sometimes emergently (suspected stroke). MRI is the imaging modality of choice to assess the labyrinth (labyrinthitis? labyrinthine hemorrhage?), internal auditory canal (vestibular schwannoma? other tumor?…) and brain parenchyma including all structures of the auditory pathways: vestibular nuclei, vestibulocerebellar tract, tracts involved with ocular motricity, vestibular cortex… Multiple central etiologies exist: stroke, multiple sclerosis, tumor… However, some etiologies are best depicted with CT, especially lesions of the labyrinth: cholesteatoma, trauma, suspected dehiscence of the superior semicircular canal, suspected labyrinthine fistula… Finally, imaging may be negative (Benign Paroxysmal Positional Vertigo, Meniere's disease, vestibular neuritis, migraine…), merely reducing the differential diagnosis.