[Radiological case of the month. Giant lobar emphysema].
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Biomedical subjects
Publications and source records attributed to M Allegue.
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The ultrasonographic findings of 4 patients with surgically confirmed urothelial tumors associated with calculic pyonephrosis are presented. All the involved were markedly enlarged and hydronephrotic with obstructive calculi, stigmata of pyonephrosis and, an echoic pelvic mass, extending in calyceas in 2 cases. The sonographic appearance correlated well with the gross pathological findings. The histological types were 2 squamous cell carcinomas, 1 adeno-squamous cell carcinoma and 1 transitional carcinoma. The chronic calculic irritation was proved to induce squamous and glandular metaplasia. The subsequent squamous carcinoma and adenocarcinoma were documented in the literature. The preoperative diagnosis of the associated tumor was rarely done. The sonographic features reported are highly suggestive of urothelial tumor and may lead to an accurate preoperative diagnosis.
The authors describe a case of congenital lobar emphysema of the upper right pulmonary lobe discovered at birth with an opaque hemithorax and a shift of mediastinum. The diagnosis was confirmed by a CT-scan. A lobectomy was performed at 6 weeks of age. The different diagnosis and physiopathological mechanisms are discussed.
Lymphocele is a rare complication of kidney surgery in pediatric practice. Recent treatment consists in long term percutaneous drainage. The case reported was diagnosed 9 years after nephrectomy and improved with 3 weeks percutaneous drainage.
We present one case of bursa formation secondary to a scapular osteochondroma. This rare condition can simulate, clinically and radiologically, a sarcomatous transformation. CT scan is helpful to demonstrate the scapular osteochondroma and the adjacent bursa.
We report a girl with juvenile primary hypothyroidism revealed by growth retardation and a syndrome of primary amenorrhea-galactorrhea with hyperprolactinemia and suprasellar pituitary enlargement. Resolution of the pituitary enlargement and the amenorrhea-galactorrhea syndrome occurred after thyroid hormone replacement. No similar observation has been reported earlier in juvenile hypothyroidism.
Renal carbuncle is a cortical lesion following bacteremia, occurring in patient without any urologic known problems. The analysis of 11 consecutive renal carbuncles showed that one should consider the diagnosis of renal carbuncle in young patients with flank pain, fever, and absence of significant leucocyturia. Our study confirms that renal carbuncle is always caused by staphylococcus aureus and that treatment is based on appropriate antibiotherapy. Isolation of the bacteria was difficult unless ponction of carbuncle under ultrasound control was performed. The usefulness of ultrasonography for the diagnosis of renal carbuncle and for its distinction from other suppurative renal lesions is emphasized.
A series of 10 cases of chronic calcifying pancreatitis from central Tunisia are reported. The mean age at presentation was 23 years and the male to female ratio was 1.5. The main clinical manifestations of the disease were abdominal pain (eight cases), weight loss (four cases), and diarrhea (three cases). Diabetes was recorded in four cases. The etiological investigations yielded negative results in all the patients. It is concluded that central Tunisia should be added to the regions where juvenile chronic calcifying pancreatitis of the "tropical type" may be observed.
Sonography seems in patients with acute renal failure a reliable method for diagnosing urinary tract obstruction, giving the kidney size and localizing the kidney for percutaneous drainage. Percutaneous nephrostomy is actually the best temporary derivation for patients with obstructive anuria before definitive treatment. 18 cases of obstructive anuria are reviewed. Urinary lithiasis is the main aetiology (13/18). 11 of our patient had undergone percutaneous nephrostomy as a first step of their treatment.
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The authors report a case of giant gastric schwannoma with dominating extra-gastric development and a cystic component simulating a pancreatic pseudo-cyst on ultrasound and computed tomography examination, the diagnosis was made only at surgery that consisted in total gastrectomy. The rarity of these tumors, their diagnostic difficulties and the particularities of their surgical treatment are outlined.
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We report 3 cases of Clostridium perfringens bacteremia with uterine gas gangrene. Clinical presentation included severe infectious syndrome, hemoglobinemia and hemoglobinuria, jaundice, uterine tenderness and hypertension. All 3 cases were first seen with installed renal failure. Diagnosis and modalities of therapy were reviewed. Clostridium perfringens bacteremia with uterine gas gangrene still occur in developing countries.
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Household members of surgical cases of hydatidosis were screened for the disease in two high-risk districts in Central Tunisia. Seventy-four index cases were identified from the 1980-1984 surgical records of Sousse University Hospital. Household members over five years of age were tested by ELISA, and if positive by counterelectrophoresis (CEP) for detection of band 5. Positive subjects underwent a chest X-ray and echotomography (ECT). Eight of the 355 household members (2.2%) living in four different houses were serologically positive. All eight had a normal chest X-ray; a hepatic cyst was detected in seven of them. Five of the seven subjects in whom a cyst was diagnosed lived in two neighbouring houses (19 household members from the same family). Among these 19 subjects, six had been previously operated on for hydatidosis (cumulative rate: 11/19). The comparisons of these results with results obtained through community-based screening in the same area suggest that households members of patients are not at particularly high risk of hydatidosis.
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28 cases of neurofibromatosis are reported. Principals bone anomalies are reviewed. The skeletal manifestations are numerous and varied. These anomalies interest specially cranial vault, spheno-orbital area and vertebral spine. It is imperative to keep in mind skeletal manifestations because neurologic and cutaneous signs can be absent.