[Brain MR imaging in shaken-baby syndrome: how? when and why?].
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Brain↗
Biomedical subjects
N Damry
Publications and source records attributed to N Damry.
[Acute myocardial infarction and MRI: a comparison of infarct size by MRI and peak creatine kinase after a first episode].
AIM: To compare the assessment of infarct size using MRI and peak CK value. POPULATION AND METHODS: 16 patients presenting with a first MI and seriall measurement of CK underwent gadolinium-enhanced MRI. RESULTS: A significant correlation was observed between both estimates of infarct size (r=0.56, p=0.0025). In addition, an inverse correlation was found between residual viability and peak CK (r=-0.51; p=0.043). CONCLUSION: After a first episode of MI, infarct size estimate by MRI correlates with that determined by peak CK measurement.
Aged↗
[Imaging in paediatric epilepsy].
Epilepsy is a chronic disease, often with an onset during childhood and characterized by spontaneous and recurrent seizures. It concerns 0.5-1% of children under 16 years of age. A classification proposed by the International League Against Epilepsy (ILEA) in 2001 takes into account recent genetic factors involved in epilepsy and attenuates the sharp demarcation between generalized and partial seizures. This classification tends to define whether imaging is indicated or not. Imaging is useless in simple cases of fits associated with hyperthermia and in benign idiopathic epilepsy. It is debated if it is a first episode of epilepsy without a particular context and no neurological signs. In all other cases of epilepsy in children, imaging is indicated. In descending order of frequency the possible causes include malformations (as abnormal gyral development and phakomatoses), hypoxic-ischemic lesions, non-accidental injuries, infections, metabolic diseases and tumors. Being much more sensitive than computed tomography (CT), magnetic resonance imaging (MRI) is the technique of choice to identify an underlying cause in symptomatic epilepsy. Clinical data are mandatory in order to direct a proper MRI investigation. The recently developed diffusion-weighted sequence is particularly useful in the acute phase of certain events such as hypoxia-ischemia, trauma and metabolic disease. CT scan is used in emergency situations and also as a complement to MRI for example to identify calcified lesions. In this way, imaging contributes to establish the nature and define the extension of epileptogenic lesions, thereby guiding therapeutic management. MRI also allows follow-up of the consequences of repeated seizures (such as mesial temporal sclerosis and selective neuronal necrosis) on the cerebral parenchyma and plays a role in the establishment of a prognosis.
Adolescent↗
[Headache in childhood: which diagnostic imaging strategies?].
There are various causes of headaches in children. The majority of cases are considered as primary and include migraine and tension headaches. Headaches secondary to an underlying pathology are much less frequent. The aim of imaging will be to depict lesions that can benefit from specific therapy and hence improve life quality and expectancy of the affected child. In case of secondary headaches, imaging will have to precise the diagnosis, which is based mainly upon history of the disease and clinical findings. These findings are important to the radiologist as they will help to choose the more adequate technique between CT scan and MRI. This choice is based upon the presumed diagnoses, degree of emergency and availability of the technique. Knowledge of the differential diagnoses influences the way to perform the examination itself (choice of slice thickness, plane of imaging, MR sequences, need for an MR angiogram or injection of contrast medium...). In our opinion, dedicated MR imaging is the technique of choice to investigate secondary headaches in children given its superior sensitivity in depicting certain tumors (glioma of the pons, posterior fossa tumors...), intracranial hypotension, Chiari I malformation, lesions of the hypothalamo-hypophyseal axis etc...
Adolescent↗
[Atypical presentation of an intestinal duplication in a three month old child].
Intestinal duplication is an uncommon congenital anomaly that often is diagnosed during childhood. Ultrasound diagnosis is based on the presence of a characteristic double-walled cystic mass. We report a case of duplication in a three Month old child presenting with small bowel obstruction. This case is unusual due to the presence of calcifications that are uncommon in intestinal duplication.
Calcinosis↗
An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament.
Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment.
Abdomen, Acute↗
Ectopic vaginal insertion of a duplicated ureter: demonstration by magnetic resonance imaging (MRI).
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Female↗
Unusual findings in two cases of Langerhans' cell histiocytosis.
We report unusual findings in two patients with Langerhans' cell histiocytosis (LCH), namely a cervical mass lesion with extensive destruction of the posterior elements of a cervical vertebra and gastrointestinal lesions as part of multisystem involvement. The aim of our report is threefold. Firstly, LCH can be responsible for osteolysis of the vertebral posterior arches, with or without involvement of the vertebral body, and should be included in the differential diagnoses of cervical mass lesions. Secondly, in a patient with confirmed LCH and additional protein-losing enteropathy, gastrointestinal involvement should be considered as a possibility since it is an important factor for establishing prognosis. Thirdly, LCH lesions can be very extensive and yet have a good response to therapy, whereas less spectacular lesions may not respond or respond only partially to therapy. Thus, an important factor in establishing prognosis is the presence of multisystem involvement at diagnosis, regardless of the extent of a lesion at a particular site.
Diagnosis, Differential↗
Helical CT without contrast in the radiological investigation of renal colic.
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Colic↗
Radiologic investigation of renal colic: unenhanced helical CT compared with excretory urography.
OBJECTIVE: Our aim was to compare unenhanced helical CT and excretory urography in the assessment of patients with renal colic. SUBJECTS AND METHODS: Fifty-three of 70 consecutive patients with acute signs of renal colic were prospectively examined with unenhanced helical CT, which was followed immediately by excretory urography. Two radiologists who were unaware of the findings independently interpreted these examinations to determine the presence or absence of ureteral obstruction. On all CT scans that had positive findings for ureteral stones or obstruction, we looked for secondary signs of obstruction (perinephric or periureteral fat stranding, ureteral wall edema, ureteral dilatation, and blurring of renal sinus fat). RESULTS: A stone was recovered in 45 of the 53 patients, nine before and 36 after imaging. The latter 36 patients had their stones identified on CT, whereas only 24 patients had their stones identified on excretory urography. Eight patients without stone disease had normal ureters on both CT and excretory urography. Of the 45 patients who had stone disease, 26 had ureteral dilatation on both CT and excretory urography, and 36 patients who recovered a stone after CT had secondary signs of obstruction. Of the nine patients who recovered a stone before CT, three had secondary signs of obstruction. Two patients had periureteral fat stranding, ureteral wall edema, and renal sinus fat blurring. One patient had only ureteral wall edema. CONCLUSION: Compared with excretory urography, unenhanced helical CT is better for identifying ureteral stones in patients with acute ureterolithiasis. Secondary CT signs of obstruction, including renal sinus fat blurring, were frequently present even when the stone was eliminated before imaging.
Acute Disease↗
Tonsillar lymphoma and AIDS.
A case of a patient presenting unilateral tonsillar enlargement, whereby non-Hodgkin lymphoma (NHL) and AIDS were diagnosed, is presented. The clinical and pathological aspects of this pathology, its pathogenicity and treatment are reviewed.
Adult↗
Stress fracture of the acetabular roof. Case report and value of MRI.
The authors report the case of an 11-year-old boy with pain in the left leg without history of recent trauma. The diagnosis of a stress fracture of the acetabulum was made based on MRI and bone marrow biopsy. They discuss the role of MRI in the diagnosis of a stress fracture.
Acetabulum↗
Association of a fetus in fetu and two teratomas: US and MRI.
We report a case of an abdominal mass in a newborn girl containing a fetus in fetu and two teratomas. Obstetrical sonography revealed the abnormality at 28 weeks of gestation. Post-natal US examination suggested the diagnosis of a fetus in fetu upon the finding of a vertebral column and fetal skeletal bones. US also showed two other rounded masses connected to the main lesion by vascular bundles. Preoperative MRI examination supplied further information regarding tissue composition and vascularisation of the mass lesion. The diagnosis was confirmed by pathological examination. Aetiological factors and radiological diagnosis of this rare tumour are reviewed and discussed.
Abdominal Neoplasms↗
Gastric outlet obstruction: unusual ultrasonographic findings in the pyloric and antral regions.
The authors present the cases of four infants aged 2-4 months with symptoms suggesting gastric outlet obstruction. All four had US evaluation of the antropyloric region and upper GI series. Three of them underwent endoscopic investigations and three, surgery. US demonstrated hypertrophied pyloric muscle and, above all, antropyloric abnormalities in all cases, namely a solid mass within the pyloric canal, hypertrophy of the pyloric mucosa in two cases and a double juxtapyloric cyst with an ulcer. Differential diagnosis of the sonographic images is discussed in each case.
Diagnosis, Differential↗
Bilateral congenital absence of the internal carotid artery with a primitive transmaxillary arterial anastomosis.
We report a case of congenital, bilateral absence of the internal carotid artery accompanied by a complex anastomotic plexus arising from the right maxillary artery, a terminal branch of the external carotid artery. We present the clinical features and the radiological diagnostic evidence which consisted of ultrasonography, brain CT and MRI, conventional angiography and skull base CT scan. We review the literature pertaining to this congenital anomaly and correlate embryology of the carotid arteries to this unusual type of collateral circulation.
Adolescent↗
Ureteral quadruplication: the fourth case report.
Among development abnormalities of the upper urinary tract, ureteral duplication is a very common finding while triplication is quite rare. Ureteral quadruplication is exceedingly unusual; to our knowledge only three cases have been reported over the past 25 years and all of them concerned adult patients. We present a case of unilateral quadruplicated ureters in a 9-month-old infant. Review of the literature failed to reveal documentation of such a case.
Humans↗
MRI evaluation and follow-up of bone necrosis after meningococcal infection and disseminated intravascular coagulation.
Disseminated intravascular coagulation (DIC) is a serious complication of meningococcal septicaemia. It often results in infarction of various tissues namely the skin, adrenal glands, kidneys, brain and, much less commonly, bones. We describe a patient who presented bone lesions after meningococcal septicaemia. In addition to plain radiography and scintigraphy the lesions were evaluated with MRI and have proved to be extensive and still progressive, approximately 18 months after the onset of the disease.
Bacteremia↗
CT and 99mTc-DMSA scintigraphy in adult acute pyelonephritis: a comparative study.
PURPOSE: The aim of this prospective study was to evaluate the relative value of CT and (99m)Tc-DMSA scintigraphy in the diagnosis of acute pyelonephritis (APN) in adult patients suspected of having urinary tract infection. METHOD: The study was conducted in 36 patients presenting with symptoms suggestive of urinary tract infection. Plain B-mode sonography, CT with contrast medium, and (99m)Tc-DMSA scintigraphy of the kidneys were performed in all patients. Both CT and (99m)Tc-DMSA scintigraphy were performed within 72 h after admission. RESULTS: Twelve patients with clinical and biological signs of urinary tract infection had no CT or (99m)Tc-DMSA scintigraphy abnormalities. Among these patients, lower urinary tract infection was found in 10 patients and 2 patients had ureteral obstruction. In the 24 remaining patients, the diagnosis of APN was made. Among these patients, a correlation was found between CT and (99m)Tc-DMSA scintigraphy in 11 cases. In two cases, both examinations were normal, and in nine cases, both were abnormal. In 11 cases of the 13 remaining patients, abnormal CT was found with normal (99m)Tc-DMSA scintigraphy, whereas the 2 last cases had normal CT and abnormal (99m)Tc-DMSA scintigraphy results. In two cases, bilateral lesions found on CT manifested as unilateral abnormalities on (99m)Tc-DMSA scintigraphy images. CONCLUSION: The diagnosis of APN in adult patients is based on clinical presentation and biological findings. Few studies have compared (99m)Tc-DMSA scintigraphy with CT in the detection of parenchymal involvement in APN. We conclude that CT is more accurate than (99m)Tc-DMSA scintigraphy in the detection of APN lesions in adult patients.
Acute Disease↗