Biomedical subjects
Publications and source records attributed to P Celard.
We present a case of herniation of the left atrial appendage through a congenital partial absence of the pericardium. The diagnosis was demonstrated by echocardiography and the surgical correction achieved with autologous pericardium.
Embolization of the systemic arteries of the lung (described by Remy and colleagues in 1973) is now a useful method for the treatment of hemoptysis or hemorrhagic lesions of the lung prior to surgical treatment, or for local treatment of hemoptysis when surgery is contraindicated or unnecessary. The technique is based on the anatomy of the different divisions of the systemic circulation (bronchial and extrabronchial), which for various physiologic reasons may develop hypervascularization. The results, complications, and contraindications of systemic embolization have previously been described and the technique is now commonly practiced.
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A series of 49 patients with pulmonary hamartoma subjected to operation is described. 28 patients were male and 21 female, with a mean age of 49.8 years. Most cases were discovered on routine chest films. Six patients had radiologic changes produced by obstruction, while 43 had a rounded peripheral opacity. Fine calcifications were present in four cases. In no case was diagnosis achieved by bronchoscopy, whereas one of the more recent cases was diagnosed by percutaneous fine needle biopsy. Sinner has shown that this last technique can establish diagnosis in most cases. As such tumors are invariably benign and grow slowly, diagnosis by percutaneous biopsy renders operation unnecessary: periodic follow up only is required.
In 200 young patients with apparently idiopathic spontaneous pneumothorax, the following radiologic features were analyzed: degree of collapse on the initial chest film, areas of atelectasis, and presence of blebs, apical opacities, fibrous adhesions, pleural effusions, and controlateral shift of mediastinal structures. Confrontation of apical changes with pathologic findings in operative specimens suggests that mesothelial rupture with reactive hyperplasia results in a "pneumatization chamber" visible as a bullous image. Following drainage, homolateral shifts of mediastinum and four cases of pulmonary edema were recorded. Risk factors for pulmonary edema include severe pulmonary collapse with areas of atelectasis, persisting for more than 48 hours and an aspiration which either exceeded 1.5 l. of air or was performed with a depression of more than 30 cm of water.
Fifty-two traumatic ruptures of the thoracic aorta were hospitalized between 1972 and 1982, with 46 angiographies. The most significant clinical sign of aortic rupture is the difference in blood pressure between the upper and lower limbs. The frequency of chest film findings is discussed. The aortography by arterial route must be performed at the sligh test suspicion, sometimes without radiographic signs, to establish diagnostics and detect associated lesions (dissection) and unusual types (low localization, multiple localization, localized rupture of the intima.
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Eight cases of broncholithiasis requiring surgical treatment are reported, and diagnostic and therapeutic difficulties of this affection discussed. Clinical symptomatology is not very specific and associates slight or moderate hemoptyses with signs of a febrile pulmonary disorder. Expectoration of a broncholith was not observed in these cases. Radiological images were suggestive by demonstrating hilar and/or peripheral calcifications, often with a parenchymatous opacity in the same region. Fibroscopy is not always conclusive and may even suggest the presence of a tumor. A tuberculous etiology is admitted in France in spite of the absence of bacilli in the sputum. Differential diagnosis from cancer is a real problem, this explaining why two pneumonectomies were performed, in addition to the six lobectomies.
The diagnosis of diaphragmatic tumours is complicated by their rarity and because they are often difficult to distinguish from the more frequent tumours of surrounding structures. We describe two cases: an invasive fibroma and a primary hydatid cyst. We discuss the differential diagnosis of diaphragmatic tumours and suggest a systematic approach to their radiological diagnosis, stressing the value of ultrasonography, CT scanning and diagnostic pneumoperitoneum.
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