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Valérie Vilgrain

Publications and source records attributed to Valérie Vilgrain.

At least 37 records · Page 2Linked to original sources
PubMed2004

Multifactorial aetiology of hepatic infarction: a case report with literature review.

The rarity of hepatic infarction has been explained by the protection from ischaemia provided by the double arterial and portal inflow. Hepatic infarction hence should require the association of multiple factors jeopardizing compensatory mechanisms. We report on a case of hepatic infarction related to combined hepatic arterial and portal venous thrombosis after a blunt abdominal trauma, a previously unreported cause of hepatic infarction. Several causes of vascular impairment were present: shear stress injury due to the trauma, protein C deficiency, type II diabetes and administration of glibenclamide, a splanchnic vasoconstrictor agent. There was repermeation of the portal vein and hepatic artery following anticoagulation therapy. Because hepatic infarction is usually explained by the concurrence of several factors impairing the hepatic blood supply, an extensive search for associated conditions is necessary even when a conspicuous cause is present.

Abdominal Injuries↗
PubMed2004

Acute pulmonary embolism: a rare complication of a large non-parasitic hepatic cyst.

A 56-year-old patient with a non-parasitic hepatic cyst developed acute dyspnoea. Pulmonary embolism was diagnosed. Bleeding into the hepatic cyst, leading to its enlargement and compression of the inferior vena cava, was the only likely cause of the pulmonary embolism. This complication of a non-parasitic liver cyst has not been reported previously. The patient was treated with heparin. Surgical evacuation of the cyst using the 'fenestration' technique was also performed. There was no recurrent pulmonary embolism or hepatic cyst during a 1-year follow-up period.

Acute Disease↗
PubMed2003

Prevalence of hepatic hemangioma in patients with focal nodular hyperplasia: MR imaging analysis.

PURPOSE: To evaluate the prevalence of hepatic hemangioma in a large population of patients with focal nodular hyperplasia (FNH) and to determine if the prevalence is higher than that in patients with other hepatic masses. MATERIALS AND METHODS: Over a period of 40 months, 247 patients with one or more hepatic masses underwent magnetic resonance (MR) imaging at our institution and met the inclusion criteria for this study. One hundred forty-eight patients received a diagnosis of FNH (study group). Ninety-nine patients had a lesion other than FNH and had no history of chronic liver disease (control group). Imaging findings of the main lesion and presence of associated hemangioma were investigated. chi2 analysis was used to determine if there was a statistically significant difference in the two groups regarding the number of patients with associated masses. RESULTS: Twenty-nine of 148 patients (20%) in the study group had FNH with one or more associated hepatic hemangiomas. Among the 99 patients in the control group, nine (9%) had an associated hemangioma. The prevalence of hemangioma was significantly higher (P <.02) in the study group than in the control group. The prevalence of hemangioma in patients with a solitary FNH lesion compared with that in patients with multiple FNH lesions was not significantly different. CONCLUSION: Patients with FNH are more likely to have an associated hepatic hemangioma than are those with another type of focal hepatic mass.

Adult↗
PubMed2003

Telangiectatic focal nodular hyperplasia: US, CT, and MR imaging findings with histopathologic correlation in 13 cases.

PURPOSE: To review the ultrasonographic (US), computed tomographic (CT), and magnetic resonance (MR) imaging findings in 13 patients with telangiectatic focal nodular hyperplasia (FNH) and to compare imaging features with histopathologic results from resected specimens. MATERIALS AND METHODS: US, helical multiphasic CT, and MR images in 13 patients with pathologically proven telangiectatic FNH were reviewed retrospectively. Two abdominal radiologists evaluated lesions for number, size, heterogeneity, surface characteristics, presence of a central scar, presence of a pseudocapsule, US appearance, attenuation at CT, signal intensity at MR imaging, and presence of associated lesions. Imaging and pathologic findings were compared. RESULTS: Sixty-one lesions (5-140 mm in diameter) were seen at imaging. Lesions were multiple in eight of 13 (62%) patients. Imaging characteristics were heterogeneity in 26 of 61 lesions (43%), well-defined margins in 43 of 61 (70%), lack of a central scar in 56 of 61 (92%), presence of a pseudocapsule in three of 61 (5%), hyperintensity on T1-weighted MR images in 17 of 32 (53%), strong hyperintensity on T2-weighted MR images in 24 of 54 (44%), and persistent enhancement on delayed contrast material-enhanced CT or T1-weighted MR images in 23 of 38 (61%). No specific US pattern was noted. Two patients had additional lesions: One had classic FNH, and the other had a cavernous hemangioma. Hyperintensity on T1-weighted MR images was due to sinusoidal dilatation. Hyperintensity on T2-weighted MR images correlated well with the presence of inflammation. CONCLUSION: Telangiectatic FNH differs from typical FNH at imaging: Atypical FNH features often observed with telangiectatic FNH are lack of a central scar, lesion heterogeneity, hyperintensity on T1-weighted MR images, strong hyperintensity on T2-weighted MR images, and persistent contrast enhancement on delayed contrast-enhanced CT or T1-weighted MR images.

Adult↗
PubMed2003

Arterial and portal circulation and parenchymal changes in Budd-Chiari syndrome: a study in 17 explanted livers.

Hepatic parenchymal changes associated with Budd-Chiari syndrome (BCS) have been tentatively explained by combined arterial and portal perfusion disturbances in addition to the complete occlusion of hepatic veins. The aim of this study was to correlate pretransplant course and vascular imaging with pathologic findings in livers explanted for BCS. Seventeen consecutive white patients who underwent transplantation for severe classic BCS were retrospectively analyzed. Pretransplant course was 1 year or less in 8 patients and more than 1 year in 9 patients. Thrombophilia was found in 16 patients (94%). Imaging showed decreased portal perfusion in 16 patients (94%) and increased arterial perfusion in 9 patients. Histology showed obstructive portal venopathy and nodular regenerative hyperplasia (NRH) aspects in all cases, large regenerative nodules resembling focal nodular hyperplasia (FNH) in 9 cases, and cirrhosis in 2 cases. Patients with increased arterial inflow had large regenerative nodules and a protracted pretransplant course. Patients with acute thrombi in portal veins had parenchymal infarcts (2 cases) and a short pretransplant course. In conclusion, patients with severe BCS have a constant impaired perfusion inflow unrelated to progression of cirrhosis but related to the outcome. An early decrease in portal perfusion is observed in the short term and is responsible for NRH or infarcts if complicated with large thrombi. An increase in arterial perfusion compensates impaired portal flow in chronic BCS. Arterial hyperemia contributes to the development of large regenerative nodules that are FNH-like. This pathologic situation offers an interesting vascular model to further understand the parenchymal response to changes in hepatic blood flow.

Adult↗
PubMed2003

Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography coupled with MR portography imaging study.

Although biliary symptoms appear to be uncommon in patients with portal cavernoma, almost all of them have endoscopic retrograde cholangiographic abnormalities. The mechanisms underlying the biliary changes are explained poorly. This study in patients with portal cavernoma had 3 aims: (1) to assess the manifestations related to biliary involvement; (2) to evaluate with magnetic resonance (MR) imaging the aspect and frequency of cholangiographic changes; and (3) to clarify the mechanisms underlying biliary involvement. From December 1999 to July 2001, 25 consecutive adults with portal cavernoma without cancer or cirrhosis were studied with MR cholangiography coupled with MR portography. Seven patients presented with clinical manifestations of biliary disease. MR cholangiography findings were stenosis in 21 patients, with upstream dilatation in 16 and displacement in 13. MR cholangiography coupled with MR portography showed in all cases that the biliary abnormalities were secondary to a mass effect directly related to pressure by the cavernoma. In conclusion, in patients with portal cavernoma, clinical manifestations of biliary disease are most frequent; the cholangiographic abnormalities are very common and usually are caused by a mass effect by pressure from the veins composing the cavernoma. MR cholangiography coupled with MR portography is an effective noninvasive examination for simultaneous visualization of bile ducts and their relationship to the cavernoma.

Bile Duct Diseases↗
PubMed2003

Portal vein embolization before right hepatectomy: prospective clinical trial.

OBJECTIVE: To assess the impact of liver hypertrophy of the future liver remnant volume (FLR) induced by preoperative portal vein embolization (PVE) on the immediate postoperative complications after a standardized major liver resection. SUMMARY BACKGROUND DATA: PVE is usually indicated when FLR is estimated to be too small for major liver resection. However, few data exist regarding the exact quantification of sufficient minimal functional hepatic volume required to avoid postoperative complications in both patients with or without chronic liver disease. METHODS: All consecutive patients in whom an elective right hepatectomy was feasible and who fulfilled the inclusion and exclusion criteria between 1998 and 2000 were assigned to have alternatively either immediate surgery or surgery after PVE. Among 55 patients (25 liver metastases, 2 cholangiocarcinoma, and 28 hepatocellular carcinoma), 28 underwent right hepatectomy after PVE and 27 underwent immediate surgery. Twenty-eight patients had chronic liver disease. FLR and estimated rate of functional future liver remnant (%FFLR) volumes were assessed by computed tomography. RESULTS: The mean increase of FLR and %FFLR 4 to 8 weeks after PVE were respectively 44 +/- 19% and 16 +/- 7% for patients with normal liver and 35 +/- 28% and 9 +/- 3% for those with chronic liver disease. All patients with normal liver and 86% with chronic liver disease experienced hypertrophy after PVE. The postoperative course of patients with normal liver who underwent PVE before right hepatectomy was similar to those with immediate surgery. In contrast, PVE in patients with chronic liver disease significantly decreased the incidence of postoperative complications as well as the intensive care unit stay and total hospital stay after right hepatectomy. CONCLUSIONS: Before elective right hepatectomy, the hypertrophy of FLR induced by PVE had no beneficial effect on the postoperative course in patients with normal liver. In contrast, in patients with chronic liver disease, the hypertrophy of the FLR induced by PVE decreased significantly the rate of postoperative complications.

Adult↗
PubMed2003

Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients.

PURPOSE: To (a) evaluate liver diffusion isotropy, (b) compare two diffusion-weighted magnetic resonance (MR) imaging sequences for the characterization of focal hepatic lesions by using two or four b values, and (c) determine an apparent diffusion coefficient (ADC) threshold value to differentiate benign from malignant lesions. MATERIALS AND METHODS: Sixty-six patients were examined with two single-shot echo-planar diffusion-weighted MR sequences. In the first sequence, liver diffusion isotropy was evaluated by using diffusion gradients in three directions with two b values. In the second sequence, a unidirectional diffusion gradient was used with four b values. ADCs were measured in 43 patients with 52 focal hepatic lesions more than 1 cm in diameter and in 23 patients with 14 normal and nine cirrhotic livers and were compared by using nonparametric tests. RESULTS: Diffusion in the liver parenchyma was isotropic. ADCs of focal hepatic lesions were significantly different between sequences (P <.01). The mean (+/- SD) ADCs in the first sequence were 0.94 x 10(-3) mm(2)/sec +/- 0.60 for metastases, 1.33 x 10(-3) mm(2)/sec +/- 0.13 for HCCs, 1.75 x 10(-3) mm(2)/sec +/- 0.46 for benign hepatocellular lesions, 2.95 x 10(-3) mm(2)/sec +/- 0.67 for hemangiomas, and 3.63 x 10(-3) mm(2)/sec +/- 0.56 for cysts. There was a significant difference between benign (2.45 x 10(-3) mm(2)/sec +/- 0.96, isotropic value) and malignant (1.08 x 10(-3) mm(2)/sec +/- 0.50) lesions (P <.01 for both sequences). CONCLUSION: Diffusion-weighted MR imaging can help differentiate benign from malignant hepatic lesions. The use of two b values in one direction could be sufficient for the design of MR sequences in the liver.

Adult↗
PubMed2003

Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations.

PURPOSE: To compare the computed tomographic (CT) appearance of pancreatic unilocular macrocystic serous cystadenoma, mucinous cystadenoma, and pseudocyst to determine if there are findings that assist in the differential diagnosis. MATERIALS AND METHODS: CT findings in 33 patients (24 women, nine men; age range, 18-84 years; mean age, 41 years) with unilocular pancreatic lesions (macrocystic serous cystadenoma, n = 12; mucinous cystadenoma, n = 11; pseudocyst, n = 10) were retrospectively and jointly reviewed by two blinded observers. Twenty-three patients underwent helical CT, which included pancreatic and portal venous phase imaging with delays of 40 seconds and 65 seconds, respectively, after contrast material injection. Ten patients underwent conventional (nonhelical) CT. The number, size, location, and contour of lesions were reviewed, along with wall thickness and enhancement and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 22) or on a combination of cytologic findings, biochemical markers, and tumor markers (n = 11). The Fisher exact test was used to analyze the results. RESULTS: Three of four CT findings were independently specific for macrocystic serous cystadenoma: location in the pancreatic head, lobulated contour, and absence of wall enhancement. When two of these four criteria were used in combination, 83% (10 of 12) of patients with unilocular macrocystic serous cystadenoma were identified. When three or four of these criteria were used, a specificity of 100% was achieved. Location in the pancreatic head (P <.05), lobulated contour (P <.005), and lack of wall enhancement (P <.005) were specific for macrocystic serous cystadenoma in comparison with mucinous cystic tumor. Lobulated contours (P <.005) were specific for macrocystic serous cystadenoma in comparison with pseudocyst. Other CT findings were not helpful in distinguishing between the three types of lesions. CONCLUSION: A combination of CT findings is helpful in making the diagnosis of pancreatic unilocular macrocystic serous cystadenoma.

Adolescent↗
PubMed2003

[Inflammatory pseudo-tumor of the liver: is pre-operative diagnosis possible?].

UNLABELLED: Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant tumors. OBJECTIVES: To specify the circumstances of detection and the clinical, biological, radiological and pathological features of inflammatory pseudo-tumors, in order to improve preoperative diagnosis. METHODS: Diagnosis of inflammatory pseudo-tumors of the liver was performed on surgical specimens in 8 patients from January 1987 to January 2001. We retrospectively analyzed the clinical, biological, radiological and pathological features of these 8 inflammatory pseudo-tumors. RESULTS: All the patients (5 females and 3 males) presented a chronic infectious syndrome and/or previous history of chronic inflammatory disease. The correlation between biological, radiological and pathological aspects showed two distinctive types of inflammatory pseudo-tumors: a type revealed by a biological inflammatory syndrome, with a non encapsulated, heterogeneous and hypervascular lesion at imaging, and a dense fibroblastic inflammatory pseudo-tumor with portal endophlebitis on histology (n=5), and a type without inflammatory syndrome, with an encapsulated, homogeneous, hypovascular lesion at imaging and abundant necrosis on histology (n=3). CONCLUSION: The analysis of previous history, of clinical, biological and radiological presentations, specially MRI, could predict the diagnosis of inflammatory lesion which must be confirmed by trans-parietal biopsy to avoid inappropriate radical hepatectomy.

Adult↗
PubMed2002

Histologic scoring of liver biopsy in focal nodular hyperplasia with atypical presentation.

The contribution of radio-guided transcutaneous biopsy in the diagnosis of focal nodular hyperplasia (FNH) of the liver was compared with the findings on surgical specimens to assess its contribution in clinical and radiologic atypical cases. This retrospective study involved 30 patients with atypical tumors on imaging who underwent liver biopsy and then surgery. All surgical specimens were diagnosed as FNH, either classical (n = 18) or nonclassical (n = 12). Imaging data were reviewed according to 4 radiologic criteria on magnetic resonance imaging (MRI) and/or computed tomography (CT) scan (hypervascularity, homogeneity, nonencapsulation, and presence of a central scar), and classified depending on the number of criteria found (group I, 4 of 4; group II, 3 of 4; group III, 2 or fewer). Histologic assessment of ultrasound (US)-guided liver biopsy recorded major diagnostic features (fibrous bands, thick-walled vessels, reactive ductules, and nodularity) and minor features (sinusoidal dilatation and perisinusoidal fibrosis). "Definite FNH" (3 or 4 major features) was diagnosed in 14 biopsies, "possible FNH" (2 major and 1 or 2 minor features) in 7 cases, and "negative for FNH" (2 or fewer major features without minor features) in 9 cases. The diagnosis of FNH on biopsy was reached in 14 cases (58.3%) in patients with 2 or fewer imaging criteria (group III; n = 24). Biopsies with a diagnosis of "possible FNH" corresponded to a large proportion of telangiectatic-type FNH on the specimen. In conclusion, liver biopsy does not appear to be necessary in cases in which imaging is typical. However, the absence of radiologic diagnostic criteria in FNH does not preclude a positive diagnosis on liver needle biopsy. Using the proposed histologic scoring system, surgical management may be avoided in these cases.

Adult↗
PubMed2002

Macrocystic form of serous pancreatic cystadenoma.

OBJECTIVES: Macrocystic serous cystadenoma of the pancreas are benign lesions with sometimes difficult diagnostic issues. We aimed to describe clinicopathological and imaging features with cyst fluid analysis in a series of patients undergoing surgery for macrocystic serous cystadenoma. METHODS: Eight patients underwent pancreatic resection for a macrocystic lesion of the pancreas diagnosed on ultrasonography or CT. Endoscopic ultrasonography and preoperative fine-needle aspiration were performed in seven patients. Immunohistochemical analysis of the surgical specimen with antibodies to carcinoembryonic-antigen (CEA), carbohydrate antigen (CA) 19-9, estrogen receptor, and progesterone receptor antibodies was performed in all cases. RESULTS: Patients included seven women and one man, with a mean age of 48 yr. Lesions were incidentally discovered on ultrasonography in six patients and had a mean size of 3 cm (range, 1.5-5 cm). Endoscopic ultrasonography revealed millimetric cysts in three cases. In the seven aspirated cysts, cytological analysis was non-contributive, but biochemical analysis showed low content of CEA (< 5 ng/ml) and CA72.4 (< 40U/ml) in all but two. At histology, cysts were lined by clear cuboidal cells. They focally expressed CA19-9 but were negative for anti-CEA, antiestrogen receptor, and antiprogesterone receptor antibodies. Microscopic cysts in the wall of the lesions were demonstrated in five cases. CONCLUSIONS: Macrocystic serous cystadenoma is a particular variant of pancreatic serous cystadenoma. Endoscopic ultrasonography may be useful in detecting peripherally located millimetric cysts in unilocular lesions, and measurement of enzymes and tumor markers in cyst fluid may also contribute to the diagnosis showing low concentrations.

Adult↗
PubMed2002

Benign inflammatory pancreatic mucinous cystadenomas mimicking locally advanced cystadenocarcinomas. Presentation of 3 cases.

We report 3 cases of benign mucinous cystadenoma of the pancreas mimicking, both clinically and on imaging findings, locally advanced cystadenocarcinoma spreading to neighbouring organs (stomach, splenic and mesenteric vessels, and diaphragm). Surgical resection was performed in light of the suspicion of invasive carcinoma in all 3 cases. Histological examination of the resected specimens showed entirely benign mucinous cystadenomas associated with marked peri-tumoural inflammation that accounted for the pre-operative misdiagnoses. All 3 patients are alive 40, 47 and 54 months after surgery without evidence of tumour relapse. These cases indicate that surgery must be considered in patients with cystic tumour of the pancreas suggesting locally advanced cystadenocarcinoma, even when pre-operative imaging findings suggest tumour extension into neighbouring organs.

Adult↗
PubMed2002

Focal nodular hyperplasia inducing hepatic vein obstruction.

OBJECTIVE: The records of 10 patients with focal nodular hyperplasia inducing intrahepatic vein obstruction were reviewed. The purpose of this study was to describe and emphasize the imaging features of these findings. CONCLUSION: Focal nodular hyperplasia may be responsible for hepatic vein obstruction with hepatic vein collaterals. The relatively large size and central location of the lesions seem to play important roles in the obstruction of the hepatic veins.

Adolescent↗
PubMedDate not supplied

Intraductal papillary mucinous tumors of the pancreas: features with multimodality imaging.

The radiologic diagnosis of intraductal papillary mucinous tumor (IPMT) of the pancreas is important to establish because of its malignant potential and in order to determine the site of tumor origin and its extent. These pancreatic tumors are recognized more often now than previously because of the increasing use of imaging modalities such as computed tomography and magnetic resonance cholangiopancreatography. The main features of IPMT are given in this pictorial essay, with illustrations provided from a series of 50 patients with a surgically proven diagnosis of IPMT.

Adult↗
PubMedDate not supplied

Helical CT of pancreatic endocrine tumors.

Pancreatic endocrine tumors are rare neoplasms. It is important to distinguish them from the more common ductal adenocarcinoma of the pancreas because they are slowly progressive and specific treatments are available. The CT findings of pancreatic endocrine tumors usually vary according to the functioning or nonfunctioning status. In this article, the authors illustrate typical and atypical CT findings of pancreatic endocrine tumors with radiopathologic correlations and give examples of other pancreatic conditions mimicking pancreatic endocrine tumors.

Adult↗