Radiological Exploration Research Articles

Factitious blue edema: a case report

Blue edema or factitious edema is an edema located in a finger, a hand or an entire limb, induced by voluntary stricture by a tourniquet. It is spectacular in its appearance but benign in its evolution. We report a case initially suspected of phlegmon of the right upper limb and which finally turned out to be factitious edema. A 14, year-old girl presenting for a painful swelling of the left upper limb, going up to the arm and evolving for a week. On clinical examination, we noted an impressive edema of the left upper limb predominantly in the hand, with fingers blocked in half-flexion. Edema had a purplish color with thin and scaly skin on the dorsal side of the hand. We suspected a problem of infectious or vascular origin, and completed by biological and radiological explorations without abnormalities. The patient was admitted and improved under broad-spectrum antibiotic therapy, but the appearance of the same symptoms in the contralateral limb, with a careful examination of the integuments of the upper limb noting a mark of strangulation in the middle of the right arm, allowed the diagnosis of factitious blue edema.

Primary Cutaneous Apocrine Carcinoma: Diagnostic and Management Difficulties of an Uncommon Neoplasm

Primary cutaneous apocrine carcinoma (PCAC) is a rare adnexal neoplasm. Due to its clinical presentation, it can mimic other tumors, especially metastasis. We present a case of primary apocrine carcinoma of the axilla mimicking breast carcinoma metastasis in a 54-year-old woman. The patient presented with a painless, lobed, and erythematous nodule in the left axilla of one year duration. We suspected an adnexal neoplasm but also considered metastasis from breast carcinoma. Histological examination revealed apocrine proliferation. Immunohistochemistry stains of tumor cells were positive for AE1/AE3, and negative for CK7, CK20, p63 and GATA3. Radiological explorations did not reveal any signs of malignancy. Considering all these features, the conclusive diagnosis was primary cutaneous apocrine carcinoma. Treatment was wide excision without adjuvant therapy, and no recurrence was noted. Due to the rarity of this carcinoma, its various clinical presentations, and histological overlaps with breast cancer metastasis, making the diagnosis may be challenging. A comprehensive evaluation of all findings is necessary to rule out other tumors. There is any consensus on the management strategy. The standard treatment is surgical excision, but adjuvant therapies such as radiotherapy or chemotherapy can be proposed in advanced stage disease.

Case Report: Giant bronchogenic cyst compressing the pericardium and the lung hilum

Introduction: The bronchogenic cyst is a congenital anomaly of the trachea and the bronchi resulting in a malformation that develop in the bronchial tree, most often in the middle mediastinum. It is a benign pathology, often asymptomatic, however in the case of a large bronchogenic cyst, signs of compression of the intra-thoracic organs appear and early surgery is necessary to avoid complications. Case presentation: A 49-year-old patient was referred to our department with dry cough, dyspnea and chest tightness progressing for six months. Radiological exploration concluded that a giant bronchogenic cyst, 90 mm in diameter, was very probable. Surgery was performed via a right posterolateral thoracotomy. Intraoperatively, there was a large cystic formation 100mm*80 mm of the middle mediastinum in intimate contact with the origin of the right pulmonary artery, the lower right pulmonary vein as well as the right atrium exerting a compressive effect on the bronchi. The lesion was firmly adhered to the pericardium. The cystic was ‘en bloc’ resected in totality. The postoperative course was uncomplicated. Histological examination confirmed diagnosis of a bronchogenic cyst. The patient was asymptomatic throughout the follow-up period. Clinical discussion: Apart from the possibility of malignant degeneration, a bronchogenic cyst can increase in size and become huge causing serious complications. Despite the predictive diagnostic value of imaging, definitive diagnosis of a bronchogenic cyst is confirmed by surgical excision and pathological examination. Conclusions: Surgery is almost obligatory especially if the cyst is above a certain size (about 60 mm) and in the case of giant bronchogenic cysts.

Surgical Treatment of a Large Isolated Aneurysm of the Right Primary Iliac Artery: About A Case

Isolated iliac artery aneurysms are extremely rare, accounting for less than 2% of all aneurysmal diseases. These aneurysms are usually seen in older men. Very mildly symptomatic but carries a significant risk of rupture when the aneurysms have reached a large size. Their operative mortality is significantly higher when undertaken as an urgent or elective procedure, highlighting the importance of early diagnosis and appropriate management. The development of radiological exploration methods has facilitated the discovery and diagnosis of these aneurysms. The emergence of endovascular techniques constitutes an alternative to traditional surgical treatment. We report our surgical management of an aneurysm of the primary iliac artery isolated in a 71-year-old man, who benefited in our department from a resection of the aneurysm with restoration of continuity by a prosthetic bypass. The objective of this article is to present and describe the diagnostic assessment; imaging data, treatment methods as well as a review of the literature concerning the history of iliac artery aneurysms.

A Rare and Challenging Entity: Sino-Nasal Nk/T-Cell Lymphoma

Extranodal NK/T-cell lymphomas are a rare subtype of non-Hodgkin’s lymphomas. They represent a diagnostic challenge due to their clinical presentation polymorphism and to the abundance of the necrotic tissues on biopsies. We report the case of a male patient that initially presented with chronic facial and palatine pain, associated to a palatine substance loss and a jugal edema on physical examination. Facial CT scan showed the lesion and its extension to the nasopharynx and association to multiple cervical lymph nodes. Initial biopsies have erred the diagnosis showing signs of a mycotic infection with no malignant cells. Considering the bad response to anti-fungal treatment, biopsies and radiological explorations were redone and were in favor of a NK/T-cell lymphoma. Locoregional and distant extensions of the disease were studied, showing an hepatic suspicious nodule and mediastinal lymph nodes. Then, the patient underwent sequential chemo and radiotherapy with a good response to treatment.

Review of olfactory cleft roof anatomy

Progress in skull-base endoscopic surgery has improved our knowledge of olfactory cleft (OC) anatomy. This article presents a review of current knowledge concerning the OC roof: descriptive anatomy, radiological exploration, and endoscopic observation. The OC is a narrow area in the most superior part of the nasal cavity. Its roof is the thinnest structure separating the nasal cavities from the brain; it comprises three superimposed tissues: nasal mucosa, ethmoid cribriform plate (ECP), and dura mater. The ECP comprises the anterior ECP containing the ethmoidal slit (ES) medially and the cribroethmoidal foramen (CEF) laterally; and the posterior ECP, comprising the olfactory foramina. The OC roof is bordered anteriorly by the nasal bone roof, laterally by the lateral ethmoid masses, and posteriorly by the jugum and anterior wall of the sphenoid sinuses. Imaging is crucial for analyzing this wall, providing precise detailed information on conformation and anatomic relations with adjacent structures such as the anterior ethmoidal artery. Understanding OC roof anatomy and correct interpretation of imaging are essential for safety in present-day functional endoscopic sinus surgery and anterior skull-base oncologic surgery.

Small bowel obstruction in infants due to complicated Meckel’s diverticulum: A case series

Objectives: Our purpose is to illustrate the radiological aspects of Meckel’s diverticulum as an etiology of small bowel obstruction in infants. Material: We report a group of 4 patients with Meckel’s diverticulum complicated with small bowel obstruction that underwent surgery. We reviewed patient records, clinical presentation, ultrasound and CT imaging and intraoperative findings. Results: All included patients presented symptoms of bowel obstruction, one patient presented acute abdomen symptoms. The median age of our group was 5 years, all patients were males. All patients underwent radiological explorations. Ultrasound showed small bowel dilatation in all cases, and CT scan confirmed small bowel obstruction with ischemic complications in one patient. All of the 4 patients had laparotomy with the finding of MD responsible of small bowel obstruction in all cases, with on case of perforated loop and latero-caecal abscess. The obstruction was secondary to fibrous adhesions in three cases and the omphalomesenteric duct in one cases. All the patients had normal evolution with no post-operative complications. Conclusion: Meckel’s diverticulum represents a rare embryological remnant. It is a differential diagnosis in pediatric bowel obstruction and remains an intraoperative surprise despite the very abvanced imaging studies.

Primary atypical rhabdoid orbital tumor: An entity with aggressive behavior

Malignant rhabdoid tumors are rare, poorly differentiated tumors which usually affect children under the age of three. These tumors have a predilection for the kidney, central nervous system and soft tissue. The definition classically relies on a characteristic morphology and the inactivation of the hSNF5/INI1 tumor suppressor gene. The diagnosis is based on radiological explorations, as well as anatomopathological and immuno-histochemical studies.Whatever the location of the tumor, the therapeutic protocol is only decided after multidisciplinary consultation meeting, while resorting to a triad of chemotherapy, surgery and radiotherapy. The prognosis remains poor and the survival rate is below 30%. We report a rare case of retro-orbital malignant rhabdoid tumor of a new born girl.

Surgical Treatment of Haglund's Disease: About 9 Cases

Haglund's disease is a rare disease of the hindfoot, linked to a morphological anomaly of the calcaneus postero-superior tuberosity, causing pre and retro-Achilles bursitis and insertional tendinopathy. The purpose of our work is to analyze the functional results according to long-term resections of the posterosuperior tuberosity of the calcaneus, specifying the radio-clinical and therapeutic aspects of this pathology. Our study is a retrospective study of nine cases of Haglund's disease operated in the Department of Orthopedic and Traumatology at the Ibn Sina hospital in Rabat, between 2019 and 2023, correlated with a simple literature review. The average age of our patients was 41 years old with a male predominance. All our patients showed painful retrocalcaneal swelling. The diagnosis was confirmed by radiological explorations (standard radiography and MRI). After failure of medical treatment, surgery consisted in an open resection of the postero-superior tuberosity of the calcaneus. The evolution was favorable in 92% of cases. Complications were rare. Haglund's disease is a pathology often underestimated, we must think about it before all Achilles insertion tendinopathy. Resection of the tuberosity is a simple technique, with undeniable effectiveness, and which is considered the best treatment.

Amoebic Liver Abscess Associated with Viral Hepatitis C in an Elderly Patient

Introduction: Amebic liver abscess is a suppurative collection of parasitic origin. The causative organism is usually the ubiquitous Entamoeba histolytica. In Mali, a study reported a hospital incidence rate of 2.4%. Radiological exploration of the liver has made a major contribution to improving early diagnosis and management. Treatment involves metronidazole and evacuation of the suppurative collection. We report the case of a 71-year-old patient who developed an amebic liver abscess associated to viral hepatitis C with a very high viral load. The diagnosis was made on the basis of clinical, biological and radiological signs, amoebic serology and the characteristic of the pus. Antiparasitic treatment, drainage of the abscess and antiviral treatment resulted in a good clinical outcome. The epidemiological, diagnostic and therapeutic characteristics of amebic abscesses are discussed. Conclusion: Hepatic amebiasis is common. Diagnosis is guided by the FONTAN triad, biology and imaging. The chocolate-coloured characteristic of the pus and the serology confirm the diagnosis. Treatment is medical and instrumental (ultrasound-guided). Association with hepatitis C infection appears to be rare.

RUPTURE DE DIVERTICULE DE L'OURAQUE : UNE CAUSE INHABITUELLE D'ASCITE URINAIRE CONGENITALE A PROPOS D’UNE OBSERVATION

Summary Introduction: The absence of complete regression of the allantoid canal can lead to various pathologies among which the diverticulum of the urachus. It is a rare malformation that is difficult to diagnose. Observation: This was a 19-day-old newborn, admitted to the surgical emergency department for severe abdominal distension with respiratory discomfort. The clinical history of the disease found a notion of post-prandial vomiting and an absence of urine emission for twelve hours. The examination objectified the abdominal distension, an unfolded umbilicus, collateral venous circulations and a dullness realizing a peritoneal syndrome. Ultrasound revealed finely echogenic intra-abdominal effusion. The surgical intervention showed a ruptured urachal diverticulum which was resected. Conclusion: The diverticulum of the urachus, although rare, must be evoked in the face of any abdominal distension in a newborn with or without umbilical urinary fistula and confirmed by radiological explorations. A complete exploration will allow the search for other pathologies of the urachus or other associated malformations. Keywords: urachal diverticulum, urinary ascites, ultrasound, surgery.

Prognostic factors for significant 6-month recovery in dysthyroid optic neuropathy in a tertiary center: A series of 69 eyes in 38 patients

PurposeTo identify initial features associated with significant recovery in patients with Graves’ disease dysthyroid optic neuropathy (DON) treated according to EUGOGO guidelines by intravenous glucocorticoids (ivGC) and decompression surgery in first and second-line, respectively. Patients and methodsConsecutive patients referred to our expert multidisciplinary consultation over a 6-year period underwent systematic exploration: endocrine assessment, ophthalmic examination and radiological exploration. Visual recovery, based on best-corrected visual acuity (BCVA) and visual field (VF), were evaluated at baseline, 1week and 6months. Baseline parameters were then tested for prognostic value on univariate and multivariate analyses. ResultsThirty-eight patients (69 eyes) with DON were included. Significant recovery at 6months was found in 48/69 eyes (70%), partial recovery in 18/69 (26%), and no recovery in 3/69 (4%). Fifty-one eyes (28 patients) required surgical decompression after ivGC. These patients showed more severe presentation at diagnosis, had received significantly less GC for Graves’ orbitopathy before onset of DON, and showed greater fat prolapse on CT scans compared to non-operated patients. On multivariate analysis, male gender (P=0.001), cumulative GC dose>1g before DON diagnosis (P=0.048) and initial BCVA≤0.3 (P=0.004) were significantly associated with better outcomes, whereas Clinical Activity Score>5 (P=0.013) was associated with a poorer outcome. ConclusionThis study confirms a generally favorable 6-month recovery rate in DON treated according to EUGOGO guidelines and provides new information on baseline predictors of poor evolution. These results may help the respective indications for medical and surgical treatment to be more effectively combined in the future.

ROBOTIC APPROACH TO THE MAIN BILE DUCT IN THE TREATMENT OF CHOLEDOCOLITIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT

Abstract Introduction The aim of this paper is to analyze the validity and safety of a new program for the implementation of a robotic approach in the treatment of choledocholithiasis (CD) in a Bilio-Pancreatic Unit, evaluating morbi-mortality and hospital stay. Methods Given the controversy of which is the best therapeutic option in CD: preoperative ERCP followed by laparoscopic cholecystectomy (LC) or laparoscopic approach to the bile duct, we designed this prospective, non-randomized and single-center study with a robotic approach to the bile duct. 25 patients were included (14 women /11 males), with a mean age of 71.4 years. Preoperative abdominal ultrasound and cholangioresonance were performed in all patients. Results The robotic approach was effective in all cases: cholecystectomy and cleaning the bile duct. In the first three cases a radiological exploration was performed through the cystic duct during intervention. In all cases an exploration of the bile duct with a flexible choledoscope after choledochotomy was performed too. The mean operative time was 128.8 +/-16.9 minutes. Choledocholithiasis was confirmed in all patients. Furthermore, a patient had a papillary tumor of the distal common bile duct associated. One patient who had advanced cholecystitis had a biliary fistula. It was resolved conservatively by placing an endoscopic plastic biliary prosthesis. If we exclude the patient with the biliary fistula, the hospital stay postoperative period was 2 days. Conclusions Robotic approach in the treatment of choledocholithiasis is an effective and safe technique. In addition, postoperative morbidity and hospital stay decreases.

Crohn's Disease: Retrospective Study In Algerian Patients

Background: Inflammatory disease of Crohn affects the entire digestive tract, with extra-intestinal manifestations and immune disorders.
 Objectives: This work aims to represent the histopathological aspects of Crohn‘s disease and the establishment of pathogenic bacteria as causal agents.
 Methodology: The histopathological aspects of the disease were studied on a colonic resection specimen and on intestinal biopsies with colorations topographic staining. Pathogenic bacteria responsible for Crohn‘s disease have also been isolated and identified. The study is continued to establish a correlation between the disease and exposure to infections by unusual bacteria, particularly pathogens (Salmonella, Shigella, Streptococcus pyogenes, Klebsiella).
 Results : The macroscopic appearance of the disease presented transmural involvement and can be complicated by abscesses and fistulas, microscopic appearance indicated the infiltrate of inflammatory cells (lymphocytes, plasma and cells) and lymphoid follicles after topographic staining.
 Crohn’s disease is an idiopathic disease, it is assumed that it is a deregulation of the immune system due to an infectious agent in genetically predisposed people.
 In our work, we studied the microbiota of intestine and stool of Crohn’s patients in which we found certain bacteria including Proteus mirabilis with a predominance of E. coli. Other pathogenic bacteria were found like Salmonella spp., Shigella spp., Klebsiella spp. and Streptococcus pyogenes. Two cases which tested positive on Ziehl Neelsen stain represented Mycobacterium avium paratuberculosis.
 Conclusion: The histopathological aspect of CD can be better visualized and identified on surgical specimens than on endoscopic biopsies, which helps to monitor the evolution of the disease and must be accompanied by clinical, serological and radiological exploration.

IMAGING OF SUPERNUMERARY KIDNEYS ABOUT A CASE IN BAMAKO

Supernumerary kidneys are very rare renal malformations, little described in the literature. Its diagnosis is difficult, most often discovered during a radiological exploration either fortuitously or during a complication. We report a case of bilateral supernumerary kidneys on fused crossed ectopia of the right kidney diagnosed by ultrasound and computed tomography in Bamako in a 16-year-old girl. The objective of this work is to provide the place of imaging in the diagnostic management of supernumerary kidneys.

Caudal regression syndrome with duplication of the inferior vena cava presenting with chronic constipation

Caudal regression syndrome is an uncommon congenital disease that occurs when a portion of the vertebral column and spinal cord fails to grow properly. Although the exact reason has yet to be determined, the link to maternal diabetes is well recognized. This spinal anomaly can thus be reduced clinically to simple coccygeal agenesis with no deficit or even lumbosacral agenesis with sphincter problems, transit disorders, and different lower limb impairments. We report this case of a 13-year-old girl who was born to a diabetic mother and suffered from persistent constipation. On radiological exploration, she was discovered to have abnormalities compatible with caudal regression syndrome, we also noticed a duplication of the inferior vena cava, this association was never described in the literature.

Sigmoid volvulus in pregnancy

Sigmoid volvulus in pregnancy is a rare but potentially serious condition. It is related to a high risk of maternal and fetal morbidity and mortality. This is mainly due to delayed diagnosis and treatment. We report the case of a 38-year-old multiparous patient, pregnant at 32 weeks of gestation, who presented to the emergency room with intestinal obstruction evolving for 2 days. At the emergency room, radiological exploration revealed a sigmoid volvulus. Endoscopic decompression was unsuccessful. A midline laparotomy was performed urgently revealing a necrotic sigmoid colon. A sigmoidal resection with a colostomy (Hartmann's procedure) was performed. In utero, fetal death occurred intraoperatively. The patient was transferred to the intensive care unit. Induction of labor was performed on the 2nd postoperative day with vaginal delivery of a stillborn. Recovery was good with the restoration of intestinal continuity 4 months later. Through this case and a review of recent literature, we discuss the diagnostic and therapeutic difficulties of this rare entity and highlight the seriousness of delay in the management of this surgical emergency.

67 Double impact: hypophosphatemic rickets and vitamin D intoxication

BackgroundVitamin D prevents deficiency rickets, but its prescription must be weighed carefully! Objective We report a rare case of iatrogenic toxic hypervitaminosis D in a child with vitamin D resistant rickets…!MethodsWe admitted a two-year-old girl, presenting signs of rickets resistant to the usual then therapeutic doses of vitamin D3. Vitamin D2 in oral suspension is then ordered in addition, for a few weeks until the onset of hearing loss motivating her hospitalization in pediatrics.ResultsBiological and radiological explorations revealed renal failure with threatening arterial hypertension, as well as diffuse and severe arteriosclerosis on Doppler signal.Eviction (stopping vitamin D in all its forms), symptomatic and conservative management by (converting-enzyme inhibitors) and hydration allowed a progressive blood pressure normalisation, arteriosclerosis disappearance (undetected by Doppler signal and by angio-scan) along with a gradual normalising of the kidney function; all this over a period of 2 yearsThe girl actually had hypophosphatemic rickets, and oral phosphorus (syrup) was also prescribedConclusionVitamin D is potentially toxic with sometimes severe renal risks (lithiasis, nephrocalcinosis), and hypercalcemia might be severe, especially if renal function is impaired.Blindly treating any rickets with vitamin D can be adventurous and might expose the child to serious morbidity.

Utility of gastrointestinal transit scintigraphy in the evaluation of chronic constipation

AimChronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. Material and methodsTwenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. ResultsOf the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. ConclusionsScintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination.

Acute kidney injury leading to the diagnosis of sporadic testicular Burkitt's lymphoma: A case report.

Burkitt's lymphoma of the testis (TBL) is a rare and extremely aggressive malignant usually diagnosed in front of a testicular mass. We report an exceptional case of a TBL revealed by an Acute Kidney Injury (AKI) of functional origin in a Tunisian man. A 53-year-old patient, known to smoke and drug addict, presented uncontrollable vomiting responsible for extracellular dehydration. Biology showed AKI and radiological explorations revealed compression of the stomach and the right urinary tract by a retro-peritoneal mass continuing with the right testicle. The testicular biopsy with immunohistochemical study concluded with a testicular Burkitt's lymphoma. After correction of hydro-electrolyte disorders with normalization of serum creatinine, the patient was transferred to oncology for chemotherapy. Unfortunately, he refused treatment. The high aggressiveness of TBL would explain the significant, and surprising intra-abdominal tumoral extension with compression of the stomach leading to the functional AKI observed in the reported case. A testicular mass is a usual circumstance for the discovery of a primary tumor of the testicle. In the case of TBL, the rapid tumor growth associated with a diagnostic delay can lead to an impressive extra gonadal extension. • Burkitt’s lymphoma of the testis is extremely aggressive. • The rapid tumor growth of Burkitt’s lymphoma of the testis can be responsible for an important tumoral extension. • Diagnostic delay can lead to an impressive extra gonadal extension of Burkitt’s lymphoma of the testis.