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Purpose: To describe the sonographic features of entesopathy in patients with psoriatic dactylitis. Materials and methods. Clinical, radiographic and sonographic evaluation of 120 hand joints with clinical abnormality including 20 fingers in 17 patients with rheumatoid arthritis (RA) and 20 fingers in 17 patients with psoriatic arthritis (PA)., Results: Forty cases of dactylitis. In patients with RA: 29 cases of synovitis, 15 cases of tenosynovitis, and 2 cases of tendinitis; in patients with PA: 21 cases of synovitis and 3 cases of tenosynovitis. Bone erosions were present in RA patients whereas erosions with bone production were present in PA patients. A total of 60% of RA and PA patients showed erosions on conventional radiographs. Features suggesting entesopathy were present in PA patients only: specific changes of P3, capsular hyperostosis and periarticular periostitis., Conclusion: Based on evaluation of PA patients, it seems that sonographic features suggesting entesopathy in patients with dactylitis may be present.

The Carney's syndrome associates three different tumors on the same subject, a young woman generally: a gastric leiomyosarcoma, a pulmonary chondroma and a non adrenal paraganglioma. The authors report a new case of that unfrequent syndrome of unexplained pathogeny.

The authors report 2 cases of congenital mesothelial cyst of the diaphragm diagnosed in adults. The differential diagnosis will be discussed and the literature reviewed.

Purpose: To evaluate the mid-term outcome following CT-guided percutaneous resection of osteoid osteoma., Materials and Methods: 38 patients who had been treated by CT-guided percutaneous resection were included. The mean follow-up of 3.7 years. Early and mid-term outcome and histology were analyzed., Results: Histological samples were adequate in 92% of cases and a diagnosis of osteoid osteoma was confirmed in 73.7% of cases. In 6 cases, the lesion was not an osteoid osteoma: 2 mucoid cysts, 1 benign fibrous dysplasia, 1 fibromucoid lesion, 1 focal osteochondritis, 1 osteomyelitis. Cure was achieved in 84.2% of patients. Minor transient complications occurred in 23.7% of cases. The most serious complications included: 1 intramuscular hematoma, 2 femoral fractures, and 1 case of S. aureus osteomyelitis., Conclusion: This study confirms that CT-guided percutaneous resection of osteoid osteomas is effective and shows that other small lesions can also be treated using this technique.

The lateral view of the chest is a complementary incidence performed less frequently nowadays with the great frequency of chest CT. In fact, this lateral radiograph has important potential and can even give some exclusive information. With the 3-dimensional visualization provided by CT, the lateral radiograph of the chest is even easier to understand. Following in the footsteps of our great predecessors (Felson, Heitzman, Proto) we propose the left lateral view and offer our opinion about indications, techniques and results. The left lateral view can be performed with perfect perpendicular orientation or with a slight lateral shift that can be chosen with the right shoulder forwards (shifted right anterior lateral) or the contrary (shifted left anterior lateral). The left lateral view, like the antero-posterior view must be interpreted in a circular-concentric fashion.

Purpose: To demonstrate that the ligamentum arteriosum is visible by precisely-oriented MRI. To demonstrate the predictive value of the ligament involvement for left upper lobe cancer surgery., Material and Methods: Fifteen controls, age-matched with bronchial cancer patients, were studied to establish how the ligamentum arteriosum could best be visualized on MRI. Visibility was optimal on RASE T1-weighted sequences on the frontal and sagittal oblique planes (aorto-pulmonary window). Acquisitions were performed with a body coil, 7 mm slices, 480 mm Fov, on a Magnetom Expert, 1T Siemens machine. Forty five patients with left upper lobe cancer underwent MRI investigation after CT had shown mediastinal proximity of the left pulmonary artery and the tumor. They underwent surgery with manual localization of the ligament at the beginning of the procedure. Findings and operative decisions were compared with those of MRI, establishing its predictive value. MRI defined the tumor-ligament and tumor first centimeters of the left pulmonary artery (LPA) relationships., Results: MRI ligamentum visibility was about 87%. Ligament non-involvement on MRI (n = 23) was confirmed at surgery in all cases (100% concordance). Involvement suggested on MRI was confirmed in 18 cases and surgery was impossible or unsatisfactory. There were four false-positives with successful surgery (8% false positives)., Conclusion: When CT shows left lobe cancers extending in the mediastinum towards the LPA, precisely-oriented MRI assesses surgical difficulty and resectability by demonstration involvement of the ligamentum and the first two centimeters of the LPA.

Mediastinal pseudotumors are present in less than 5% of patients with long-standing portal hypertension. These pseudotumors may be caused by para-esophageal collateral vessels or greatly dilated azygos or hemiazygos veins. Enhanced CT seems to be the best tool for the diagnosis and in evaluating the overall status of portosystemic collateral vessels. In this case report, MRI ruled out tissular mass by showing vascular signal.

We report three cases of synovial sarcoma strictly located in the muscles. Synovial sarcoma generally arises in the vicinity of joints, tendon sheaths, bursae, fascia, and ligaments. Strictly intramuscular locations are not well known and not described in the literature to our knowledge although they seem to be frequent. The different characteristics on the radiographic examinations are non specific, and this location may be misleading. MRI is considered the procedure of choice for staging this tumor and to visualize soft tissues and bone invasion. CT scans may be useful in detecting more specific small calcifications.

The authors report 42 cases of symptomatic pulmonary aspergilloma treated by intracavitary percutaneous injections of Amphotericine paste. These patients were not considered as operable. The aspergillomas complicated tuberculosis sequels and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection under CT guidance; the aim being to obtain complete filling of the cavity and creating an "anaerobic" environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other treatments (drugs and surgery).

We present 3 cases of tracheal bronchus. The right tracheal bronchus is an uncommon anomaly, more frequent however than on the left side. Two variations are knows, with or without real ectopy. The radiologist can recognize this abnormal bronchus on the CT slices. Most often it is a non-pathogenic finding (unlike the left-sided anomaly). One of the cases, however, had lung cancer in the segment ventilated by the anomalous right bronchus.

Unlabelled: The aim of this study was to evaluate chest radiographs and computed tomography (CT) in patients with thoracic actinomycosis., Material and Method: Chest radiographs and CT scans of 9 patients with proved thoracic actinomycosis were reviewed. CT scans were performed after intravenous contrast administration., Results: Airspace consolidation was present in the upper lobes in 6 patients and in the lower lobes in 3. Cavitations not apparent on the radiographs were seen on CT s in 2 cases. Mediastinal lymphadenopathies were seen on CT s in 2 cases, in one the infection extended through the mediastinal pleura into the mediastinum. Pleural thickening adjacent to the airspace consolidation was identified in 6 cases. Chest wall invasion occurred in 4 cases with a wavy periostal reaction involving ribs adjacent to the site of parenchymal involvement in 3 cases. Extension into the abdomen through the diaphragm was seen in one case., Discussion: In humans, actinomycosis involves the thorax in 15% of the cases. Thoracic and pulmonary parenchymal involvement is usually secondary to aspiration of colonized material from the oropharynx in patients with poor oral hygiene. There is a basilar predominance of the disease, but some studies have reported apical predominance. The pulmonary infection leads to an airspace consolidation mainly in the lung periphery. The infection may extend across fissures and through the pleura. Chest wall and bone invasion are not uncommon. A wavy periosteal reaction involving ribs is said to be highly suggestive of pulmonary actinomycosis., Conclusion: Thoracic actinomycosis is characterized by airspace consolidation with adjacent pleural thickening. Chest wall invasion with a wavy periosteal reaction is highly suggestive.

Purpose: To define the normal patterns of gleno-humeral joint, with kinematic MR imaging in asymptomatic volunteers., Material and Method: Twenty asymptomatic volunteers (39 shoulders) were studied with a 1.5 Tesla imager. Successive acquisitions Flash (99, 18, 15 degrees) were obtained in the axial plane, from full internal to full external rotation, at the superior, mid and inferior glenoid level., Results: Free edge of the anterior labrum was noted slightly mobile, its base was always immobile. The anterior labrum exhibited modification of shape and increased signal intensity in internal rotation (54%). The posterior labrum remained motionless in 97% and neither shape or signal intensity changes were noted in internal rotation. Inferior labro-capsular ligamentous complex was visualised in all cases. The anterior capsular joint was taut in external rotation and exhibited a slack (51%) or folded (13.5%) pattern during internal rotation., Conclusion: Kinematic MR imaging allows a dynamic assessment of the different anatomic components which may be implicated in shoulder instability. It provides information about the labro-capsular ligamentous complex.

We described on computed tomography, two cases of pleural tuberculosis with parietal pleural enhancement and thickening associated with another external high density line. We called this parietal pleural and extra pleural change, the "double band sign". After study of the regional anatomy, we think that this external line is the endothoracic fascia.

Purpose: Spiral computed tomography was compared retrospectively with digital subtraction pulmonary angiography (PA) in 45 patients suspected of having acute or chronic pulmonary embolism., Materials and Methods: 45 patients in whom the presence of acute or chronic pulmonary embolism was suspected underwent examination by spiral CT and PA. Diagnosis of pulmonary embolism was based on the direct visualization of intraluminal clots. The study of the agreement between the two methods was based on the Kappa test. In 35 cases, pulmonary emboli were proved. Acute pulmonary emboli were present in 28 cases and chronic in 7 cases., Results: Spiral computed tomography represents an excellent way to detect acute pulmonary embolism. In the chronic form, spiral CT is better than PA to detect intraluminal clots. However, Spiral CT can fail to detect small embole in the peripheral arterial bed. In the 10 patients without pulmonary embolism, the spiral CT proved diagnosis pulmonary oedema (n = 3), lymphangitic carcinoma (n = 4), pleural effusion (n = 3)., Conclusion: This study suggest that the spiral CT examination is accurate for diagnosis of pulmonary embolism specifically in case of suspected important embolism. The advantages of spiral CT are multiple (non invasive, wide diagnosis spectrum). However, may be a limitation to is use is insufficient distal thrombi detection. This eventuality (5 to 10% in the Pioped study) justify the practice of pulmonary angiography. Spiral CT improvements should reduce this insufficiency in the next future.

The authors report a case of bronchiolitis obliterans with organizing pneumonia (BOOP) pathologically proved. They give an analysis of the radiological semiologic findings on plain-film and high-resolution CT (HR-CT). In 1985, Epler proposed a nosologic status but the review of the literature and the findings of their own case give to the authors, the opportunity to discuss the entity on the clinical, evolutive, radiological and pathological point of view.

A case of aneurysm of the pulmonary artery diagnosed by CT scan and MRI and confirmed by angiography is reported. The discussion considers the literature review.

The authors have studied the files of 50 consecutive patients (1987-89) operated for abdominal aortic aneurysm (AAA) and examined with CT. The criteria for inclusion were surgical features. CT can be made more accurate for the study of AAA: Thus the location of the neck of the aneurysm relative to the renal arteries was defined in 94% of all cases. In addition, CT yields information about the wall of the aneurysm, whether it be thickened (3 inflammatory aneurysms were properly diagnosed) or, mor importantly, weakened (solution of continuity in the wall in the "prior-to-rupture" appearance). Owing to the quality of its performances and to its noninvasive character, the authors regard CT with contrast injection as an essential technique for the preoperative assessment of abdominal aortic aneurysm in most cases. The examination must be carried out strictly, especially for the contiguous sections of the renal arteries and their extension to the crural arch. As it demonstrates weakened areas more easily, a more accurate study of the aneurysmal wall with CT might increase the surgical indications for some smaller aneurysms, the potential evolution of which does not seem to be associated with their diameter only.

Hemangiopericytoma is a rare vascular tumor of pericyte origin and of variable but always preoccupying potential since falling within the category of sarcomas. A thoracic localization is rare and primary pulmonary parenchyma lesions even more so, only 87 cases being reported in the literature. Radiological diagnostic criteria are of weak specificity, diagnosis being provided by thin section CT scan imaging with contrast. The differential diagnosis of these vascular tumors includes arteriovenous fistula, pulmonary varices, other vascular tumors or even organized bronchomucoceles. The value of CT scan puncture is obviously limited. The course is unpredictable since even histopathology findings fail to provide definitive data.

The authors report a case-report of tracheo-bronchopathia chondro-osteoplastica with High-Resolution CT scan examination. They emphasize the rarity of this disease, its long clinical latency and the radiologic patterns of tracheal stenosis and calcificated in ward projecting formations from the tracheal wall. The radiologic diagnosis is discussed. Endoscopy and histology are the diagnosis. The etiology, prognosis and specific treatment remain unknown.

The authors report a case of chronic interstitial pneumonia with a very unusual appearance (on plain films and CT); in fact such ribbon-like linear opacities with concentric and pseudo-cavitary disposition have not been previously described. They are comparable but different from the linear opacities described by Carrington in some cases of chronic eosinophilic interstitial pneumonia, which are vertical and peripheral. They are also different from the curvilinear sub-pleural opacities reported in some cases of asbestosis. On the basis of the anatomic findings they discuss the specificity of such radiologic patterns or their sole value as an evolutive state.

Is by its acinar-shadows and interstitial enhancement a pathologic situation of optimal value for the study of alveolar and lobular anatomy. Millimetric slices with high resolution C.T. Scanning seem to be Gough anatomic preparations and are very favourable for the inner anatomy pulmonary study.

The authors report about a very peculiar case of cervical paraganglioma which had two specific features. This is a familial case with 2 sisters presenting with bilateral paragangliomas. In addition, this patient's aortic trunk is very peculiar, with a retroesophageal right subclavian artery and, above all, a divided intrathoracic right common carotid artery, producing an ascending pharyngeal supply for the right paraganglioma, which can be embolized without any risks of reflux.

The very sudden onset of a painful muscular tumefaction was suggestive of a para-ostal osteosarcoma or myosarcoma. Ultrasound imaging showed a heterogeneous echogenic mass with several extending shadow cones, raising the possibility of the benign nature of the lesion, but urgent operation showed the pseudomalignant circumscribed myositis nature of the affection.