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Objective: Nasopharyngeal tonsilloliths are less well known to radiologists than palatine tonsil lithiases. The possibility of routinely available fine slices during CT scans of the head and neck prompted a retrospective study on the causes and radiological signs and patterns of nasopharyngeal tonsilloliths., Material and Methods: A total of 515 CT scans were retrospectively re-examined looking for calcifications of the posterior wall of the nasopharynx. One patient with this type of calcification underwent a cerebral MRI as part of the etiological workup of his faintness, which also provided a study of the nasopharyngeal wall. The size, density, and position of these calcium concretions were analyzed with CT in all cases., Results: In 31 patients (18 men, 13 women), we discovered one or several calcifications in the pharyngeal mucous area, between 2 and 5.5 mm in size, with a median density of 202 HU. In two cases, we observed that these calcifications adhered to an adenoid cyst, whereas in three cases, the patients had both palatine tonsil and nasopharyngeal calcifications. None of the 31 patients had previously had an adenoidectomy. Sagittal CT and MRI images clearly localized all these calcifications before the pharyngobasilar fascia., Discussion: The position of these nasopharyngeal calcifications in front of the pharyngobasilar fascia means that a calcified vestige of the notochord can be ruled out. Moreover, the simultaneous presence of nasopharyngeal tonsil and palatine tonsil calcifications in three patients is an additional argument for considering these calcifications of the posterior wall of the nasopharynx as tonsilloliths, all of which, representing 6% of the CTs in our series, were asymptomatic., Conclusion: The nasopharyngeal tonsilloliths are stones less than 1 cm in size lodged in the pharyngeal tonsils that are frequently detected on CT when there are no clinical symptoms.

Purpose: Psoas abscess is a rare disease in developed countries. Its diagnosis is difficult and any delay could lead to a worsen prognosis. The aim of this study is to determine the best diagnostic and therapeutic practices., Methods: A retrospective study of psoas abscess that occurred during six months was performed., Results: Six cases of secondary psoas abscess are reported. They were associated with spondylodiscitis in three cases, arthritis and gynaecologic infection in the three remaining cases. Anatomic diagnosis was performed by tomodensitometry. Microbiologic diagnosis was obtained by blood culture or direct puncture of the abscess. Antibiotics were associated with percutaneous drainage in two cases, with simple puncture in one case, and with surgery in one case. A local improvement w observed in all cases. The oldest patients presented the worst complications which were not directly caused by the abscess., Conclusion: Physicians must be aware of psoas abscess because of their increasing incidence. Despite the fact that digestive pathologies are the main cause of secondary psoas abscess, bone infections, particularly spine infections, should be taken into consideration. Tomodensitometry guided puncture or percutaneous drainage are of diagnostic and therapeutic interest. Infectious samples must be taken before starting antibiotics, which have to be efficient against Gram negative bacillus, anaerobes and Staphylococcus aureus. Surgery must be quickly performed when the primary infection localisation need it, in case of voluminous abscess or when antibiotics and drainage are inefficient.

The main goal of urgent imaging evaluation of patients with suspected CNS infection is to differentiate infectious from tumoral or vascular lesions in order to provide appropriate management. MR imaging, including diffusion weighted imaging and spectroscopy, is superior to CT imaging to characterize lesion location and etiology. The CT and MRI features of the more frequent bacterial, viral and parasitic CNS infections will be described.

We present four cases of subcutanea trochanterica bursitis (one involving both sides). The bursitis was acute and inflammatory in two cases, chronic and microtraumatic in one, asymptomatic in one and septic in the last case. The acutely inflamed bursa may contain a blood effusion increasing the pain. CT and MRI provide distinctive images for the diagnosis of these particular types of periarticular diseases.

In neutropenic patients, one way of improving invasive pulmonary aspergillosis (IPA) prognosis is an earlier initiation of the antifungal treatment. We report our experience with 36 cases of IPA in 35 patients with haematological malignancies. When aspergillosis was diagnosed, all but 2 patients were neutropenic (PMN < 500; median duration = 20 days). The most frequent clinical signs were cough (100%), chest pain (78%) and haemoptysis (58%). Before the diagnosis of IPA, Aspergillus antibody test was positive in 60% of cases. A thoracic CT-scan was performed in 23 patients and demonstrated highly suggestive images in 22 cases (96%) with presence of CT halo sign (n = 13) or CT air-crescent sign (n = 9). Moreover, Aspergillus antigen test was positive in 13 of 28 tested patients. IPA diagnosis was determined to be definite in 23 cases and probable or possible in 13 cases. Thirty-five patients were treated: in 3 cases with amphotericin B (2 failures) and in 32 cases with itraconazole (7 failures and 25 successes or improvements). In 7 cases (including 5 emergencies) surgical resection was successfully combined with the medical treatment. In neutropenic patients with fever, we consider that thoracic CT-scan and repeated biological tests (Aspergillus antibody and antigen tests) can be used to establish the diagnosis of aspergillosis. Early treatment with itraconazole and surgical resection appears to improve prognosis.

We report 2 cases of lissencephaly and review the cardinal symptoms: microcephalia, mental retardation, pyramidal syndrome and generalized epilepsy. CT-Scan and MRI show the anatomical abnormalities of this malformation: microcephalia, smooth cortex reducing the surface of white matter and lack of sulci and gyri. The fact that the myelin is normal on MRI suggests that this major disorder of neuronal migration does not come from radial glial fibers.

Computerised axial tomography requires total immobility, which must be obtained by a simple and safe technique of anaesthesia. Three anaesthesia techniques were used and analysed in 54 children aged less than 5 years: the technique of the feeding bottle, sedation with pentobarbital or diazepam and general anaesthesia with ketamine hydrochloride. The technique of the feeding bottle can be proposed in selected patients. Sedation can be also used but judiciously, not to deep. The systematic use of an depression immobilizing mattress with these two techniques gives better results. Intramuscular ketamine hydrochloride, when not contrindicate (intracranial hypertension or acute hydrocephaly), has been used always successfully.

The authors report one case of Moya-Moya disease in a 3 month-old infant, who developed microcephaly, mental retardation and tetraparesis. The appearance in the following months of a Raynaud's phenomenon in the upper limbs and of IgA deficiency may be of interest for the understanding of the disease.

A case is described of a child aged twelve with rib abnormalities, a Klippel-Feil syndrome and a complete fusion between C2 and C7. The atlas showed abnormal ossification of the anterior and posterior arches. No similar description has been found in the literature. A posterior spine fusion between C1 and C2 was performed.

A young male was observed with papilledema and optic nerve enlargement on CT scanning. Visual acuity and field were not affected. A microsurgical procedure, through a para-latero-nasal approach, revealed a blue domed cyst around the neural structure. Incision of the cyst released old hemorrhagic fluid and biopsies of the cyst wall were collected. Microscopy showed granuloma and hemosiderin pigments. The post-operative course was uneventful, and the papilledema resolved in six weeks. The clinical presentation and surgical findings, the histopathology and the post-operative course lead us to conclude that this is a case of spontaneous hematoma of the optic nerve. Although intracranial and chiasmal optic nerve hematomas have been described since 1966, this is the first report to our knowledge of a hematoma involving the intraorbital portion of the optic nerve. The para-latero-nasal approach seems to be a easy way of acquiring good visualization without any osteotomy, when an operating microscope is available. This report may alert ophthalmologists to consider a cyst as a rare cause of papilledema.

In 22 months, about 2 000 patients were hospitalized for head injury and 410 of these had computerized tomography to determine the presence and extent of intracranial pathology. 165 patients had normal C.T. scan, and in 245 cases the scan showed an intracranial pathology: 132 brain contusions, 45 epidural hematomas, 36 subdural hygromas, 32 chronic subdural hematomas, 8 intracerebral hematomas, 2 pneumocephalus. The C.T. scan is a very useful technique for evaluation of the head injured patient in emergency. For epidural hematomas, mortality rate which was 16% before C.T. scan period decreased to 8% after C.T. scan period. The C.T. scan has a definite advantage over angiography in brain contusions. Instead of seeing only mass effect, one can tell on C.T. scans whether the abnormality is a small hematoma, an area of contused swollen brain, an hemorrhagic contusion, or a brain oedema. The surgical decisions are more precise with this information. In the management of head injury, we think that C.T. scan must be repeat because many patients developed new lesions and delayed hematomas: intracerebral, subdural, epidural.