Tuberculose Pulmonaire


Cliché thoracique de face et de profil: infiltrat micronodulaire apical gauche, avec doute sur la présence d'une image de caverne en rétro claviculaire. Pas d'anomalie retenue de profil.

TDM: confirme l'atteinte typique, bilatérale, avec présence de cavernes au niveau apical gauche. Confirmation biologique du diagnostic. 

Osteochondroma

General Considerations Osteochondroma is the most common benign bone tumor and the most common skeletal neoplasm They account for approximately 35% of all benign bone tumors and 9% of all bone tumors They are cartilage-capped bony projections from the external surface of a bone They occur only in bones which form by enchondral bone formation and most commonly found around the knee (40%) and shoulder, although they can occur in any bone Almost all are diagnosed in patients under the age of 20 with a marked male:female predominance (3:1) They grow until skeletal maturity and then stop growing when the epiphyseal plate fuses, although the cartilage cap can continue to grow slowly until about age 30 Osteochondromas tend to occur near an epiphyseal growth plate and grow away from the physis Clinical Findings Most are diagnosed incidentally Or, they may come to clinical attention because they produce a mass They are usually asymptomatic When painful, they should be evaluated for Mechanical irritation and inflammation of the surrounding soft tissues Fracture of the stalk Avascular necrosis of the cartilaginous cap Malignant degeneration Imaging Findings Conventional radiography is the study of first choice CT can be used to determine if the marrow and cortices of the lesion are continuous with the parent bone MRI can be used to asses surrounding soft tissues and to measure the thickness of the cartilage cap, which can be important in evaluating for malignant generation A thick cartilaginous cap (>1 cm) in adults should raise the possibility of malignant transformation They can vary is size considerably, with the average tubular bone lesion being about 4 cm Osteochondromas can either be sessile (flat) or pedunculated (stalk) Sessile lesions are more likely to be associated with abnormalities of tubulation of the underlying bone leading to metaphyseal widening or a "trumpet shaped” deformity on x-ray Malignant Degeneration Fewer than 1% of solitary osteochondromas undergo malignant degeneration of the cartilage cap into secondary chondrosarcoma It is usually preceded by New onset of growth of the lesion Rapid growth of a lesion, or New onset of pain The risk of malignant degeneration increases with an increase in the number and size of the osteochondromas In general, a sessile lesion is more likely to degenerate into sarcoma than a pedunculated lesion (exostosis) Associations and Syndromes Hereditary multiple exostoses Autosomal dominant condition Short stature Multiple osteochondromas Asymmetric growth at the knees and ankles Risk of malignant degeneration is 1-20% Dysplasia epiphysealis hemimelica (DEH, Trevor disease) Osteochondromas arising in the epiphyses Involve the joint Lesions restricted to one side of the body–either left or right May be multiple lesions in a single limb Primarily involves one side of an epiphysis Medial side is affected twice as often as the lateral side Usually occurs in infants or young children Treatment There is no treatment necessary for asymptomatic osteochondromas The cornerstone of treatment is observation because most lesions are asymptomatic If the lesion is causing pain or neurologic symptoms due to compression, it should be resected at the base None of the cartilage cap or perichondrium should be left in the resection bed or  recurrence can occur. As long as the entire cartilage cap is removed there should be no recurrence Patients with many large osteochondromas should have regular radiographic screening exams for the early detection of malignant transformation

- See more at: http://www.learningradiology.com/archives2012/COW%20532-Osteochondroma/osteochondromacorrect.html#sthash.uWETvknz.dpuf

FIBROSE RETROPERITONEALE BENIGNE DE TYPE IDIOPATHIQUE CONFIRMEE PAR INTERVENTION CHIRURGICALE

Cette urographie met en évidence un aspect particulier de fibrose rétropéritonéale avec d'une part une localisation unilatérale et d'autre part l'absence d'attraction vers la ligne médiane de l'uretère.

UIV : perméabilité des voies urinaires gauches. A droite, syndrome obstructif modéré avec néphrographie intense et dilatation modérée des cavités pyélo-calicielles et de l'artère proximale. Ce syndrome obstructif est secondaire à une sténose localisée en regard de L3 centrée et régulière (flèche). Il n'y a pas d'attraction évidente vers la ligne médiane.

KYSTE JUXTA-ARTICULAIRE DE LA CHEVILLE(GANGIAL CYST)

La tomographie confirme l'aspect de la lésion kystique et montre une communication avec l'interligne articulaire (flèche).

Le kyste juxta-articulaire est une lésion kystique bénigne composé d'un tissu fibreux à évolution mucoïde , localisé à l'os sous-chondral. L'articulation voisine doit être normale. C'est en fait un diagnostic d'élimination. Cliniquement il est asymptomatique ou associé à quelques douleurs mécaniques. Autres sièges moins fréquents : extrémité supérieure du tibia, tête cubitale,olécrâne.

Diagnostic : KYSTE HYDATIQUE PLEIN DU LOBE INFERIEUR DROIT DE 15 cm DE DIAMETRE.

Les calcifications du kyste hydatique au niveau du poumon sont exceptionnelles et infraradiologiques. La TDM a permis demettre en évidence de petitescalcifications pariétales dans 2 cas sur36 explorés par TDM.

             RADIOGRAPHIE DIGITALISEE DU THORAX deface en décubitus : importante opacitédes deux tiers inférieurs de l'hémithorax.                                                                             

TDM THORACIQUE : masse de densité liquidienne (1 U.H., de 10,5 cm de diamètre), homogène, tassement pulmonaire antérieur.

Thrombophlébite cérébrale du sinus latéral G et du sinus longitudinal supérieur avec hématome intraparenchymateux pariétal gauche 

On voit bien le thrombus dans le sinus latéral gauche.

Le sinus longitudinal supérieur n'est pas opacifié.

L'hyperpression veineuse est responsable du saignement intra parenchymateux, qui ne contre-indique pas la décoagulation.

Coffee bean sign - an abdominal plain film sign of sigmoid volvulus. The sigmoid colon has twisted on its mesentery becoming a distended closed loop projecting up and away from the left iliac fossa. The two inner bowel wall edges directly oppose each other simulating the central crevice of a coffee bean. This case also demonstrates
Rigler’s sign of free intraperitoneal gas indicating bowel perforation.   

Extradural haemorrhage

 - a collection of blood between the inner surface of the skull and the outer layer of the dura. It is typically due to meningeal arterial bleeding and very often associated with a skull fracture. The lentiform shape of extradural haematoma is classically taught as the major method of distinguishing it from the typically crescent shaped subdural haematoma, however there are other helpful distinguishing signs. Unlike subdural blood, extradural blood is not able to cross skull sutures and cannot extend along dural reflections (falx and tentorium).

The above case shows the typical appearance of an extradural haematoma, with the hyperdense lentiform shaped blood being associated with a skull fracture (blue arrow) and the haematoma stopping precisely at the coronal suture (yellow arrow). 

Pneumopericardium

Air appears around heart but does not extend above great vessels

Air in the pericardial sac is limited by the normal pericardial reflections. Pneumo-pericardium is often secondary to an infectious process with associated pericardial fluid and thickening, which will produce an air-fluid level on horizontal beam radiographs. Pneumo-pericardium may produce a similar finding continuous diaphragmatic sign
.
Air within the pericardial sac will rise to a nondependent position on decubitus positioning, unlike mediastinal air, which is not mobile.