Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures

Purpose:We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy.Methods:All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable.Results:A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16–0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049).Conclusion:The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy

Value of 18-F-FDG PET/CT and CT in the Diagnosis of Indeterminate Adrenal Masses

The purpose of this paper was to study the value of 18-FDG PET/CT and reassess the value of CT for the characterization of indeterminate adrenal masses. 66 patients with 67 indeterminate adrenal masses were included in our study. CT/MRI images and 18F-FDG PET/CT data were evaluated blindly for tumor morphology, enhancement features, apparent diffusion coefficient values, maximum standardized uptake values, and adrenal-to-liver maxSUV ratio. The study population comprised pathologically confirmed 16 adenomas, 19 metastases, and 32 adrenocortical carcinomas. Macroscopic fat was observed in 62.5% of the atypical adenomas at CT but not in malignant masses. On 18F-FDG PET/CT, SUVmax and adrenal-to-liver maxSUV ratio were significantly lower in adenomas than in malignant tumors. An SUVmax value of less than 3.7 or an adrenal-to-liver maxSUV ratio of less than 1.29 is highly predictive of benignity

Reversible Decrease of Portal Venous Flow in Cirrhotic Patients: A Positive Side Effect of Sorafenib

Portal hypertension, the most important complication with cirrhosis of the liver, is a serious disease. Sorafenib, a tyrosine kinase inhibitor is validated in advanced hepatocellular carcinoma. Because angiogenesis is a pathological hallmark of portal hypertension, the goal of our study was to determine the effect of sorafenib on portal venous flow and portosystemic collateral circulation in patients receiving sorafenib therapy for advanced hepatocellular carcinoma. Porto-collateral circulations were evaluated using a magnetic resonance technique prior sorafenib therapy, and at day 30. All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%. In contrast, no specific change was observed in the azygos vein or the abdominal aorta. No portal venous flow modification was observed in the control group. Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients

Valeur du scanner et du 18 F-FDG TEP scanner dans le diagnostic des adénomes corticosurrénaliens atypiques

L' objectif de cetet étude est d' évaluer la valeur du scanner, de l IRM et du 18 F-FDG TEP scanner pour la caractérisation des masses surrénaliennes indéterminées.66 patients avec 67 masses surrénaliennes indéterminées ont été inclus dans notre étude. Les données d imagerie en scanner, en IRM et en 18 F-FDG TEP scanner ont été évaluées pour la morphologie tumorale, les caractéristiques de rehaussement, les valeurs de SUVmax et les valeurs des ratios de fixation tumorale surrénalienne maximale par rapport à la fixation hépatique (S/H SUVmax ratio). Finalement 16 adénomes atypiques, 19 métastases et 32 corticosurrénalomes sont entrés dans l étude. Les caractéristiques en imagerie des masses surrénaliennes ont été comparées en utilisant des tests statistiques. La présence de graisse macroscopique en scanner a été observée dans 62,5% des adénomes corticosurrénaliens, mais pas dans les masses malignes. En IRM, les valeurs d ADC étaient significativement plus élevées pour les adénomes (valeur moyenne d ADC de 1842 mm2/s) que pour les tumeurs malignes (valeur moyenne d ADC 1002 mm2/s, p=0,03). En 18 F-FDG TEP scanner, les valeurs de SUVmax et de S/H SUVmax ratio étaient significativement plus faibles pour les adénomes (respectivement 3,24 et 1,33) que pour les tumeurs malignes (respectivement 10,4 et 3,9). En utilisant une valeur seuil au-dessus de 3,7 pour les SUVmax ou au-dessus de 1,29 pour les S/H SUVmax ratios, la sensibilité et la spécificité pour distinguer les adénomes surrénaliens des tumeurs surrénaliennes malignes étaient respectivement de 96,7% et de 83%.La présence de graisse macroscopique au scanner est un important indicateur de bénignité pour les tumeurs surrénaliennes indéterminées. Le 18 F-FDG TEP scanner est très sensible et spécifique pour distinguer les tumeurs surrénaliennes bénignes et malignes dans le cas de masses surrénaliennes indéterminées.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

ATTEINTE BRONCHIQUE AU COURS DE LA RECTOCOLITE HEMORRAGIQUE (APPORTS DE LA TOMODENSITOMETRIE HAUTE RESOLUTION (DES RADIODIAGNOSTIC ET IMAGERIE MEDICALE))

PARIS5-BU Méd.Cochin (751142101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Laparoscopic division of a portosystemic shunt to treat chronic hepatic encephalopathy

In the event of liver cirrhosis with severe portal hypertension, voluminous portosystemic shunt may lead to refractory encephalopathy. Obliteration of the shunt has been described as a satisfactory therapeutic solution, and reported procedures are mainly endovascular embolization and surgical shunt ligation through laparotomy. The former procedure is less invasive and seems to be as efficient. Laparoscopy, which is widely recognized to minimize mortality and morbidity in cirrhotic patients undergoing surgery, has never been used for such a procedure. Shunt division can therefore be considered using this modern approach to good effect and reduced morbidity. In support of this view, we report a case of severe chronic encephalopathy cured by laparoscopic surgical division of a large shunt after failure of the percutaneous technique

Recurrent liver abscess secondary to ingested fish bone migration: report of a case.

ERMAInternational audiencePyogenic liver abscess is an unusual cause of fever and abdominal pain, but it is potentially fatal. It is rarely caused by a local event, but rather by hematogenous dissemination or biliary tract disease. We report an uncommon case of liver abscess caused by the migration of a fish bone through the gastrointestinal wall

Pregnancy does not accelerate corticotroph tumor progression in Nelson's syndrome

Pituitary surgery is the first line of treatment for Cushing's disease; when surgery fails, bilateral adrenalectomy may be proposed, particularly for women with a desire for pregnancy. Little is known about the impact of pregnancy on corticotroph tumor progression after bilateral adrenalectomy

Key Indexing Terms: POLYARTERITIS NODOSA VISCERAL HEMATOMA Personal, non-commercial use only

P e r s o n a l n o n -c o m m e r c i a l u s e o n l y . T h e J o u r n a l o f R h e u m a t o l o g y . C o p y r i g h t © 2 0 0 4 . A l l r i g h t s r e s e r v e d The Paris, Cochin Hospital, Paris, France; and Department of Rheumatology, Bulgarian Medical Academy, Sofia, Bulgaria. Y. Allanore, MD; C. Rosenberg, MD, Department of Rheumatology; O. Vignaux, MD, PhD; P. Legmann, MD, PhD, Department of Radiology, Cochin Hospital; K. Kanev, MD, Rheumatology Clinic, Bulgarian Medical Academy; C.J. Menkes, MD; A. Kahan, MD, PhD, Department of Rheumatology, Cochin Hospital. Address reprint requests to Dr. Y. Allanore, Hôpital Cochin, Service de Rhumatologie A, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France. E-mail: [email protected] Submitted December 29, 2003; revision accepted March 24, 2004. Polyarteritis nodosa (PAN) is a rare disease characterized by necrotizing vasculitis of small and medium size arteries 1 . The clinical symptoms that usually reveal PAN are neuritis, arthralgia, myalgia, cutaneous lesions, orchitis, and abdominal pain 2 . Prompt diagnosis is important because PAN can be life-threatening: severe organ manifestations include congestive heart failure, cerebrovascular events, gastrointestinal (GI) tract hemorrhage, and malignant hypertension. We describe a patient with an unusual presentation of PAN, revealed by successive spontaneous visceral hematomas involving the kidneys, bladder, and liver. CASE REPORT A 28-year-old Bulgarian man was admitted to our department for exploration of repeated spontaneous hematomas. Symptoms began in March 2000, with isolated, violent lumbar pain, and no decline in general health status. Ultrasound and computed tomography (CT) scans revealed a left perinephritic hematoma. Surgery was performed. Pathological analysis confirmed the diagnosis and identified no other abnormality. The pain disappeared with standard analgesic treatment, and he resumed all regular activities. One year later, he suffered the same symptoms, with right kidney involvement, and the same course. In June 2001, he suffered spontaneous bleeding of the bladder, as revealed by macroscopic hematuria, with no renal insufficiency. This bleeding stopped spontaneously within a few days. One year later, he reported spontaneous pain in the right upper abdominal quadrant, and CT scan revealed the presence of a hematoma in the liver. Investigations over this 2-year period revealed no coagulation or immunological abnormalities, but biological examinations showed repeated signs of transient inflammation with increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Histological analysis of a kidney sample removed during surgery revealed no inflammatory disease, specific infiltration, or vessel abnormalities other than hematoma. By the time of admission to our hospital in March 2003, our patient had lost 20 kg over 2 years (weight 58 kg; height 1.75 m); he had had fever and abdominal pain for 4 days. On physical examination, he was pale and sweating. His blood pressure was 130/80 mm Hg, pulse 100/min, and temperature 38.8°C. Diffuse tenderness was noted on abdominal pressure, without palpable abnormality. Neurological and cardiopulmonary examinations were normal. Laboratory investigations gave the following results: white blood cell count 14,000/mm 3 , ESR 74 mm/h, CRP 240 mg/l (normal < 5 mg/l), hemoglobin concentration 12.6 g/dl, aspartate aminotransferase 402 IU/l, alanine aminotransferase 648 IU/l, creatininemia 67 µmol/l, and absence of proteinuria. Hemostasis test results: prothrombin time 104%, activated partial thromboplastin time 40 s (normal = 40 ± 5), lupus anticoagulant absent; and factor VIII, IX, and von Willebrand levels were normal. Blood cultures, urinalysis, and tests for tuberculosis (skin test and gastric culture), human immunodeficiency virus, hepatitis C virus, and hepatitis B virus (last generation ELISA tests) were negative. No autoantibodies, including antinuclear, anti-dsDNA, antiphospholipid, antiextractible nuclear antigens, antineutrophil cytoplasmic antibodies, rheumatoid factor, or cryoglobulinemia were detected. Thoracic and abdominal radiographs, electrocardiogram, and echocardiography results were normal. Thoracoabdominal CT scan showed 2 recent intrahepatic hematomas, visible as spontaneous hyperdensity lesions DISCUSSIO