The dorsal tangent line - A new approach in the radiological analysis of metacarpal fractures

Traditionally, the angle between the intersecting central axes (lateral projection intersecting central axes - LCA) of the proximal and distal fragments of metacarpal fractures is measured on radiographs. We recommend using the angle between the intersecting dorsal tangent lines instead (lateral projection intersecting dorsal tangent lines - LDT). We analyzed radiographs of 25 fractures of the fifth metacarpal bone shaft in three planes. Intraclass correlation coefficients (ICC) were used to estimate inter-rater and intra-rater reliability. Mean palmar tilt was 35.6° ± 12.5° according to LCA and 27.6° ± 12.0° according to LDT. There were no differences during repeated measurements. Intra-rater reliability was high: ICC (95% CI) for LDT was 0.82 (0.74-0.88) and for LCA it was 0.71 (0.51-0.83). Mean values of palmar tilt using LCA exceeded those using LDT by 8.0° ± 7.7° (p < 0.001). Only LDT measurements provided comparable results between all raters. In conclusion, we demonstrated the feasibility and reliability of intersecting dorsal tangent lines for measuring palmar tilt in fifth metacarpal fractures as an alternative to the commonly used angle between the intersecting central axes.

[Role of computed tomography in bronchial carcinoid tumors for diagnosis and local staging]

PURPOSE

Report radiographic aspects and assess the contribution of computed tomography for the diagnosis and search for extension of bronchial carcinoid tumors.

MATERIAL AND METHODS

This retrospective study included 9 patients with a bronchial carcinoid tumor during a four years period. In all patients, the exploration included standard chest radiography, computed tomography (CT) and abdominal ultrasonography.

RESULTS

This series included three females and six males, mean age 25 years (age range 20-52 years). The average time between clinical symptoms and diagnosis was 24 months. The important signs were chest pain, dry cough and dyspnea in 7 cases, hemoptysis in 4 cases. Chest radiography has objectified a rounded opacity speculated in 4 cases, opacity systematized in 3 cases and an opaque lung in 2 cases. Computed tomography (CT) revealed an endobronchial process with a endobronchial budding in 5 cases, pneumonia systematized in 4 cases, collapse in 7 cases, a localized dilatation of bronchus in 2 cases, lymph node metastases in 4 cases. Bronchoscopy has the macroscopic diagnosis in all cases. All patients have surgical treatment, the lobectomy in 4 cases, pneumonectomy in 3 cases and bilobectomy in 2 cases.

CONCLUSION

CT is indispensable for positive diagnosis, and topographic localization of extension of bronchial carcinoid tumors. The main contribution of CT compared with fibroscopy is to demonstrate exobronchial tumor development and upstream pulmonary complications.

[CT Scan Angiography In The Pulmonary Embolism's Diagosis At Radiology And Nuclear Medicine Department In Hôpital Du Point "G"]

OBJECTIVE

The aim of this study was to precise the role of thoracic CT angiography in the diagnosis of pulmonary embolism in our practice.

PATIENTS AND METHODS

We conduct a prospective eight (8) month study in the radiology department of the Teaching Hospital of Point "G" Seventy seven patients suspected of pulmonary embolism were included. A thoracic CT angiography was performed in emergency after chest X ray for each patient. Pulmonary embolisms were classified according to the Qanadli index.

RESULTS

The average age of our patients was 52 years old (23 - 85 years). The age group 55-64 was predominant. The clinical probability was low, medium and high respectively in 8,9%, 28,9% and 62,33%. Chest X ray was suspect of embolism in 92,2% (71/77%), thoracic CT angiography was positive in 58,44% (45/77). Embolism was located in a lobar pulmonary artery in 57,78% and the right side was the most concerned. Among the cardiopulmonary consequences, dilatation of the trunk of the pulmonary artery predominated in 42,22% of cases. According to Qanadli index, the severity of pulmonary embolism was moderate (53;33%), severe (35,56%), and massive (11,11%).

CONCLUSION

CT angiography is in our practice, the best choice in the diagnosis of pulmonary embolism. It allows to confirm the diagnosis, and to precise the topography of pulmonary embolism. In addition, this examination makes it possible the severity specification of the affection.

[Spirometric and radiographic profile of patients with pulmonary tuberculosis treated and cured at the Department of Pulmonology of Brazzaville University Hospital]

INTRODUCTION

Tuberculosis is a real public health problem in Congo. Pulmonary localization can lead to sequelae of respiratory functional repercussions.

OBJECTIVE

Describe the spirometric and radiographic profile of patients treated with pulmonary tuberculosis treated and cured.

PATIENTS AND METHODS

This was a cross-sectional study that included 150 patients with previous pulmonary tuberculosis with positive microscopy treated and cured in the Pulmonary Department of Brazzaville University Hospital. In which we performed a functional exploration (Spirometry) and a chest X-ray. The study took place from 1st January 2016 to 31st August 2016.

RESULTS

The spirometry performed in all patients was pathological in 68.67% (103 cases/150) of the cases. Among them 74.76% (77 cases/103) had a restrictive profile (FEV1/FVC >70% and CVF <80%), 9.71% (10 cases/103) an obstructive syndrome (FEV1/FVC ≤70% and CVF >80%) and 15.53% (16 cases/103) a mixed syndrome (FVC <80% and FEV1/FVC <70%). Of the 150 chest radiographs performed, 120 or 80% were pathological; the degree of parenchymal stage III destruction represented 28.33%. There was a significant correlation between the degree of parenchymal destruction and the delay in treatment on the one hand and between the degree of parenchymal destruction and the different pulmonary volumes and volumes on the other hand.

CONCLUSION

The prevention of these respiratory functional disorders is based on the prophylaxis of tuberculosis on early diagnosis of the disease.

[Paget's disease of bone: Diagnostic and therapeutic updates]

Paget's disease of bone is the second most common metabolic bone disease after osteoporosis. Its pathogenesis is not yet clearly understood. Geographic distribution and epidemiological variations suggest a role of genetic and environmental factors in its pathophysiology. The frequency of the Paget's disease of bone increases with age. Its discovery can be fortuitous. Prognosis mainly depends on the occurrence of complications involving bones and joints, neurological, cardiovascular or metabolic systems. Treatment of symptomatic forms currently relies on bisphosphonates that have transformed its prognosis.

[The role of imaging in thoracic tuberculosis]

Tuberculosis is an infectious disease mostly due to Mycobacterium tuberculosis. It is frequent in developing countries and its incidence is rising in developed countries. Lungs are the most involved organs of the chest but other structures can be affected. Imaging is fundamental in the management of the disease. Confirmation of diagnosis can be made only by bacteriologic and/or histologic exams. The first approach of diagnosis is based on clinical symptoms and chest X-ray signs. Radiologic signs depend on patient's age, his immune status and his previous contact with M. tuberculosis. Conventional chest X-ray remains the first-line exam to realize. It can suggest the diagnosis on the appearance and location of the lesions. CT scan is recommended for the positive diagnosis in case of discrepancy between clinical and radiographic signs, as for the diagnosis of parenchymal, vascular, lymph nodes, pleural, parietal or mediastinal complications. It is also essential for the evaluation of parenchyma sequelae. MRI and PET-scan have limited indications. The purpose of this article is to illustrate different radiological forms of chest tuberculosis, its sequelae and complications and to highlight the role of each imaging technique in the patient's management.

[Étienne Destot (1864-1918): the first radioanatomist in Lyon, France]

Destot was born in Dijon, France, in 1864. He began his education in Burgundy, then he started his preclinical curriculum in Lyon, France, from 1884. He had to leave Lyon, and spent some times in Algeria to treat a tuberculosis. He came back in Lyon as a resident in 1886. Destot worked as an assistant in the laboratory of anatomy of Leo Testut in 1880. His thesis, in 1892, analyzed mortality in the departments of surgery of the Lyon hospitals. The polemical results he presented compromised his surgical career. He went on as prosector by Leo Testut, and then became electrician-physician in 1895 (electrotherapy and galvanotherapy). Étienne Destot of Lyon, France, developed in 1895 the first radiography room ever at the Hôtel-Dieu of Lyon, France. Wilhelm Röntgen discovered the X-rays in the same year, and Destot felt his discovery could revolutionize the approach of anatomy and traumatology. He studied wrist, ankle and calcaneus fractures, and described a new anatomy: "traumatic anatomy". For example, he focused on the posterior talar surface hollow in posterior tarsus fractures. He proposed the term of "thalamus" for this articular surface; this term is nowadays widely used by the clinicians. He introduced the term of "third malleolus" to describe the posterior part of the distal extremity of the tibia. He was the first author to analyze the normal and pathological movements of the scaphoid bone and the lunatum in wrist extension.