Bruno Coulier

• MD
• Clinique Saint-Luc, Bouge at Clinique Saint-Luc, Bouge

In contrast with their colonic equivalents, noncolonic diverticula of the gastro-intestinal tract are much rarer and an uncommon site of inflammation. Symptoms and signs are generally nonspecific and before the advent and development of CT, clinical and radiological diagnosis was very difficult. As a result laparotomy was carried out in most cases...

The aim of this retrospective study was to emphasize the performances of spiral CT (HCT) and multidetector-row CT (MDCT) as very effective imaging modalities for the diagnosis of intestinal perforations caused by calcified alimentary foreign bodies. Eight sites of perforations of the ileum by ingested foreign bodies were found in seven patients--on...

Although true physical-chemical experimental proofs are lacking in the literature, numerous clinical reports have shown that many radiological manifestations of the so-called vacuum phenomenon (VP) only represent snapshots of a complex dynamic hydropneumatical continuum extending from true vacuum to gas and/or fluid and vice versa. In the great maj...

Whether extragonadal germ cell tumors develop primarily in the retroperitoneum or whether they are essentially metastases of a primary testicular tumor has long been debated and remains controversial. Three patients presenting with apparent primary extragonadal retroperitoneal germ cell tumors are reported. Ipsilateral testicular evaluation was ext...

Mesenteric panniculitis is an uncommon benign inflammatory condition of unknown etiology that involves the adipose tissue of the mesentery and for which an extremely varied terminology has been used, causing considerable confusion. It can be evaluated as a single disease with two pathological subgroups: Mesenteric Panniculitis (MP), representing th...

Meandering right pulmonary vein (MRPV) is an exceedingly rare congenital pulmonary vascular variant with less than 20 reported cases. MPVR is a tortuous aberrant venous drainage of the right pulmonary upper lobe anastomosing with the right lower pulmonary vein instead of directly joining the left atrium. The variant is benign with an orthotopic ven...

Left isomerism (polysplenia), one of the two major variants of heterotaxia with right isomerism (asplenia), may be rarely diagnosed in adulthood. Most cases are nevertheless asymptomatic and incidentally detected during imaging or surgery performed for unrelated conditions. We hereby report a case of left isomerism fortuitously diagnosed in a 55-ye...

We report a case of reversed rotation (RR) of the midgut, the rarest form of intestinal malrotation (IMR), revealed by a chronic volvulus, in a 42-year-old woman presenting with episodes of abdominal pain occurring after heavy meals. The complete preoperative diagnosis was obtained by contrast-enhanced computed tomography (CT). Classical signs of v...

Purpose To confirm and illustrate the great variability of morphology of the Cerebral Arterial Circle (CAC)—also commonly called “Circle of Willis”—in current clinical Computed Tomography Angiography (CTA) practice. Methods Computed Tomographic Angiographic 3D Volume Rendering reconstructions of the CAC performed in a series of 511 patients were r...

Hepatic “hot spots” in anterior paraumbilical hepatic segments of patients suffering from superior vena cava syndrome may be revealed by angio-computed tomography. They may be due to a collateralizing system, the epigastric-paraumbilical venous system (EPVS), which enters the liver as a “third inflow”. We report a typical case emphasizing the role...

Teaching Point: The advantages of CT over other imaging techniques for the diagnosis of acute appendicitis in adults include the ability to identify foreign bodies that may be involved.

Teaching point: CT may help distinguishing benign from life-threatening pneumatosis intestinalis.

Leiomyosarcoma is a rare malign neoplasm, representing about 5-7% of all tissue sarcomas while inferior vena cava leiomyosarcomas accounts for only 1%. This paper presents the case of a 74 years old patient that was diagnosed with an abdominal venous leiomyosar-coma involving the inter-renal segment of the inferior vena cava. Tumor was treated by c...

Teaching Point: Abnormal embryological cecal fixation may lead to volvulus, which accounts for approximately 1 to 3 percent of all colic obstructions. A pack of suggestive CT features can make the diagnosis.

Teaching Point: Sigmoid diverticulitis may cause colo-vesical fistula from which intravesical protrusion of a pedunculated colonic polyp is an exceptional event that should not be regarded as a bladder cancer.

Teaching point: The typical "cracked dry mud" pattern on ultrasound may help avoiding biopsy for proliferative myositis which is a self-resolving benign process.

Case Reports In less than three months, two middle-aged women-51 (Figure 1) and 53 (Figure 2) years old-were referred to our department with very similar complaints of acute pain in the right upper epigastric area. Both had epigastric defense, nausea, and moderate biological inflammatory syndrome. Emergency ultrasound excluded gallstones and/or cho...

Teaching point: Multiple buccal exostosis are rare but asymptomatic, unequivocal, and always benign conditions of the jaws

A large abdominal mass was found in a 19-year-old woman presenting with an increasing subcostal pain that initially appeared 6 months before. Abdominal computed tomogra-phy (CT) examination revealed a 21.5 × 15 × 21 cm giant splenic cyst (Fig. 1) that was hyperintense on both T1-and T2-weighted MR images suggesting a mixed hemorrhagic and protein-r...

Case A 65-year-old woman presented with a three-month history of persistent ocular-nasal catarrh, sub-febrile state, myalgia, night sweats, weight loss and early daily bi-temporal pain. Severe biological inflammatory syndrome with CRP at 105 mg/l and sedimentation rate at 97 mm was present. Colour Doppler Ultrasound (CDU) (Figure 1) showed a typica...

We report an unusual case of small bowel obstruction caused by a large enterolith released from small bowel diverticulitis in a 81-year-old patient with occult massive Diffuse Jejuno-Ileal Diverticulosis (DJID). DJID is a rare condition whose symptoms are usually absent or non-specific. In most cases, the diagnosis of DJID is incidentally made or c...

Angioedema (AE) classically manifests as an acute transient swelling of extra-visceral spaces, subcutaneous and submucosal tissues. Sometimes it may be a life-threatening condition. The causes are numerous, and the common denominator is an increased vascular permeability allowing diffusion or extravasation of fluid from the vascular bed to the inte...

Multidetector computed tomographic angiography (MDCTA) is the new gold standard for diagnostic evaluation of the abdominal and/or mesenteric arteries. It is not invasive and provides a 2D and 3D global cartography of all abdominal arteries and that with only a limited amount of contrast media. MDCTA allows the optimal diagnosis of single or multipl...

Metastatic infiltration of a peripheral plexus, also named metastatic plexopathy (MP), often results in severe pain and muscular weakness. This rather rare event may have a dramatic impact on the quality of life of patients affected by cancer. We hereby report a rare case of painful MP of the left cervicobrachial plexus presenting as the inaugural...

Pancreatic lipomatosis – also commonly called fat replacement – represents the most frequent benign pathologic condition of the adult pancreas. Most cases remain asymptomatic, and only some rare extreme degrees of lipomatosis or fat replacement may lead to exocrine pancreatic insufficiency. The precise etiology of the entity remains unclear, and th...

Henoch-Schönlein purpura (HSP) is a form of immune complex-mediated leukocytoclastic vasculitis involving the skin and other organs. It primarily affects children. The occurrence of HSP in adults is rare, and gastrointestinal (GI) involvement is one of its most common clinical manifestations. The GI symptoms are caused by hemorrhage and edema withi...

We report a rare case of purely retrograde stenosing stricture of the sigmoid descending colonic junction fortuitously diagnosed during the waning of a failed virtual colonoscopy in a 69-year-old patient. The rather asymptomatic patient was addressed to investigate a positive fecal occult blood test. He had suffered a single acute colonic diverticu...

We report a typical case of acute avulsion of the anterior iliac crest apophysis diagnosed in an indoor football player. The injury occurred as a result of a sudden twist of the trunk while kicking. Plain radio-graphs made the diagnosis. Complementary CT with 3D reconstructions was preferred to ultrasound because of the very strong habitus – 110 ki...

We report a very rare case of acute congestive ischaemic colitis of the left colon caused by brutal decompensation of an uncommon arteriovenous malformation (AVM) in the territory of the inferior mesenteric artery (IMA) in a 45-year-old male patient. The patient presented with severe abdominal pain in the left iliac fossa and abundant mucoid stools...

No abstract. Letter to the Editor

The hepatic falciform artery (HFA) may be found in 68 % of subjects in post-mortem dissections. It is well known by interventional radiologists who perform selective hepatic angiography. The reason essentially results from the potential supraumbilical skin complications which may produce by the distribution of chemotherapeutic agents through the HF...

We report a very rare case of acute obstructive hemobilia caused by bleeding of a mass-forming intrahepatic cholangiocarcinoma in a 75-year old man. The prompt complete emergency diagnosis was made by ultrasound and confirmed by MDCT. The features of hemobilia and intrahepatic cholangiocarcinoma are briefly reviewed.

Solitary fibrous tumor (SFT) is an unusual spindle cell neoplasm rarely described in the kidney. Usually occurring in the pleura, it has also been described in various extrapleural sites. We report a rare case of SFT of the kidney fortuitously found in a 55-year-old patient. The imaging features are illustrated. The definite diagnosis was made thro...

Morgagni hernia is considered to be the rarest form of all diaphragmatic hernias. It develops through a congenital defect in the retrosternal area. Usually asymptomatic, this entity can lead to life-threatening complications such as incarceration, strangulation or volvulus of the herniated viscus. We hereby report a rare case of organoaxial gastric...

We report a rare case of early onset type Trocar Site Hernia (TSH) producing in the right lower abdominal quadrant of a 64-year old obese woman. The patient was admitted in the emergency room for abdominal pain producing four days after laparoscopic adnexectomy. The hernia atypically externalized in two-steps creating two superposed concentric smal...

We report the CT, surgical and histopathologic findings of a rare case of Hepatic Angiosarcoma (HAS) diagnosed in a 85-year old women 65 years after Thorotrast (Th-232) exposure for angiography. At the early arterial phase of dynamic MDCT, peripheral curvilinear and central nodular puddling of contrast produced in the 8 cm tumor. Then progressive c...

Thoracic multidetector computed tomography-MDCT-was simultaneously performed during emergency abdominal CT in a patient presenting with abdominal pain and acute cardiogenic edema related to sick sinus syndrome and mitral prolapse with regurgitation. A constellation of severe but completely reversible interstitial and mediastinal features was found...

We report two cases of elderly patients presenting with life-threatening complications due to inadvertent accidental ingestion of blister pill packs (BPPs). The first patient presented with obstruction followed by anemia and finally perforation of the small bowel. The second presented with rapidly lethal mediastinitis due to a large perforation of...

We hereby report a case of diffuse pelvic peritoneal involvement by immunoglobulin G4-related disease (IgG4-RD). Numerous pelvic masses and nodules showing delayed enhancement on enhanced abdominal CT were found to congregate in the pelvic organs of a 57-year-old female presenting with intestinal subocclusion. The differentiation between peritoneal...

We present the case of a patient who died from multiple organ failure due to acute liver failure as a result of malignant hepatic infiltration by an adenocarcinoma. A review of the literature revealed that the clinical picture, laboratory examination, and imaging studies do not contribute to the diagnosis of this rare cause of liver failure. Theref...

We report an incidental case of combined disproportionate deep inspiration and breath-old artifacts producing during computed tomography pulmonary angiography performed to exclude pulmonary embolism in a 69-year-old patient. These known but unwelcome cumulated artifacts may cause transient major attenuation or interruption of the contrast bolus whi...

We report two very unusual observations in which gas and fluid effusions were transiently and unexpectedly found in the extravertebral spaces of patients presenting with painful necrotic vertebral collapse containing a vacuum cleft. We hypothesize that gas and/or fluid which progressively may replace vacuum in vertebral compression fractures could...

The extremely rare extensive propagation of a giant retroperitoneal pancreatic pseudocyst into the posterior compartment of the lower limb as far as the knee is reported. The extension was found producing through the sciatic foramen and the full diagnosis was made by MDCT. A complete healing was progressively obtained in the 78-year old female afte...

We present the case of a 26-year-old man with schizoid personality disorder who suffered from a very focal and transparietal necrosis of the sigmoid after an overdose of atypical neuroleptics. This is a singular, rather unknown and potentially lethal side effect of these drugs. The physiopathology of this complication is multifactorial.

Thanks to its very high performances in term of spatial resolution, table speed and multiplanar reconstructions (MPR), 64-row MDCT today produces unrivalled high quality images of the entire abdominal wall (AW) during a single short breath hold. It appears thus particularly useful for the evaluation of AW hernias, allowing accurate identification o...

An apparently healthy 31-year-old man presented with dysphonia. Laryngoscopy revealed a mass at the right side of epiglottis. He underwent a CT examination after intravenous injection of a iodinated contrast agent and this showed the presence of a paralaryngeal mass with rim enhancement. The diagnosis of laryngopyocele was made. Treatment consisted...

We report the case of an 82-year-old female presenting with acute epigastric abdominal pain after traumatic blow on the epigastrum. High-resolution multimodal imaging comprising Ultrasound, CT and MR, correlation with laboratory blood analyses and a 6 months CT follow-up allowed us to make a definite diagnosis of traumatic heterotopic pancreatitis....

Perforation of the gallbladder has an incidence of 1.6 to 2.8% in gallbladder disease. Among these cases transhepatic rupture is a very rare event. We report a case associated with secondary massive hemoperitoneum, free gallstone spillage, partial portal vein thrombosis and secondary pulmonary embolism.

Extra-abdominal abscesses of gastrointestinal origin developing within the lumbar subcutaneous tissues are extremely rare. We report two cases of retroperitoneal bowel perforation presenting spontaneously at admission with a lumbar abscess trespassing the lumbar triangle of Petit, a classical "locus of minus resistencia" of the posterior abdominal...

Pylephlebitis is a very rare and dangerous complication of inflammatory abdominal processes, mainly appendicitis (1) and diverticulitis (2).We describe a case of peridiverticular inflammation leading to a extensive phlebitis of the adjacent sigmoid vein, extending to the inferior mesenteric vein up to the proximal portal vein, with distal embolus i...

Sinonasal myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of paranasal sinus surgery. Rare cases have been sporadically reported. We report a case found in a 79-year-old female 8 months after functional endoscopic sinus surgery during which sinus cavities had been packed with gauze coated with Ter...

Mesenteric panniculitis (MP) is an uncommon benign inflammatory condition of unknown etiology that involves the adipose tissue of the mesentery. I can be evaluated as a single disease with two pathological subgroups: MP, representing the very large majoritary subgroup where inflammation and fat necrosis predominate and Retractile Mesenteritis, rare...

A 74-year- old patient was addressed to the department of gastro - enterology with complaints of epigastric pain. Hepatic tests where moderately altered with signs of cholestasis. Contrast enhanced abdominal CT demonstrated carcinoma of the lower back of the gallbladder with numerous distant epigastric tumoral lymphadenopathies (not illustrated).

We report a rare case of diffuse alteration of the vertebral bony structure fortuitously found in a 20-year-old patient and essentially characterized by an impressive "vertebra-within-vertebra" appearance. This aspect was found being the result of an unusual use of intravenous perfusions of biphosphonate (Pamidronate) during early adolescence for r...

The term IFFI--for intraperitoneal focal fat infarction--includes various acute abdominal clinical conditions in which focal fatty tissue necrosis represents the common pathologic denominator. Only differing by their various anatomical locations and dimensions, all cases nevertheless present rather similar clinical signs, aetiology, radiological fe...

An 81-year-old female was admitted to the emergency room with complaints of nausea, vomiting, vertigo and episodes of paresia of her right inferior face, right arm and both legs. There was neither confusion nor aphasia.

A 62-year-old female was referred to the department of medical imaging with complaints of right cervico brachialgia. MDCT examination of the cervical spine was performed.

In a recent large pictorial review we have revisited the spectrum of intraperitoneal focal fat infarction - IFFI - a term including various acute abdominal conditions in which focal fatty tissue necrosis represents the common pathologic denominator (1). The option of conservative treatment after a very specific imaging diagnosis - today mostly obta...

A 70-year-old female was referred to our department with complaints of bilateral lumbar sciatalgia. Lumbar CT was performed. Bilateral spondylolysis of L5 with secondary olisthesis had been previously surgically stabilised by anterior arthodesis. Ankylosis appeared effective at this level.

A 49-year-old female presented to the emergency room with a one week history of continuous pain in the left iliac fossa. Local tenderness was present and a painful olive-shaped mass was clearly palpable in this area. Ultrasound revealed an 18 x 10 mm painful hyperechoic avascular mass (Fig. A, sagittal and axial view) which was trespassing the abdo...

A 68-year-old male was referred to our imaging department with a history of pain in the right groin. There was no history of unusual strain and the pain had progressively developed over the last four days.

An 80-year-old male was admitted with a 15-h history of persistent epigastric and peri umbilical pain. Pain had spontaneously appeared during night and awakened the patient. There was neither nausea nor vomiting. Physical examination revealed moderate epigastric and supraumbilical abdominal tenderness. The patient was without surgical antecedent.

A 73-year-old patient was addressed to our department of medical imaging for combined CT imaging of the head and petrous bone. The patient had fallen from his height on his mandibula and reported pain in the area of the left temporo mandibular joint. The pain was associated by external otorrhagia. At physical otoscopic exam there was some narrowing...

We report a rare case of small bowel obstruction of a 45-year-old female which was caused by internal hernia of the terminal ileum and cecum through the foramen of Winslow. The patient presented to the emergency department with acute abdominal pain, distention, and nausea, suggesting an intestinal obstruction. The complete unambiguous preoperative...