Artériopathies périphériques juvéniles

Peripheral arterial disease (PAD) encompasses disease of all arteries of the body except the coronary arteries. The main etiology whatever the patient's age is atherosclerosis. Different etiologies can induce PAD especially when patients are younger than 50 years old and have no cardiovascular risk factors (smoking, hypertension, diabetes…). PAD that appears before 50 years old can be named juvenile PAD (JPAD) although there is no consensus about the definition. The aim of this work is to present the different etiologies of JPAD according to their hereditary, acquired or mixed origins. The following hereditary causes are addressed: Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria, pseudoxanthoma elasticum, osteogenesis imperfecta “mid-aortic” syndrome. Among the acquired etiologies, inflammatory JPADs without extravascular signs such as atherosclerosis and Buerger's disease, inflammatory JPADs with extravascular signs as Takayasu's disease, Behçet's disease and Cogan's syndrome, JPADs like aortitis, embolic JPADs, iatrogenic JPADs, and mechanical or traumatic JPADs are described. Finally, mixed origins as thrombotic disease and fibromuscular dysplasia are presented. This work will assist clinicians in the diagnosis of JPAD.     

Endométriose péritonéale révélée par une ascite hémorragique : premier cas malgache

The peritoneal endometriosis is defined by the presence of endometrial tissue, in an ectopic way, apart from the uterine cavity. The evocative usual signs of pathology are the secondary dysmenorrhoea, the deep dyspareunia, the chronic pelvic pains and infertility. The form associated with a hemorrhagic ascitis is exceptional with 41 cases published, of which none of them is in Madagascar. Our objective is to report a case of peritoneal endometriosis revealed by a hemorrhagic ascite. It is about a 33 years old woman, from Madagascar, nulliparous and having presented an abundant hemorrhagic ascite associated with chronic pelvic pains characterised by the menstruations. In front of the difficulty of access to the coelioscopy, the complicated diagnosis of peritoneal endometriosis of a hemorrhagic ascite in our patient was retained on lines of evidence epidemiologics, anamnestics, clinicals, morphologicals and biologicals. The evolution marked by the draining of the ascite and the disappearance of the chronic pelvic pains under freinator hormonal treatment represented an additional argument in favour of the diagnosis of peritoneal endometriosis.     

Lymphangiome kystique rétropéritonéal

The cystic lymphangioma is a vascular tumor that arises at the expense of lymphatic vessels. It is a rare and benign dysplasia that occurs mainly in children. Adult forms are rare. Its expression is mainly cervical or axillary, with a few locations in the abdominal cavity. We report the case of a patient who presented with cystic lymphangiomas located in the retroperitoneal region. Various clinical aspects, diagnosis and treatment were studied.     

Un cas d’encéphalomyélite aiguë disséminée post-infectieuse découvert devant une rétention vésicale fébrile

Introduction

MRI should be performed in the presence of an acute febrile urinary retention, when septic and obstructive causes are eliminated. We report a case of post-infectious probable acute disseminated encephalomyelitis (ADEM) with a mostly spinal cord tropism of involving Campylobacter.

La fibrose rétropéritonéale idiopathique

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the presence of fibro-inflammatory tissue around the aorta entrapping the adjacent structures. RPF can be idiopathic or secondary to many disorders. The physiopathology is unknown but can be part of the spectrum of IgG4 related diseases. Imaging studies and inflammatory markers are essential for initial evaluation and follow-up. Biopsy is usually not recommended. The first line of treatment is corticosteroids associated or not with immunosuppressive drugs. In case of ureteral obstruction with renal failure, ureteral stent placement or nephrostomies are recommended. Initial response to treatment is usually good but relapses are frequent.