[Diagnostic value of transthoracic ultrasound compared to chest radiography in the detection of a post-interventional pneumothorax]. / Diagnostische Wertigkeit der transthorakalen Sonografie vergleichend zur Thoraxübersicht beim Nachweis eines postinterventionellen Pneumothorax.

PURPOSE: Chest radiography is standard for the diagnosis of a pneumothorax. However, also ultrasound of the chest has considerable value in the detection of a pneumothorax. A typical sonographic feature is the lack of the lung gliding sign. Aim of our trial was to evaluate the significance of ultrasound of the chest in the diagnosis of a pneumothorax supplemented by using power colour Doppler imaging. PATIENTS AND METHODS: Following transbronchial biopsy, patients received transthoracic ultrasound of the chest for evaluation of a pneumothorax. Immediately afterwards, a chest radiograph was performed and results were compared. RESULTS: 1023 patients (321 female, 702 male, median age 47 years) were examined. In 30 patients (2.9%) chest radiograph revealed a pneumothorax, while in ultrasound of the chest a pneumothorax was diagnosed in 36 of the cases. Defining chest radiography as gold standard, ultrasound of the chest had a sensitivity of 100%, a specificity of 83% and an accuracy of 99%. CONCLUSION: Transthoracic ultrasound of the chest is a highly sensitive and specific diagnostic tool in the diagnosis of a pneumothorax. In comparison to chest radiography, it is better available and prevents administration of ionizing radiation. However, a disadvantage of ultrasound is the lack of quantification of a pneumothorax and the assessment of the indication for chest tube drainage.

[MRT, CT and sonography in the preoperative assessment of the primary tumor spread in malignant pleural mesothelioma]. / MRT, CT und Sonographie in der präoperativen Beurteilung der Primärtumorausdehnung beim malignen Pleuramesotheliom.

PURPOSE: Evaluation of the diagnostic value of the imaging modalities computed tomography (CT), magnetic resonance imaging (MRI), and thoracic sonography in the preoperative staging of malignant pleural mesothelioma. MATERIALS AND METHODS: The diagnostic accuracy of CT (n = 41), MRI (n = 24), and thoracic sonography (n = 37) were evaluated in 51 patients with histologically proven diffuse malignant pleural mesothelioma. Values of sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for the assessment of the diaphragm, lung, thoracic wall, pericardial wall, myocardium, and (retro)peritoneal space. RESULTS: The accuracy rates for CT were 85%, 98%, 83%, 73%, 71%, and 83%. MRI had an accuracy of 71%, 92%, 71%, 83%, 71%, and 96%, the thoracic ultrasound examinations of 76%, 63%, 51%, 60%, 71%, and 89%. CONCLUSIONS: According to these results CT remains the method of choice in the preoperative assessment of T-stage of malignant pleural mesothelioma. MRI is of nearly the same value, but is not a must. Sonography may be supplementary method for operation planning.

[Mediastinal actinomycosis with formation of an esophagotracheal fistula. A case report]. / Mediastinale Aktinomykose mit ösophagotrachealer Fistelbildung. Ein Fallbericht.

Before antibiotics were available, actinomycosis was the most commonly diagnosed "fungal disease" of the lung because of its morphological similarity to true fungi. At that time actinomycosis presented a fairly typical clinical picture of empyema thoracis and sinus tracts in the chest wall. Nowadays it has become a rare infectious disease that is usually caused by the bacterium Actinomyces israelii and is amenable to treatment by most antibiotics available today. The following report describes the case of a 59-year-old man with an uncommon mediastinal actinomycosis that caused an oesophagotracheal fistula. This complication may develop due to the necrotizing inflammatory process that is typical for actinomycosis. With regard to the literature, the clinical manifestations of the disease and diagnostic and therapeutic considerations are discussed.

[Computerized tomography findings in rare malignant processes of the thorax]. / Computertomographische Befunde bei seltenen malignen Prozessen des Thorax.

The CT findings in 21 patients with rare malignant space-occupying growths in the thorax were evaluated retrospectively under morphological aspects. The possibility of rare malignant thoracic space-occupying growths should be considered mainly 1) in patients who are either very young or of very old age, 2) if risk factors are absent, especially abuse of nicotine, 3) if there are large inhomogeneous growths, possibly with calcareous areas or necrotic zones and sharp marginal delineation in the node status, 4) if the tumour localisation is atypical of bronchial carcinoma.

[Oleothorax 40 years later]. / Oleothorax nach 40 Jahren.

Between 1930 and 1950 the induction of an oleothorax was widely accepted as treatment of patients with progressive tuberculosis. Now, the late complications of this therapeutic approach can occasionally be observed. A patient with an oleothorax induced forty years ago and extensive x-ray exposure through frequent fluoroscopie follow-up is presented. In addition, he has a carcinoma of the lung infiltrating the chest wall. The late complications of oleothorax and the possibility of a radiation-induced malignancy are discussed.

Pleural metastasis of malignant thymoma. A pitfall in the CT-diagnosis of pleural mesothelioma.

We report two cases with metastatic thymomas mimicking the CT feature of pleural mesothelioma.

[Computerized tomography aspect of empyema necessitatis]. / Computertomographischer Aspekt des Empyema necessitatis.

In two case reports the development of an empyema necessitatis in the course of long-standing tuberculosis and after pneumonectomy because of lung carcinoma is presented. The computer tomographic aspect and the differential diagnosis are discussed.

Primary mediastinal clear cell lymphoma of B-cell type.

This is a report on 8 mediastinal tumours that occurred in young adults (19-43 years, mean: 29.4); predominantly in females (6/8). Initial symptoms consisted of thoracic pain and venectasia and in only one case in B symptoms. After surgical tumour reduction, radiation and/or chemotherapy, local recurrence was observed in each case under clinical care; abdominal spread is presently suspected in 3 patients; 3 died 11, 13 and 22 months after diagnosis. None developed leukaemia. The tumours are B-cell neoplasms with a characteristic immunophenotype: leucocyte common antigen+, common acute lymphoblastic leukaemia antigen-, B 1-antigen+, surface and cytoplasmic immunoglobulin-. Flow cytometry revealed DNA-diploidy in 7 cases and a moderately (3.2-3.8%) to extremely high (8.0-20.6%) S-phase component. The proliferation associated antigen Ki67 was detectable in 10-60% of the tumour cell nuclei, thus stressing the considerable or rapid growth. Histopathology is characterized by a diffuse growth pattern and a clearness and abundance of cytoplasm of the pleomorphic tumour cells, which vary in size and nuclear morphology from patient to patient. Apoptoses are more numerous than mitoses. Fibrosis and focal necrosis are common, sclerosis is present in 3 cases. We suggest that primary mediastinal lymphoma of B cell type is a novel B-lymphoma variant.