[Acute thoracic pain]. / Akuter Thoraxschmerz.

We report the case of a 56 year-old female patient without previous medical history presenting in the emergency room with acute left-sided thoracic pain and dyspnea. Initial lab exams, ECG and chest X-ray in supine position were normal and excluded most common pathologies, e.g. a large pneumothorax or myocardial infarction. A subsequent computed tomography to exclude an aortic dissection or pulmonary embolism showed left-sided sero-pneumothorax and mediastinal air. A spontaneous esophageal rupture (Boerhaave Syndrome) was diagnosed. An additional fluoroscopic study was performed to evaluate the exact site of rupture.

[Pelvic congestion syndrom]. / Beckenvenensyndrom.

We describe imaging findings and interventional therapy of a 37-year old female patient suffering from chronic pelvic pain with associated vulvar varicosis. MR-angiography showed multiple varices in the left hemi-pelvis, a dilated draining vein from the left ovary as well as a left-sided vulvar varicosis, which was clinically evident. In addition, the MRI suggested insufficiency of the great saphenous vein with varicosis of its tributaries. After crossectomy and infragenual stripping of the great saphenous vein, we proceeded with a left phlebectomy and ligation of the supplying veins. Due to post-operative persistence of the vulvar varicosis the patient underwent coil-embolisation and liquid sclerotherapy (Aethoxysklerol) of the varicose pelvic veins and the left ovarian vein with good results.

[Ovarian fibrothecoma: MR imaging findings and differential diagnosis]. / Fibrothekom des Ovars: MR-bildgebung und Differentialdiagnose.

We report the preoperative MR imaging of a 70 year old woman with a large tumor of the lower abdomen. MRI shows a extensively large mass with low signal in T2-weighted images. The origin of this tumor was suspected to be either the left ovary or the uterus. In the differential diagnosis a large subserous pedunculated leiomyoma or a low cellular, primarily benign ovarian tumor were considered.

[Evaluation of bloody nipple discharge]. / Abklärung einer blutigen Mamillensekretion.

A 64-year old woman was referred for radiological evaluation of right sided bloody nipple discharge lasting for five months. Finally galactography supposed the diagnosis of an intraductal papilloma which was confirmed by surgery. Histopathologically an eight millimeter measuring intraductal papilloma with atypical ductal hyperplasia with signs of a carcinoma in situ was seen.

Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: a comparison with positron emission tomography and coronary angiography.

BACKGROUND: Monitoring contrast medium wash-in kinetics in hyperemic myocardium by magnetic resonance (MR) allows for the detection of stenosed coronary arteries. In this prospective study, the quality of a multislice MR approach with respect to the detection and sizing of compromised myocardium was determined and compared with positron emission tomography (PET) and quantitative coronary angiography. METHODS AND RESULTS: A total of 48 patients and healthy subjects were studied by MR using a multislice hybrid echo-planar pulse sequence for monitoring the myocardial first pass kinetics of gadolinium-diethylenetriamine pentaacetic acid bismethylamide (Omniscan; 0.1 mmol/kg injected at 3 mL/s IV) during hyperemia (dipyridamole 0.56 mg/kg). Signal intensity upslope as a measure of myocardial perfusion was calculated in 32 sectors per heart from pixelwise parametric maps in the subendocardial layer and for full wall thickness. Before coronary angiography, coronary flow reserve (hyperemia induced by dipyridamole 0.56 mg/kg) was determined in corresponding sectors by (13)N-ammonia PET. Receiver-operator characteristic analysis of subendocardial upslope data revealed a sensitivity and specificity of 91% and 94%, respectively, for the detection of coronary artery disease as defined by PET (mean coronary flow reserve minus 2SD of controls) and a sensitivity and specificity of 87% and 85%, respectively, in comparison with quantitative coronary angiography (diameter stenosis >/=50%). The number of pathological sectors per patient on PET and MR studies correlated linearly (slope, 0.94; r=0.76; P<0.0001). CONCLUSIONS: The presented MR approach reliably identifies patients with coronary artery stenoses and provides information on the amount of compromised myocardium, even when perfusion abnormalities are confined to the subendocardial layer. This modality may qualify for its clinical application in the management of coronary artery disease.