RESUMEN
A 17-year-old young man presented at our clinic with asymptomatic microhematuria. Ultrasonography and computer tomography found an intraperitoneal lesion of unknown dignity located on top of the bladder. Surgical exploration and histological examination confirmed the diagnosis of a secondary pelvic spleen, a lien bipartitus.
Asunto(s)
Coristoma/diagnóstico por imagen , Hematuria/diagnóstico por imagen , Hematuria/etiología , Pelvis Menor/diagnóstico por imagen , Páncreas , Enfermedades de la Vejiga Urinaria/diagnóstico por imagen , Adolescente , Coristoma/patología , Diagnóstico Diferencial , Hematuria/diagnóstico , Humanos , Pelvis Menor/patología , Masculino , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Enfermedades de la Vejiga Urinaria/patologíaAsunto(s)
Adenocarcinoma/secundario , Enfisema/diagnóstico por imagen , Gastritis/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Neoplasias Ováricas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma/diagnóstico por imagen , Enfisema/complicaciones , Femenino , Gastritis/complicaciones , Gastroscopía , Humanos , Isquemia/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/secundario , Estómago/irrigación sanguínea , Estómago/diagnóstico por imagenRESUMEN
Diaphragmatic hernia can be inborn as well as acquired. We report on the manifestation of an intrathoracic hernia after laparoscopic nephrectomy. Intraoperative and postoperative complications could make intense medical treatment or further surgery necessary. In cases of lasting abdominal discomfort or pulmonary symptoms after abdominal surgery, radiological investigation to exclude intrathoracic hernia should be considered.
Asunto(s)
Hernia/etiología , Hernia/prevención & control , Laparoscopía/efectos adversos , Nefrectomía/efectos adversos , Traumatismos Torácicos/etiología , Traumatismos Torácicos/prevención & control , Anciano , Femenino , HumanosRESUMEN
Acute respiratory failure and the "acute respiratory distress syndrome" (ARDS) are frequent medical conditions in critically ill patients. Various causes can potentially result in the development of ARDS. Two cases are presented, in which malignant diseases were identified as causes of the respiratory failure. The first patient was diagnosed with an acute myeloic leukemia M5 (FAB). In the second patient, lung histology revealed an adenocarcinoma of the lung. These case reports show that in addition to the classical causes of ARDS, specific disease entities can mimic this form of respiratory failure. Beside solid cancers and lymphomas, acute and progressive forms of inflammatory, parenchymal lung diseases (such as acute interstitial pneumonitis, acute eosinophilic pneumonia, diffuse alveolar hemorrhagia, and acute hypersensitivity pneumonitis) can manifest with this picture. As a consequence, the diagnostic workup of respiratory failure of unknown cause should include these entities.
Asunto(s)
Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Endoscopic retrograde cholangiopancreaticography (ERCP) is the morphologic gold standard for the diagnosis of chronic pancreatitis. Magnetic Resonance Imaging (MRI) enables the visualization of not only the pancreatic duct but also the surrounding parenchyma using T2- and T1-weighted sequences before and after the application of a contrast agent. Moreover, it allows the depiction of ductal segments distal to a stenosis or occlusion. However, conventional Magnetic Resonance Cholangiopancreaticography (MRCP) was not able to achieve accuracy similar to that of ERCP. Despite many technological innovations, such as fast breath-hold acquisitions or respiratory-gated 3D sequences, this drawback could not be overcome. In recent years, secretin-enhanced MRCP has been used for the diagnosis of chronic pancreatitis. A recent study showed that secretin not only improves the visibility of the pancreatic duct and its side branches but it also enhances the diagnostic accuracy of MRCP. The sensitivity, specificity, and positive and negative predictive values were improved by the application of secretin. Moreover, the agreement between independent observers increased after the use of secretin. In addition, quantitative post-processing tools have been developed that enable the measurement of the exocrine pancreatic output non-invasively using secretin-enhanced MRCP. These tools facilitate applications, such as functional follow-up after pancreaticogastrostomy and pancreaticogastric anastomoses, evaluation of the functional status of the graft after pancreas transplantation and follow-up of pancreatic drainage procedures and duct disruption.
Asunto(s)
Pancreatocolangiografía por Resonancia Magnética/métodos , Medios de Contraste , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Pancreatitis Crónica/diagnóstico , Secretina , Humanos , Sensibilidad y EspecificidadRESUMEN
To ensure safe, quick, pain-relieving, standardized, and reproducible high quality plain film radiography in fractures of the proximal humerus, the MSR splint was introduced into clinical practice. With the rectangular and completely radiolucent splint the shoulder radiographs are obtained in supine position by a sole radiographer. Two radiographs are taken in projection at 90 degrees to one another: the true anteroposterior and axillary views, the most important views for fracture visualization and assessment. The smooth flat bottom part of the splint glides easily across the X-ray table below the injured shoulder. The arm lying on the chest is carefully rotated externally up to the neutral position and placed in the splint, then fixed with Velcro fastening with the forearm supinated. The splint is adjusted to the patient for the anteroposterior view which is taken with the central ray directed at the coracoid process and perpendicularly on the film cassette. For the axillary view the MSR splint holding the upper extremity is carefully swiveled into a 80-90 degrees abduction position. Even in cases of comminuted fractures this maneuver is not painful for the patients. The X-ray tube is put into a horizontal position with the central ray pointing to the humeral head in an angle about 25 degrees to the long body axis. The cassette is placed upright in touch with the shoulder girdle. In our institution the MSR splint is not only routinely used for diagnosing fractures of the proximal humerus but also for radiological follow-up controls.
Asunto(s)
Postura , Garantía de la Calidad de Atención de Salud/normas , Radiografía/normas , Fracturas del Hombro/diagnóstico por imagen , Férulas (Fijadores)/normas , Diseño de Equipo , Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/cirugía , Humanos , Sensibilidad y Especificidad , Fracturas del Hombro/cirugía , Articulación del Hombro/diagnóstico por imagen , Posición SupinaRESUMEN
A 92-year-old woman incurred an unstable pertrochanteric hip fracture with avulsion of the lesser trochanter (type 31-A2 according to the AO classification). The fracture was treated by gliding nail osteosynthesis, without fixing the minimally displaced lesser trochanter. No intra- or postoperative complications were detected. Suddenly, after 30 days, a swelling of the proximal femoral region, accompanied by signs of haemorrhage, occurred.CT-scans showed a false aneurysm of the deep femoral artery and a dorsal laceration of the artery proximal to the aneurysm. X-rays showed a further dislocation with rotation of the lesser trochanter fragment. Intraoperatively, the tip of the lesser trochanter fragment was identified to be responsible for the laceration of the artery. The false aneurysm was resected and the defect bridged by a vascular prosthesis while the fragment was removed. Follow-up showed no further complications. According to case reports from the literature, false aneurysms and laceration of the deep femoral artery caused by dislocated lesser trochanter fracture fragments are rare.
Asunto(s)
Aneurisma Falso/etiología , Disección Aórtica/etiología , Arteria Femoral/lesiones , Fracturas de Cadera/complicaciones , Cuerpos Libres Articulares/complicaciones , Hemorragia Posoperatoria/etiología , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Implantación de Prótesis Vascular , Femenino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Fijación Intramedular de Fracturas , Fracturas Conminutas , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Politetrafluoroetileno , Hemorragia Posoperatoria/diagnóstico por imagen , Reoperación , Tomografía Computarizada por Rayos XRESUMEN
Toxic-shock-syndrome (TSS) is an acute febrile, exanthematous illness caused by toxins such as toxic-shock-syndrome-toxine-1 (TSST-1) and other endotoxines from staphylococcus aureus with an incidence of 0,5 per 100.000 inhabitants. Patients with menstrual toxic-shock-syndrome (menstrual-TSS) usually have TSS associated with menstruation and use of a vaginal device such as tampons. Other patients with non-menstrual toxic-shock-syndrome (non-menstrual-TSS) have a focus of staphylococcal infection such as a surgical wound infection or soft tissue abscess. TSS usually presents with fever, pharyngitis, diarrhoea, vomiting, myalgia and may progress rapidly (within hours) to signs of hypovolaemic hypotension and shock. In some cases TSS is associated with multisystem failure including shock, renal failure, myocardial failure and adult respiratory distress syndrome. In its acute phase the diagnosis of TSS is often uncertain because of its initial symptoms are non-specific and numerous conditions need to be considered in the differential diagnosis. But obviously less incidence, the signs and symptoms of toxic-shock-syndrome should be recognised early to permit successful therapy. The site of infection should be adequately drained and treated with antimicrobial therapy. Possible complications including ARDS and myocardial failure require a thorough understanding of its underlying pathophysiology to ensure appropriate intensive-care treatment. Only if appropriate therapy is instituted as early as possible, most of patients will be able to survive their toxic-shock-syndrome. In other cases TSS can be a rapidly progressive and perhaps lethal ending disease because of possible multiple organe failure such as ARDS.
Asunto(s)
Toxinas Bacterianas , Enterotoxinas , Insuficiencia Multiorgánica/etiología , Síndrome de Dificultad Respiratoria/etiología , Choque Séptico/fisiopatología , Infecciones Estafilocócicas/fisiopatología , Superantígenos , Adolescente , Cuidados Críticos , Diagnóstico Diferencial , Femenino , Humanos , Productos para la Higiene Menstrual/efectos adversos , Insuficiencia Multiorgánica/diagnóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Choque Séptico/complicaciones , Choque Séptico/microbiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/microbiologíaAsunto(s)
Bronquitis/etiología , Hemoptisis/etiología , Arteria Pulmonar/anomalías , Adulto , Angiografía , Bronquios/irrigación sanguínea , Bronquitis/diagnóstico por imagen , Broncoscopía , Diagnóstico Diferencial , Dilatación Patológica/diagnóstico por imagen , Femenino , Hemoptisis/diagnóstico por imagen , Humanos , Arteria Pulmonar/diagnóstico por imagen , Intensificación de Imagen Radiográfica , RecurrenciaRESUMEN
AIM OF THE STUDY: To evaluate the usefulness of a self-constructed holding device for standardized, investigator-independent radiodiagnostics for ulnar capsulo-ligamentous lesions of the thumb metacarpophalangeal joint compared to the uninjured side. MATERIAL AND METHODS: A holding device for stress roentgenograms was constructed. Normal abduction arcs were evaluated in 20 degrees flexion in 28 healthy volunteers. The investigator-dependent variance was assessed. The study group comprised 123 consecutive patients (68 male, 55 female, aged 7 to 68 years, mean age 30 years). RESULTS: The normal arc of abduction was calculated to be 12 degrees (range 3 degrees to 24 degrees), while the mean individual difference in side by side comparison in volunteers was 0.3 degree (SD 2.69 degrees, range 0 degree-8 degrees). A rupture was diagnosed in 47 patients; 41 were operated. The preoperative diagnoses confirmed correct in all operated patients. A difference of greater than 6 degrees is indicative of a rupture with a sensitivity of 66.7% and a specificity of 96.9%. CONCLUSIONS: In summary, the holding device is useful for the practical work. Individual differences of less than 4 degrees are negative, between 4 degrees and 7 degrees questionable positive, between 7 degrees and 12 degrees are positive and over 12 degrees proof indicator of a rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint.
Asunto(s)
Inmovilización , Ligamentos Articulares/lesiones , Articulación Metacarpofalángica/lesiones , Pulgar/lesiones , Adolescente , Adulto , Anciano , Niño , Diseño de Equipo , Femenino , Humanos , Ligamentos Articulares/diagnóstico por imagen , Masculino , Articulación Metacarpofalángica/diagnóstico por imagen , Persona de Mediana Edad , Radiografía , Valores de Referencia , Pulgar/diagnóstico por imagenAsunto(s)
Anticuerpos Antinucleares/sangre , Enfermedades Autoinmunes/diagnóstico , Calcinosis/inmunología , Enfermedades de la Piel/inmunología , Artritis/inmunología , Enfermedades Autoinmunes/patología , Enfermedades Autoinmunes/fisiopatología , Calcinosis/patología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Miositis/inmunología , Fibrosis Pulmonar/inmunología , Enfermedades de la Piel/patología , SíndromeRESUMEN
We report on a high vena cava inferior interruption immediately at the insertion to the right atrium in a patient with Hirschsprung disease assessed by angiography, CT, and MRI. Hirschsprung disease is frequently associated with Down, Undine, Waardenburg, Bardet-Biedl, Smith-Lemli-Opitz and Goldberg-Sphrintzen syndromes. We suggest that the association of these two malformations are most likely interrelated and should be considered as a new syndrome.
Asunto(s)
Angiografía , Cardiopatías Congénitas/diagnóstico , Enfermedad de Hirschsprung/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Vena Cava Inferior/anomalías , Atrios Cardíacos/anomalías , Atrios Cardíacos/patología , Cardiopatías Congénitas/complicaciones , Enfermedad de Hirschsprung/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Vena Cava Inferior/patologíaRESUMEN
Pulmonary infarction and hemorrhage are important differential diagnoses in pulmonary coin lesions, especially in patients with underlying hematologic malignancies. We report a 58-year-old female patient suffering from polycythemia vera presenting with multiple pulmonary coin lesions. Open lung biopsy and subsequent histologic investigations showed organized pulmonary infarction and primary pulmonary thrombotic arteriopathy. Although histologic features are non-contributory in distinguishing organized thrombosis from organized thromboembolism, the clinical setting and localization of the lesions suggest that in the present case the vascular lesions are due to organized thrombosis.
Asunto(s)
Policitemia Vera/complicaciones , Arteria Pulmonar/patología , Embolia Pulmonar/etiología , Nódulo Pulmonar Solitario/etiología , Biopsia/métodos , Diagnóstico Diferencial , Femenino , Humanos , Pulmón/irrigación sanguínea , Pulmón/diagnóstico por imagen , Pulmón/patología , Persona de Mediana Edad , Policitemia Vera/patología , Embolia Pulmonar/diagnóstico , Nódulo Pulmonar Solitario/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The role of simultaneous adrenalectomy in combination with radical nephrectomy in the treatment for renal cell carcinoma (RCC) remains controversial. With nephron-sparing surgery being commonly applied, the indication for adrenalectomy has to be critically assessed. PATIENTS AND METHODS: In a retrospective analysis the outcome of 589 patients, who underwent ipsilateral adrenalectomy along with radical nephrectomy in the treatment for RCC between 1985 and 1997 at our institution, was evaluated. The mean follow-up time was 34 months (range 1-95). RESULTS: Histologically an ipsilateral adrenal metastasis was found in 19/589 patients (3.2%). 16/19 patients had >/= T3, 3/19 had T1 tumours. The average size of the primary tumours with adrenal metastasis was 7.8 cm (range 2.3-13) in diameter with no preferential primary tumour site within the kidney (6/19 upper, 4/19 middle and 9/19 lower third). Only 4/19 patients had suspect adrenal findings in preoperative diagnostics (ultrasound, CT scan). 6/19 (31.5%) patients with adrenal metastasis are alive without evidence of disease at a mean of 41 months (range 11-95) after surgery for RCC. CONCLUSIONS: The probability of adrenal metastasis correlates with primary tumour stage, but not with its location within the kidney. The preoperative diagnostics are not reliable concerning small adrenal metastases. We thus still recommend simultaneous adrenalectomy in those cases where radical nephrectomy in patients with RCC is indicated.
Asunto(s)
Adrenalectomía , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/epidemiología , Neoplasias de las Glándulas Suprarrenales/secundario , Adrenalectomía/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Femenino , Humanos , Incidencia , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Nefrectomía/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: Clinical evaluation of CT fluoroscopy and comparison with conventional CT guidance for monitoring of non-pulmonary percutaneous biopsy procedures. MATERIALS AND METHODS: 20 non-pulmonary CT-guided biopsy procedures were prospectively performed either with CT fluoroscopy or with conventional CT guidance. CT fluoroscopy was performed using 120 kV and 50, 70 or 90 mA at a frame-rate of three or six images per second. Number of punctures and biopsies, procedure times, radiation doses and histologic results were analyzed separately for conventional CT guidance and for CT fluoroscopy. RESULTS: With CT fluoroscopy, yield of biopsies was improved (p = 0.005, t-test) and procedure times were shorter than for conventional CT guidance (11.4 +/- 6.0 vs. 23.6 +/- 13.8 min; p = 0.03, t-test). Analysis of procedure related radiation exposure and histologic outcome showed no significant difference between conventional and fluoroscopic CT-guided procedures (p > 0.05, t-test). CONCLUSIONS: CT fluoroscopy facilitates guidance of percutaneous biopsy procedures. Compared to conventional CT assistance, procedure times are decreased while yield of biopsies is improved.
Asunto(s)
Biopsia con Aguja/instrumentación , Fluoroscopía/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Adulto , Anciano , Diagnóstico Diferencial , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/patología , Estudios Prospectivos , Dosis de Radiación , Sensibilidad y EspecificidadRESUMEN
Simple bone cysts are asymptomatic, benign lesions which are usually an incidental finding on a radiograph. Etiology and treatment are controversially discussed. The weight-bearing status of the calcaneus and possible pathologic fracturing lead many authors to recommend therapeutic measures after diagnosis has been made. We present a case report of an intact unicameral bone cyst of the calcaneus concomitant with tibial and talar fractures following crush trauma. Several types of treatment for simple bone cysts of the calcaneus have been suggested. The question whether treatment is unconditionally necessary is controversially discussed. It is the author's opinion, that asymptomatic bone cysts of the calcaneus require no further treatment.
Asunto(s)
Quistes Óseos/cirugía , Calcáneo/cirugía , Fracturas Óseas/cirugía , Astrágalo/lesiones , Fracturas de la Tibia/cirugía , Adulto , Quistes Óseos/diagnóstico por imagen , Calcáneo/diagnóstico por imagen , Fijación Interna de Fracturas , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Fracturas de la Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos XAsunto(s)
Drenaje/métodos , Fluoroscopía/métodos , Radiografía Intervencional , Tomografía Computarizada por Rayos X/métodos , Sistemas de Computación , Drenaje/instrumentación , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Radiografía Intervencional/instrumentación , Radiografía Intervencional/métodosRESUMEN
AIM: In patients with congenital dislocation of the hip the assessment of the correct position of the hip joint after closed or open reduction is very difficult to make from the radiograph with the hips in plaster. As the delayed recognition of a recurrent hip dislocation has bad effects on the outcome of the affected hip a safe and reliable imaging method must be employed. METHOD: From 1993 to 1996 6 patients with 8 congenital dislocations of the hip joint were examined by magnetic resonance imaging for evaluation of the position of the hip in plaster after reduction. Magnetic resonance imaging was performed immediately after closed or open reduction. 3 hips had to be treated by open surgery. RESULTS: The investigation confirmed that magnetic resonance imaging allows perfect differentiation between the bony and cartilaginous parts of the hip joint in plaster as well. Interpositioning of soft tissues which prevent reduction could also be visualized clearly. The best sequence in order to differentiate bony from cartilaginous structures was a gradient echo sequence in flash-technique using a flip-angle of 60 degrees. In all cases the correct position of the hip joint after reduction could be demonstrated in plaster. CONCLUSION: Therefore, magnetic resonance imaging is the imaging method of choice for confirmation and documentation of the reduced position of the hip joint in plaster. Radiographs are no longer needed.