[Bullet embolism in the right pulmonary artery]. / Projektilembolus in der rechten Pulmonalarterie.

We report about a bullet embolus in the middle lobe pulmonary artery (a patient who was sent for a routine-chest-film preoperatively). The patient, 74 years old, was hit by a bullet in localization of the left masseteric region during world war II. The bullet entered the left Vena jugularis and was embolised into the middle lobe pulmonary artery (shock-position). By the means of CT-curved-reformations we could localize the bullet (2 x 0.7 cm) in the middle lobe pulmonary artery and diagnosed a lobar fibrosis as a sequel of the focal hypoxemia.

Ultrasonography in the initial evaluation and follow-up of blunt abdominal injury.

BACKGROUND: Ultrasonography has been routinely performed in the assessment of blunt abdominal injury at our department of surgery since 1980. To establish its reliability, a retrospective study was carried out on 818 consecutive patients in the years 1980 to 1990. METHODS: Seven hundred twenty six patients underwent real-time ultrasonographic examination of the abdomen. Indication for ultrasonography included all cases evaluated for blunt abdominal trauma. Ninety two patients before 1985 were excluded. RESULTS: Two hundred seventy (37.2%) patients underwent laparotomy, 252 patients (34.7%) because of ultrasonographic diagnosis. Celiotomy was nontherapeutic in 28 patients; 26 of these patients had positive findings from ultrasonography (false positive, 3.6%). Eighteen patients with negative findings from ultrasonography also underwent laparotomy, which was nontherapeutic in two patients (false negative, 2.2%). Four hundred fifty six patients (62.8%) were managed without operation, relying on initial and follow-up ultrasonography, which was negative in 386 (53.2%) and positive in 70 patients (9.6%). The accuracy of ultrasonography was 94.2%, with 91.9% sensitivity, 96.0% specificity, and 94.9% predictive value. The rate of delayed recognition of documented visceral injury was 5.1%, but no false-negative findings from ultrasonography were noted among these patients. CONCLUSIONS: Ultrasonography has proved to be a thoroughly reliable, cost efficient, and noninvasive modality in primary evaluation and follow-up of blunt abdominal trauma.

Incarcerated bariolith of the cecum eight months after a barium meal.

Barioliths consist of inspissated barium mixed with feces. They are a rare complication after barium contrast roentgenography and occur almost exclusively in the large bowel. Mostly asymptomatic or causing only slight symptoms and signs, they may persist for months or years. We report a severe case of cecal bariolith. Clinical symptoms and signs, radiological findings, intraoperative findings, and histology are presented and discussed with reference to the literature.

[A two-stage kidney rupture following an intrarenal kidney cystic lesion]. / Zweizeitige Nierenruptur nach intrarenaler Nierenzystenläsion.

Five days after a blunt trauma with intrarenal rupture of a renal cyst, whereby temporarily a calyceal communication had formed, there was a spontaneous second rupture of the cyst with excessive retroperitoneal haemorrhage. Surgical treatment was necessary and could be accomplished without nephrectomy. Both an arterial bleeding at the bottom of the cyst and a several days' old renal infarction at the edge of the cyst seemed to be relevant for the two-stage rupture. The sonographic, urographic and surgical findings are reported.

[The effect of sonography on the therapeutic outcome in posttraumatic, postoperative and inflammatory soft tissue lesions]. / Einfluss der Sonographie auf das therapeutische Vorgehen bei posttraumatischen, postoperativen und entzündlichen Weichteilläsionen.

A total of 135 patients with a suspected diagnosis of post-traumatic, postoperative or inflammatory soft-tissue lesions were examined by ultrasound. The majority of patients (n = 48) showed post-traumatic soft-tissue hematomas with or without muscle rupture. Post-operative hematomas were found in 23 and hematomas after anticoagulation therapy in 4 patients. Inflammatory soft-tissue lesions were diagnosed in 14 patients and inflammatory tendon lesions in 16. The ultrasonographic diagnoses and therapeutic consequences were compared retrospectively. Therapeutic management was based upon the clinical signs and sonographic findings. Ultrasonically guided needle aspiration is of diagnostic value and is performed as a therapeutic modality as well.

[Computerized tomography diagnosis of cavernous thymus hemangioma and differentiation from other mediastinal hemangiomas]. / Computertomographische Diagnose eines kavernösen Thymushämangioms und seine Abgrenzbarkeit gegen andere mediastinale Hämangiome.

A case of cavernous haemangioma of the thymus is reported, including the findings of conventional X-ray imaging, computed tomography, surgery and histology. In addition, the literature of thymic angiomatous mesenchymomas as well as of mediastinal haemangiomas is reviewed. The tumour of a 29-year old and asymptomatic woman was located in the anterior mediastinal compartment at the site of the left thymic lobe. The tumour contained phleboliths and was surrounded by a small capsule of fat. After bolus infusion of contrast agent a delay of enhancement could be detected by CT, which led to the diagnosis. Due to the fact that the status of thymic tumours must assessed with special care, operation and histologic investigation were required. Thymic haemangiomas in contrast to other mediastinal haemangiomas are most amenable to surgical treatment. One year after surgery the patient is still in good health without evidence of tumour regrowth.

[Injuries of the intracranial arteries in the angiogram]. / Verletzungen intrakranieller Arterien im Angiogramm.

Damage to intracranial arteries was demonstrated angiographically in 24 patients with severe trauma to the skull and brain. The most common abnormalities were damage to the intima and traumatic carotid-cavernous fistulae (nine cases each). In addition, there were six traumatic aneurysms of the internal carotid artery, two extravasates from ruptured intracranial branches and one traumatic A-V fistula between the middle meningeal artery and the spheno-parietal sinus. The arterial damage was diagnosed either during the acute stage or after a latent period of days and weeks, if there were signs of intracranial bleeding or other evidence of vascular damage. Cerebral angiography in two or more projections is the method of choice for demonstrating even minor vascular lesions.

[The value of seminal vesicle sonography in transrectal ultrasonic examination of the prostate]. / Die Wertigkeit der Samenbläschensonographie bei transrektalen Ultraschalluntersuchungen der Prostata.

During the course of four and a half years, transrectal sonography was performed in 724 men; in each case the seminal vesicles and prostate were evaluated. In 149 examinations, changes were found in the seminal vesicles and in 143 of these, the sonographic finding suggested that the changes were due to prostatic disease. In 95 histologically proven prostatic carcinomas, infiltration of the seminal vesicles could be demonstrated. In three patients there was an empyema and in three others a malformation of the seminal vesicles. Prostatic sonography is essential for accurate diagnosis of the basic abnormality.

[Improvement in the informativeness of diuretic kidney function scintigraphy by calculation of a washout index]. / Verbesserung der Aussagekraft der Diuresenierenfunktionsszintigraphie durch Berechnung eines Auswaschindexes.

Diuresis renography after administration of 123I-(131I-)Hippuran of 248 patients (492 kidneys) were compared retrospectively with clinical findings, history, i.v. urography, and ultrasound examinations. A new wash-out-index was calculated. In cases with obstructive dilatation of the collecting system this index was smaller than 0.9. If it was 0.9 to 1.2 additional diagnostic procedures seem necessary. An index more then 1.4 excludes obstruction. The shape of the renogram curve after furosemide is important for the diagnosis too. A concave shape was found in non-obstructive dilatation, a convex shape in obstructive dilatation of the renal pelvis. The wash-out-index is a reliable parameter if cases with reflux, lower ureteral obstruction and shrunken kidneys are excluded.