Differential diagnosis of intracranial ring enhancing cystic mass lesions--role of diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI).

Objective: To evaluate the contribution of DWI and DTI to the differential diagnosis of cerebral ring enhancing lesions by describing DWI and ADC (apparent diffusion coefficient) findings and measuring the two DTI parameters mean diffusivity (MD) and fractional anisotropy (FA).

Materials And Methods: A total of 17 patients presenting with 26 rim enhancing cysts were investigated with DWI and DTI. Parameter maps of the DTI metrics MD and FA were calculated and quantified using regions of interest (ROIs).

Diffusion-weighted MR imaging improves diagnosis of CNS lymphomas. A report of four cases with common and uncommon imaging features.

The frequency of CNS lymphomas is increasing in immunocompetent as well as in immunocompromised patients and its incidence accounts for approximately 1-2% of all primary cerebral neoplasms. It is a challenge to recognize CNS lymphomas by MR imaging as early as possible in order to dispose an optimal therapy. The aim of this report is to demonstrate, how diffusion-weighted MR imaging improves the accuracy of the differential diagnosis of CNS lymphomas.

[Regional lung edema in acute mitral valve insufficiency following chordae tendineae rupture with prolapse of the posterior mitral valve leaflet].

An unilateral or predominantly lobar pulmonary edema is an unusual clinical or radiological finding, often misdiagnosed as one of the more common causes of focal lung disease. We report 2 cases of a regional pulmonary edema caused by the acute onset of a severe mitral insufficiency after the rupture of chordae tendinae resulting in a prolaps of the posterior mitral leaflet. In both cases the regional pulmonary edema was initially misdiagnosed as a pneumonic infiltration, which delayed the cardiological diagnostical procedures and the surgical intervention.

[Acute myocardial infarct in pheochromocytoma crisis. Early coronary angiography findings and echocardiography follow-up].

A myocardial infarction is a rare complication of a pheochromocytoma. A pheochromo-cytoma crisis may occur spontaneously, during pregnancy, or may be induced by a local trauma of the tumor or by drugs. We present a case report of a 41-year-old woman without anamnestic episodes of hypertension or angina pectoris.

[Ileus of the small intestine as sequela of intraduodenal diverticulum. Contribution of roentgen diagnosis to pathophysiology of diverticulum formation].

The case of a 31-year-old male is reported who had recurrent, unexplained abdominal complaints. After hospitalization, an ileus was localized by plain abdominal film in the ileocecal region. A contrast meal revealed a typical intraluminal (duodenal) diverticulum with an enlarged prestenotic duodenum that was undetected during endoscopy.

Effect of local low-dose thrombolysis on clinical outcome in acute embolic renal artery occlusion.

Purpose: To determine the utility of local thrombolysis in treatment of acute embolic renal artery occlusion.

Materials And Methods: Fourteen patients with acute embolic renal artery occlusion treated with local low-dose thrombolysis were studied. Diagnosis was made with renal scintigraphy and selective renal arteriography.

[The development and x-ray morphology of amiodarone pneumopathy].

Besides general extracardiac physical side effects, the antiarrhythmic amiodarone hydrochloride gives rise to morphologically manifest organ changes. Pneumopathy has been reported in up to 8% of the patients treated with this preparation. Radiologically and histologically, the clinical picture can resemble that of exogenous allergic alveolitis.

Scintigraphic assessment of bowel involvement and disease activity in Crohn's disease using technetium 99m-hexamethyl propylene amine oxine as leukocyte label.

Using a novel labeling technique with technetium 99m-hexamethyl propylene amine oxine, we studied 29 patients with known or suspected Crohn's disease. Technetium 99m-hexamethyl propylene amine oxine leukocyte scanning (99mTc scan) was prospectively compared with the results of independently performed radiologic, endoscopic, and histologic examinations, and with findings at surgery, to assess the clinical usefulness of this technique to localize inflammatory lesions. In addition, uptake of technetium 99m-hexamethyl propylene amine oxine in the bowel was graded by comparing it with the uptake in liver and bone marrow and correlating this with established parameters of disease activity.

Extraction of an intracardial catheter embolus using combined radiography and transesophageal echocardiography.

Embolism of a fragment of a central venous catheter is a serious clinical complication, especially when the fragment cannot be made visible by radiological methods. We report a case where such a fragment could only be localized by transesophageal echocardiography (TEE). With combined use of x-rays and TEE, the catheter embolus was successfully extracted using a conventional Dormia catheter.

[Nuclear magnetic resonance tomography of the sacroiliac joint. A new examination technic in the differential diagnosis of rheumatic diseases of the lumbosacral transition].

25 patients with the clinical diagnoses of possible sacroiliitis were investigated by Magnetic Resonance Tomography (MR). Using axial or coronal tomography in a T1-weighted sequence (7 slices, 1 echo, NEX: 2, slice thickness 8 mm, TR: 600 ms, TE: 33 ms) and in a T2-weighted sequence (7 slices, 4 echos, NEX: 2, slice thickness 8 mm, TR: 1800 ms, TE: 33, 66, 99, 132 ms) we found normal sacroiliac joints in 10 patients, in 12 patients we diagnosed a sacroiliitis, in 3 patients a sacroiliac sclerosis. Descriptive evaluation and T2-calculation we showed, that MR is specific in differentiation of inflammation from sclerosis.

A case of pneumonia caused by Legionella pneumophila serogroup 8 in West Germany. Etiological diagnosis by immunofluorescence, enzyme immunoassay, and immunoblot.

The severe and complicated course of a Legionella pneumonia in an 18-year-old female patient is reported. The serogroup 8 of Legionella pneumophila was identified as the infecting agent for the first time in West Germany. The etiological diagnosis was confirmed by immunofluorescence, enzyme immunoassay, and immunoblot.

[Diagnosis of thoracic aortic aneurysms and dissections using transesophageal echocardiography].

Transesophageal echocardiography was performed in 25 patients with the clinical suspicion of an aneurysm or dissection of the thoracic aorta. The results obtained were compared to those of conventional transthoracic echocardiography. An aortic dissection was found in 11 patients, an aortic aneurysm in 9 patients, and an aneurysm of the left subclavian artery, an abscess of the aortic ring and a perforated aortic sinus in one patient each.

[Local fibrinolytic therapy in thrombotic complications of peritoneovenous shunt].

Since 1981 in the University Hospital of Freiburg 41 patients with ascites have been treated by installation of a peritoneo-venous shunt system. In 9 patients thrombotic complications occurred. Two patients had to undergo a second surgical treatment.

Non-surgical biliary drainage: endoscopic conversion of percutaneous transhepatic into endoprosthetic drainage.

Percutaneous transhepatic drainage (PTD) is associated with many long-term complications. Therefore a large-diameter endoscopic endoprosthesis is preferentially employed to bridge a malignant obstruction of the biliary tract. Only if the placement of an endoprosthesis fails, must PTD be established.

[Spontaneous pneumoperitoneum in progressive systemic sclerosis (generalized scleroderma)].

In a twenty-nine year old female patient with progressive systemic sclerosis (scleroderma) (PSS) and an impressing involvement of the intestine (disturbance of the oesophageal motility, pseudo-obstruction, malabsorption) a spontaneous, asymptomatic pneumoperitoneum is observed. Perforation or pneumatosis cystoides intestinalis (PCI) could not be proved. The possible pathogenesis, course, prognosis and therapy of this rare complication are discussed.

[Changes in the esophageal wall following sclerotherapy of varices--roentgen morphology and therapy].

Endoscopic sclerotherapy of esophageal varices is a widely used procedure. It reduces the frequency of rebleeding and improves the survival of cirrhotics with portal hypertension. The intravariceal or paravariceal injection of sclerosing agents causes structural changes of the esophageal wall recognisable radiologically.

[Peritoneovenous shunt in ascites therapy. Complications and their treatment].

Complications occurred in 29 of 37 patients after ascites retransfusion (n = 16) or introduction of a peritoneovenous shunt (n = 21). Blood clotting disturbances, that could either be successfully treated with drugs or which led to interruption of the reinfusion, appeared in 38%. Estimation of plasminogen proved to be of reliable prognostic value thus enabling prophylactic measures to be taken.

[Benign and malignant tumors of the thoracic skeleton after percutaneous radiotherapy of Hodgkin's and non-Hodgkin's lymphomas].

Disorders of the skeleton in the thoracic area after percutaneous irradiation of malignant lymphomas are relatively rare. The most common site for pathologic changes is the clavicula. Local overdosage and, in case of malignant alterations, an additional chemotherapy might be the reasons.

[Hemorrhage into a liver adenoma associated with long-term use of oral contraceptives].

A 39-year-old woman was evaluated for acute midepigastric pain. The patient was never severely ill; her only medication was an oral contraceptive (OC) which she took regularly over the last 12 years. Abdominal ultrasonography and computed tomography revealed bleeding into a liver tumor.

[Bile duct endoprostheses. Insertion using a combined endoscopic-radiologic technic].

Percutaneous transhepatic biliary drainage is a proven method for treating obstructive jaundice due to malignancy. However, the rate of complications for primary internal drainage is relatively high. Consequently, various types of biliary endoprostheses which can be introduced transhepatically or endoscopically have been developed.