RESUMEN
Epitheloid sarcoma is a rare malignant soft tissue sarcoma. We present a 36-year-old male patient with a primary tumour on his wrist and subcutaneous spread in a sporotrichoid pattern along the upper extremity. Early surgical treatment with micrographic control of all margins provides best long term outcome as long as a solitary lesion is present. In case of cutaneous and internal spread of the disease treatment options are only palliative. Early diagnosis, therefore, is most crucial.
RESUMEN
Penetrating gunshot injuries to the head and brain are rare in Germany and the rest of Western Europe. Due to the small number of cases over here no consistent diagnostic and therapeutic standards exist in this respect. Thus these kinds of injuries present a great challenge to the attending physicians. Most of these violations are a result of a suicidal attempt or an accident. Beside violations by firearms also penetrating injuries to the head and brain due to captive bolt devices, as used in slaughtery business for the "humane" killing of animals, occur from time to time. The impact on the head differs from that caused by firearms because no projectile is leaving the barrel and the used bolt, as a fix part of the device, does not remain in the affected tissue. That implies characteristic results within the radiological imaging that might be pathbreaking for the further treatment, because the origin of such a head injury is often unknown during primary care. Consequently the knowledge of these specific findings is central to the radiologist to make the appropriate diagnosis. Based on some clinical examples the trauma-related CT-findings are introduced and a short overview of the relevant literature is also given.
Asunto(s)
Lesiones por Armas Conductoras de Energía/diagnóstico por imagen , Traumatismos Penetrantes de la Cabeza/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Encéfalo/diagnóstico por imagen , Edema Encefálico/diagnóstico por imagen , Hemorragia Cerebral Traumática/diagnóstico por imagen , Diagnóstico Diferencial , Hematoma Subdural/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Intento de SuicidioAsunto(s)
Angiografía , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Músculo Esquelético/patología , Miositis/diagnóstico , Sarcoma/diagnóstico , Neoplasias de los Tejidos Blandos/diagnóstico , Tomografía Computarizada por Rayos X , Prótesis Vascular , Diagnóstico Diferencial , Arteria Femoral/cirugía , Oclusión de Injerto Vascular/diagnóstico , Oclusión de Injerto Vascular/cirugía , Humanos , Hallazgos Incidentales , Claudicación Intermitente/etiología , Masculino , Persona de Mediana EdadRESUMEN
Local catheter-directed thrombolysis for thromboembolic extremity artery or bypass occlusions is a promising therapeutic option with comparatively low complication rates if the severity of the ischemia does not require an urgent surgical revascularization. This therapeutic decision has to be made by the vascular team under consideration of individual circumstances and contraindications. Apart from an adequate dosage, a strict intrathrombotic application of the fibrinolytic agent and careful clinical monitoring, including surveillance of the coagulation system is necessary. If needed, the thrombolysis therapy can be combined with interventional thrombaspiration and balloon dilatation or surgical correction of an underlying lesion.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/tratamiento farmacológico , Extremidades/irrigación sanguínea , Extremidades/diagnóstico por imagen , Fibrinolíticos/administración & dosificación , Radiografía Intervencional/métodos , Terapia Trombolítica/métodos , HumanosRESUMEN
Computed tomography (CT) and magnetic resonance imaging (MRI) are emerging noninvasive techniques for imaging of the pancreas. Based on multislice technology, CT enables multiplanar imaging of the pancreas (multislice-CT, MSCT) with a high contrast between vessels and parenchyma. In addition, MRI of the pancreas including the imaging of the lumina of the biliary tree and the pancreatic duct (magnetic resonance cholangiopancreaticography, MRCP) and the abdominal vessels (MR angiography, MRA) has become available for daily clinical practice in most hospitals. The addition of multiplanar and curved reformations may increase the sensitivity of CT and improves its agreement with surgical findings. Beyond abdominal MR imaging, techniques such as magnetic resonance cholangiopancreaticography (MRCP) and MR angiography should be integrated in the imaging protocol whenever possible.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Neoplasias Pancreáticas/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Humanos , Neoplasias Pancreáticas/diagnóstico por imagenAsunto(s)
Histiocitosis Sinusal/diagnóstico , Imagen por Resonancia Magnética , Ultrasonografía , Biopsia , Niño , Diagnóstico Diferencial , Histiocitosis Sinusal/patología , Histiocitosis Sinusal/cirugía , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Enfermedades Linfáticas/diagnóstico , Enfermedades Linfáticas/patología , Enfermedades Linfáticas/cirugía , Masculino , Cuello/patología , Cuello/cirugíaRESUMEN
BACKGROUND: To investigate the role of N-terminal pro-BNP (NT-proBNP) for the estimation of right heart failure and pulmonary pressure in patients with atrial septal defects (ASD) before and after percutaneous defect closure. METHODS: We performed correlation analysis for NT-proBNP and right ventricular systolic pressure (RVSP) as well as right ventricular enddiastolic and endsystolic volume (RVEDV, RVESV) determined by cardiac magnetic resonance imaging (MRI) before and up to one year following ASD closure. Additionally NT-proBNP concentrations were correlated with right atrial (RA) and RV enddiastolic pressure (RVEDP), ASD size and interatrial left-to-right shunt. RESULTS: Baseline RVSP was 33+/-8 mmHg, which decreased significantly during follow-up. Initially, NT-proBNP levels were 240+/-93 pg/ml. After closure, a reduction to 116+/-62 pg/ml was obvious (p<0.01). Baseline MRI showed enlarged RV volumes in all individuals. At six and twelve months follow-up a significant reduction of RVEDV and RVESV was apparent. A positive correlation was noted between RV volumes and NT-proBNP (r=0.65, p<0.05). Furthermore RA pressure, RVEDP, RVSP and left-to-right shunt significantly correlated to peptide levels. No correlation was seen between ASD size and NT-proBNP. CONCLUSION: NT-proBNP correlates to right ventricular dilatation, pulmonary pressure and left-to-right shunt in volume load of the right heart caused by an underlying ASD.
Asunto(s)
Presión Sanguínea/fisiología , Volumen Cardíaco/fisiología , Insuficiencia Cardíaca/fisiopatología , Defectos del Tabique Interatrial/fisiopatología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Disfunción Ventricular Derecha/fisiopatología , Adulto , Función del Atrio Derecho/fisiología , Cateterismo Cardíaco , Diástole/fisiología , Ecocardiografía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/cirugía , Defectos del Tabique Interatrial/diagnóstico , Defectos del Tabique Interatrial/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Valores de Referencia , Estadística como Asunto , Sístole/fisiología , Disfunción Ventricular Derecha/diagnóstico , Disfunción Ventricular Derecha/cirugía , Función Ventricular Derecha/fisiologíaRESUMEN
Limping and groin pain can issue diagnostic problems during late pregnancy. Differential diagnosis of two idiopathic syndromes, transient osteoporosis and osteonecrosis of the femoral head, is made possible by MRI in the early stages. This case is reported to demonstrate the need to distinguish between those syndromes early so as to prevent further joint damage.
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Necrosis de la Cabeza Femoral/diagnóstico , Complicaciones del Embarazo/diagnóstico , Embarazo Múltiple , Trastornos Puerperales/diagnóstico , Adulto , Diagnóstico Precoz , Femenino , Cabeza Femoral/patología , Estudios de Seguimiento , Fracturas por Compresión/diagnóstico , Fracturas Espontáneas/diagnóstico , Fracturas de Cadera/diagnóstico , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Osteoporosis/diagnóstico , Embarazo , GemelosAsunto(s)
Angina de Pecho/etiología , Neoplasias Cardíacas/complicaciones , Linfoma no Hodgkin/complicaciones , Angina de Pecho/tratamiento farmacológico , Femenino , Neoplasias Cardíacas/diagnóstico , Humanos , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/tratamiento farmacológico , Imagen por Resonancia Magnética , Persona de Mediana Edad , Derrame Pericárdico/citología , Derrame Pericárdico/etiologíaRESUMEN
INTRODUCTION: Extracranial metastases of pineal germinomas are rare. CASE REPORT: The case of a metastasis of a primary intracranial germ cell tumor via a temporary-ventriculo-peritoneal shunt as a cause of acute abdominal pain is reported. The germ cell tumor markers were useful in establishing the diagnosis. CONCLUSIONS: With an appropriate clinical history, intra-abdominal metastases via a temporary ventriculo-peritoneal shunt should be considered in the differential diagnosis of acute abdominal pain.
Asunto(s)
Abdomen Agudo/etiología , Cólico/etiología , Hidrocefalia/cirugía , Enfermedades Renales/etiología , Siembra Neoplásica , Neoplasias Pélvicas/secundario , Pinealoma/diagnóstico , Pinealoma/secundario , Derivación Ventriculoperitoneal/instrumentación , Adulto , Diagnóstico Diferencial , Humanos , Hidronefrosis/diagnóstico , Hidronefrosis/etiología , Imagen por Resonancia Magnética , Masculino , Neoplasias Pélvicas/diagnóstico , Reoperación , Obstrucción Ureteral/diagnóstico , Obstrucción Ureteral/etiologíaRESUMEN
OBJECTIVE: To characterise prospectively by magnetic resonance imaging (MRI) changes in right ventricular (RV) volume, function, and mass after transcatheter closure of atrial septal defects (ASDs) and to evaluate the course of pulmonary pressure and functional class criteria. METHODS: In 20 patients with secundum-type ASD and dilated RV diameter, MRI was performed to quantify RV end diastolic (RVEDV) and end systolic volumes (RVESV), RV mass, tricuspid annular diameter, and RV ejection fraction before and 6 and 12 months after transcatheter closure of the ASD. RV systolic pressure was measured during follow up by transthoracic echocardiography. RESULTS: Functional class improved in the majority of patients after ASD closure. RVESV (from 81 (18) ml/m2 to 53 (15) ml/m2, p < 0.001), RVEDV (from 127 (17) ml/m2 to 99 (18) ml/m2, p < 0.001), and RV mass (from 79 (10) g to 63 (8) g, p < 0.01) decreased significantly during follow up, although tricuspid annular diameter did not. RV ejection fraction improved (by 9% compared with baseline, p < 0.05) and RV systolic pressure decreased significantly (from 33 (8) mm Hg to 24 (6) mm Hg, p < 0.001) after closure. CONCLUSION: MRI studies showed significant improvement of RV volumes, mass, and function after transcatheter closure of ASDs. Restoration of the RV leads to decreased pulmonary pressure resulting in a better functional class in the majority of patients.
Asunto(s)
Cateterismo Cardíaco/métodos , Defectos del Tabique Interatrial/terapia , Adulto , Oclusión con Balón/instrumentación , Oclusión con Balón/métodos , Presión Sanguínea/fisiología , Cateterismo Cardíaco/instrumentación , Ecocardiografía , Femenino , Defectos del Tabique Interatrial/fisiopatología , Humanos , Angiografía por Resonancia Magnética , Masculino , Estudios Prospectivos , Volumen Sistólico/fisiología , Ultrasonografía IntervencionalRESUMEN
Thanks to the potency of antibiotics, life-threatening complications of otitis media are rare. In many cases, however, the symptomatology is veiled, and the course of the disease tends to be protracted. Secondary symptoms may preponderate and often mask those associated with the ear itself. If a case of otitis media fails to clear up, or mastoiditis develops, or sensorineural deafness, vertigo, headaches, seizures, or meningism occur, the possibility of an otogenous complication must immediately be considered and the patient submitted to diagnostic imaging without delay, so as to ensure early surgical treatment of a possible lesion in the ear.
Asunto(s)
Sordera/etiología , Encefalitis/etiología , Mastoiditis/complicaciones , Meningismo/etiología , Otitis Media/complicaciones , Enfermedad Aguda , Adulto , Antibacterianos/uso terapéutico , Niño , Diagnóstico Diferencial , Encefalitis/diagnóstico , Femenino , Estudios de Seguimiento , Cefalea/etiología , Humanos , Lactante , Trombosis del Seno Lateral/complicaciones , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Mastoiditis/diagnóstico , Persona de Mediana Edad , Otitis Media/diagnóstico , Otitis Media/tratamiento farmacológico , Otitis Media/cirugía , Embarazo , Complicaciones del Embarazo , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
A total of 50 unrelated marrow donors were examined by pelvic magnetic resonance imaging (MRI) to investigate the morphological sequelae of bone marrow harvesting (BMH). Signal increase in T2-weighted sequences and contrast media enhancement in T1 sequences at the operative sites were found as typical MRI morphology 4 weeks after harvest (group A, n=16), corresponding to edema, hyperemia and proliferative activity. Although tissue repair was completed in the majority of donors 1 year after BMH, about 36% of donors in group B (n=16) had abnormal findings. These included a persistence of the 'acute injury' signal pattern (2/16, 12%), and signal alterations due to fatty marrow conversion (4/16, 24%). The proportion of MRI abnormalities increased to over 70% in two-time donors (group C, n=11), which might indicate a cumulation of tissue damage after repetitive harvests. If donors had experienced prolonged discomfort after BMH (group D, n=7), MRI revealed pathological signals in 86%. In conclusion, the MRI morphology reflects the pathophysiological reactions after BMH, including inflammation and tissue repair. A further prospective evaluation in a larger number of donors is necessary to confirm these results and to identify the factors which influence the extent and duration of tissue damage.
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Trasplante de Médula Ósea/efectos adversos , Médula Ósea/patología , Imagen por Resonancia Magnética/métodos , Pelvis , Donantes de Tejidos , Adulto , Médula Ósea/lesiones , Femenino , Humanos , Inflamación/etiología , Masculino , Persona de Mediana Edad , Dolor/etiología , Estudios Retrospectivos , Cicatrización de HeridasRESUMEN
Clinically manifest hyperthyroidism is a rare paraneoplastic syndrome in patients with excessive HCG production due to testicular cancer. A 40-year-old patient with right testicular cancer (teratoma, embryonal cell carcinoma), diffuse pulmonary metastases and high serum HCG levels presented with symptomatic hyperthyroidism. The patient received immediately thyrostatic therapy and 4 cycles of PEI chemotherapy (Cisplatin, Etoposide, Ifosfamide). Thyroid function had returned to normal by the beginning of the second course of chemotherapy. After right orchiectomy and resection of residual pulmonary masses which revealed vital tumor cells, two additional courses of chemotherapy were performed. The patient is well and without evidence of disease 11 months after therapy. All patients with testicular cancer and excessive HCG production should be evaluated for biochemical and clinical signs of hyperthyroidism and treated accordingly with antithyroidal medication and immediate cytoreductive chemotherapy.
Asunto(s)
Gonadotropina Coriónica/sangre , Hipertiroidismo/diagnóstico , Neoplasias Pulmonares/secundario , Síndromes Paraneoplásicos/diagnóstico , Teratocarcinoma/secundario , Neoplasias Testiculares/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antitiroideos/uso terapéutico , Terapia Combinada , Humanos , Hipertiroidismo/tratamiento farmacológico , Hipertiroidismo/cirugía , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Metástasis Linfática , Masculino , Terapia Neoadyuvante , Orquiectomía , Síndromes Paraneoplásicos/tratamiento farmacológico , Síndromes Paraneoplásicos/cirugía , Neumonectomía , Teratocarcinoma/diagnóstico , Teratocarcinoma/tratamiento farmacológico , Teratocarcinoma/cirugía , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: The aim of this prospective study was to determine the role of diffusion-weighted MR imaging combined with conventional MR imaging for the detection of residual or recurrent cholesteatoma in patients who have undergone middle ear surgery. SUBJECTS AND METHODS: Twenty-two patients who had undergone resection of cholesteatoma were referred for MR imaging. MR imaging (1.5 T) was performed using a diffusion-weighted single-shot spin-echo echoplanar sequence, a proton density and T2-weighted double-echo turbo spin-echo sequence, and T1-weighted spin-echo sequences before and after IV injection of gadopentetate dimeglumine (0.1 mmol/kg of body weight). An experienced reviewer evaluated the diffusion-weighted MR images for the presence of a high-signal-intensity cholesteatoma. Imaging findings were correlated with findings from surgery in 17 patients and with findings from clinical follow-up examination in five patients. RESULTS: Diffusion-weighted MR imaging combined with conventional MR imaging depicted 10 of 13 cholesteatomas (sensitivity, 77%). The three lesions that were missed were smaller than 5 mm. All the MR images of patients without cholesteatoma were correctly interpreted as showing negative findings for cholesteatoma (specificity, 100%). The positive predictive value and negative predictive value were 100% and 75%, respectively. CONCLUSION: Diffusion-weighted MR imaging combined with conventional MR imaging can confirm residual or recurrent cholesteatoma in patients who have undergone middle ear surgery by showing a high-signal-intensity lesion. Because tumors smaller than 5 mm may be missed, a diffusion-weighted MR imaging study with negative findings does not exclude small residual or recurrent cholesteatoma.
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Colesteatoma del Oído Medio/patología , Colesteatoma del Oído Medio/cirugía , Imagen de Difusión por Resonancia Magnética , Adulto , Anciano , Niño , Medios de Contraste , Femenino , Gadolinio DTPA , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recurrencia , Sensibilidad y EspecificidadRESUMEN
AIM: In MR perfusion measurements of contrast uptaking lesions, time intensity curves are hampered by T 1 shortening as well as by the change of T 2 * due to interstitial contrast material (CM). Using double echo sequences, the influence of T 1 can be mathematically eliminated. For correction of the T 2 * influence an empirical algorithm using time-intensity-curves exclusively measured in the suspected lesion is proposed. METHODS: The interstitial CM concentration is assumed to be proportional to the change of the intensity for T E = 0 or to the change of the relaxation rate DeltaR 1 respectively. The intravascular CM concentration is estimated from DeltaR 2 *. It is adjusted to zero for a time point sufficiently late after the bolus injection by subtraction of the interstitial concentration. This method was applied to double echo FLASH measurements on 15 pharyngeal tumors. RESULTS: The proposed correction transforms the time dependence of the estimated intravascular CM concentration into a plausible course. CONCLUSION: Double echo perfusion measurements can be corrected for the interstitial CM induced T 2 * shortening without additional measurements with proneness to errors. This does not necessarily improve the diagnostic value, since possibly "implied multivariate aspects" of uncorrected parameters (here: contrast uptake of the lesion is related to tumor neoangiogenesis as well) are eliminated.
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Carcinoma de Células Escamosas/diagnóstico , Medios de Contraste/farmacocinética , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Neoplasias Faríngeas/diagnóstico , Algoritmos , Artefactos , Carcinoma de Células Escamosas/irrigación sanguínea , Carcinoma de Células Escamosas/radioterapia , Humanos , Procesamiento de Imagen Asistido por Computador , Microcirculación/fisiopatología , Neovascularización Patológica/diagnóstico , Consumo de Oxígeno/fisiología , Consumo de Oxígeno/efectos de la radiación , Neoplasias Faríngeas/irrigación sanguínea , Neoplasias Faríngeas/radioterapia , Sensibilidad y EspecificidadAsunto(s)
Cerebelo/anomalías , Fosa Craneal Posterior/anomalías , Imagen por Resonancia Magnética , Rombencéfalo/anomalías , Cerebelo/patología , Ventrículos Cerebrales/anomalías , Ventrículos Cerebrales/patología , Derivaciones del Líquido Cefalorraquídeo , Preescolar , Fosa Craneal Posterior/patología , Imagen Eco-Planar , Femenino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirugía , Complicaciones Posoperatorias/diagnóstico , Reoperación , Rombencéfalo/patologíaRESUMEN
A 69-year-old man was referred to our department with an exorbitant foetor ex ore, dysphagia and dyspepsia. Upper endoscopy had been performed prior by an outpatient gastroenterologist and the patient had received an eradication therapy for a Helicobacter pylori-induced gastritis. At admission upper endoscopy showed a gastric ulcer which drained a stinking fluid. Endosonography, computed tomography and an upper gastrointestinal series with water soluble media revealed a gastrocolic fistula. Multiple biopsies showed a low-grade gastric MALT lymphoma. Therefore, a surgical reconstruction with Roux-en-Y esophagojejunostomy and transverso-descendostomy was performed. The histology of the completely removed stomach revealed a high-grade Non Hodgkin Lymphoma (NHL) with parts of a low-grade NHL. 3 weeks after surgery chemotherapy was started with the CHOP-regime which was well-tolerated by the patient.