[The task of the radiologist in the diagnosis and differential diagnosis of acute appendicitis].
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Acute Disease↗
Biomedical subjects
D Beyer
Publications and source records attributed to D Beyer.
[Radiologic diagnosis of maxillary sinus aspergillosis].
Aspergillosis of the maxillary sinuses shows an increasing incidence in even otherwise healthy patients. Next to inhalation as the mode of infection, a dental root canal filling with an orosinusal fistula can be the cause. As most infections remain initially undetected or underestimated as common sinusitis, early diagnosis must be achieved. Standard X-ray of the paranasal sinuses, conventional tomography as well as CT scans are of major importance. Centrally located hyperdense opacifications are a good criterion and can be best seen in CT. Even when the case has not progressed too much, radical surgery combined with Amphotericin B therapy is still the treatment of choice since the infection may progress rapidly.
Adult↗
[Acute adverse effects and complications of central venous digital subtraction angiography (DSA). Results of 2,600 studies].
Side-effects and complications from 2,600 intravenous digital-subtraction-angiographies (IV-DSA) are reported. All studies were performed in a standardized technique using a non-ionic contrast agent (Iopromid 370 mg J/ml). Side-effects or complications were noted in 2.5% of all IV-DSA. Most often nausea (0.92%), urticaria (0.5%), angina pectoris (0.5%) and symptomatic alterations of blood-pressure (0.27%) were recorded. 8.4% of all reactions occurred with a delay of at least one hour. All side-effects and complications resolved, partly under symptomatic therapy. In one (0.04%) out of 2,600 studies a severe allergoid reaction occurred, affording intensive-care therapy. With proper patient selection and a suitable technique, IV-DSA may be regarded--within the angiographic methods--as a procedure of relatively low risk.
Aged↗
[Complications following percutaneous transluminal angioplasty].
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Aortic Dissection↗
[Complications after percutaneous transluminal angioplasty and vascular surgery].
Percutaneous transluminal angioplasty (PTA) is an accepted technique in the treatment of occlusive vascular disease. We report complications associated with balloon catheter dilatation and their treatment in the period from 1. 1. 1986 to 31. 3. 1990. Complications were found at the site of dilatation and the site of insertion of the catheter, mostly in the pelvic and femoral region. Surgical correction was successful in all patients, however three patients died postoperatively of acute myocardial ischemia. To avoid these complications close co-operation between the radiologist performing the dilatation and the vascular surgeon managing the complications should be assured.
Aged↗
Empyema after pneumonectomy--empyema window or thoracoplasty?
369 pneumonectomies carried out within the years 1981 to 1988 and their empyema complications form the basis for a retrospective analysis to assess the outcome of treating pneumonectomy cavity empyema by window healing. During the same period 31 empyema after 322 pneumonectomies to treat bronchial carcinoma are investigated in more detail as far as their therapeutic modalities are concerned. 20 patients received a thoracic window. 18 of 31 patients (58%) could be cured, and 9 of these were in the thoracic window group. The hospital mortality of empyema patients after pneumonectomy amounted to 42%. In an historical comparison no progress could be recognized in the treatment of this septic complication.
Bronchial Fistula↗
[Sonography in suspected appendicitis: a decisive factor in diagnosis and therapy? Results of a prospective study of 669 patients].
The appendectomy-rate in the Federal Republic of Germany is decreasing. German surgeons have begun to refuse appendectomy if there are no signs of acute inflammation. Preoperative assessment of patients with right lower quadrant pain has acquired new significance. The authors report on 2 years of experience with routine use of high-resolution ultrasonography in 669 cases of suspected acute appendicitis. Only 101 patients (= 15.1%) turned out to be suffering from acute appendicitis. Ultrasonography evaluation was found to have a sensitivity of 84.2%, a specificity of 96.8% and an overall accuracy of 94.9%. Ultrasonography was also useful in detecting mimicking diseases of acute appendicitis. Sonography should help to rule out severe disease in the frequent cases of functional abdominal pain.
Acute Disease↗
Digital subtraction angiography: the intravenous approach.
With further improvement of digital subtraction angiography (DSA) equipment, and the development of sophisticated soft-ware programs, the intravenous approach again has become an promising diagnostic alternative in certain clinical settings, if the patient's cardiac output is not severely diminished. In many cases an additional arterial study is not necessary. The diagnostic results, advantages and limitations of the intravenous approach in imaging the brachiocephalic, renal and peripheral vessels are discussed.
Angiography↗
[X-ray diagnosis of colorectal carcinoma today--a determination of where we stand].
Long-term prognosis of this malignant and frequent disease can be improved only by early diagnosis of small polyps and of carcinomas in the early stage. It is necessary to coordinate high-quality colon contrast medium enemas (double-contrast method) and hypotension with coloscopy and endoscopic removal of polyps. If a colon carcinoma is identified, it is additionally also necessary--probably mostly by colon enema--to exclude preoperatively a metachronous second carcinoma which can be expected in about 5% of the cases. Ultrasound and computed tomography will help in visualising advanced carcinomas that have already passed the wall and are borderline cases in respect of operability, as well as in identifying lymph node and liver metastases, besides in identifying complicating local perforations. Proof, however, is only rendered by a positive finding. It will be necessary to determine at what extent magnetic resonance can be useful in this context.
Colonic Neoplasms↗
Abdominal and thoracic coarctation of the aorta with bilateral renal artery stenosis.
A case of a young patient with mild coarctation of the thoracic and abdominal aorta associated with bilateral renal arterial stenosis is reported. The only clinical finding was hypertension. Surgical treatment with bilateral aortorenal venous bypass was successful.
Adolescent↗
[Value of magnetic resonance tomography prior to surgery and irradiation of peripheral soft tissue tumors].
The experience with magnetic resonance imaging (MRI) of 37 patients with peripheral soft tissue tumours and tumour-like lesions is reported. MRI proved to be a highly sensitive method in detecting soft tissue tumours. The main advantages of MRI compared to CT were the high contrast resolution of MRI and the multiplanar display. The anatomic setting of the soft parts tumour could be defined in most cases as either intracompartmental or extracompartmental. The relationship to the major neurovascular bundles and bone could be assessed accurately. Tumour-induced subtle periosteal reactions and cortical erosions are better defined with CT and plain film, especially. An imaging technique using small excitation angles, echoes produced by gradient inversion and extremely fast repetition times ("Fast Field Echo Imaging") is capable of producing MR images in only a few seconds acquisition time. Preliminary experience shows that soft tissue tumours can be evaluated with this rapid pulse sequence.
Chondroma↗
[MR of the shoulder joint with surface coils at 1.5 tesla. Its anatomy and possible clinical use].
High spatial resolution magnetic resonance images of the shoulder were obtained in axial, sagittal and coronal orientations using a 1.5 T imaging system and anatomically shaped, wrap-around surface coils. Variations in scapular position induced by patient positioning change the relationship of the planes to the shoulder anatomy and make reproducibility of sagittal and coronal planes difficult. We, therefore, use--after axial orientation--image-oblique planes perpendicular and parallel to the glenoid fossa. In this manner MRI can visualise the anatomic structures of the shoulder including rotator cuff, long biceps tendon, articular capsule, articular cartilage, muscles and bones due to the high soft tissue contrast of MRI.
Humans↗
[DSA for the imaging of tumor-caused vascular changes and complications during local chemotherapy of the liver via the portal system].
In 18 patients with primary or secondary liver tumours, 38 digital subtraction angiographies (DSA) of totally implanted catheter systems for liver perfusion were performed during a period of 8 months. The systems had been used for an average of 6.9 months. In 22 out of 38 examinations secondary reactions of liver arteries were observed, in 7 the therapeutic regimen was changed after DSA. Patients with an extensive tumour involvement of the liver showed mural thromboses or obstructions of liver arteries relatively more often (4 of 7) than patients with smaller size tumours (2 of 11). In 7 cases the therapeutic regimen was changed after DSA. DSA of implanted liver catheters is a valuable, well tolerated, easily and rapidly performed method.
Adult↗
[Primary malignant lymphoma of the stomach. Barium meal, sonography and computed tomography].
The features of barium meal, ultrasonography and CT in 18 patients with proven primary gastric lymphoma were analyzed retrospectively. Only barium meal could reveal highly suspicious features in 16 cases, whereas ultrasonography and CT showed a non specific wall thickening. Although single signs in a barium meal are non-specific, the combination of clubbing of mucosal folds, atypical ulcerations and extensive mural infiltration is highly suspicious of lymphomatous involvement. A negative barium meal, ultrasonography and/or CT result does not exclude gastric lymphoma.
Adult↗
[Hematogenous gastrointestinal metastases--limits of radiologic diagnosis].
Roentgen morphological, ultrasonographical and CT findings in a patient with mammary cancer metastasising hematogenously to the duodenum and colon and in four patients with malignant melanoma metastasising hematogenously to the stomach, duodenum, small bowel and colon.
Adult↗
[Imaging of iatrogenic aneurysms and AV fistulas of the lower extremity with IV-DSA and sonography].
Using IV-DSA and ultrasound (real-time), we demonstrated 13 false aneurysms, 2 isolated AV fistulas, 7 aneurysms of profunda patches and 8 aneurysms of bypass grafts. Aneurysms and AV fistulas developed in all 30 patients after different diagnostic and therapeutic procedures. Ultrasound showed partial thromboses of the aneurysms, perivascular changes and compression of the femoral vein, that could not be demonstrated by IV-DSA. On the other hand IV-DSA allowed the recognition of important findings not shown sonographically, such as AV fistulas and stenoses of the proximal and distal arteries. These findings were relevant for further surgical approach. It is therefore concluded that in patients with suspected aneurysm of the femoral or popliteal artery, IV-DSA and ultrasound should be used in conjunction rather than as alternative methods.
Adult↗
[Complications of intravenous digital subtraction angiography--results in 500 patients].
500 patients were studied respectively for complications of intravenous digital subtraction angiography (IV-DSA) performed with non-ionic contrast media, using a central venous injection technique. In 21 patients (4.2%) during or shortly after the procedure 23 systemic, 1 neurologic, and 7 local complications occurred. In addition 1 patient developed acute renal failure 26 hours after the IV-DSA, whereas 4 patients later showed on thromboses of the catheterised vein. No permanent neurologic or systemic complications and severe allergic reactions were seen.
Acute Kidney Injury↗
[Sonographic findings in complications of cystic echinococcosis].
Apart from the difficult differential diagnosis of hydatid liver disease, diagnostic problems may increase in chronic disease because of complications. Compression or infiltration of bile ducts is the most common complication occurring in 16%. Other complications are infiltration of adjacent organs and structures, for instance the right kidney and the diaphragm, or the (often iatrogenic) rupture of hydatid cysts with intraperitoneal spread. Preoperative sonographic diagnosis is important in influencing the surgical procedure.
Adult↗