Search

Es gibt eine Fotografie von Jacob Burckhardt, deren Wert als Quelle zur Erschließung von Lebensgefühl und Denkweise er selbst wohl sehr hoch eingeschätzt hätte, weil historische Zeugnisse ihm für umso wahrer galten, «je unabsichtlicher» sie sind.

The purpose of this work is to draw attention to the characteristic sonographic features of carotidynia, which, in the context of a typical clinical picture support its diagnosis. Six patients presented with primary symptoms of neck pain and focal tenderness. In all patients, focal wall thickening of the distal end of the common carotid artery was found exactly in the region of tenderness, leading to mild lumen narrowing. Treatment with nonsteroidal anti-inflammatory drugs or glucocorticoids led to full symptom resolution. Carotidynia will often be encountered first on sonography performed for evaluation of neck pain and has a characteristic sonographic appearance.

A variety of extratesticular tumors and tumor-like conditions can occur in the scrotum. Angiomyofibroblastoma is a rare, slow-growing, well-circumscribed mesenchymal tumor, found predominantly in women, and is even a more unusual occurrence in the male genital tract. We describe a case of a 64-year-old male presenting with a scrotal painless mass. On sonography, a well-circumscribed extratesticular mass was present. As no specific imaging findings were present, it was a surprise to learn that the subsequently excised mass proved to be an angiomyofibroblastoma-like tumor. To the best of our knowledge, the sonographic appearance of this tumor in the scrotum has been reported previously in only one case. A variety of extratesticular tumors and tumor-like conditions can occur in the scrotum. Angiomyofibroblastoma is a rare, slow-growing, well-circumscribed mesenchymal tumor, found predominantly in women, and is even a more unusual occurrence in the male genital tract. We describe a case of a 64-year-old male presenting with a scrotal painless mass. On sonography, a well-circumscribed extratesticular mass was present. As no specific imaging findings were present, it was a surprise to learn that the subsequently excised mass proved to be an angiomyofibroblastoma-like tumor. To the best of our knowledge, the sonographic appearance of this tumor in the scrotum has been reported previously in only one case.

«Und die klaffende Lücke in Ihrem Geschichtswerk / War ein Schmerz in meinem wie lange noch atmenden Körper», rief 1993 der Dramatiker Heiner Müller dem Althistoriker Theodor Mommsen ins Grab, «Wissend der ungeschriebene Text ist eine Wunde / Aus der das Blut geht das kein Nachruhm stillt». Es sind die verzweifelten Pathosformeln eines Chronisten, der sein Tagewerk verbittert aufgegeben hat, unfähig, die Ereignisse und den Wandel seiner Zeit in Worte zu fassen. Eindrucksvolles Zeugnis der Überidentifikation eines gescheiterten Werkarbeiters, der sich Schützenhilfe sucht bei einem, der ebenfalls verstummt ist angesichts des wilden Zeitstroms – genannt «Geschichte»: Theodor Mommsen, der berühmteste Althistoriker des Deutschen Kaiserreiches, dessen Publikationsliste mehr als tausend Veröffentlichungen aufführt, der aber nie das eine, von der Öffentlichkeit so sehr ersehnte Buch über die römische Kaiserzeit geschrieben hat.

Objectives To determine the proportion of benign testicular lesions among candidates for testicular sparing surgery (TSS) and to assess the safety and efficacy of this procedure. Methods and Materials Sixteen patients underwent surgical exploration for testicular tumors with TSS intent in our center. Surgery was performed via an inguinal approach with temporary cord occlusion and frozen section (FS) analysis of the lesions. Benign findings allowed for TSS, whereas cancer prompted total orchiectomy. Results The lesions measured 8–25 mm in the largest diameter. Eleven of the 16 lesions were benign (69%) and TSS was accomplished in these cases. Complete concordance was observed between the results of FS and permanent sections. Of the 5 patients with cancer, 3 had pure seminoma, and embryonal carcinoma and teratoma were found in 1 patient, each. Surveillance was applied in 4 of these patients, and chemotherapy was used in the patient with embryonal carcinoma. With an average follow-up duration of 48 months, all are alive and free of disease. All 11 patients in whom TSS was accomplished had an uneventful postoperative course, and with an average follow-up duration of 28 months, 9 have normal scrotal physical examination and ultrasound, whereas 2 patients were lost to follow-up. Conclusions Sixty-nine percent of testicular lesions under 25 mm are benign. TSS is safe and effective in patients with small benign lesions. Cancer is reliably detected by FS, and testicular exploration is not associated with local or distant recurrence in any of our patients.

The purpose of this study was to evaluate interobserver and intraobserver variability in the sonographic assessment of the presence and severity of fatty liver.We retrospectively evaluated the static images of 168 adult patients who had undergone abdominal sonography. Three experienced radiologists independently graded the hepatic images as normal, mild steatosis, moderate steatosis, or severe steatosis. Assessment of liver steatosis was repeated on the same set of images 1 month later under the same conditions and blinded to the initial reading. Weighted kappa statistics were used to analyze interobserver and intraobserver agreement, and the agreement percentages were calculated.The mean interobserver and intraobserver agreement rates for the presence of fatty liver were 72% (kappa = 0.43) and 76% (kappa = 0.54). For severity of fatty liver, the initial reading for pairs of observers had 47-59% (kappa = 0.40-0.51) interobserver agreement. The interobserver agreement for the second reading was 59-64% (kappa = 0.43-0.54). The mean agreement rates for pairs of observers were 53% (kappa = 0.47) and 62% (kappa = 0.50) on the first and second readings. Intraobserver agreement for severity of fatty liver ranged from 55% to 68% (kappa = 0.51-0.63).Subjective visual assessment of fatty liver on sonography has substantial observer variability. There is a need for a more objective quantitative method of grading fatty liver on sonography that would be easily available and applicable in routine clinical practice.

The objective of this study was to assess the frequency of symptomatic urinary tract infections (UTIs) following voiding cystourethrography (VCUG) while using prophylactic antibiotics. Medical records of 421 patients who underwent a VCUG during a period of 4 years were reviewed. Three hundred forty-nine had a VCUG following a febrile UTI, and 72 had the test for evaluation of hydronephrosis. All received prophylactic antibiotics and were evaluated within 7-10 days following the VCUG. One hundred seventy-two children (41%) had an abnormal VCUG. Seven of 421 children (1.7%) had symptoms suggestive of UTI. Two had culture negative pyuria; one had Escherichia Coli UTI, and four had Pseudomonas aeruginosa UTI. On multivariate logistic regression analysis, the risk factors contributing to the development of UTI following VCUG were the presence of vesicoureteral reflux (VUR) and its severity (odds ratio [OR] 2.52; 95% confidence interval [CI] 2.24, 2.83, p =0.001; and OR 2.32; 95% CI 2.05,2.62, p =0.04, respectively). The incidence of VCUG-induced UTI in children receiving prophylactic antibiotic therapy is low. There is a relatively high rate of Pseudomonas UTI, especially in children with moderate to severe reflux. We recommend that children with symptoms suggesting a UTI following a VCUG should be treated for Pseudomonas aeruginosa pending culture results.

To determine the gray scale and color Doppler sonographic features of Leydig cell tumors of the testis in a series of patients.We retrospectively analyzed the sonographic appearance of 10 proven Leydig cell tumors in 9 patients aged 26 to 47 years. Sonographic features that were reviewed included the size and echogenicity of the tumors, presence of cystic areas or calcifications, and distribution pattern of detectable blood flow on color or power Doppler imaging.The tumors ranged from 0.4 to 3.0 cm in diameter, but most were less than 1.0 cm in diameter. In 1 testis, 2 discrete Leydig cell tumors were found. Nine (90%) of the 10 tumors were homogeneously hypoechoic. Only 1 tumor was isoechoic with the testis. None of the tumors contained calcifications. Of 8 tumors with color Doppler imaging, 7 (88%) showed a characteristic pattern of increased peripheral blood flow, which was either circumferential or punctate. Only 1 tumor was found with internal hypervascularity.Peripheral hypervascularity in a hypoechoic testicular tumor that has little or no internal color Doppler flow should suggest the possibility of a Leydig cell tumor, and consideration should be given to testicle-sparing surgery.

Background: Actual guidelines recommend an invasive approach (CORO) in case an ischemic cause of sudden cardiac arrest (SCD) can`t be excluded. Methods: In a retrospective study we investigated procedures and course of 767 consecutive OHCA pts. of whom 220 pts who survived to hospital admission and 166 were admitted to our hospital. Results: CORO was performed in 91 pts. Of these 83 had a prehospital ECG or an ECG at admission: Thirty-nine (47%) of the pts with CORO had typical ECG signs of a STEMI (SECG), 44 pts had CORO without a SECG. On the other side 52 of 58 (89%) pts without CORO had not a typical SECG. A “culprit lesion” was detected in 30 of 39 (70%) of pts with an SECG but also in 21 of 44 (46%) pts without an SECG. Creatinine levels a admission were elevated in pts with CORO (1.4 mg/l) as well as in pts without CORO (1.8 mg/l). During hospital stay hemodialysis/CVVH was considered necessary in 28 of 91 pts (31%) with CORO and 21 of 75 pts (28%) without CORO (p=ns). We did not observe a selection bias concerning admission of pts to our hospital or other hospitals respectively. With regard to perform CORO, however, there was a significant tendency to preference of prognostic favorable groups i.e. younger pts Conclusion: Intervention is principally justified in resuscitated pts in whom an ischemic cause has to be assumed. Without a randomized prospective study, however, it will remain unclear, to which extend CORO improves prognosis after CPR or if CORO is only an “add-on” of minor relevance in a group of pts with a basically good prognosis.

Long-term follow-up of a tenotomized Achilles tendon reveals healing with formation of a tendonlike structure between the cut tendon ends. A prospective study to show sonographic healing stages was designed. Twelve patients (21 Achilles tendons) with the diagnosis of cerebral palsy, spastic diplegia, and shortening of their Achilles tendons underwent a tenomuscular release. The healing process was documented by monthly ultrasound studies. Overall, 102 examinations were done, with a mean follow-up of 5.3 months. The authors found six distinct healing stages, with no significant change occurring in the length of the primary gap at the tenotomy site throughout healing. Based on these results, the authors conclude that sonographic healing stages of the cut Achilles tendon can be defined and staged. They also suggest that transverse tenotomy at the tenomuscular junction is a safe method, with no risk of over-lengthening.

Treatment for cure is reserved for patients with organ-confined prostate cancer. The clinical staging of prostate cancer lacks accuracy regarding local extension. The results of a transrectal ultrasound-guided staging biopsy (TGSB), performed in addition to routine sextant biopsies (RSBs) of the prostate, is defined as being positive when tumor cells are shown to invade extraprostatic loci and, thus, would certainly differentiate between organ-confined and locally advanced disease. Seventy-seven RSB + TGSB procedures were compared to 223 routine sextant prostate TRGBs. Prostate cancer (CaP) was detected in 24 patients (31%) and 60 patients (27%), respectively. In four RSB + TGSB procedures, local extension of CaP was depicted, and as a result radical prostatectomy was withheld. In six of seven patients undergoing radical prostatectomy (86%), the specimen analysis result was in agreement with the results of the preoperative TGSB. There were no extra complications associated with the performance of staging biopsies. We conclude that TGSB is safe and efficacious and that it should be performed in candidates for radical prostatectomy.

Objective.To assess the frequency of urinary tract anomalies in male neonates Design.During a period of 4.5 years, from July 1994 through December 1998, 45 male neonates A dimercaptosuccinic acid (DMSA) scan was recommended to all patients but was performed only in 30 of 45, most of them with an abnormal VCUG. The renal scan was performed at least 4 months after the UTI.Results.Urinary tract abnormalities were observed in 22 of 45 male neonates. Nineteen had vesicoureteral reflux (VUR), 1 had VUR and a double collecting system, 1 had VUR and a posterior urethral valve, and 1 had an ureteropelvic junction stricture. Renal atrophy or scars, as demonstrated by DMSA scan, were detected almost exclusively in neonates with VUR grade 3 and above. Only 1 neonate with VUR grade 1 had a pathologic DMSA, and the US of this male also demonstrated renal atrophy. Escherichia coli was the pathogen in 62% (28 of 45), and 9 boys had bacteremia.Conclusion.We suggest that US and VCUG should be performed routinely after the initial UTI in male neonates. Renal scan should be reserved for those cases in which the US suggests renal parenchymal damage or when VCUG detects VUR grade 3 and above.

The purpose of this study was to determine the distribution pattern of calcification in cricoid cartilage of healthy children.Sonography of the neck was performed with a high-resolution linear array transducer to show the sides of the cricoid cartilage ring in both the sagittal and transverse planes. Twenty-three boys and 33 girls, who ranged in age from 6 to 17 years, were examined. Calcifications in the cartilage were characterized by number and size, distribution pattern, and side-to-side symmetry.Calcifications were seen either as small echogenic, nonshadowing foci or as larger irregular, echogenic areas with acoustic shadowing. Calcifications were found in 19 of the 23 boys and 26 of the 33 girls. The earliest cases were in three 7-year-old children. The incidence and number of echogenic foci generally increased with age. Most calcifications were in the center of the cartilage or distributed diffusely throughout. Side-to-side comparison of the number, size, and distribution pattern of the calcifications showed considerable variation.The sides of the cricoid cartilage ring could be seen on sonography in both the sagittal and transverse planes. Calcifications within the cartilage were readily shown and were found in children at an earlier age than previously reported.

SummaryThrombosis of the ovarian vein is a remarkable process occuring within a few days of labor in 1:500-1:2000 women. Its presentation is characterized by fever, abdominal pain and occasionally by a palpable abdominal mass that in earlier years sometimes lead to explorative laparotomy. With the advent of modern imaging techniques the diagnosis can be made relatively easily. The pathogenesis has been attributed to an infectious process expanding from the uterus to the right ovarian vein and stasis. A predisposition towards thrombosis has not been so far explored. In this study we retrospectively analysed the clinical features, diagnosis and treatment of 22 patients with objective documentation of post partum ovarian vein thrombosis (POVT) and assessed potential risk factors. In 11 of the 22 patients (50%) inherited prothrombotic risk factors were detected as follows: 4 were heterozygous for factor V G1691 A, 2 had protein S deficiency, one had protein S deficiency and was heterozygous for factor V G1691A, and 4 were homozygous for MTHFR C677T. Eight of the 11 patients who bore a prothrombotic predisposition underwent cesarean section. Taken together, the data suggest that POVT may result from the combined effect of an infection, cesarean section and a prothrombotic tendency.

Purpose. To describe a case of quadriceps tendon rupture in a patient with postanoxic choreoathetotic movements.Case report: A 20-year-old man was admitted to a rehabilitation hospital after anoxic brain injury. As a result of the injury, he developed continuous flowing choreoathetotic movements. He contracted fever and swollen and painful right knee, and only when periarticular edema decreased did a suprapatellar gap appear and quadriceps tendon rupture was diagnosed.Conclusions: Considering the possibility of tendon rupture when evaluating a patient with non-volitional movements and ‘arthritic’ presentation in a rehabilitation setting, may prevent delay of quadriceps surgical repair.

Acute renal failure was preceded by prolonged bilateral renal ischemia in a fifty-four- year-old woman presenting with suprarenal abdominal aortic stenosis, severe systolic hypertension, and congestive heart failure. An axillofemoral bypass caused retrograde flow in the lower aorta and reestablished the perfusion of the renal arteries and the ischemic kidneys. This resulted in complete and immediate restoration of renal function and blood pressure even though the patient was anuric for four days prior to the procedure.

OBJECTIVE. We describe the sonographic features of focal intratesticular lesions seen in men who underwent sperm retrieval procedures. CONCLUSION. Although many urologists believe that solid intratesticular masses are malignant until proven otherwise, a growing number of benign focal testicular lesions have been described. Awareness of the cause and sonographic appearance of focal abnormalities in men who have undergone testicular aspiration or extraction should help radiologists suggest the correct diagnosis and advise a conservative approach on the basis of close surveillance by serial physical, laboratory, and imaging studies.

To evaluate the concordance between testicular tumor size and benign histology in order to identify a cut-off size, below which the rate of benign lesions would be highest.During the years 1995-2008, we performed 131 consecutive testicular operations for testicular tumors. Ten of these were testicular preserving surgery, whereas the other 121 patients had radical orchiectomy. We searched for the rate of benign lesions in the following 3 groups of tumor diameter: 10 mm or less, 11-20 mm, and greater than 20 mm. ROC analysis was used to find the optimal size cut-off below which the rate of benign lesions would be highest.Benign lesions were found in 11 patients (8%), including epidermoid cyst (n = 4), Leydig cell tumor (n = 3), fibrosis (n = 1), adenomatoid tumor (n = 2), and 1 patient with a simple cyst. Small tumor size strongly correlated with benign histology. The mean diameter of benign vs. malignant lesions was 15 mm and 41 mm, respectively (P0.05). The rate of benign lesions in tumors with a diameter of 10 mm or less, 11-20 mm and greater than 20 mm was 50%, 17%, and 2%, respectively. Receiver Operating characteristic (ROC) analysis with 87% sensitivity and 83% specificity revealed a cut-off value of 18.5 mm tumor diameter below which the proportion of benign lesions was 38.5% compared with 2% above it (P0.05).While benign lesions comprise only 8% of all testicular tumors, their proportion among small lesions is much higher. With a size cut-off of 18.5 mm, 38.5% of smaller lesions are benign. These findings support consideration of testicular exploration for small testicular lesions aiming at preservation rather than predetermined radical orchiectomy.

Intravascular papillary endothelial hyperplasia, also known as Masson's tumor, is a benign, vascular lesion in which there is papillary proliferation of endothelial cells. The lesion presents as a palpable soft-tissue mass, often located within normal or dilated vascular spaces, and may be mistaken for a sarcomatous tumor on imaging. We present the case of an intravascular papillary endothelial hyperplasia in the forearm, with a remarkable appearance on color Doppler sonography, and suggest that this entity will be encountered more frequently by sonologists in the future.

Objective: The aim of our study was to evaluate whether intracardiac echogenic foci (ICEFs) may be associated with increased risk for structural cardiac anomalies in the low-risk population. Methods: During a 24-month period, 3,744 low-risk patients were prospectively screened for ICEFs by prenatal sonography. The study group was composed of 138 fetuses (3.7%) with ICEF. The control group was composed of 167 fetuses without ICEF. In all fetuses a complete echocardiographic evaluation was performed. Results: Among the 138 fetuses in the study group, 108 (78%) ICEFs were found in the left ventricle, 25 (18%) were found in the right ventricle, and 5 (4%) were found to be bilateral. No statistically significant difference was found between the study and the control group regarding the presence of cardiac anomalies. Only 1 case (0.7%) of pulmonic stenosis was found in the study group, compared to 1 case (0.6%) of bicuspid aortic valve in the control group. Conclusions: We conclude that ICEFs found in low-risk patients are not associated with a significant increase in the risk of cardiac anomalies.

We report on 2 sisters presenting with acute torsion of a wandering spleen within a 3-year interval. The diagnosis was made preoperatively by computed tomography (CT) in both cases. A high index of suspicion because of our experience with the first patient, who underwent splenectomy, enabled a correct early diagnosis in the sibling. On urgent surgery, reversible ischemic changes were found, and detorsion and splenopexy resulted in preservation of the spleen.

Spontaneous dissection of the SMA is a rare occurrence, especially when not associated with aortic dissection.1 Only sporadic case reports of the sonographic demonstration of isolated spontaneous dissection of the SMA have been published,2,3 and for the most part color Doppler imaging is not included. We report the sonographic findings in an asymptomatic patient with isolated dissection of an SMA aneurysm and discuss the unique flow dynamics seen by color Doppler sonography. CASE REPORT

Various congenital anomalies may affect the spleen, starting with common anomalies, such as an accessory spleen, up to rare conditions such as a wandering spleen and polysplenia. Most of these anatomic variants have no clinical significance; they need, however, to be recognized by the radiologist as such. Awareness of these variants is important for the radiologist to interpret the findings correctly and avoid mistaking them for a clinically significant abnormality. In this review we illustrate the spectrum of congenital anomalies of the spleen and stress pitfalls and possible complications resulting from these anomalies.