[Sonographic findings in trauma-induced liver injuries]

In 12 of 49 patients operated on for liver injuries we performed sonographic examination of the abdomen on admission to hospital within the framework of emergency diagnostics. The most sensitive finding was the identification of the presence of intraabdominal free fluid. The liver injury itself was sonographically diagnosed in only 5 patients. Sonographically, an additional injury of the spleen was found in 2 of 3 patients; in one patient it was possible to detect an injury of the kidney.

[Early and late results of percutaneous transluminal angioplasty (PTA) in diabetic patients]

Results of 127 iliac and femoropopliteal transluminal angioplasties in 97 diabetic patients are presented. Patients who had undergone iliac (n = 70), femoral (n = 41), and popliteal (n = 16) angioplasties for stenoses up to 15 cm long were followed up for 6-60 months. In diabetic patients presenting with only claudication or adequate runoff, the 5-year iliac patency rate was 76% and the femoral patency rate was 60%; these results were comparable with those found in non-diabetic patients. For limb salvage, 3-year patency rates were 66% for iliac, 37% for femoral, and 37% for popliteal angioplasties, and 5-year patency rates were 29% for iliac, 7% for femoral, and 0% for popliteal angioplasties. Our findings suggest that the overall decreased PTA success rates typically associated with diabetes are due to the larger percentage of these patients who present with symptoms of severe peripheral vascular disease and not to the presence of diabetes per se.

[High-resolution thin-section CT in the preoperative staging of rectal tumors: a comparison with endoluminal sonography and histology]

Rectal carcinomas are amongst the most common malignant tumours. The aim of this work was to determine whether high resolution CT with thin sections (1 mm) can provide satisfactory delineation of perirectal tumour infiltration. Correct determination of local tumour spread was possible in four out of nine patients and distinction between those tumours confined to the rectal wall and those infiltrating the perirectal tissues was possible in four out of eight patients.

[Endosonographic staging of rectal tumors]

Pre-operative staging was performed in 81 patients with rectal tumours by means of endorectal sonography. In 87% of cases (70 out of 81), the endosonographic findings corresponded with the histopathological appearance; the recognition of T0 and 1 tumours, which is important in deciding surgical procedures, was possible in 94% (51 out of 54). Differentiation between T0 and T1 tumours (i.e. between adenomas and carcinomas infiltrating the submucosa) was not possible. Five out of ten of T2 and 14 out of 16 T3 tumours were staged correctly. One T4 tumour was placed in too low a stage. A comparison of the echo structure of adenomas and carcinomas in 76 patients showed that 28 out of 43 adenomas (65%) have homogeneous echoes, while 24 out of 33 carcinomas (73%) showed inhomogeneous low intensity echoes.

[Focal liver lesions as incidental findings. 2: Diagnostic procedures in sonographically homogeneous echo-rich, echo-poor or inhomogeneous lesions]

Hemangioma is one of the most common incidental findings in the ultrasonographic image. In 80% to 90% of the cases, the hemangioma presents as a homogeneous lesion in the US image. In asymptomatic patients and a lesion diameter of less than 2 cm, further clarification additional to ultrasonography is not necessary. Major differential diagnoses are focal nodular hyperplasia, metastasis, hepatocellular carcinoma and liver cell adenoma. With exceptions, the biological significance of echo-poor or inhomogeneous lesions cannot be established on the basis of the US image. In such cases, additional diagnostic procedures are required.

[Focal liver lesion as an incidental finding. 1: Diagnostic management--procedure in sonographically echo-free tumors]

The spread of diagnostic ultrasound has led to an increase in the incidental detection of lesions of the liver in patients with unrelated symptoms and no history of tumor disease. In this article, suggestions are made on how to proceed with the further diagnostic workup of such patients. In part 1 these suggestions are aimed at identifying patients who might benefit from further investigation, while at the same time avoiding unnecessary procedures.

[Computerized tomography findings in hormonally inactive adrenal gland tumors]

CT examinations of 6 years served as basis for the incidence of hormonally inactive space-occupying masses at the adrenal. Of a total of 25,000 patients, 313 (1.3%) suffered from disease of the adrenals, and of these 261 patients had a hormonally inactive adrenal tumour. Adenomas were the most frequent space-occupying growths (101 patients), followed by metastases of the adrenals (77 patients), whereas adrenal carcinomas (4 patients), myelolipomas (3 patients), ganglioneuromas (3 patients) adrenal cysts (3 patients) and adrenal haemorrhages (2 patients) were rare findings.

Pulmonary contusion: CT vs plain radiograms

In experimentally induced pulmonary contusions, CT (n = 27) and chest X-ray (n = 24) findings were compared with the findings at autopsy. Twenty-seven of 27 (100%) pulmonary contusions were visible by CT immediately after trauma compared with 9 of 24 (37.5%) in the chest X-ray. After 30 min follow-up, 18 of 24 (75%) lesions were seen on the plain film. Five of 24 (21%) contusions escaped detection on conventional radiographs. Computed tomography underestimated lesion size in 5 of 60 (8%) measurements, conventional radiographs in 21 of 36 (58%) measurements. Pathological examination never revealed a pulmonary contusion that was not demonstrated by CT. Therefore, pulmonary contusion seems unlikely in a trauma patient with normal pulmonary CT.

[Traumatology and diagnosis of scaphoid fracture]

In 9 years, 1,104 patients had one or more roentgenological studies of the scaphoid; 252 fractures of the scaphoid were found. The most reported traumatic mechanism was a fall on the extended wrist. The form of fracture most seen was transverse fracture of the scaphoid; most of the fractures were found in the middle third of the scaphoid. The primary radiodiagnostic procedure should contain pictures of the wrist in two planes and four special pictures of the scaphoid. The "fat-pad sign" seems to be an unreliable indicator of fracture, but nearly two-thirds of fractures of the scaphoid showed a swelling of the soft tissues in the X-ray picture.

[Diagnosis of unusual fractures of the wrist bones]

Fractures of the navicular bone are the most frequent fractures in the region of the wrist bone. Injuries of the other carpal bones are often primarily overlooked, since the examiner commands over less routine in diagnosing these rare fractures and the carpal bones are often superimposed over one another. We examined 9.723 x-ray films of the hand performed because of suspected fracture of the os naviculare, in order to find out how often lesions of the carpal bones - with the exception of those of the scaphoid bone - were discovered via the x-ray series of the os naviculare manus. For each individual wrist bone we recorded the incidence of fractures, clinical treatment and diagnoses, including any special x-ray takes that would be necessary for the detection of a particular fracture.

[The Cruveilhier-von Baumgarten syndrome. Presentation of radiologic findings based on a case]

Marked portosystemic venous anastomosis of the parumbilical veins is referred to as the Cruveilhier-Baumgarten syndrome. Opening of these vessels has been described mainly in the sonographic literature. In this case report CT and MR findings are presented, which have been confirmed by angiography. This paper is intended to draw the radiologist's attention to dilatation of the parumbilical veins, which is a highly specific sign of portal hypertension resulting from intrahepatic blockage.

[Endorectal sonography in rectal cancer]

35 patients with rectal cancer were examined in a prospective trial by endorectal ultrasound. In 27 patients the sonographic diagnosis of tumour penetration was correct as compared with histologic findings, in 7 patients infiltration depth was overestimated, and in one case underestimated. In 21 resected specimens, examined postoperatively in a water tank with the same equipment, ultrasonic examination was correct in 17; in no case was the infiltration depth underestimated. The different technical approaches in local sonographic staging of rectal cancer are discussed.

[Fractures of the clavicle: classification, diagnosis, therapy]

Clavicular fracture is one of the most frequent skeletal lesions. In most cases the median third of the clavicula is affected (this is due to the peculiar biomechanical structure). Accompanying lesions and complications of clavicular fractures are rare. A total of 13 x-ray diagnostic techniques are described for clavicular fractures. X-ray film should, as a matter of principle, always be taken in two planes. Definitely the major part of clavicular fractures are treated conservatively (rucksack dressing), whereas surgery is reserved for few and strictly defined indications.

[Structure of the wall of the gastrointestinal tract: a comparative sonographic-morphologic study]

High frequency ultrasound can resolve the structure of the wall of the gastro-intestinal tract into three highly echogenic lines with poorly echogenic zones between them. Sequential removal of layers of the walls of fresh specimens of the gastro-intestinal tract showed the following correlation between the sonographic and histological findings: the innermost and outermost highly echogenic lines correspond to incident and exit echoes. The middle line corresponds with the sub-mucosa and the junctional zones of the mucosa/muscularis mucosa and sub-mucosa/muscularis propria. The intervening low echo lines correspond with the mucosa and muscularis propria.

[Typical radiologic findings in Mirizzi syndrome]

In extrahepatic cholestasis it is necessary to include Mirizzi's syndrome in the differential diagnostic considerations. Characteristic findings in sonography and computed tomography are: a stone incorporated in the neck of the gallbladder or cystic duct with an extension of the common hepatic duct above the stone and normal width of the bile duct below the stone; in endoscopic retrograde cholangiography (ERC, direct cholangiography), a characteristic finding is a smooth-walled, segmental stenosis through external compression or an incorporated stone.

[Sonography of pancreatic carcinoma. Sonomorphology, diagnostic accuracy and tumor staging]

Ultrasonography was performed in 125 consecutive patients with clinically suspected carcinoma of the pancreas. The most important diagnostic criteria were reflectivity and echo amplitude, which were locally decreased in 71% (50/70) and increased in 27% (19/70) of the cancers. The echogenicity and reflectivity did not differ in four endocrine active tumors and adenocarcinomas. The diagnostic accuracy was 83% (101/122); in 3 patients ultrasonography failed to provide adequate information. Dilation of the biliary tree was found in 68% (43/50) of the carcinomas and dilation of the Wirsungian duct in 52% (32/58). There was some difficulty in differentiating between pancreatic carcinoma and chronic pancreatitis because the echogenicity is similar for both and inflammatory and neoplastic pancreatic processes are also present in both diseases. Although only 2-3 cm in diameter, 87% (7/8) of the carcinomas were already in the T3 stage. Angiography to evaluate resectability is unnecessary only when vascular encasement, extensive infiltration of peripancreatic fat, or tumor thrombus has been demonstrated sonographically.

[Kidney metastases in computerized tomography]

The CT image of renal metastases is described for 29 patients. The most frequent primary tumour was the bronchial carcinoma, followed by melanoma and cervical carcinoma. In 12 of 29 patients (41%) the metastases occurred bilaterally, in 17 (59%) unilaterally. 9/29 (31%) had solitary, 20/29 (69%) multiple renal metastases. In 19 (66%) these had a size of up to 3 cm and were situated intraparenchymally. Space-occupying growths up to a size of 10 cm which grew exophytically were seen in melanoma and carcinoma of the larynx and chorion. In the plain CT the metastases presented isodense or slightly hypodense in 25 of 27 examinations (93%). After application of contrast medium all presented hypodense with the exception of metastases of a chorionic carcinoma.

[Diffuse leiomyomatosis of the stomach]

Sonography and computed tomography were the first imaging methods enabling the visualization of intramurally growing tumours of the stomach. The article reports on a rare case of a diffuse leiomyoma that was diagnosed by means of computed tomography.

[Computed tomography of atelectasis. A comparative experimental study]

After breathing pure oxygen, total atelectasis of one lung was produced in ten dogs; its development and regression was followed by CT and by conventional radiology. 30 seconds after cessation of ventilation, it was possible to show a rise in CT density of the atelectatic lung from -764 +/- 32 HU to -739 +/- 49 HU. The average time from the cessation of ventilation to total atelectasis averaged 5.5 +/- 1.1 minutes. The earliest sign on conventional radiographs was often seen after 30 seconds and usually after 60 seconds and consisted of mediastinal displacement. Extensive atelectasis regressed in only one out of six animals within one hour after resuming ventilation. The experimental methods and results and the significance of the physiological findings in a clinical context are discussed.

[Computed tomography of lung contusion. An experimental study]

A new experimental model has been developed to determine whether computed tomography has any advantages for the investigation of lung contusions. In 27 dogs, chest wall deformation was produced at speeds varying from 17.3 m/sec to 45.7 m/sec, leading to lung contusion. After the injury, 27 out of 27 (100%) CT examinations demonstrated the contusions, but only nine out of 24 (37.5%) were seen on conventional radiographs. In contrast to conventional radiography, which either failed to show the presence of a contusion, or which under-estimated the extent by more than one cm, in more than half the cases CT agreed with the pathological findings in more than 90%. No lung contusions were found at autopsy which had not been demonstrated by CT.