1
|
Liu QM, Chen Y, Fan WJ, Wu XH, Zhang ZW, Lu BL, Ma YR, Liu YY, Wu YZ, Yu SP, Wen ZQ. Value of orthogonal axial MR images in preoperative T staging of gastric cancer. Abdom Radiol (NY) 2024:10.1007/s00261-024-04322-8. [PMID: 38755454 DOI: 10.1007/s00261-024-04322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To assess the value of orthogonal axial images (OAI) of MRI in gastric cancer T staging. METHODS This retrospective study enrolled 133 patients (median age, 63 [range, 24-85] years) with gastric adenocarcinoma who underwent both CT and MRI followed by surgery. MRI lacking or incorporating OAI and CT images were evaluated, respectively. Diagnostic performance (accuracy, sensitivity, and specificity) for each T stage, overall diagnostic accuracy and rates of over- and understaging were quantified employing pathological T stage as a reference standard. The McNemar's test was performed to compare the overall accuracy. RESULTS Among patients with pT1-pT4 disease, MRI with OAI (accuracy: 88.7-94.7%, sensitivity: 66.7-93.0%, specificity: 91.5-100.0%) exhibited superior diagnostic performance compared to MRI without OAI (accuracy: 81.2-88.7%, sensitivity: 46.2-83.1%, specificity: 85.5-99.1%) and CT (accuracy: 88.0-92.5%, sensitivity: 53.3-90.1%, specificity: 88.7-98.1%). The overall accuracy of MRI with OAI was significantly higher (83.5%) than that of MRI without OAI (67.7%) (p < .001). However, there was no significant difference in the overall accuracy of MRI with OAI and CT (78.9%) (p = .35). The over- and understaging rates of MRI with OAI (12.0, 4.5%) were lower than those of MRI without OAI (21.8, 10.5%) and CT (12.8, 8.3%). CONCLUSION OAI play a pivotal role in the T staging of gastric cancer. MRI incorporating OAI demonstrated commendable performance for gastric cancer T-staging, with a slight tendency toward its superiority over CT.
Collapse
Affiliation(s)
- Quan-Meng Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yan Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Wen-Jie Fan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518017, China
| | - Xue-Han Wu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518017, China
| | - Zhi-Wen Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Bao-Lan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yu-Ru Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yi-Yan Liu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yun-Zhu Wu
- MR Scientific Marketing, SIEMENS Healthineers Ltd., Shanghai, 210031, China
| | - Shen-Ping Yu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
| | - Zi-Qiang Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
| |
Collapse
|
2
|
Vanolli K, Jost ML, Clerc O, Genné D, John G. Radiological Explorations of Patients with Upper or Febrile Urinary Tract Infection. Infect Dis Rep 2024; 16:189-199. [PMID: 38525762 PMCID: PMC10961809 DOI: 10.3390/idr16020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59-77%) and 64% (95%CI: 54-73%) of them were adequately managed according to Van Nieuwkoop's clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33-61%) and 57% (95%CI: 44-69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0-46.5), gross haematuria (OR = 5.9; 95%CI: 1.6-22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8-18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop's rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule.
Collapse
Affiliation(s)
- Katia Vanolli
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000 Neuchâtel, Switzerland; (K.V.)
| | - Mike Libasse Jost
- Department of Internal Medicine, Bienne Hospital Center, Chante-Merle 84, CH-2501 Bienne, Switzerland (D.G.)
| | - Olivier Clerc
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000 Neuchâtel, Switzerland; (K.V.)
| | - Daniel Genné
- Department of Internal Medicine, Bienne Hospital Center, Chante-Merle 84, CH-2501 Bienne, Switzerland (D.G.)
- Department of Medicine, Geneva University, Michel-Servet 1, CH-1206 Geneva, Switzerland
| | - Gregor John
- Department of Internal Medicine, Neuchâtel Hospital Network, Rue de la Maladière 45, CH-2000 Neuchâtel, Switzerland; (K.V.)
- Department of Medicine, Geneva University, Michel-Servet 1, CH-1206 Geneva, Switzerland
- Department of Internal Medicine, Geneva University Hospitals (HUG), Gabrielle-Perret-Gentil 4, CH-1205 Geneva, Switzerland
| |
Collapse
|
3
|
Tahir MH, Sohail S, Shahid D, Hussain I, Malik J, Iqra S, Faraz M. Postcardiac Injury Syndrome After Cardiac Surgery: An Evidence-Based Review. Cardiol Rev 2024:00045415-990000000-00206. [PMID: 38323874 DOI: 10.1097/crd.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Postcardiac injury syndrome (PCIS) serves as a comprehensive term encompassing a spectrum of conditions, namely postpericardiotomy syndrome, postmyocardial infarction (MI) related pericarditis (Dressler syndrome), and post-traumatic pericarditis stemming from procedures like percutaneous coronary intervention or cardiac implantable electronic device placement. These conditions collectively give rise to PCIS, triggered by cardiac injury affecting pericardial or pleural mesothelial cells, leading to subsequent inflammation syndromes spanning from uncomplicated pericarditis to substantial pleural effusion. A thorough literature search conducted on MEDLINE/PubMed utilizing search terms including "postacute cardiac injury syndrome," "postcardiac injury syndrome," "postcardiotomy syndrome," "postpericardiotomy syndrome," and "post-MI pericarditis" was instrumental in collating pertinent studies. To encapsulate the amassed evidence, relevant full-text materials were meticulously selected and amalgamated narratively. The pathophysiology of PCIS is proposed to manifest through an autoimmune-mediated process, particularly in predisposed individuals. This process involves the development of anti-actin and antimyosin antibodies after a cascade of cardiac injuries in diverse forms. Treatment strategies aimed at preventing recurrent PCIS episodes have shown efficacy, with colchicine and nonsteroidal anti-inflammatory drugs, including ibuprofen, demonstrating positive outcomes. Conversely, corticosteroids have exhibited no discernible benefit concerning prognosis or recurrence rates for this ailment. In summary, PCIS serves as a unifying term encompassing a spectrum of cardiac injury-related syndromes. A comprehensive review of relevant literature underscores the autoimmune-mediated pathophysiology in susceptible individuals. The therapeutic landscape involves the proficient use of colchicine and Nonsteroidal anti-inflammatory drugs to deter recurrent PCIS episodes, while corticosteroids do not appear to contribute to improved prognosis or reduced recurrence rates. This nuanced understanding contributes to an enhanced comprehension of PCIS and its multifaceted clinical manifestations, potentially refining its diagnosis and management.
Collapse
Affiliation(s)
- Muhammad Hamza Tahir
- From the Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan
| | | | | | | | | | | | | |
Collapse
|
4
|
Wiest I, Safai Zadeh E, Görg C, Teufel A, Michels G, Dietrich CF. Value of contrast-enhanced ultrasound for vascular diseases of the liver - current indications and open questions. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1504-1517. [PMID: 36522165 DOI: 10.1055/a-1973-5731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Contrast-enhanced ultrasonography (CEUS) is a widely available and well-tolerated technique that can expand the diagnosis of a variety of vascular liver diseases. This paper presents an overview of the current possibilities of the use of CEUS in vascular liver diseases. Particularly where Doppler sonography has technical limitations, CEUS provides additional opportunities to visualize vascular thrombosis and other obstructions restricting blood flow. When CT or MRI contrast agents cannot be used because of severe allergy or renal insufficiency, CEUS can be a valuable diagnostic alternative and has demonstrated comparable diagnostic performance in at least some vascular liver diseases, such as portal vein thrombosis. In addition, CEUS works without radiation and, therefore, might be particularly suitable for young patients and children. This may be useful, for example, in congenital disorders such as persistent umbilical vein or preduodenal portal vein. Vascular liver disease is rare and comprehensive data are still lacking, but the available literature provides promising insights into potential new ways to study vascular liver disease. Although most studies are based on small sample sizes or even case reports, the high diagnostic utility is undisputed.
Collapse
Affiliation(s)
- Isabella Wiest
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ehsan Safai Zadeh
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Andreas Teufel
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland, Eschweiler, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| |
Collapse
|
5
|
Cekuolis A, Schreiber-Dietrich D, Augustinienė R, Taut H, Squires J, Chaves EL, Dong Y, Dietrich CF. Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients. Cancers (Basel) 2023; 15:cancers15082360. [PMID: 37190288 DOI: 10.3390/cancers15082360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental imaging findings-the role of ultrasound". IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient's safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.
Collapse
Affiliation(s)
- Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | | | - Rasa Augustinienė
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01062 Dresden, Germany
| | - Judy Squires
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Edda L Chaves
- Radiology Department, Hospital Regional Nicolas Solano, La Chorrera 1007, Panama
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland
| |
Collapse
|
6
|
Ko JJ, Banerji S, Blais N, Brade A, Clelland C, Schellenberg D, Snow S, Wheatley-Price P, Yuan R, Melosky B. Follow-Up Imaging Guidelines for Patients with Stage III Unresectable NSCLC: Recommendations Based on the PACIFIC Trial. Curr Oncol 2023; 30:3817-3828. [PMID: 37185402 PMCID: PMC10137068 DOI: 10.3390/curroncol30040289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
The PACIFIC trial showed a survival benefit with durvalumab through five years in stage III unresectable non-small cell lung cancer (NSCLC). However, optimal use of imaging to detect disease progression remains unclearly defined for this population. An expert working group convened to consider available evidence and clinical experience and develop recommendations for follow-up imaging after concurrent chemotherapy and radiation therapy (CRT). Voting on agreement was conducted anonymously via online survey. Follow-up imaging was recommended for all suitable patients after CRT completion regardless of whether durvalumab is received. Imaging should occur every 3 months in Year 1, at least every 6 months in Year 2, and at least every 12 months in Years 3–5. Contrast computed tomography was preferred; routine brain imaging was not recommended for asymptomatic patients. The medical oncologist should follow-up during Year 1 of durvalumab therapy, with radiation oncologist involvement if pneumonitis is suspected; medical and radiation oncologists can subsequently alternate follow-up. Some patients can transition to the family physician/community primary care team at the end of Year 2. In Years 1–5, patients should receive information regarding smoking cessation, comorbidity management, vaccinations, and general follow-up care. These recommendations provide guidance on follow-up imaging for patients with stage III unresectable NSCLC whether or not they receive durvalumab consolidation therapy.
Collapse
|
7
|
Würstle S, Hapfelmeier A, Karapetyan S, Studen F, Isaakidou A, Schneider T, Schmid RM, von Delius S, Gundling F, Burgkart R, Obermeier A, Mayr U, Ringelhan M, Rasch S, Lahmer T, Geisler F, Turner PE, Chan BK, Spinner CD, Schneider J. Differentiation of Spontaneous Bacterial Peritonitis from Secondary Peritonitis in Patients with Liver Cirrhosis: Retrospective Multicentre Study. Diagnostics (Basel) 2023; 13:diagnostics13050994. [PMID: 36900138 PMCID: PMC10000989 DOI: 10.3390/diagnostics13050994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Ascitic fluid infection is a serious complication of liver cirrhosis. The distinction between the more common spontaneous bacterial peritonitis (SBP) and the less common secondary peritonitis in patients with liver cirrhosis is crucial due to the varying treatment approaches. This retrospective multicentre study was conducted in three German hospitals and analysed 532 SBP episodes and 37 secondary peritonitis episodes. Overall, >30 clinical, microbiological, and laboratory parameters were evaluated to identify key differentiation criteria. Microbiological characteristics in ascites followed by severity of illness and clinicopathological parameters in ascites were the most important predictors identified by a random forest model to distinguish between SBP and secondary peritonitis. To establish a point-score model, a least absolute shrinkage and selection operator (LASSO) regression model selected the ten most promising discriminatory features. By aiming at a sensitivity of 95% either to rule out or rule in SBP episodes, two cut-off scores were defined, dividing patients with infected ascites into a low-risk (score ≥ 45) and high-risk group (score < 25) for secondary peritonitis. Overall, the discrimination of secondary peritonitis from SBP remains challenging. Our univariable analyses, random forest model, and LASSO point score may help clinicians with the crucial differentiation between SBP and secondary peritonitis.
Collapse
Affiliation(s)
- Silvia Würstle
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Einsteinstr. 25, 81675 Munich, Germany
| | - Siranush Karapetyan
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Einsteinstr. 25, 81675 Munich, Germany
| | - Fabian Studen
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andriana Isaakidou
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Tillman Schneider
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Roland M. Schmid
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stefan von Delius
- Department of Internal Medicine II, RoMed Hospital Rosenheim, Pettenkoferstr. 10, 83022 Rosenheim, Germany
| | - Felix Gundling
- Department of Gastroenterology, Hepatology, and Gastrointestinal Oncology, Bogenhausen Hospital of the Munich Municipal Hospital Group, Englschalkinger Straße 77, 81925 Munich, Germany
- Department of Internal Medicine II, Klinikum am Bruderwald, Sozialstiftung Bamberg, Buger Straße 80, 96049 Bamberg, Germany
| | - Rainer Burgkart
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas Obermeier
- Clinic of Orthopaedics and Sports Orthopaedics, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marc Ringelhan
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Fabian Geisler
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Paul E. Turner
- Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA
- Program in Microbiology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Benjamin K. Chan
- Department of Ecology and Evolutionary Biology, Yale University, 165 Prospect Street, New Haven, CT 06520, USA
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Ismaninger Str. 22, 81675 Munich, Germany
- Correspondence:
| |
Collapse
|
8
|
Helbig L, Stier B, Römer C, Kilian M, Slagman A, Behrens A, Stiehr V, Vollert JO, Bachmann U, Möckel M. [The abdominal pain unit as a treatment pathway : Structured care of patients with atraumatic abdominal pain in the emergency department]. Med Klin Intensivmed Notfmed 2023; 118:132-140. [PMID: 34928407 PMCID: PMC9992050 DOI: 10.1007/s00063-021-00887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with atraumatic abdominal pain are common in the emergency department and have a relatively high hospital mortality, with a very wide spectrum of different causes. Rapid, goal-directed diagnosis is essential in this context. METHODS In a Delphi process with representatives of different disciplines, a diagnostic treatment pathway was designed, which is called the Abdominal Pain Unit (APU). RESULTS The treatment pathway was designed as an extended event process chain. Crucial decision points were specified using standard operating procedures. DISCUSSION The APU treatment pathway establishes a consistent treatment structure for patients with atraumatic abdominal pain. It has the potential to improve the quality of care and reduce intrahospital mortality over the long term.
Collapse
Affiliation(s)
- Lukas Helbig
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Britta Stier
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Claudia Römer
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Maik Kilian
- Abteilung für Allgemein- und Viszeralchirurgie, Evangelische Elisabeth Klinik Berlin, Lützowstraße 26, 10785, Berlin, Deutschland
| | - Anna Slagman
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Angelika Behrens
- Abteilung für Innere Medizin, Gastroenterologie und Pneumologie, Evangelische Elisabeth Klinik Berlin, Lützowstraße 26, 10785, Berlin, Deutschland
| | - Vera Stiehr
- Abteilung für Innere Medizin, Gastroenterologie und Pneumologie, Evangelische Elisabeth Klinik Berlin, Lützowstraße 26, 10785, Berlin, Deutschland
| | - Jörn Ole Vollert
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Ulrike Bachmann
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Martin Möckel
- Akut- und Notfallmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| |
Collapse
|
9
|
Pi S, Li Y, Lin C, Li G, Wen H, Peng H, Wang J. Arterial spin labeling and diffusion-weighted MR imaging: quantitative assessment of renal pathological injury in chronic kidney disease. Abdom Radiol (NY) 2023; 48:999-1010. [PMID: 36598569 DOI: 10.1007/s00261-022-03770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of the study was to investigate the performance of arterial spin labeling (ASL), diffusion-weighted imaging (DWI), and clinical biomarkers in assessing renal pathological injury in CKD. MATERIALS AND METHODS Forty-five biopsy-proven CKD patients and 17 healthy volunteers underwent DWI and ASL examinations. Renal cortical blood flow (RBF) and apparent diffusion coefficient (ADC) values were acquired. Correlations between RBF, ADC, serum creatinine (SCr), estimated glomerular filtration rate (eGFR), and pathological scores were assessed. The diagnostic efficacy of SCr, eGFR, RBF, and ADC in assessing renal pathological injury was assessed by ROC curve analysis. RESULTS The cortical RBF, ADC, SCr, and eGFR were significantly correlated with the renal histology score (all p < 0.01). The AUC values of SCr, eGFR, RBF, and ADC were 0.705 (95% confidence interval (CI): 0.536-0.827), 0.718 (0.552-0.839), 0.823 (0.658-0.916), and 0.624 (0.451-0.786), respectively, in discriminating the minimal-mild renal pathological injury group (N = 30) from the control group (N = 17). The diagnostic ability of ASL was significantly higher than that of DWI (p = 0.049) and slightly but not significantly higher than that of eGFR and SCr (p = 0.151 and p = 0.129, respectively). When compared with that of eGFR, the sensitivity of ASL in detecting early renal injury increased from 50 to 70% (p = 0.014). However, in differentiating between the minimal-mild and moderate-severe renal injury groups (N = 15), there was no significant difference in diagnostic ability among the four parameters (all p > 0.05). CONCLUSION ASL is practicable for noninvasive evaluation of renal pathology, especially for predicting early renal pathological injury in CKD patients.
Collapse
Affiliation(s)
- Shan Pi
- Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Yin Li
- Department of Nephrology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Churong Lin
- Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Gang Li
- Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Huiquan Wen
- Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China
| | - Hui Peng
- Department of Nephrology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China.
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital, Sun Yat-Sen University (SYSU), Tianhe Road, No 600, Guangzhou, 510630, Guangdong, People's Republic of China.
| |
Collapse
|
10
|
Jiang ZH, Xv R, Xia L. Foreign body granuloma in the tongue differentiated from tongue cancer: A case report. World J Clin Cases 2022; 10:6247-6253. [PMID: 35949813 PMCID: PMC9254197 DOI: 10.12998/wjcc.v10.i18.6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/12/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Embedded foreign bodies in the tongue are rarely seen in clinical settings. An untreated foreign body can cause a granuloma which often presents as an enlarged tongue mass. However, if foreign body ingestion status is unknown, physical examination and magnetic resonance imaging (MRI) tend to lead to suspicion of tongue cancer, especially in older patients. Thus, differential diagnosis of an enlarged tongue mass is important, especially because it is closely related to the choice of treatment method.
CASE SUMMARY A 61-year-old woman was admitted to the hospital with pain and noticeable swelling in the tongue that had persisted for over 1 mo. She had no previous medical history. MRI revealed abnormal signal intensities that were indicative of a neoplasm. Thus, the oral surgeon and radiologist arrived at a primary diagnosis of tongue cancer. The patient visited the Ear Nose and Throat Department for further consultation and underwent an ultrasound examination of the tongue. The ultrasonography was consistent with a linear hyperechoic foreign body which was indicative of an embedded foreign body (bone) in the tongue, even though the patient denied any history of foreign body ingestion. Complete surgical enucleation of the lesion was conducted. The mass which included a fish bone was completely removed. The post-operative pathological examination confirmed that the mass was a granuloma containing collagen fibers, macrophages and chronic inflammatory cells. The patient recovered without complications over a 2 mo follow-up period.
CONCLUSION We report a rare case of foreign body granuloma in the tongue that was primarily diagnosed as tongue cancer. The MRI and ultrasound examinations revealed a piece of bone in the left lateral aspect of the tongue. The granuloma, which contained a fish bone, was completely removed via surgery and confirmed via biopsy. Differential diagnosis of the enlarged tongue mass was critical to the selection of treatment method.
Collapse
Affiliation(s)
- Zhen-Hua Jiang
- Department of Otolaryngology - Head and Neck Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Ran Xv
- Department of Otolaryngology - Head and Neck Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| | - Li Xia
- Department of Otolaryngology - Head and Neck Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
| |
Collapse
|
11
|
Dietrich CF, Zander T. [All about the Pancreas]. PRAXIS 2022; 111:519-524. [PMID: 35765789 DOI: 10.1024/1661-8157/a003910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
All about the Pancreas Abstract. Ultrasound has made tremendous progress with the use of contrast media and elastography, particularly in patients with small, solid pancreatic lesions (SPL) <20mm and cystic tumors (CPL) of any size. In the case of solid and cystic pancreatic lesions, the differential diagnosis must first be evaluated after detection in order to define the indications for radical surgery, strategies for preserving the pancreatic parenchyma or simply for control examinations. Contrast-enhanced transcutaneous (TUS, CEUS) and endoscopic (EUS, CE-EUS) ultrasound and elastography facilitate further characterization of SPL and ZPL. Pancreatic ductal adenocarcinomas (PDAC) show hypoenhancement in contrast-enhanced ultrasound. The majority of the important differential diagnoses, on the other hand, are multi-enhancing. PDAC are almost always harder than healthy pancreatic parenchyma. In contrast, elastographically soft SPL are - with very few exceptions - benign. This review provides an overview of the use of modern ultrasound techniques to detect and characterize solid and cystic pancreatic lesions.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Departement Allgemeine Innere Medizin (DAIM) der Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| | - Tobias Zander
- Departement Allgemeine Innere Medizin (DAIM) der Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz
| |
Collapse
|
12
|
Waheed S, Tahir MJ, Ullah I, Alwalid O, Irshad SG, Asghar MS, Yousaf Z. The impact of dependence on advanced imaging techniques on the current radiology practice. Ann Med Surg (Lond) 2022; 78:103708. [PMID: 35592825 PMCID: PMC9111924 DOI: 10.1016/j.amsu.2022.103708] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/05/2022] Open
Abstract
Medical imaging techniques are a helpful tool for physicians to diagnose and treat diseases. Some of these techniques are conventional and include X-rays, Ultrasounds while others are advanced imaging modalities such as MRI and CT scans. Recently, more and more physicians are relying on these advanced imaging modalities because of advancements in technology, increased patient demand, greater finances, and the fear of any malpractice suits in case of missed diagnosis. While these techniques, no doubt, offer a quicker and correct diagnosis owing to their sharp resolution and sensitivity, they do expose the patient to a great source of radiation, are expensive, time consuming, and are not an ideal means to be used in all situations. Thus, it is crucial to mitigate their unnecessary use. The following article focuses on the growing use of such techniques, their advantages and disadvantages and how to alleviate their exaggerated use.
Collapse
|
13
|
Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
Collapse
Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
| |
Collapse
|
14
|
Abstract
Colorectal cancer (CRC) is one of the most common cancers in the world. The most important determinant of survival and prognosis is the stage and presence of metastasis. The liver is the most common location for CRC metastasis. The only curative treatment for CRC liver metastasis (CRLM) is resection; however, many patients are ineligible for surgical resection of CRLM. Locoregional treatments such as ablation and intra-arterial therapy are also available for patients with CRLM. Assessment of response after chemotherapy is challenging due to anatomical and functional changes. Antiangiogenic agents such as bevacizumab that are used in the treatment of CRLM may show atypical patterns of response on imaging. It is vital to distinguish patterns of response in addition to toxicities to various treatments. Imaging plays a critical role in evaluating the characteristics of CRLM and the approach to treatment. CT is the modality of choice in the diagnosis and management of CRLM. MRI is best used for indeterminate lesions and to assess response to intra-arterial therapy. PET-CT is often utilized to detect extrahepatic metastasis. State-of-the-art imaging is critical to characterize patterns of response to various treatments. We herein review the imaging characteristics of CRLM with an emphasis on imaging changes following the most common CRLM treatments.
Collapse
|
15
|
Malik J, Zaidi SMJ, Rana AS, Haider A, Tahir S. Post-cardiac injury syndrome: An evidence-based approach to diagnosis and treatment. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2021; 12:100068. [PMID: 38559602 PMCID: PMC10978175 DOI: 10.1016/j.ahjo.2021.100068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 04/04/2024]
Abstract
Post-cardiac injury syndrome (PCIS) is an umbrella term used for the post-pericardiotomy syndrome, post-myocardial infarction (MI) related pericarditis (Dressler syndrome), and post-traumatic pericarditis (percutaneous coronary intervention (PCI) or cardiac implantable electronic device (CIED) placement). All these conditions give rise to PCIS due to an inciting cardiac injury to pericardial or pleural mesothelial cells, leading to subsequent inflammation syndromes ranging from uncomplicated pericarditis to massive pleural effusion. We did a literature search on MEDLINE/PubMed for relevant studies using the terms "post-acute cardiac injury syndrome", "post-cardiac injury syndrome", "post-cardiotomy syndrome", "post-pericardiotomy syndrome", "post-MI pericarditis" and to summarize the body of evidence, all relevant full texts were selected and incorporated in a narrative fashion. Pathophysiology of PCIS is suggested as autoimmune-mediated in predisposed patients who develop anti-actin and anti-myosin antibodies following a cascade of cardiac injury in various forms. Colchicine and NSAIDs including ibuprofen are demonstrated as efficacious in preventing recurrent attacks of PCIS while corticosteroids show no benefit on prognosis and recurrence of the disease.
Collapse
Affiliation(s)
- Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 46000, Pakistan
| | | | - Abdul Sattar Rana
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 46000, Pakistan
| | - Ali Haider
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 46000, Pakistan
| | - Saleha Tahir
- Department of Respiratory Medicine, Shifa International Hospital, Islamabad 44000, Pakistan
| |
Collapse
|
16
|
Wiest I, Teufel A, Ebert MP, Potthoff A, Christen M, Penkala N, Dietrich CF. [Budd-Chiari syndrome, review and illustration]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1335-1345. [PMID: 34820810 DOI: 10.1055/a-1645-2760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Budd-Chiari syndrome is a rare vascular disorder characterized by obstruction of the hepatic venous outflow. Various diseases causing coagulopathy play a role in aetiology, such as myeloproliferative disorders. Acute vascular occlusion may lead to acute phlebitis with fever. The classic triad of acute liver failure may be present with ascites, hepatomegaly, and abdominal pain. However, subacute courses of disease were also observed. Because of the variable symptoms and severity extent, depending on the acuity of the course and the extent of the affected vessels, diagnosis is often difficult. Sonography, as a ubiquitously available and cost-effective diagnostic tool, plays a leading role. Doppler ultrasonography can be used to visualize hemodynamics in particular. In acute thrombotic occlusion, the affected hepatic veins usually cannot or only partially be visualized. In non-occluding thrombi, turbulent flow patterns may develop in the area of venous outflow obstruction, and flow velocity is then increased in the area of stenosis. Contrast enhanced ultrasound offers even better specificity of diagnosis. Computed tomography and magnetic resonance imaging can directly visualize thrombi and the cause of obstruction. Once the diagnosis is confirmed, anticoagulation must be initiated, but therapy of the underlying disease must also be started. If symptom-controlling measures are not sufficient, angioplasty/stenting to reopen short-segment stenoses or implantation of a TIPSS device may be considered. Liver transplantation remains ultima ratio. As studies on the precision of diagnostic methods are controversial, the characteristics of imaging for BCS are therefore summarized in this review on the basis of several illustrating case reports.
Collapse
Affiliation(s)
- Isabella Wiest
- II. Medizinische Klinik, Sektion Hepatologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Andreas Teufel
- II. Medizinische Klinik, Sektion Hepatologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.,Klinische Kooperationseinheit Healthy Metabolism, Zentrum für Präventivmedizin und Digitale Gesundheit Baden-Württemberg, Universität Heidelberg, Mannheim, Germany
| | - Matthias Philip Ebert
- Klinische Kooperationseinheit Healthy Metabolism, Zentrum für Präventivmedizin und Digitale Gesundheit Baden-Württemberg, Universität Heidelberg, Mannheim, Germany.,II. Medizinische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - Andrej Potthoff
- Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, Hannover, Germany
| | - Michael Christen
- Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| | - Nadine Penkala
- Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| |
Collapse
|
17
|
Möller K, Dietrich CF, Faiss S, Mutze S, Goelz L. [Alternatives of histological material collection - When and how is histological confirmation by ultrasound (US), computer tomography (CT) or endosonography (EUS) useful?]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:937-958. [PMID: 34781389 DOI: 10.1055/a-1482-9448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histological classifications of tumorous lesions together with adequate staging are necessary for stage-appropriate and personalized therapies. The indications, technical possibilities, and limitations as well as potential complications of image-guided needle biopsy by ultrasound, computed tomography, and endosonography are described. Which procedure for which organ and which lesion?
Collapse
Affiliation(s)
- Kathleen Möller
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | | | - Siegbert Faiss
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | - Sven Mutze
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany.,Institut für Radiologie, SANA-Klinikum, Berlin, Germany.,Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany.,Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
| |
Collapse
|
18
|
Childs JT, Thoirs KA, Esterman A, Lamb K. The diagnostic accuracy of using a predictive equation for liver volume derived from simple sonographic measurements in the determination of hepatomegaly. SONOGRAPHY 2021. [DOI: 10.1002/sono.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jessie T. Childs
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Kerry A. Thoirs
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| | - Adrian Esterman
- Biostatistics and Epidemiology, Clinical and Health Sciences University of South Australia Adelaide South Australia Australia
| | - Kate Lamb
- Allied Health and Human Performance University of South Australia Adelaide South Australia Australia
| |
Collapse
|
19
|
Zou YZ, Yang JP, Zhou XJ, Li K, Li XM, Song CH. Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report. World J Clin Cases 2020; 8:4660-4666. [PMID: 33083431 PMCID: PMC7559646 DOI: 10.12998/wjcc.v8.i19.4660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The occurrence of a diaphragmatic hernia during the third trimester of pregnancy is rare; to our knowledge, there has only been a single case report related to congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy. Nonspecific symptoms and lack of experience due to its rarity make the diagnosis of this condition very challenging. We report a case of diaphragmatic hernia accompanied by mild acute pancreatitis in the third trimester of pregnancy, which was misdiagnosed as severe acute pancreatitis.
CASE SUMMARY A 19-year-old woman presented at gestation of 31+2 weeks with continuous distension pain for 3 d in the left lumbar region of no obvious cause. Ultrasonographic findings of left ureterectasis, with nonspecific lumbago and abdominal pain, led to the misdiagnosis of renal colic. Increased serum amylase and/or lipase levels indicated acute pancreatitis. Following the treatment of pancreatitis, her condition deteriorated. The patient was finally diagnosed with a diaphragmatic hernia complicated with mild acute pancreatitis on magnetic resonance imaging at our hospital. Caesarean section was performed at gestation of 31+6 weeks, followed by hernia repair, and the pancreatitis was treated sequentially. The patient was discharged in good condition 20 d after the surgery.
CONCLUSION In this case, surgical treatment was not the same as that for non-pregnant diaphragmatic hernia repair. It is important to first perform a cesarean section before commencing the therapy.
Collapse
Affiliation(s)
- Yun-Zhi Zou
- Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jin-Pu Yang
- Department of Gastroenterology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Jiang Zhou
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ke Li
- Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xiao-Mei Li
- Clinical Research Center, Xiamen University, Xiamen 361102, Fujian Province, China
| | - Cong-Hua Song
- Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| |
Collapse
|
20
|
Caraiani C, Yi D, Petresc B, Dietrich C. Indications for abdominal imaging: When and what to choose? J Ultrason 2020; 20:e43-e54. [PMID: 32320166 PMCID: PMC7266076 DOI: 10.15557/jou.2020.0008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/18/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging. Imaging has a very important role in evaluating abdominal pathology. A good knowledge of indications is of crucial importance in the management of the patient with abdominal pathology. Ultrasound, which on its own can lead to an accurate diagnosis, plays a pivotal role in the management of abdominal pathology. The use of ultrasound contrast agents has significantly improved ultrasound diagnostic capacities in both hepatic and non-hepatic pathology. The use of computed tomography should be limited due to the potential harmful side effects of ionizing radiation, but it has established roles in evaluating severe abdominal traumatic and non-traumatic emergencies as well as in staging oncologic patients. Magnetic resonance imaging has very limited utility in abdominal emergencies due to difficulty of accessing the scanner and the long duration of the examination compared to computed tomography or ultrasound. However, magnetic resonance imaging has well-established clinical roles particularly for evaluating diffuse or focal hepatic pathology, benign and malignant bile duct pathology, pancreatic tumors, inflammatory bowel disease and rectal tumors. The aims of the following paper are to familiarize the clinician with the indications for imaging in abdominal pathology, to guide the clinician and radiologist in choosing the correct technique for a particular clinical situation, to prevent the overuse of imaging techniques and to prevent misdiagnosis of disease and incorrect therapy resulting from inappropriate imaging.
Collapse
Affiliation(s)
- Cosmin Caraiani
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Dong Yi
- Department of Ultrasound, Zhongshan Hospital, Fudan University , Shanghai , China
| | - Bianca Petresc
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Christoph Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirlsanden Bern Beau Site , Salem und Permanence , Switzerland ; Ultrasound Department, First Affiliated Hospital of Zhengzhou University , China
| |
Collapse
|