1
|
Kolck J, Auer TA, Walter-Rittel T, Hosse C, Elkilany A, Marth AA, Pelzer U, Mohr R, Krenzien F, Lurje G, Schöning W, Hamm B, Geisel D, Fehrenbach U. Prediction of regional lymph node metastasis in intrahepatic cholangiocarcinoma: it's not all about size. Abdom Radiol (NY) 2023; 48:3063-3071. [PMID: 37354262 PMCID: PMC10480242 DOI: 10.1007/s00261-023-03991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Lymph node metastases (LNM) are frequent in patients with intrahepatic cholangiocarcinoma (iCC) and worsen their prognosis even after surgery. Our aim was to investigate the predictive value of lymph node (LN) short axis, the most common discriminator for identifying LNM in tumor-imaging and to develop a predictive model for regional LNM in iCC taking computed tomography (CT) features of extranodal disease into account. MATERIALS AND METHODS We enrolled 102 patients with pathologically proven iCC who underwent CT prior to hepatic resection and hilar lymph node dissection (LND) from 2005 to 2021. Two blinded radiologists assessed various imaging characteristics and LN diameters, which were analyzed by bivariate and multivariate logistic regression to develop a prediction model for LNM. RESULTS Prevalence of LNM was high (42.4 %) and estimated survival was shorter in LN-positive patients (p = 0.07). An LN short axis diameter of ≥ 9 mm demonstrated the highest predictive power for LNM. Three additional, statistically significant imaging features, presence of intrahepatic metastasis (p = 0.003), hilar tumor infiltration (p = 0.003), and tumor growth along the liver capsule (p = 0.004), were integrated into a prediction model, which substantially outperformed use of LN axis alone in ROC analysis (AUC 0.856 vs 0.701). CONCLUSIONS LN diameter alone proved to be a relevant but unreliable imaging-marker for LNM prediction in iCC. Our proposed prognostic model, which additionally considers intrahepatic metastases and hilar and capsular infiltration, significantly improves discriminatory power. Hilar and capsular involvement might indicate direct tumor extension to lymphatic liver structures.
Collapse
Affiliation(s)
- Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Timo Alexander Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Clarissa Hosse
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Aboelyazid Elkilany
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Uwe Pelzer
- Department of Hematology/Oncology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Raphael Mohr
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Krenzien
- BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité -Universitätsmedizin Berlin, Berlin, Germany
- Department of Surgery CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Lurje
- Department of Surgery CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery CCM/CVK, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
2
|
Chen J, Alexander T, Walter-Rittel T, Ziagaki A, Siffrin V. Mepolizumab as an effective treatment in a case of hypophysitis in eosinophilic granulomatosis with polyangiitis. Ther Adv Neurol Disord 2023; 16:17562864231182519. [PMID: 38274358 PMCID: PMC10809015 DOI: 10.1177/17562864231182519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 03/31/2023] [Indexed: 01/27/2024] Open
Abstract
Granulomatosis or eosinophilic granulomatosis with polyangiitis (GPA/EGPA) can affect multiple organs resulting in heterogeneous symptoms and phenotypes. Pituitary gland dysfunction rarely occurs in GPA (1-3%) and even less in EGPA (two case reports). Here, we report a case of a 51-year-old female patient with a four-year history of EGPA who presented with new polydipsia and polyuria. Laboratory testing and magnetic resonance imaging (MRI) confirmed pituitary gland dysfunction caused by a hypophysitis. Therapeutic adjustment with a switch from dupilumab to mepolizumab resulted in a decrease in clinical symptoms, inflammation in MRI, and normalization of C-reactive protein in serum. This case underlines hypophysitis as a rare organ involvement also in EGPA. Moreover, this case demonstrates the responsiveness of neuroinflammatory manifestations to the recently approved anti-interleukin-5 monoclonal antibody mepolizumab as a new potential treatment option.
Collapse
Affiliation(s)
- Jessy Chen
- Department of Neurology and Experimental Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Alexander
- Department of Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Athanasia Ziagaki
- Department of Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Siffrin
- Department of Neurology and Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
3
|
Beetz NL, Trippel TD, Philipp K, Maier C, Walter-Rittel T, Shnayien S, Gehle P. Discrepancy of echocardiography and computed tomography in initial assessment and 2-year follow-up for monitoring Marfan syndrome and related disorders. Sci Rep 2022; 12:15333. [PMID: 36097197 PMCID: PMC9468173 DOI: 10.1038/s41598-022-19662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with Marfan syndrome and related disorders are at risk for aortic dissection and aortic rupture and therefore require appropriate monitoring. Computed tomography (CT) and transthoracic echocardiography (TTE) are routinely used for initial diagnosis and follow-up. The purpose of this study is to compare whole-heart CT and TTE aortic measurement for initial work-up, 2-year follow-up, and detection of progressive aortic enlargement. This retrospective study included 95 patients diagnosed with Marfan syndrome or a related disorder. All patients underwent initial work-up including aortic diameter measurement using both electrocardiography-triggered whole-heart CT and TTE. Forty-two of these patients did not undergo aortic repair after initial work-up and were monitored by follow-up imaging within 2 years. Differences between the two methods for measuring aortic diameters were compared using Bland-Altman plots. The acceptable clinical limit of agreement (acLOA) for initial work-up, follow-up, and progression within 2 years was predefined as < ± 2 mm. Bland-Altman analysis revealed a small bias of 0.2 mm with wide limits of agreement (LOA) from + 6.3 to - 5.9 mm for the aortic sinus and a relevant bias of - 1.6 mm with wide LOA from + 5.6 to - 8.9 mm for the ascending aorta. Follow-up imaging yielded a small bias of 0.5 mm with a wide LOA from + 6.7 to - 5.8 mm for the aortic sinus and a relevant bias of 1.1 mm with wide LOA from + 8.1 to - 10.2 mm for the ascending aorta. Progressive aortic enlargement at follow-up was detected in 57% of patients using CT and 40% of patients using TTE. Measurement differences outside the acLOA were most frequently observed for the ascending aorta. Whole-heart CT and TTE measurements show good correlation, but the frequency of measurement differences outside the acLOA is high. TTE systematically overestimates aortic diameters. Therefore, whole-heart CT may be preferred for aortic monitoring of patients with Marfan syndrome and related disorders. TTE remains an indispensable imaging tool that provides additional information not available with CT.
Collapse
Affiliation(s)
- Nick Lasse Beetz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Tobias Daniel Trippel
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Karla Philipp
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christoph Maier
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Petra Gehle
- Department of Internal Medicine - Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| |
Collapse
|
4
|
Kolck J, Ziegeler K, Walter-Rittel T, Hermann KGA, Hamm B, Beck A. Clinical utility of postprocessed low-dose radiographs in skeletal imaging. Br J Radiol 2022; 95:20210881. [PMID: 34919419 PMCID: PMC8822553 DOI: 10.1259/bjr.20210881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography. METHODS In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader's total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores. RESULTS Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value. CONCLUSION In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice. ADVANCES IN KNOWLEDGE The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value.
Collapse
Affiliation(s)
- Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Beck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
Auer TA, Walter-Rittel T, Geisel D, Schöning W, Schmelzle M, Müller T, Sinn B, Denecke T, Hamm B, Fehrenbach U. HBP-enhancing hepatocellular adenomas and how to discriminate them from FNH in Gd-EOB MRI. BMC Med Imaging 2021; 21:28. [PMID: 33588783 PMCID: PMC7885421 DOI: 10.1186/s12880-021-00552-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Recent studies provide evidence that hepatocellular adenomas (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25-50%, 50-75% and 75-100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed. RESULTS Subjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)-p < 0.001) with significantly higher uptake scores assigned to FNHs (Cut-off: 75%-100%). Typical lobulation and presence of a central scar in FNH achieved an accuracy of 0.750 or higher in at least one reader (lobulation-AUC: 0.809 (R#1); 0.736 (R#2); central scar-AUC: 0.595 (R#1); 0.784 (R#2)). The multivariate regression emphasized the discriminatory power of the Gd-EOB scoring (p = 0.001/OR:22.15 (R#1) and p < 0.001/OR:99.12 (R#2). The lesion-to-liver ratio differed significantly between FNH and HCA in the PV phase and HBP (PV: 132.9 (FNH) and 110.2 (HCA), p = 0.048 and HBP: 110.3 (FNH) and 39.2 (HCA), p < 0.001)), while the difference was not significant in arterial and transitional contrast phases (p > 0.05). CONCLUSION Even in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA.
Collapse
Affiliation(s)
- Timo Alexander Auer
- Klinik Für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, 10178, Germany.
| | - Thula Walter-Rittel
- Klinik Für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Dominik Geisel
- Klinik Für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte | Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Tobias Müller
- Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bruno Sinn
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, Universitätsklinikum Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
| | - Bernd Hamm
- Klinik Für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Uli Fehrenbach
- Klinik Für Radiologie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| |
Collapse
|
6
|
Voss JO, Doll C, Raguse JD, Beck-Broichsitter B, Walter-Rittel T, Kahn J, Böning G, Maier C, Thieme N. Detectability of foreign body materials using X-ray, computed tomography and magnetic resonance imaging: A phantom study. Eur J Radiol 2020; 135:109505. [PMID: 33421828 DOI: 10.1016/j.ejrad.2020.109505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of plain radiography (X-ray. XR), computed tomography (CT) and magnetic resonance imaging (MR) in visualising commonly seen foreign bodies. A special focus was put on objects relevant to head and neck surgery. METHOD Thirty-four commonly encountered objects of different compositions including wood, plastic, and glass were embedded in a gelatin gel phantom and imaged using XR, CT and MR. The success rates of radiologists in detecting and correctly identifying the foreign objects were evaluated. Subjective visibility was rated on a 4-point Likert scale. Objective visibility was analysed using region of interest-based contrast for CT. RESULTS Sensitivity in foreign bodies detection was highest in MR (97.1 %) followed by CT (86.0 %) and x-ray (61.8 %). Success rates for the correct identification of the objects and material types were highest in MR (33.3 % and 39.2 %, respectively) followed by CT (25.5 % for both) and XR (16.7 % and 15.7 %). Overall, subjective visibility was rated higher in CT and MR imaging ("good visibility"), as compared to XR ("poor visibility"). Interreader agreement was high across modalities (Kendall's W = 0.935, 0.834 and 0.794 for XR, MR and CT, respectively). CONCLUSIONS Detection and identification of non-ferromagnetic objects was most successful in MR followed by CT imaging in this experimental setup.
Collapse
Affiliation(s)
- Jan Oliver Voss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany.
| | - Christian Doll
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jan D Raguse
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Fachklinik Hornheide, Department of Oral and Maxillofacial Surgery, Dorbaumstraße 300, 48147 Münster, Germany.
| | - Benedicta Beck-Broichsitter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Thula Walter-Rittel
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Diagnostic and Interventional Radiology and Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Johannes Kahn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Diagnostic and Interventional Radiology and Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Georg Böning
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Diagnostic and Interventional Radiology and Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Christoph Maier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Diagnostic and Interventional Radiology and Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Nadine Thieme
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Diagnostic and Interventional Radiology and Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany.
| |
Collapse
|
7
|
Schneider M, Morris DA, Pieske-Kraigher E, Walter-Rittel T, Parwani AS, Pieske B, Boldt LH. Left atrial diverticulum-An unexpected finding in routine transesophageal echocardiography. Echocardiography 2020; 38:147-148. [PMID: 33280163 DOI: 10.1111/echo.14949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
We report a 55-year-old male patient with lone paroxysmal atrial fibrillation who underwent routine transesophageal echocardiography (TOE) at our institution. In a mid-esophageal 125° three-chamber angulation, a distinct thinning of the left atrial (LA) wall was observed, forming a 7 × 4 mm canal with only a small membrane separating the LA from the pericardial space. Cardiac magnetic resonance imaging diagnosed a small LA diverticulum. To the best of our knowledge, this is the first manuscript describing detection of a small LA diverticulum via TOE.
Collapse
Affiliation(s)
- Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Elisabeth Pieske-Kraigher
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Abdul S Parwani
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| | - Leif-Hendrik Boldt
- Department of Internal Medicine and Cardiology, Charité University Medicine (Campus Virchow Klinikum), Berlin, 13353, Germany
| |
Collapse
|