ZUSAMMENFASSUNG Die Nierenbiopsie ist eine integrale Maßnahme zur richtungsweisenden Diagnostik und Prognose. In der klinischen Routine ist die perkutane, sonografisch gesteuerte Durchführung fest etabliert. Eine gefürchtete Komplikation der Nierenbiopsie ist eine assoziierte relevante Blutung. Bei erhöhtem Blutungsrisiko bietet die transvenöse transjuguläre Nierenbiopsie (TJNB) eine unkomplizierte Alternative, die eine höhere Sicherheit und vergleichbare klinische Ergebnisse aufweist. In diesem Beitrag erhalten Sie einen Überblick über Empfehlungen zu den Indikationen, die Technik und die Ergebnisse im Vergleich zur üblichen perkutanen Nierenbiopsie.

Erratum Erratum zu Jakob M, Backes M, Schaefer C et al. MR Enterography in Crohnʼs Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding. Fortschr Röntgenstr 2022; DOI 10.1055/a-1826-0049 Der erste Satz der Abbildungslegende zu Abbildung 1 wurde am 27.09.2022 geändert. Richtig ist: KM Aufnahme und parametrische Darstellung der „area under the curve“ mit erfolgter Bildersubtraktion.

Purpose We compared contrast-enhanced MR enterography with diffusion-weighted sequences to evaluate the validity of diffusion-weighted sequences for activity assessment in Crohn & apos;s disease compared to endoscopy. In addition, we investigated a new color-coded image post-processing technique in comparison with standard sequences and endoscopy. Materials and Methods Included were 197 MR enterographies (2015-2017) performed by using standardized examination protocols. The intestine was divided into 7 segments, which were compared separately. The accuracy of the MR examinations with regard to disease activity was validated using the Seo and MaRIA score and endoscopy findings. In addition, the image data were post-processed using a color-coded evaluation method (DCE tool on OsiriX). Results The comparison between contrast-enhanced and diffusion-weighted sequences showed a highly significant correlation for all bowel sections with a mean Spearman correlation coefficient of 0.876 (0.809-0.928). The color-coded image post-processing showed a sensitivity of 83.2 % and a specificity of 70.5 % in comparison with the MaRIA score. In comparison to endoscopy, a sensitivity of 81.3 % and a specificity of 70.5 %. In comparison with endoscopy, the MaRIA score showed a sensitivity of 80.2 % and a specificity of 84.0 % at a cut-off of 7. The visual score according to Seo showed a sensitivity of 85.7 % with a specificity of 77.0 % in the contrast-weighted examination and a sensitivity of 87.9 % and a specificity of 71.8 % for diffusion weighted images. Conclusion Diffusion-weighted sequences are as good as contrast-weighted sequences for assessing inflammatory activity in Crohn & apos;s disease. Contrast is often helpful for assessing complications, but this was not the purpose of this study. Visual imaging using color-coded data sets was similarly good at detecting inflammation. Citation Format Jakob M, Backes M, Schaefer C et al. MR Enterography in Crohn & apos;s Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding. Fortschr Rontgenstr 2022; DOI: 10.1055/a-1826-0049 Purpose We compared contrast-enhanced MR enterography with diffusion-weighted sequences to evaluate the validity of diffusion-weighted sequences for activity assessment in Crohn & apos;s disease compared to endoscopy. In addition, we investigated a new color-coded image post-processing technique in comparison with standard sequences and endoscopy. Materials and Methods Included were 197 MR enterographies (2015-2017) performed by using standardized examination protocols. The intestine was divided into 7 segments, which were compared separately. The accuracy of the MR examinations with regard to disease activity was validated using the Seo and MaRIA score and endoscopy findings. In addition, the image data were post-processed using a color-coded evaluation method (DCE tool on OsiriX). Results The comparison between contrast-enhanced and diffusion-weighted sequences showed a highly significant correlation for all bowel sections with a mean Spearman correlation coefficient of 0.876 (0.809-0.928). The color-coded image post-processing showed a sensitivity of 83.2 % and a specificity of 70.5 % in comparison with the MaRIA score. In comparison to endoscopy, a sensitivity of 81.3 % and a specificity of 70.5 %. In comparison with endoscopy, the MaRIA score showed a sensitivity of 80.2 % and a specificity of 84.0 % at a cut-off of 7. The visual score according to Seo showed a sensitivity of 85.7 % with a specificity of 77.0 % in the contrast-weighted examination and a sensitivity of 87.9 % and a specificity of 71.8 % for diffusion weighted images. Conclusion Diffusion-weighted sequences are as good as contrast-weighted sequences for assessing inflammatory activity in Crohn & apos;s disease. Contrast is often helpful for assessing complications, but this was not the purpose of this study. Visual imaging using color-coded data sets was similarly good at detecting inflammation. Citation Format Jakob M, Backes M, Schaefer C et al. MR Enterography in Crohn & apos;s Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding. Fortschr Rontgenstr 2022; DOI: 10.1055/a-1826-0049

A coronary-pulmonary artery fistula with giant aneurysmal dilatation is an extremely rare clinical constellation. The natural course of this disease and the incidence of complications are unknown. Hence, optimal treatment, particularly in asymptomatic patients, is still a matter of debate. Here we report a case of a 71-year-old asymptomatic woman with a diastolic murmur. Comprehensive cardiovascular assessments including cardiac computed tomography and invasive coronary angiography revealed a coronary-pulmonary artery fistula with giant aneurysmal dilatation. The patient was managed conservatively and has now been followed up for 5 years without any events.

Background The diagnostic performance of adenosine stress cardiovascular magnetic resonance (CMR) for the detection of significant stenosis in infarct-related arteries is widely unknown. Two different types of perfusion defects can be observed: (a) larger than or (b) equal size as scar. We hypothesized that: (a) defect>scar predicts significant coronary stenosis, and (b) defect=scar predicts an unobstructed infarct-related artery, and (c) angina symptoms might be of additional value in stratification. Patients and methods Patients with previous myocardial infarction referred for work-up of myocardial ischemia undergoing adenosine stress CMR were included if they had coronary angiography within 4 weeks of CMR. Results Two hundred patients with a mean age of 66 +/- 11 years, ischemic scars (subendocardial/transmural), and a mean left ventricular ejection fraction of 53% were included. In patients with defect>scar, the positive predictive value was excellent (88%) and typical angina was reported only in the stenosis group (P=0.002). However, patients with defect=scar (with 50% showing subendocardial scar) had a prevalence of 37% for stenosis, yielding a low negative predictive value of 63%. In this group, symptoms of typical angina were independent of stenosis (P=1.0). Conclusion A perfusion defect larger than scar is highly predictive for significant stenosis in infarct-related arteries. However, more than a third of the patients with perfusion defect of equal size as scar also showed significant coronary stenosis. As half of these patients showed still viable (subendocardial) scars, there is a high-risk of reinfarction. The addition of angina symptoms seems to increase diagnostic accuracy only in patients with perfusion defects larger than scar. Copyright (c) 2019 Wolters Kluwer Health, Inc. All rights reserved.

INTRODUCTION:Cardiac haemangiomas are rare vascular tumours of the heart accounting for less than 5% of benign primary cardiac neoplasms. They are sometimes diagnosed incidentally, since patients can be asymptomatic. The clinical presentation in symptomatic patients, however, is variable, depending on size and exact localization of the tumour. Although cardiac haemangiomas have been reported everywhere in the heart, those localized in the pericardium are extremely rare. CASE PRESENTATION:A 48-year-old female patient with a history of pericardial effusion and pneumonia was admitted to our hospital with progressive dyspnoea on exertion. Echocardiography demonstrated recurrence of pericardial effusion with 'swinging heart'. Further investigation by computed tomography, cardiac magnetic resonance imaging and coronary angiography revealed a hypervascular pericardial mass with typical 'tumour blush' after contrast injection. The tumour could be resected in toto by open heart surgery, and histological evaluation confirmed the diagnosis of a pericardial capillary haemangioma. There were no signs of recurrence of neither the pericardial effusion nor the tumour during follow-up. DISCUSSION:We here report a very rare case of a pericardial haemangioma in the adult which was diagnosed by multi-modality workup of recurrent pericardial effusion. This case illustrates that in the setting of chronic pericardial effusion non-inflammatory and non-malignant causes should be taken into account.

BackgroundThe diagnosis of cardiac involvement in rheumatic disorders is challenging due to its varying clinical presentation. Since clinical consequences range from immediate treatment changes to adverse long-term outcome, individual risk stratification is of great clinical interest. Primary aim was to evaluate the prevalence of cardiac involvement in patients with different rheumatic disorders using late gadolinium enhancement–cardiac magnetic resonance imaging (LGE-CMR). In addition, we sought to investigate if different rheumatic disorders would demonstrate different LGE patterns.MethodsTwo-hundred-ninety-seven patients with rheumatic disorders were included and underwent LGE-CMR for work-up of cardiac involvement, which was defined by the presence of LGE in the myocardium. Patients were divided into five subgroups: 1) ANCA-associated vasculitis, 2) non-ANCA-associated vasculitis, 3) connective tissue disorders, 4) arthritis, and 5) sarcoidosis.ResultsMean ejection fraction in the overall population was 65%, with a mean age of 55yrs. Prevalence of cardiac involvement in the five subgroups were as follows: 54% in the ANCA-associated vasculitis group, 22% in the non-ANCA-associated vasculitis group, 14% in the group with connective tissue disorders, 21% in the arthritis group, and 24% in sarcoid patients. Each of the five subgroups demonstrated a distinct pattern of LGE.ConclusionThere is a wide range in the prevalence of cardiac involvement in different rheumatic disorders (54%–14%). Different groups of rheumatic disorders demonstrate different patterns of LGE.Condensed abstractPrimary aim of the study was to evaluate the presence of cardiac involvement in patients with different rheumatic disorders using LGE-CMR. In addition, we sought to investigate if different rheumatic disorders would reveal different LGE patterns.In our 297 patients, the highest prevalence of cardiac involvement was found in patients with ANCA-associated vasculitis (54%), whereas the lowest prevalence was demonstrated in patients with connective tissue disorders (14%). Furthermore, different groups of rheumatic disorders demonstrate distinct patterns of LGE.

Increased cardiac fat has been identified as a risk factor for coronary artery disease. Metabolic syndrome is associated with increased cardiac fat deposition. Steroids are known to imitate some effects of metabolic syndrome and are frequently used in patients with rheumatic disorders. Primary aim was to evaluate the impact of long-term steroid use on cardiac fat deposition in patients with rheumatic disorders. In addition, we sought to investigate if this effect might be dose-dependent.

With older age and increasing comorbidities, conventional operative procedures for severe symptomatic aortic stenosis are associated with a high surgical risk. To date, transfemoral transcatheter aortic valve implantation (TF-TAVI) represents an accepted alternative method of intervention with a cardiovascular and all-cause mortality similar to operative replacement at early and long-term follow-up in this high risk population (Thomas et al., Circulation 124:425–433, 2011). Despite growing experience of the operators and improvement of the devices procedural and perioperative complications still occur (Panchal et al., Am J Cardiol, 2013). Aortic annulus rupture as well as the rupture of the membranous ventricular septum has been reported (Aminian et al., Catheter Cardiovasc Interv 81:E72–E75, 2013). We present the unusual case of an 80-year-old female who developed a false aneurysm following a contained aortic annulus rupture during a TF-TAVI procedure.

PURPOSE:To assess prevalence and significance of extra cardiac findings (ECF) in clinical routine cardiovascular magnetic resonance (CMR) studies reported by cardiologists alone versus cardiologist and radiologist working together.METHODS:One-thousand-seventy-four consecutive patients presenting at our institution for CMR work-up of multiple cardiovascular disease entities were enrolled retrospectively in two groups (cardiologists reading alone vs. cardiologists and radiologist reading together).RESULTS:In 1,074 routine CMR studies a total of 357 ECF's were identified in 235 patients yielding a prevalence of 21.9 %. Of these 357 ECF's more than one-third were previously known. In the remaining 223 previously unknown findings 118 (52.9 %) were considered as major ECF's (92 patients), and 105 (47.1 %) were considered as minor ECF's (69 patients). Cardiologists reading alone reported 23 previously unknown ECF's in 23 patients, versus 200 previously unknown ECF in 138 patients by cardiologists and radiologists working together, p < 0.0001. Nevertheless, highly significant ECF's with major prognostic implications, such as the initial diagnosis of malignancy in an individual with no history of cancer, are extremely rare (n = 3, 0.3 %). Cardiologists alone, as well as cardiologists and radiologists working together seem to do well with reporting of such extremely important ECF's.CONCLUSIONS:The prevalence of all ECF's was 21.9 %, and 14.9 % of previously unknown ECF's, respectively. However, the prevalence of highly significant ECF's was low. Joint reading with cardiologists and radiologists may increase the number of ECF's detected in CMR studies, but it remains unclear if this could result in an improved long-term outcome of patients undergoing routine CMR.

Background: Extracardiac findings should not be ignored in a routine clinical setting as they may have important influence on further patient management. In comparison to computer tomography (CT) there is some lack of data regarding the incidence of extra-cardiac findings on clinical CMR in a real world setting. As far as we know there is no study which compared the incidence of extra-cardiac findings analyzed by cardiologists only vs. radiologist and cardiologist in consensus. Methods: We included 1074 consecutive patients (mean age 58 yrs, 65% males) who underwent CMR at 1,5T mostly due to cardiomyopathy and ischemic heart disease. N = 491 patients were enrolled in 2011 from February 1 to May 15 and had been interpreted by a cardiologist (level III trained in CMR). N = 583 patients were enrolled in 2012 for the same time period (February 1 to May 15) and had been interpreted by a radiologist (with fellowship training in CMR) and a cardiologist. All exams were based on the standardized CMR image acquisition protocols recommended by the ESC Working Group. Results: In 2011 n = 137 extra-cardiac findings were reported in n = 106 patients. Of these, n = 73 were classified as major findings (of potential clinical significance) and n = 64 as minor findings (benign or of no clinical importance). In 2012 n = 423 extra-cardiac findings were reported in n = 233 patients. Of those, n = 233 were classified as major findings and n = 190 as minor findings. Previously unknown major findings were detected in n = 34 patients (by cardiologists only) vs. n = 160 patients (in 2012 by consensus of radiologist and cardiologist), p < 0.0001. Among the major findings n = 10 (9 reported in 2012) were considered highly significant requiring urgent further diagnostics and/or treatment. Conclusion: CMR readings acquired in a routine clinical setting show more (major) extra-cardiac findings in a consensus read (radiologist and cardiologist) vs. read by cardiologist alone. Nevertheless in our population of >1000 patients in only 0.9% of the patients extra-cardiac findings were considered highly significant.

HomeCirculationVol. 125, No. 18Long-Term Impact of Undetected Kawasaki Syndrome on Coronary Morphology and Physiology Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessBrief ReportPDF/EPUBLong-Term Impact of Undetected Kawasaki Syndrome on Coronary Morphology and Physiology Stefan Grün, MD, Maik Backes, MD, Julia Schumm, MD, Simon Greulich, MD, Peter Ong, MD, Angela Geissler, MD, Udo Sechtem, MD and Heiko Mahrholdt, MD Stefan GrünStefan Grün From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Maik BackesMaik Backes From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Julia SchummJulia Schumm From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Simon GreulichSimon Greulich From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Peter OngPeter Ong From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Angela GeisslerAngela Geissler From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Udo SechtemUdo Sechtem From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. and Heiko MahrholdtHeiko Mahrholdt From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. Originally published8 May 2012https://doi.org/10.1161/CIRCULATIONAHA.111.076612Circulation. 2012;125:e640–e644A 68-year-old white man presented for work-up of recurring atypical resting chest pain in the setting of known coronary artery disease. ECG and chest x-ray on admission can be viewed in Figures 1 and 2. Two years previously, invasive angiography was performed because of unstable angina revealing dilative coronary sclerosis of all coronaries with a proximal right coronary artery stenosis, which was treated with percutaneous intervention by another cardiologist at that time (Figure 3 and online-only Data Supplement Movies I–III).Download figureDownload PowerPointFigure 1. Twelve-lead ECG on admission demonstrating left-axis deviation, ectopic beats, and nonsignificant ST-segment abnormalities.Download figureDownload PowerPointFigure 2. Chest x-ray on admission revealing a normal-size heart, aspects of pulmonary emphysema, and small amounts of fluid in the right costophrenic angle.Download figureDownload PowerPointFigure 3. First invasive coronary angiography of the left (LCA) (A) and the right (RCA) (B) coronary arteries performed by another cardiologist 2 years previously. Note the proximal RCA stenosis (white arrows) in the setting of diffuse dilative coronary sclerosis (C), which was treated by percutaneous intervention.To evaluate possible progress of coronary artery disease, adenosine stress first-pass perfusion cardiovascular magnetic resonance (CMR) using a 1.5T Magnetom Aera (Siemens Healthcare, Erlangen, Germany) was performed. However, no myocardial ischemia could be detected by CMR in this patient (Figure 4 and online-only Data Supplement Movies IV and V). Late gadolinium enhancement revealed subendocardial infarcts in the inferior and lateral walls (Figure 4).Download figureDownload PowerPointFigure 4. Perfusion CMR results can be viewed in the upper panel. (A, B) Note that no perfusion defect is detectable by visual analysis in this patient. Additional post processing to maximize the display of contrast or quantitative perfusion analysis may be helpful in this setting; however, these techniques are not yet widely available to clinicians. The bottom panel (C, D) shows the results of late gadolinium enhancement in the 4-chamber view (4 CH) and the short axis (SAX). White arrows indicate subendocardial infarct scars in the lateral and inferior walls.In the presence of atypical chest pain and 2 subendocardial infarct scars, we performed additional invasive angiography to rule out a false-negative first-pass perfusion CMR study failing to detect flow inhomogeneity as a result of very diffuse coronary disease. We also performed acetylcholine testing for work-up of possible functional coronary disease. Angiography did not reveal any relevant coronary stenosis but confirmed severe dilative coronary sclerosis (Figure 5), which had also been present and reported 2 years before. In addition, an unclear calcified structure (20×17 mm) in proximity to the right coronary artery was detected for the first time (Figure 5). Acetylcholine testing demonstrated epicardial coronary artery spasm with >75% epicardial narrowing in the left as well as in the right coronary artery (Figure 6, white arrows, and online-only Data Supplement Movies VI–IX). During spasms, the patient reported the same chest pain leading to the actual hospital admission. Chest pain as well as spasms resolved after nitroglycerine, indicating that epicardial coronary spasm was involved in the patient's current complaints.Download figureDownload PowerPointFigure 5. Second invasive coronary angiography of the left (LCA) (A) and the right (RCA) (B) coronary arteries. Note severe dilative coronary sclerosis (white arrows) in the entire system. The right image demonstrates an unclear calcified structure (20×17 mm) in proximity to the right coronary artery (white box) (C).Download figureDownload PowerPointFigure 6. Results of intracoronary acetylcholine testing to identify coronary spasm (A–D). The acetylcholine dose is 80 to 100 μg per vessel (> 200 μg unselective in the left main and 80 μg in the right coronary artery). Note epicardial coronary spasm in the right and the left coronary arteries indicated by white arrows (compare upper to lower panel). ACH indicates acetylcholine.Cardiac computed tomography using a 128-slice dual-source Somatom Definition Flash (Siemens Healthcare, Erlangen, Germany) was also performed for evaluation of the unclear calcified cardiac mass seen during invasive angiography. Computed tomography clearly identified the mass as a giant calcified aneurysm of the proximal right coronary artery (31×19×15 mm) with significant intra-aneurysmal thrombus formation (Figure 7). Additional aneurysms could be identified in the distal right coronary and the circumflex artery, indicating that this patient may have suffered from undetected and untreated Kawasaki syndrome during childhood.Download figureDownload PowerPointFigure 7. A, Volume-rendering technique reconstruction of the myocardial surface in left-posterior projection with view on the ramus circumflexus (CX). The white arrow marks an aneurysm of the CX. B, Curved reconstruction of the CX. C, The primary reconstructed transversal data set (the CX aneurysm is marked with a white square). Most notable (D) is a parietal incomplete thrombosis of the aneurysm. D, Volume-rendering technique reconstructed image in right anterior projection with view of the right coronary artery (RCA). This aneurysm could not be assessed satisfactorily by invasive angiogram because of partial thrombosis within the aneurysm (white arrow). The curved reconstruction of the RCA (E) and the primary reconstructed transversal data set prove that the unclear structure shown in Figure 5c is an almost circularly calcified, partially thrombosed RCA aneurysm.Combining all available evidence in this case, one may conclude that this patient suffered Kawasaki syndrome causing multiple calcified (giant) coronary aneurysms and dilative coronary sclerosis. Intra-aneurysmal thrombus formation and subsequent coronary embolism are the most likely mechanism for the 2 subendocardial infarcts in the circumflex and right coronary artery territory, whereas the actual episodes of atypical resting chest pain leading to the current hospital admission are most likely the result of recurring epicardial coronary vasospasm. With this in mind, it remains unclear why Kawasaki syndrome was not already suspected on the basis of the coronary morphology demonstrated by the first invasive angiography performed 2 years previously. However, this diagnosis was not made at that time.This case is unique in that we do not only visualize the long-term impact of undetected and untreated Kawasaki syndrome on coronary morphology and physiology using a multimodality approach, but also describe coronary vasospasm as a clinically relevant feature in addition to coronary aneurysm formation in this setting for the first time.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.111.076612/-/DC1.Correspondence to Heiko Mahrholdt, MD, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany. E-mail Heiko.[email protected]de Previous Back to top Next FiguresReferencesRelatedDetailsCited By Li C, Du Y, Wang H, Wu G and Zhu X (2021) Neonatal Kawasaki disease, Medicine, 10.1097/MD.0000000000024624, 100:7, (e24624) Blaivas M (2020) Unexpected finding of myocardial depression in 2 healthy young patients with COVID‐19 pneumonia: possible support for COVID‐19‐related myocarditis, Journal of the American College of Emergency Physicians Open, 10.1002/emp2.12098, 1:4, (375-378), Online publication date: 1-Aug-2020. Ye Q, Shao W, Shang S, Zhang T, Hu J and Zhang C (2015) A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease, Arthritis & Rheumatology, 10.1002/art.39112, 67:7, (1943-1950), Online publication date: 1-Jul-2015. May 8, 2012Vol 125, Issue 18 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.111.076612PMID: 22566354 Originally publishedMay 8, 2012 PDF download Advertisement SubjectsComputerized Tomography (CT)Diagnostic TestingImaging

A 31-year–old white male patient was transferred from a local district hospital for suspected pericardial mass. Two months earlier he had been admitted there for worsening shortness of breath and subsequently was diagnosed with a large pericardial effusion. He had no other pertinent past medical history. After pericardiocentesis (1.5 L) there was no evidence of malignant cells on cytology, and a computed tomography scan did not reveal any abnormality. Thus, the incident was interpreted as (viral) infectious pericarditis and the patient clinically improved under anti-inflammatory medication within 4 weeks. After that, while on a holiday in Tunisia, he again reported worsening shortness of breath. On day 6 of his holiday, he suddenly passed out and was admitted to a local hospital for unexplained syncope, where again a large pericardial effusion was seen. This time, after another pericardiocentesis (1 L), a pericardial mass was suspected …

BACKGROUND:The purpose of this study was to examine the efficacy of sodium 2-mercaptoethanesulfonate (MESNA), a reactive oxygen scavenger, in at-risk patients given radiographic contrast agents. Contrast-induced nephropathy (CIN) is a common complication of radiographic procedures; reactive oxygen species (ROS) could play a key role.METHODS:We conducted a randomized, double-blinded, placebo-controlled trial in 100 patients with stable serum creatinine levels ≥ 150 µmol/l. They received an infusion of either 1,600 mg of MESNA (n = 51) or placebo (n = 49) plus 0.9% saline prior to and after contrast administration. CIN was defined as a ≥ 25% increase in serum creatinine after 48 h compared to baseline.RESULTS:CIN occurred in 7 patients in the placebo group and none in the MESNA group (p = 0.005). The adjusted odds ratio for CIN was 0.17 (95% confidence interval 0.03 - 0.80, p = 0.026) in the MESNA group compared to the placebo group. Cystatin C concentrations decreased slightly in the MESNA group but increased in the control group (p < 0.05).CONCLUSION:MESNA plus volume expansion before and during contrast exposure was effective in this single-center study for preventing CIN compared to volume expansion alone.

Eine Nebenmilz besteht aus heterotopem Milzgewebe im Abdominalraum. Die Nebenmilzen liegen meist perilienal im Milzhilusbereich und am cranialen bzw. caudalen Milzpol. Andere Lokalisationen, wie im Pankreascaudabereich, in der Umgebung der Nebennieren und Nieren, des Ligamentum colicolienale und gastrocolicum sowie im Mesocolon transversum sind möglich. Sehr seltene, atypische Lokalisationen nach splenogonadaler Fusion sind im Becken und im Skrotum auch beschrieben worden. Folglich müssen in die Differentialdiagnose unterschiedliche Läsionen einbezogen worden, wie intra- und peripankreatische Tumoren, Nebennieren- und Nierenraumforderungen, retroperitoneale Prozesse, vergrößerte Lymphknoten und sogar Raumforderungen im Beckenbereich.

Toxic acute renal failure iv105Also there were relationship between level of serum,s Ca with T-Score,s mean of left femoral neck (P-Value=0.031).Conclusions: We foumd great relationship existed between level of serum,s Ca, Alk.P, PTH and duration of hemodialysis with BMD of lumbar and femoral neck in ESRD patients.We recommend measurement of BMD for all patients every year and measurement level of Ca, Alk.P and PTH every 2 months in dialysis patients for diagnosis of high risk patients for enough treatment to prevented.Renal osteodysytrophy should be controlled by this factors to was prevented of morbidity and mortality due to fracture in lumbar and femoral neck regions in ESRD patients. Toxic acute renal failure