Introduction and question Contrast-enhanced ultrasound is a proven method for the characterization of benign and malignant liver masses and also for metastasis detection in the context of staging and follow-up of oncological patients. Nevertheless, the current German S3 guideline calls for a dwMRI of the liver to rule out metastasis in the case of a potentially resectable pancreatic tumour. PET-CT but not CEUS is recommended as an alternative. The aim of the study was to compare CEUS, ceCT and dwMRI in metastasis detection prior to pancreatic/Whipple resection in the case of suspected cancer.
Akute Erkrankungen des Ösophagus sind selten und damit bei Notfallmedizinern nicht Teil der täglichen Routine. Ein relevanter Anteil an Patienten mit ösophagealen Notfällen sind zudem Kinder mit zu beachtenden Besonderheiten in der Diagnostik und Therapie. Die folgende Übersichtsarbeit soll die wichtigsten Notfälle, deren diagnostische Abklärung und Therapie zusammenfassen.
To enable sonographic classification of different stages of pyogenic liver abscesses, sonographic findings in 86 patients with 113 pyogenic liver abscesses were retrospectively analyzed and compared with established pathomorphologic descriptions of the disease. The typical findings in contrast-enhanced ultrasound were sub-segmental hyperemia (93/113, 82%) and necrosis with a hyperemic margin (109/113, 96%) in the arterial phase and a washout of liver tissue surrounding necrosis in the late phase (101/113, 89%). Four different sonomorphologic stages of pyogenic liver abscess were identified. Stage I was defined by focal inflammation without necrosis (n = 2); stage II by focal clusters of micro-abscesses appearing to coalesce (n = 41); and stage III by a single cavity with or without capsule (n = 64). Stage IV was defined as numerous small abscesses scattered all over the liver (n = 6). The results indicate that contrast-enhanced ultrasound is suitable for classifying different stages of pyogenic liver abscesses. Knowledge of the described morphologic patterns influences therapeutic decisions and helps distinguish abscesses from other liver masses.
