[Dissection of the superior mesenteric artery: a rare cause of abdominal pain]. / Dissektion der Arteria mesenterica superior als Ursache abdomineller Schmerzen.

HISTORY: A previously healthy 47-year-old man had suffered from intermittent subacute abdominal pain for six weeks. He had no significant past medical history except of smoking (30 pack years). INVESTIGATIONS: Physical examination and laboratory tests were unremarkable. Sonography and endoscopy showed no pathological findings. Eventually contrast-enhanced computed tomography revealed dissection of the superior mesenteric artery and an additional angiography showed a false aneurysm. TREATMENT AND COURSE: Because of the extended dissection thrombarterectomy was preferred to percutaneous stent placement. Five months later the patient was free of symptoms and continues to take 100 mg aspirin daily. CONCLUSIONS: Although spontaneous visceral artery dissection is uncommon, awareness of this event is crucial for diagnosis and therapy to prevent hemorrhage and potential bowel infarction. This case highlights the importance of computed tomography in the work-up of nonspecific abdominal pain.

[Contrast-enhanced magnetic resonance cholangiography using gadolinium-EOB-DTPA. Preliminary experience and clinical applications]. / Kontrastverstärkte MR-cholangiographie mit Gadolinium-EOB-DTPA. Erste Erfahrungen und klinische Einsatzmöglichkeiten.

Magnetic resonance cholangiopancreaticography (MRCP) with heavily T2-weighted RARE and HASTE sequences has become an important imaging modality for the morphologic evaluation of intra- and extrahepatic bile ducts. However, for the diagnosis of functional biliary disorders, cholangiopancreaticography (ERCP) and endoscopic manometry, two invasive techniques with considerable morbidity and mortality, remain the standard. Biliary scintigraphy, secretin-stimulated MRCP, and secretin-stimulated endoscopic ultrasound have not proven to be sufficient to replace these techniques as they lack diagnostic accuracy and correlate poorly with manometry results. Contrast-enhanced magnetic resonance cholangiography (CE-MRC) uses hepatocyte-selective contrast agents that are eliminated by the biliary system. Therefore, these substances can serve as biliary contrast agents in T1-weighted MR imaging. This method makes a noninvasive functional evaluation of the hepatobiliary system possible. In the present article, our preliminary experience with Gd-EOB-DTPA-enhanced MRC is summarized and potential clinical applications of this method are discussed. Additionally, the article reviews publications evaluating a possible benefit of CE-MRC with other hepatobiliary contrast agents such as mangafodipir trisodium.

Cine magnetic resonance imaging of the small bowel: comparison of different oral contrast media.

PURPOSE: To evaluate several substances regarding small bowel distension and contrast on balanced steady-state free precession (bSSFP) cine magnetic resonance (MR) images. MATERIAL AND METHODS: Luminal contrast was evaluated in 24 volunteers after oral application of two different contrast agent groups leading to either bright lumen (pineapple, blueberry juice) or dark lumen (tap water, orange juice) on T1-weighted images. Bowel distension was evaluated in 30 patients ingesting either methylcellulose or mannitol solution for limiting intestinal absorption. Fifteen patients with duodeno-jejunal intubation served as the control. Quantitative evaluation included measurement of luminal signal intensities and diameters of four bowel segments, qualitative evaluation assessed luminal contrast and distension on a five-point scale. RESULTS: Quantitative and qualitative evaluation of the four contrast agents revealed no significant differences regarding luminal contrast on bSSFP images. Quantitative evaluation revealed significantly lower (P<0.05) small bowel distension for three out of four segments (qualitative evaluation: two out of four segments) for methylcellulose in comparison to the control. Mannitol was found to be equal to the control. CONCLUSION: Oral ingestion of tap water or orange juice in combination with mannitol is recommended for cine MR imaging of the small bowel regarding luminal contrast and small bowel distension on bSSFP sequences.

Posterior "nutcracker" phenomenon: hemodynamic relevant aorto-retroaortal renal vein fistula leading to fatal right heart failure.

A rare complication of an aneurysm of the abdominal aorta is the so-called "posterior nutcracker phenomenon", which describes compression of a retroaortal renal vein between the abdominal aorta and the vertebral column. The clinical presentation is flank pain and hematuria, which are usually caused by a renal (respectively ureteral) calculus or neoplasia. Another rare differential diagnosis for these very common clinical symptoms is an aorto-left renal vein fistula (ALRVF), which is a spontaneous vascular fistula, usually also associated with an aortic aneurysm, infrequently a result of abdominal trauma.