[Quadruple negative SARS-CoV-2-PCR: still COVID-19 pneumonia!] / Vierfach negative SARS-CoV-2-PCR ­ dennoch COVID-19-Pneumonie!

MEDICAL HISTORY AND CLINICAL FINDINGS: A 78-year-old man fell ill with weakness, coughing and fever 19 days after a cruise in early April 2020 and was admitted 4 days later with increasing shortness of breath. EXAMINATION AND DIAGNOSIS: On admission, the patient had subfebrile temperatures, exercise dyspnea, and right-basal rales. CRP was moderately elevated and oxygen saturation was slightly reduced. Thoracic CT showed bilateral ground-glass infiltrates. Immediately after the cruise a nasopharyngeal swab was negative for SARS-CoV-2. THERAPY AND COURSE: Due to the fact that the patient's asymptomatic wife had been tested positive for SARS-CoV-2 immediately after returning from the cruise, we suspected COVID-19 disease and admitted the patient to our isolation ward. Two nasopharyngeal swabs and bronchial lavage yielded negative results for SARS-CoV-2. Finally, suspected COVID-19 diagnosis was verified serologically. CONCLUSION: In case of a high degree of clinical suspicion in combination with typical findings of thoracic imaging, the suspected diagnosis COVID-19 disease should be maintained even in case of multiple negative SARS-CoV-2-PCR. Seroconversion occurs a few days to 2 weeks after the onset of symptoms and can be used to confirm the diagnosis.

[Differential diagnosis of intra- and perilienal tumors by use of a RES-specific MRI contrast agent]. / Differenzialdiagnose von Intra- und Perilienalen Tumoren mit Hilfe eines RES-spezifischen MRT-Kontrastmittels.

PURPOSE: To describe the additional benefit in detection and differential diagnosis of peri- and intrasplenic tumors by use of an superparamagnetic iron oxide contrast agent (SPIO). MATERIALS AND METHODS: We represent 7 patients with known malignant tumors. Aim of the examination was the detection and characterisation of intra- or perisplenic tumors. We performed T2w TSE breath triggered sequences before and 10 min after application of SPIO and T1w Flash 2D GRE sequences before and after SPIO and Gadopentetate dimeglumin application. All images were presented to two radiologists, who were asked to asses the presence and characterisation of tumors by using a five-point confidence scale. RESULTS: In two patient intrasplenic hemangiomas were detected, intrasplenic lymphoma, metastasis was excluded, respectively. In two patients perisplenic tumors were diagnosed as gastrointestinal stroma tumors, confirmed by biopsy. In two patients accessory spleens were identified and lymph node metastasis excluded. In one patient an intrasplenic cyst was diagnosed. SPIO enhanced T2w images and Gadopentetate dimeglumin enhanced T1w sequences were evaluated as superior. CONCLUSION: The examination of the spleen by use of superparamagnetic iron oxides offers additional abilities in depiction and charaterisation of intra- and perisplenic tumors in first experiences. First clinical observations indicate that a combination of SPIO enhanced T2w sequences and Gadopentetate dimeglumin enhanced T1w dynamic sequences might be superior to other sequences in detection and characterisation of splenic tumors.