[Ultrasound findings in rupture of the colon after blunt abdominal trauma]. / Sonographische Befunde bei Ruptur des Kolons nach stumpfem Bauchtrauma.

A 20-year old man presented with pain in the upper abdomen but without external signs of injury after blunt abdominal trauma. On sonography free fluid and a mixed echogenic mass in the upper right abdominal quadrant were observed. On laparotomy a hematoma in the ascending colon following rupture of the serosa and muscularis and a hemoperitoneum were discovered.

[Roentgen findings in spontaneous esophageal perforation (Boerhaave syndrome)]. / Röntgenbefunde bei spontaner Osophagusperforation (Boerhaave-Syndrom).

Having experienced two cases of Boerhaave's syndrome (spontaneous rupture of the oesophagus), one a 42-year-old man, the other a 76-year-old woman, who both died of complications failing operative repair, the authors undertook a survey of the literature in order to evaluate the role of radiology in the detection of this life-threatening condition. An analysis of 118 clinically and 67 radiologically well-documented cases yielded pathologic findings in chest X-rays in 90% of the cases. Hydropneumothorax was found in 51%, pneumomediastinum in 30%, isolated pleural effusion in 25%, and infiltration of the parenchyma in 14% of the patients. In all cases it was possible to demonstrate by contrast medium-filling of the oesophagus with an aqueous medium.

[An arteriovenous fistula following laminectomy--sonographic diagnosis]. / Arteriovenöse Fistel nach Laminektomie--sonographische Diagnose.

In a 36-year-old woman, 10 years after laminectomy, a tentative diagnosis of arteriovenous shunt between the right iliac artery and vein, a rare complication of this procedure, was made on the basis of ultrasonographic findings. The signs consisted of dilatation of the iliac vein and of the inferior vena cava, a vascular bruit and tactile fremitus in the abdomen. In addition, cardiac enlargement and slight tricuspid and mitral incompetence in the absence of cardiac insufficiency were noted. After angiographic verification of the diagnosis the anomaly was corrected surgically.

[Tuberculosis of the pancreatic region--sonographic and CT findings]. / Tuberkulose der Pankreasregion--sonographische und CT-Befunde.

In the case reports of two black men of 29 and 32 years of age the rare condition of tuberculous involvement of the pancreas is described. The diagnosis was established by exploratory laparotomy and by the culture of mycobacterium tuberculosis. Ultrasonography demonstrated inhomogeneous, hypoechoic masses in and around the pancreas. Contrast-enhanced computed tomography of the abdomen revealed enlargement of the pancreas and the presence of lesions of decreased attenuation or cystic collections with involvement of the peripancreatic area.

[Ultrasonic diagnosis of so-called "occult" testicular tumor]. / Sonographische Diagnose des sogenannten "okkulten" Hodentumors.

A 40-year old man complaining of severe pain in the right mid-abdomen, nausea and vomiting was brought to the casualty department. Sonography revealed retroperitoneal masses in the right mid-abdomen and the left lower abdomen. These masses were confirmed by computed tomography and lymphography to be lymph node metastases. In the smaller right testis, in which a tumour was not suspected, a hypoechoic region was identified, which on histological examination after orchiectomy proved to be a pure seminoma.

[The sonographic diagnosis of a spontaneous rectus sheath hematoma]. / Sonographische Diagnose spontaner Rektusscheidenhämatome.

In 4 patients between 52 and 66 years of age with acute abdominal pain, rectus sheath haematoma in the right and left lower quadrant was diagnosed. In one case it was a condition after exertion, in another case after coughing, in the third case in thrombocytopenia and in the last case as a consequence of a contusion. Sonomorphology revealed a spindle-shaped or round hypoechoic mass localised in the rectus sheath. Two of the patients were operated on, and two were treated conservatively.

[An unusual x-ray picture in sarcoidosis of the lung]. / Ungewöhnliches Röntgenbild bei Sarkoidose der Lunge.

The chest x-ray film of a 33-year-old man revealed circular densities which were suspected to be metastases combined with hilar and mediastinal lymphadenopathies. Histology of a paratracheal lymph node gave the diagnosis sarcoidosis. Nine months later the intrapulmonary densities had disappeared. Radiological findings are now stage II sarcoidosis.

[Behavior of the blood vessels of the lung on the roentgen image in children with bronchial asthma--determination of the width of the blood vessels]. / Das Verhalten der Lungengefässe im Röntgenbild bei Kindern mit Asthma bronchiale--Eine Bestimmung der Gefässweite.

On x-ray films of 51 children with asthma bronchiale the authors determined the vascular diameter of the right ascending pulmonary artery, the right vein of the upper lobe, and the peripheral vessels in the upper and lower pulmonary fields at an exactly defined distance from the hilus point, and compared these data with those of a control group of 143 healthy children. During the asthma attack the width of the right descending pulmonary artery and of the vein of the upper lobe corresponded to the values of the control group, whereas the vascular diameters in the upper and lower fields were clearly narrowed. Moreover, in most of the asthmatic children the authors found arc-shaped vessels and irregularly occluded vessels in the periphery of the lungs.

[Comparison of vascular width and accuracy in the subjective assessment of pulmonary circulation in the roentgen picture of children with left-right shunts]. / Vergleich von Gefässweite und Treffsicherheit bei der subjektiven Beurteilung der Lungengefässfüllung im Röntgenbild von Kindern mit Links-Rechts-Shunt.

The authors established a comparative relationship between accuracy of measurement of pulmonary flow and extent of vascular widening in 72 children with Left-Right shunt vitiae; this accuracy of pulmonary flow measurement had been subjectively estimated by 4 investigators without knowing the diagnosis and in comparison to the haemodynamic values (percentage of correct findings). The following procedure was adopted: In a control group of 143 healthy children, we first determined the vascular diameter of the right descending pulmonary artery, of the right upper lobal vein, and of the peripheral vessels in the upper and lower pulmonary fields, at an accurately defined distance from the point of the hilus, and compared with the vascular diameters of the children with left-right shunt, employing the method of discrimination analysis. Comparison of the judgement by the 4 investigators with the degree of increase of the vascular diameters showed an accuracy of 65-100% if the right descending pulmonary artery became wider by 2.6 mm, and an accuracy of 79-95% if the mean vascular width in the right upper field increased by 0.7 mm. The accuracy was 83-94% if the mean vascular width in the right lower field increased by 0.6 mm. Statistical studies also showed that the judgement of the 4 investigators was influenced by different vessels.

[X-ray diagnosis of bones in replantations in children]. / Röntgendiagnostik des Skeletts bei Replantation im Kindesalter.

The article reports on x-ray findings in the skeleton of 20 finger replants, one successful arm replant and two successful replants of toes to the hand in 23 children aged one to fourteen years. The quota of successful healing together or setting was 80% in finger replants. Setting of the fracture was delayed by an average period of seven days. Osteonecrosis and osteomyelitis were equally frequent in two children each (10%) and resulted in problems of differential diagnosis. In three children the bone fracture set in false position, without, however, causing any complaints. All epiphyses not destroyed by infection were preserved.

[Diagnostic accuracy of pulmonary vessel blood flow assessed by roentgenography--a comparison with haemodynamic data (author's transl)]. / Zur Treffsicherheit der Beurteilung der Lungengefässfüllung im Röntgenbild--ein Vergleich zu hämodynamischen Daten.

The article reports on an examination of the diagnostic accuracy in assessing the pulmonary vessel blood flow via x-ray films of the thorax in 323 children by means of a comparison with the haemodynamic data of four examiners, on the basis of a Yes/No (True/False) decision. Overall accuracy in the total group of examined children--depending on the experience of the examiners--was 60 to 66%; in children below 2 years of age, it was 63-69%, and in children over 2 years old it was 59-65%. In a Left-Right Shunt smaller than 35%, accuracy was between 33 and 63%; if the Left-Right Shunt was greater than 57%, it was 81-97%. Diagnosis of reduced pulmonary blood flow proved more difficult than of an enhanced flow. Sensitivity of the examination method was 53-71%, whereas its specificity was 57-70%.

[X-ray differential diagnosis of unilateral pulmonary emphysematous expansion in newborn and babies (author's transl)]. / Zur röntgenologischen Differentialdiagnose der einseitigen Lungen-überblähung im Neugeborenen- und Säuglingsalter.

The article discusses the x-ray signs seen in 14 babies with unilateral emphysematous expansion. 7 of these infants had a lobar emphysema without any defect of the bronchial cartilage, whereas two had pulmonary cysts, one suffered from a congenital cystic adenomatoid pulmonary malformation, and one infant had been suffering from lymphangiectasy; in all cases, successful lobectomy had been performed. One patient with pneumatocele, one with a left-side agenesia of the upper lobe and one with a transient obstruction of the bronchi by a mucous plug, were given conservative treatment. The article discusses the x-ray differentiation of the following disturbances: pneumothorax, diaphragmatic hernia, compensatory and obstructive emphysematous expansion of a pulmonary lobe, cystic changes in the lung, and lobar emphysema, although this does not offer any possibility of discovering the reason for its occurrence. Attention is drawn to the diagnostic value of bronchoscopy and bronchography, as well as angiography, especially in case of suspected vascular malformation.

[The child's skeleton following renal transplant. A correlation of the radiographic findings to the amount of parathormone (author's transl)]. / Das Verhalten des kindlichen Skeletts nach Nierentransplantation. Ein Vergleich von Röntgenbefunden und Parathormonkonzentrationen.

The skeletal X-rays (magnification radiography of hand, pelvis, knee and shoulder joint) of 20 children before and after successful kidney transplantation were compared with the parathormone concentrations measured in the interval closest to the roentgenological examination. In 19 children, renal osteodystrophy existed before kidney transplantation, which was diagnosed based on the following radiographic findings of varying frequency: rarefaction and fuzziness of the spongiosa, fraying of metaphysical ends, widening of the growth plates, subperiosteal resorption and acroosteolysis. The parathormone concentrations were definitely increased before kidney transplantation. After kidney transplantation the abnormal radiographic findings receded corresponding to normalisation of the parathormone concentrations. Nevertheless, in 14 out of 19 children a rarefaction of the spongiosa remained, the cause of which is presumed to be steroid therapy.

[Special factors governing x-ray examination of the hip joint in children (author's transl)]. / Besonderheiten bei der Röntgenuntersuchung des kindlichen Hüftgelenkes.

The special features governing roentgen examinations of the hip joint in children in respect of positioning, x-ray technique and radiation protection, are explained. Particular attention is paid to the criteria of an accurate focussing of the pelvis in infants. Furthermore, standard focussing procedures and x-ray symptoms are described for the following diseases and malpositionings: changes of the centre-collum-diaphysis angle (coxa vara, coxa valga), torsional hip, epiphysiolysis capitis femuris, aseptic necrosis of the femoral head (M. Perthes), and coxitis in babies, infants, and juveniles.

[Identification of metastases in the infant skeleton--comparison of methods of roentgenology and scintigraphy (author's transl)]. / Metastasennachweis im kindlichen Skelett--ein Vergleich röntgenologischer und szintigraphischer Verfahren.

Conventional x-ray examination and a whole body scintigram were performed within four weeks in 40 children with tumours. The findings obtained by both methods were subjected to a comparative analysis. Pathological findings were revealed in eleven children; in eight of these, the findings were partly confirmed as metastases. Of 39 metastases confirmed by x-ray film, 16 were found to be negative according to scintigraphy. On the other hand, 34 of a total of 60 scintigraphically pathological findings could not be confirmed by x-ray examination six months later. The falsely negative scintigraphic findings were mainly localised in the region of the ribs, the pelvis and the long bones near the epiphysis. Our own case material demonstrated these findings.

[Diagnosis of subpulmonary effusion in children (author's transl)]. / Uber die Diagnostik des subpulmonalen Ergusses im Kindesalter.

If an elevation of the right or left base of the lung is found on a chest x-ray film, differential diagnosis will have to consider the follwoing possibilities: 1. Elevation of the diaphragm, 2. Subpulmonary effusion and 3. Hernia of abdominal organs through the diaphragm. Suspicion of a subpulmonary effusion is prompted by the following x-ray findings: 1. Flattening of the costophrenic angle and elevation of the base of the lung. 2. Increased distance between "magenblase" (stomach bubble) and base of the lung. 3. Elevation of the lower margins of the lung, the apex being in the region of the lateral hemithorax. 4. Translucency of the margins of the diaphragm below the elevated base of the lung. 5. Absence of vascular shadoes behind the diaphragm on a wellexposed x-ray film. If one or several of these symptoms is seen, proof should be obtained by provoking issuing of the effusion by placing the patient in supine position or in lateral position on the affected side, and by trying to achieve visualization of the resulting condition.

[Changes in the pulmonary vessels during asthma in childhood (author's transl)]. / Veränderungen des Lungengefässbildes bei Asthma bronchiale im Kindesalter.

One hundred and twenty-eight erect radiographs of the thorax in 42 children with bronchial asthma have been analysed. The criterium for inclusion in this study was the demonstration on once occasion at least of hyperinflation of the lung with a low diaphragm, increased size of lung, narrow heart and increase in the retrosternal transparent area. In all patients there was narrowing of the vessels. In addition, the vessels appeared irregular and curved. Other characteristic radiological findings were tram-lines, obstructed bronchi, peribronchial infiltrates and atelectases. Increasing severity of the attack lead to increasing finding of other radiological changes in the thorax, but these have not yet been statistically examined.

["Hepatoportal pneumatosis with pneumatosis intestinalis in the neonate" (author's transl)]. / Luftportogramm bei Pneumatosis intestinalis im Neugeborenanalter.

A fullterm newborn infant two weeks of age, suffering from congestive heart failure due to a large patent ductus arteriosus, deteriorated suddenly presenting with a paralytic ileus. Radiographically diffuse intestinal pneumatosis and gas in the portal vein system could be shown. A mechanical reason was excluded by laparotomy shortly after which the infang died. Out of blood Klebsiella pneumonia could be grown. A survey of the literature on the syndrome of pneumatosis intestinalis and gas embolization into the portal vein system in the neonatal age group disclosed 41 cases. Based on this material etiology radiological features, differential diagnosis, prognosis and treatment is discussed in detail.