[Diagnostic error of thrombosis of the inferior vena cava with contrast-CT in tricuspid valve insufficiency]. / Fehldiagnose einer Thrombose der Vena cava inferior im Kontrast-CT bei Trikuspidalinsuffizienz.

Sonographic evidence of a cystic adrenal tumour was found in a 73-year-old female patient with a 6-month history of chest pain and dyspnoea. A computed tomogram of the abdomen revealed, in addition to the 5-cm lesion, a contrast medium-free area in the vena cava inferior, leading to an initial diagnosis of recurrent pulmonary emboli due to a thrombosis of the vena cava inferior. Further diagnostic procedures excluded emboli and indicated a dilating cardiomyopathy with mitral and tricuspid regurgitation. The contrast medium-free area in the vena cava inferior was caused by the influx and regurgitation of contrast medium-free blood from the renal and hepatic veins in addition to blood from the right atrium due to the tricuspid valve regurgitation. A thrombosis was excluded by means of a color-duplex investigation. The patient declined any further diagnostic procedures concerning the lesion.

[Gastrointestinal amyloidosis in IgG-chi-light chain plasmacytoma. Diagnostic problems despite advanced changes]. / Gastrointestinale Amyloidose bei IgG-xi-Leichtketten-Plasmozytom. Diagnostische Probleme trotz fortgeschrittenen Befalls.

A 50-year-old man with an IgG-chi light chain multiple myeloma stage IIIA, developed--in a phase of low disease activity, after 18 months of an uncomplicated course--marked malabsorption syndrome with 20 kg weight loss, diarrhoea and meteorism. Although the H2-breath test indicated intestinal bacterial colonisation, neither antibacterial treatment with trimethoprim/sulphamethoxazole and metronidazole nor prokinetic treatment with cisapride (30 mg daily) and erythromycin (1 g twice daily) improved the symptoms. Suspected amyloidosis was not demonstrable at first, despite repeated step biopsies of stomach, duodenum and rectum. Amyloidosis of the entire gastrointestinal tract was proven only by repeated biopsies deep into the submucosa. Despite treatment of the underlying disease with melphalan and prednisone (Alexanian's scheme) the amyloidosis advanced further to involve liver, spleen, lung, kidneys and heart. The patient died, 2 years after diagnosis of the multiple myeloma, from recurrent pulmonary emboli due to atrial fibrillation.