[Concretions and iatrogenic foreign bodies in the lacrimal system : Treatment recommendations]. / Konkremente und iatrogene Fremdkörper der ableitenden Tränenwege : Therapeutische Empfehlungen.

BACKGROUND: Deposits (dacryoliths or foreign bodies) inside the lacrimal system can cause chronic inflammation and recurrent lacrimal stenosis. Furthermore, dacryoliths can occur due to chronic inflammation. OBJECTIVE: Considering typical clinical courses, the different localizations and surgical options for removing deposits from the lacrimal system are demonstrated. MATERIALS AND METHODS: A retrospective analysis of 1451 lacrimal surgeries in 1131 patients was performed. Fourteen representative lacrimal surgeries of 11 patients were retrospectively analyzed in terms of current complaints, prior surgery, and the performed surgical intervention. In three cases, histologic findings of removed dacryoliths were assessed. The surgical approaches are described using precise photodocumentation. RESULTS: In 220 lacrimal surgeries (15.2 %), dacryoliths were detected. Iatrogenic foreign bodies were found in 0.8 % (n = 12). All chosen patients suffered painful chronic inflammation of the lacrimal system. Localization was either intrasaccular or intracanalicular. In 10 eyes, surgery was performed using a transcanalicular dacryoendoscope, either alone or in combination with another method. An external approach (transcutaneous/transconjunctival) was performed in 4 patients. Regarding the whole study population, dacryoliths were found in 16.9 % (n = 91) of dacryocystorhinostomies, in 14.6 % (n = 77) of dacryoendoscopies, and in 35.6 % (n = 52) of canaliculotomies. CONCLUSION: Foreign bodies and dacryoliths are important differential diagnoses in the treatment of chronic dacryocystitis. Different surgical approaches are possible and should be available for treatment. Patients' history often reports prior lacrimal surgery.

[The Interdisciplinary Conference on Lacrimal System Disorders of ophthalmic and ENT surgeons at the University Hospital Halle : An analysis of present patient material]. / Die interdisziplinäre Tränenwegskonferenz von Ophthalmo- und Rhinochirurgen am Universitätsklinikum Halle (Saale) : Eine Auswertung des bisherigen Krankenguts.

BACKGROUND AND AIM: The lacrimal system (LS) crosses regions of ocular adnexa, the nose, and the paranasal sinuses. Surgery of disorders requires a targeted ophthalmologic and otolaryngologic examination. Since 2013, an Interdisciplinary Conference on Lacrimal System Disorders (ICLSD) has existed at the University Hospital Halle. First results of our experiences with this cooperation between ophthalmic and ENT surgeons are presented. METHODS: In a retrospective study at the Department of Ophthalmology, University Hospital Halle, all patients aged 22-80 years (n = 43, 10 with bilateral manifestation; mean age 65.1 years) having had a consultation in ICLSD between February 2013 and May 2015 were analyzed. Thereby, 53 LS were included in the descriptive evaluation. RESULTS: The main relevant pathology in terms of ophthalmologic manifestation was chronic dacryocystitis and its complications (n = 42), whereas nasal septum deviation (n = 11) and chronic rhinosinusitis (n = 10) were the most frequent otorhinolaryngologic pathologies. Prior to consultation, ENT (n = 34) and/or ophthalmic surgery (n = 40) had been performed. During ICLSD, an individualized therapeutic regime for each patient was developed. Surgery was required in 43 out of 53 LS. Of these, 32 were mainly ophthalmic, 11 mainly ENT interventions. At the time of evaluation (median 3 months; range 1 to 24 months), 29 out of 38 patients (76.3 %) were free of complaints. CONCLUSION: Since 2013, competences of ophthalmic and ENT surgeons have been integrated in ICLSD for advanced diagnosis and therapy of lacrimal disorders at the University Hospital Halle. Encouraging functional results are shown in this study, as most patients have had a long and complicated history of lacrimal system disorders. ICLSD enables interdisciplinary patient care.

[Surgical therapy of secondary elephantoid lymphedema of the eyelids]. / Chirurgische Therapie sekundärer, elefantoider Lymphödeme der Lider.

Because of the disfiguring changes they cause, prominent secondary lymphedemas of the face represent an extreme burden for afflicted patients. Many of these patients already have considerable restrictions imposed upon their quality of life as a consequence of the primary cancer therapy. Therapeutic options are often limited, mainly comprising physical therapy and pharmacological interventions. Only in exceptional cases is surgical therapy a treatment facility. We report the successful surgical treatment of a patient with secondary elephantoid lymphedema following primary radiochemotherapy for squamous cell cancer of the base of the tongue.

Quality of care of patients with chronic lymphoedema in Germany.

BACKGROUND: The management of lymphoedema is complex and should be based on guidelines. To date, no data assessing quality of care in lymphoedema in Germany are available. OBJECTIVE: We aimed at evaluating the quality of care of lymphoedema in the metropolitan area of Hamburg using guideline-based indicators. METHODS: Cross-sectional, community-based study including patients with lymphoedema. Assessment included a structured interview, clinical examination and patient-reported outcomes. Quality indicators derived from guidelines by a Delphi consensus were applied. RESULTS: 348 patients (median age 60.5 years) with lymphoedema (66.4%), lipoedema (9.5%) or combined oedema (24.1%) were included. 86.4% performed compression therapy, 85.6% received lymphatic drainage. On average 55.0% of the quality of care criteria were met; 64.8% were satisfied with care. The distribution curve of the health care index was almost normal. Treatment by specialists led to a higher quality of care index. CONCLUSION: Although overall quality of care in lymphoedema is fair, many patients are not treated properly according to guidelines.

Development and use of guideline-derived quality indicators for community lymphoedema.

BACKGROUND: Treatment of lymphoedema is complex and needs specific skills. There are no standards for the evaluation of quality of care. OBJECTIVE: Development and application of indicators for the measurement of quality of care in lymphoedema. METHODS: In a three-step process including a national Delphi expert consensus, quality indicators were derived from national and international guidelines. In a cross-sectional study involving a large spectrum of care providers, the quality of lymphoedema care in the community was assessed by transforming the indicators to one unweighted quality index (QI). RESULTS: A total of 12 quality indicators were identified and applied to n = 348 patients with lymphoedema and lipolymphoedema of any origin in the metropolitan area of Hamburg (90.8% female, mean age 57, SD 14.5 years). On average, 55% of the quality indicators were met, and 64.8% of the patients were satisfied with lymphoedema care. There was a significant correlation between QI and satisfaction. CONCLUSIONS: The quality indicators and the QI are feasible and valid for the evaluation of quality of care. They can support optimizing lymphoedema care.

[Swallowing disorders after partial laryngectomy. Prevalence and predictors]. / Schluckstörungen nach Kehlkopfteilresektion. Auftrittshäufigkeit und Prädiktoren.

BACKGROUND: Improvements in surgical techniques have led to a higher percentage of larynx preservations. These do not always include preservation of the swallowing function. This study investigates the prevalence of swallowing disorders after partial laryngectomy and their predictors. PATIENTS AND METHODS: In a multicenter cross-sectional study with patients who received a partial laryngectomy (n=154) the prevalences of problems related to swallowing and eating were gathered. Additionally, medical and sociodemographic data were obtained as well as information about alcohol and tobacco consumption. RESULTS: Twenty percent of the patients had problems related to swallowing and eating; more specifically, eating solid foods and eating in public. Chances of having swallowing disorders were significantly lower for patients who received laser therapy (OR=0.12; 95% CI: 0.04-0.37; p<0.01), when time since the last laryngeal surgery was longer (OR=0.89; 95% CI: 0.75-0.99; p<0.03) and when patients were non-smokers (OR=3.39; 95% CI: 1.29-8.94; p<0.02). CONCLUSION: Swallowing disorders correlate with post-surgery smoking. Physicians and therapists should focus more on the negative side effects of smoking on swallowing during patient consultations.

Phase I trial of dose-escalated cisplatin with concomitant cetuximab and hyperfractionated-accelerated radiotherapy in locally advanced squamous cell carcinoma of the head and neck.

BACKGROUND: Cetuximab is active in the treatment of squamous cell carcinoma of the head and neck (SCCHN), enhancing both radiotherapy and chemotherapy effects. This phase I study was designed to investigate the safety and tolerability of combining weekly cisplatin treatment with cetuximab and hyperfractionated-accelerated radiotherapy (HART) for locally advanced SCCHN. PATIENTS AND METHODS: Patients with unresectable stage III or IVA/B SCCHN were treated with cetuximab, 400 mg/m² initial dose on day -7 of HART, followed by 250 mg/m² weekly during the administration of HART, which started with 2.0 Gy/day (5 days/week) for 3 weeks followed by 1.4 Gy/twice-daily (Monday to Friday) for another 3 weeks, resulting in a total dose of 70.6 Gy. Cisplatin was administered weekly starting on the first day of radiotherapy until week 6. Cisplatin was dose escalated of four dose levels from 20 to 40 mg/m² using a classical 3 + 3 dose escalation algorithm. RESULTS: Eighteen patients were enrolled. Sixteen patients were eligible for toxicity, and 15 for response. No maximum tolerated dose was reached for cisplatin. One of six patients of dose level 4 had grade 4 neutropenia. This patient died 1 week after the end of the study treatment. The most common types of grade 3+ adverse events were mucositis (9 of 16 patients), in-field dermatitis (6 of 16 patients) and neutropenia (4 of 16 patients). Cetuximab-related hypersensitivity was observed in 1 out of 18 patients. Six weeks after the end of the study treatment, 5 complete responses, 8 partial responses and 1 progressive disease (at distant sites) were documented in a total of 15 patients (objective response rate 87%). CONCLUSIONS: The combination of cisplatin with cetuximab and HART is active, well tolerated and merits additional investigation. The recommended weekly dose of cisplatin for phase II studies is 40 mg/m².

[Cogan's disease. Report of two cases]. / Das Cogan-Syndrom. Zwei Fallberichte.

BACKGROUND: Cogan's disease is a diagnostic challenge. The typical form of this chronic inflammatory disease is characterized by non-syphilitic interstitial keratitis and acute audiovestibular impairment. CASE REPORTS: The first patient had "typical" symptoms of Cogan's syndrome with recurrent keratoconjunctivitis, severe hearing loss and vertigo. Systemic cardiovascular manifestations occurred in the further course of the disease with multiple vascular stenoses of the carotids and vessels of the lower limbs. The second patient had "atypical" symptoms of Cogan's disease with progressive bilateral hearing loss and vestibular deficits, unilateral conjunctivitis and orbital swelling and unspecific symptoms, such as fever and headaches. Therapy with systemic and local corticoids was successful in both cases concerning ocular and systemic symptoms. The first patient had received additional therapy with methotrexate, but had already become deaf before therapy had started. Cochlear implantation was successfully carried out. In the second patient hearing loss was stationary under therapy and the patient could be provided with hearing aids. CONCLUSION: Because of obligatory cochleovestibular symptoms the otorhinolaryngologist has a key position in diagnosis and therapy of this rare entity. Early diagnosis is a crucial prognostic factor concerning preservation or restitution of hearing function.

[Value of hyperbaric oxygen in the treatment of advanced skull base osteomyelitis]. / Nutzen der HBO bei der Therapie der fortgeschrittenen Schädelbasisosteomyelitis.

BACKGROUND: The therapy of skull base osteomyelitis (SBO) is still challenging. Standard therapy includes the use of antibiotics, local treatment and surgical removal of necrotic bone and tissue. This study reports on the value of adjuvant hyperbaric oxygen therapy with respect to the functional outcome in SBO. Furthermore diagnostic signs especially on imaging are elaborated. METHODS: The retrospective study included all cases of SBO treated between July 2002 and November 2006 in our department. Clinical data, microbiology, laboratory and radiological findings were reviewed. Treatment modality data, especially the use of adjuvant hyperbaric oxygen therapy (HBO) were analysed. The outcome with regard to neurological or functional deficit was assessed and the value of adjuvant HBO therapy was evaluated in comparison with the literature. RESULTS: In the given time period ten patients with SBO could be selected. The presumption diagnosis based on CT and/or MRI in first line. It was confirmed by histology in all cases. Treatment included high dose antibiotics, surgical debridement and adjuvant HBO therapy. Cure rate of treated patients was 8/8, regarding inflammatory signs. Two patients refused any further therapy during the course, in both the outcome was fatal. Functional recovery of cranial nerve deficits could be reached in 6/8. Two patients had residual cranial nerve palsies. The outcome was mainly influenced by the treatment modality and duration of cranial nerve involvement. CONCLUSIONS: Adjuvant hyperbaric oxygen therapy has been proved to be highly effective in the treatment of advanced SBO. Cranial nerve palsies can recover completely under optimized treatment including adjuvant HBO therapy.

Cutaneous dissemination of nasal NK/T-cell lymphoma in a young girl.

In Europe and the USA, the incidence of primary nasal natural killer (NK)/T-cell lymphoma is rare. The skin is one of the predilection sites for dissemination. Cutaneous dissemination is a poor prognostic sign and is consistently fatal. We describe the case of a 17-year-old white German girl with a primary nasal NK/T-cell lymphoma and cutaneous dissemination. She presented with multiple maculopapular patches involving the trunk and thighs, and a 4-week history of headache, fever and fatigue. Biopsies of the skin and the nasal mucosa were taken. Pathological examination of both specimens revealed a NK/T-cell lymphoma. Epstein-Barr virus RNA was detected in the lymphoma cells by in situ hybridization. Unfortunately, the patient died of disease within 1 week.

[Results of antegrade intramedullar Kirschner-Wire pinning of subcapital fracture of the fifth metacarpal bone using Foucher's technique]. / Ergebnisse der antegraden, intramedullären Kirschner-Draht-Schienung der subkapitalen MHK-V-Fraktur nach Foucher.

One of the most common hand injuries is the subcapital fracture of the fifth metacarpal bone. We propose a surgical procedure when the fracture is angulated for at least 40 degrees in a palmar direction or when we find a rotatory deformity. Our standard operation procedure is a closed reposition with an intramedullar Kirschner-wire pinning with 2 curved wires according to Foucher's technique. During the period from 8/2003 to 6/2006 we repaired 126 distal metacarpal fractures in the mentioned technique with the use of 1.2 mm Kirschner wires. We suggest an early functional aftercare with a middle hand brace for four weeks. In a retrospective study we were able to examine 41 patients. Our research included objective parameters like the grip power and the range of motion as well as subjective parameters with the use of the DASH score and a self-created questionnaire to check the individual satisfaction with the operative procedure. 41 patients (94 %) were satisfied or very satisfied with the result of the operation and 35 (79 %) were satisfied or very satisfied with the local anaesthesia.

[Stomal metastases after translaryngeal tracheotomy (TLT) according to Fantoni: a rare complication]. / Impfmetastasen nach translaryngealer Tracheotomie nach Fantoni: Eine seltene Komplikation bei Tumoren des oberen Aerodigestivtrakts.

The translaryngeal tracheotomy (TLT) according to Fantoni with rigid endoscopy is well known and easy to execute. In our department we have used this method since 2002. In 17 patients suffering from carcinomas of the upper aerodigestive tract, we performed a TLT. Peri- and postoperative complications were examined. In 17 patients there were no intraoperative complications. As an early complication we found in one case a dislocation of the tracheostomy tube postoperatively. In one patient we observed metastases in the prior TLT stoma as a major late complication. Another patient also probably suffered from metastases in the prior TLT stoma. We did not find tracheoesophageal fistulas or stenosis of the trachea. Iatrogenic neoplastic seeding of squamous cell carcinomas of the upper aerodigestive tract is a serious complication. Our experience with these two cases and a review of the literature indicates that in patients with head and neck cancer, pull procedures for placement of TLT tubes may induce metastases by direct implantation of tumor cells because of contact between the TLT tube and the primary tumor cells. TLT according to Fantoni cannot be recommended for the treatment of cancer of the upper aerodigestive tract. Methods of tube insertion that avoid such contact, e.g., Ciaglia, surgical tracheostomy, should be preferred.

[Secondary amaurosis after infraorbital injury with a wooden foreign body]. / Sekundäre Erblindung nach orbitaler Holzfremdkörperverletzung.

We report a 68-year-old male who had orbital trauma from a bicycle accident. His vision was initially normal but deteriorated over 8 days to complete blindness. After 13 days, when he first consulted a physician, clinical investigation revealed total ophthalmoplegia, ptosis, and chemosis. Computed tomographic scan showed fractures of the medial orbital wall, orbital floor, and posterior ethmoid with dislocation into the orbital apex near the optic nerve. The patient was sent to our department for optic nerve decompression. Clinical examination showed induration and an already healed infraorbital entry wound suggesting an orbital foreign body, which was confirmed by ultrasound. Renewed analysis of CT scans in different window settings could clearly demonstrate a wooden foreign body in the lower eyelid. Additionally, a diffuse inflammation in the orbital apex was diagnosed. The foreign body was removed and decompression of the orbita and optic nerve was performed. Antibiotics and corticosteroids were administered i.v. Unfortunately, no visual improvement could be achieved.

[Primary nasal natural killer/T-cell lymphomas: classification and clinicopathological features]. / Primäre nasale NK/T-Zell-Lymphome: Klinisch-pathologisches Erscheinungsbild und Einteilung.

BACKGROUND: Nasal NK/T-cell lymphomas are rare malignancies in Europe or North America. Histological diagnosis is difficult, because tumors imbedded in large necrotic areas and neoplastic infiltrates may be admixed with small lymphocytes, plasma cells, eosinophils, and histiocytes, and thus the process could be misdiagnosed as chronic inflammation. Progression of the disease leads to septal perforation and may also result in destruction of the hard palate, and if left untreated it ends fatally. This introduced the term "lethal midline granuloma", a term which should not be used any more. MATERIAL AND METHODS: Clinical features, pathohistology, and current classification of primary nasal NK/T-cell lymphomas are described against the background of the recent literature and a case report. RESULTS: Immunophenotyping is essential for the diagnosis. Tumor cells are uniformly infected by Epstein-Barr virus, which could be verified by EBER in situ hybridization. Immunohistochemically, tumor cells are positive for CD56, cytoplasmic CD3epsilon, and CD2 and they express cytotoxic molecules like granzyme B, TIA-1, GMP17, and perforin. Therapeutic options are radio- or radiochemotherapy. On average, 2- and 5-year survival rates of 50% are obtained in stages I and II. The prognosis of advanced tumor stages is very poor. CONCLUSIONS: Immunohistochemical and molecular genetic early diagnosis is of crucial prognostic relevance.

["Descending necrotizing mediastinitis" due to deep neck infections. Incidence and management]. / "Descending necrotizing mediastinitis" infolge tiefer Halsinfektionen. Inzidenz und Management.

BACKGROUND: "Descending necrotizing mediastinitis" (DNM) is a rare but potentially life-threatening complication of deep neck infections caused by the rapid downward spread of a oropharyngeal infection along the facial planes into the mediastinum. MATERIAL AND METHODS: Between June 1997 and December 2004, 6 patients with DNM were treated in our department. The primary etiology was a peritonsillar abscess in 2 cases, a parapharyngeal abscess in 3 cases and in 1 case an odontogenic abscess. Most patients presented with risk factors such as diabetes mellitus or alcoholism, the mean age was 44.3 years and the mean duration of signs before diagnosis was 6.3 days. Thoracotomy was associated with the cervical approach in 4 cases and tracheostomy was also performed in 4 cases. RESULTS: Four patients were successfully treated, the mean duration of hospitalisation was 48.2 days and 2 patients died from sepsis and multiorgan failure despite intensive treatment. CONCLUSIONS: Descending necrotizing mediastinitis must be detected as soon as possible. The mean symptoms are persistent complaints after treatment of oropharyngeal infections, which may be masked by analgetic treatment. Only an immediate computer tomographic scanning, aggressive surgical drainage and debridement of the neck and the mediastinum can reduce the high mortality rate.

[Experiences with the subfrontal approach to manage extensive fractures of the frontal skull base]. / Erfahrungen mit dem subfrontalen Zugang zur Rekonstruktion ausgedehnter Frakturen im Bereich der Frontobasis.

BACKGROUND: Surgical management of multiple traumatized patients with head and neck trauma is highly individualized and depends on a number of factors including etiology, intracranial pressure, concomitant injuries, patient age and the possibility of an interdisciplinary procedure. Severe head and neck trauma are often connected with fractures of the frontal skull base or nasoethmoido-orbital complex and CSF leakage. If there is suspicion of a CSF leakage surgical management to cover the dura-defect is essential. An intradural approach is necessary in case of concomitant intradural injuries while primary extradural access provides excellent exposure of the rhinobasis with low morbidity and good results. METHODS AND MATERIAL: We report about our surgical experiences of 55 patients with severe frontobasal trauma, who were operated between 1/1999 and 11/2003. The subfrontal approach according to Raveh we had chosen in 20 patients which were operated by an interdisciplinary team together with the neurosurgeons. With an average follow up of 36 month we report about early and late complications. RESULTS: 19/20 patients showed sufficient coverage of the CSF leakage, once a revision surgery was necessary. Finally this patient had also an unobjectionable coverage of the CSF leakage. We saw no major complication like meningitis or brain abscess, intracerebral haematoma or surgical injury of the orbital wall. The most important complication was an anosmia, which depending on the extension of the approach results in any patients. CONCLUSIONS: Our results show that the subfrontal approach is a reliable method to explore extensive frontal dural defects and to reconstruct fractures of the frontal skull base without additional trauma to the frontal lobe.

Quantitative analysis of lung and tumour mobility: comparison of two time-resolved MRI sequences.

The purpose of this study was to describe the use of parallel imaging technique (PAT) using dynamic MRI in lung and tumour mobility during the breathing cycle. 20 patients with stage I non-small cell lung carcinoma were investigated using two dynamic gradient echo sequences with PAT (TrueFISP (fast imaging with steady precession), and fast low angle shot (FLASH). Craniocaudal distance from the apex to the diaphragm of the thorax and tumour mobility during the breathing cycle were measured. Signal-to-noise ratio (SNR) of the tumour was determined. In spite of the different temporal resolutions both trueFISP and FLASH sequence proved to be adequate to continuously measure lung motion and tumour mobility. SNR of the tumour was significantly higher using the trueFISP sequence than FLASH sequence (20.7+/-3.6 vs 5.8+/-2.3, p<0.01). Mobility of the tumour bearing hemithorax was significantly lower compared with the non-tumour bearing hemithorax (p<0.05). Dynamic MRI using PAT allows for continuous quantitative documentation of tumour mobility and lung motion. Because of the higher SNR, trueFISP sequence provides a better delineation of intrapulmonary lesions with a sufficient temporal resolution.

[Experiences with a new plate-like implant system (Ti-Epiplating System) for rehabilitation of orbital and midfacial defects]. / Erfahrungen mit einem subperiostalen Plattensystem aus Titan ("Ti-Epiplating-System") zur epithetischen Rehabilitation von Mittelgesichts- und Orbitadefekten.

BACKGROUND: Since Tjellstrom introduced in 1977 percutaneous osseointegration, the importance of osseointegrated implants has increased in the head and neck region. Implants and craniofacial surgery technology have been permanently improved and the use of extraoral osseointegration has expanded considerably. The surgical reconstruction of the exenterated orbit provides often only poor aesthetic results. Therefore the rehabilitation of complex midfacial structures is an indication for osseointegrated retained facial prostheses. METHODS AND MATERIAL: The international literature has been reviewed concerning the topic of osseointegration for the retention of orbital and midfacial prostheses. A new plate-like implant system is introduced. We report about our experiences with the "Ti-Epiplating System". DISCUSSION: The "Ti-Epiplating System" is available since 2001. For every location in the head and neck there exists a specially shaped plate. The "Ti-Epiplating System" is fixed subperiostally with normal bone screws, the same as used in traumatology. In cases of extended resections with less bone substance left, the application is simplified. The osseointegration time is reduced to a minimum of 6 weeks. Postoperative radiation is possible. CONCLUSION: The improved application of the "Ti-Epiplating System" is beneficial in the reconstruction of extended craniofacial defects with osseointegrated implants.

[Prospective feasibility study of chest X-ray vs. thoracic MRI in breath-hold technique at an open low-field scanner]. / Prospektive Machbarkeitsstudie zum Vergleich von Röntgenübersichtsaufnahme und Thorax-MRT in Atemanhaltetechnik am offenen Niederfeldgerät.

PURPOSE: MR investigations using a breath-hold sequence at an open low-field MR had to be compared to chest X-rays in patients with a wide spectrum of cardio-thoracic pathologies. MATERIAL AND METHODS: 114 patients and three volunteers who actually received a chest X-ray due to different indications underwent triplanar breath-hold (17 - 20 s) True-FISP sequence using a 0.2 T low-field MR (Siemens Magnetom Open, TR/TE/alpha: 7.3/3.5/80 degrees, SD: 10 mm, Pixel: 2.81 x 1.41 mm) a mean of 5.1 (+/- 8.2) days later. RESULTS: Signal-to-noise ratio as basics for pattern recognition was 3.2 in nodule, 5.0 in infiltration, and 12.0 in effusion, and therefore True-FISP is usable for the detection of these findings. MRI demonstrated nodules (89 % vs. 57 %), infiltration (81 % vs. 71 %), pleural effusions (86 % vs. 75 %), pericardial effusions (100 % vs. 21 %) and pulmonary congestion (90 % vs. 80 %) clearly more frequently compared to chest X-ray. DISCUSSION: MRI of the lung has been implemented successfully at an open low-field MR system. Diagnostic safety and accuracy are at least comparable to those of chest X-ray. The lack of superimposition led to a major improvement in the detection of pericardial effusions and nodules, and an increase in identification of infiltration, pleural effusion, and pulmonary congestion.