[Bronchogenic cyst. A rare benign esophageal tumor]. / Die bronchogene Zyste. Eine seltener benigner Osophagustumor.

A case of confirmed esophageal bronchogenic cyst is reported. We review the clinical and pathologic features of this rare congenital foregut anomaly, and emphasize its radiographic appearances with special reference to differential diagnosis.

[Radiodiagnosis of gastrointestinal lymphomas]. / Radiodiagnostik gastrointestinaler Lymphome.

Radiological synopsis of primary gastrointestinal lymphoma depends on the growth direction and dynamism of the tumor, i.e. grade of malignancy and stage of the pathological processes at diagnosis. Initial nodal-polypoid lesions, because of their mucosal/submucosal aggregation, in combination with more or less pathological small bowel relief, are successfully diagnosed by conventional barium studies. Progressive ulcerous and narrowing destruction of the gut wall, as a result of the advanced mural infiltration, increases the success rate of tomographic examination. Tomographic imaging, particularly computed tomography, is considered the primary method, alongside the selective small bowel double-contrast study for demonstration of diffuse tumor infiltration.

[Magnetic resonance tomography of hypophyseal tumors]. / Zur Magnetresonanztomographie der Hypophysentumoren.

After describing the topographical anatomy of the pituitary gland, the sellar and parasellar region, in magnetic resonance (MR) imaging, the morphology of pituitary adenomas in MR imaging will be discussed and illustrated, with special reference to differential diagnostic aspects. The diagnostic information and the present clinical relevance of MR imaging, both in pretherapeutic and follow-up situations, will be considered. This will be done using unenhanced and gadolinium-enhanced T1-weighted spin-echo sequences in coronal as well as in sagittal cross sections at 1.5 tesla. Using MR imaging, questions of therapeutic significance concerning the definition of the tumor (evidence of its presence, size, the extent and the degree of infiltration) can be answered with greater precision. The procedure can be repeated with consistency. The contribution of magnetic resonance imaging to tissue characterization is limited. The latter requires consideration of the clinical symptoms and endocrine laboratory findings for differential diagnostic purposes. As disadvantages of MR imaging we should mention the exclusion of certain classes of patients (e.g. those with cardiac pacemaker), the limited potential for evaluation of the extent of invasion of the dura, poor visualization of calcification and insufficient recognition of changes in compact bone.

[Computed tomographic diagnosis of dissecting aneurysm of the aorta]. / Zur computertomographischen Diagnostik des Aneurysma dissecans aortae.

Twenty-four patients with dissecting aortic aneurysms have been examined by CT and possible causes of mistaken diagnosis are discussed. Failure to diagnose a dissection by CT may be due to atypical localisation and thrombosis of the aortic dissection; dissections of small volume, particularly in the ascending aorta; failure to demonstrate an intimal flap and inadequate contrast enhancement. A false positive diagnosis may be due to fibrotic, inflammatory or neoplastic periaortic changes, aneurysm of the sinus of Valsalva, or artifacts.

[Optimizing puncture of the internal jugular vein. Effects and advantages of the Valsalva maneuver in catheterization]. / Optimierung der Vena jugularis interna-Punktion. Effekte und Vorteile des Valsalvamanövers für die Katheterisierung.

Shortly after the publication by English et al. on catheterization of the internal jugular vein (VJI) in 1969, the first papers reporting complications appeared. To reduce the rate of puncture failures with their consequences and complications, we tried to find the optimal conditions for successful puncture by evaluating serial CT scans. The diameter increase of the VJI was studied in 8 women and 9 men with an average age of about 39 years with 30 mmHg pressure in the upper respiratory passages. The measurement was performed 2 cm below the level of the cricoid cartilage (the probable puncture point for posterior access). It was carried out first during normal respiration, then after forced inspiration and bearing down with the glottis open against a closed system consisting of a manometer. By means of continuous bearing down, a pressure of 30 mmHg was maintained during CT scanning. With this pressure in the upper respiratory passages, the mean increase in diameter of the VJI was 58% on the left side (P less than 0.002) and as much as 78% on the right (P less than 0.001), which is highly significant. In 12 of the 17 test persons (70.6%), the right VJI proved to be the dominant vessel, and the diameter increase achievable by the Valsalva maneuver likewise seems to be greater on the right side than on the left (Table 1). We now recommend a slight Trendelenburg position with the head rotated 45 degrees to the contralateral side. For the first puncture we consider the posterior approach (see Fig. 2) on the right side to be the best.(ABSTRACT TRUNCATED AT 250 WORDS)

[Computed tomographic diagnosis and differential diagnosis of leiomyosarcoma of the inferior vena cava]. / Zur computertomographischen Diagnose und Differentialdiagnose des Leiomyosarkoms der Vena cava inferior.

The computer tomographic appearances of the rare leiomyosarcoma of the inferior vena cava are described and illustrated by one case. CT is particularly informative and the differential diagnosis from caval thrombosis and extension of tumour thrombus into the cava is discussed.

Computed tomography in acute pyelonephritis.

The computed tomographic findings in nine female patients with acute pyelonephritis were reviewed. The major impact of CT was the demonstration of renal enlargement, abnormal contour, perirenal inflammatory extension and, on contrast-enhanced scans, abnormal nephrograms and impaired renal function. It was concluded that CT can provide specific information about the nature and extent of the inflammatory process, thus complementing intravenous urography so that appropriate therapy may be selected. Follow-up studies can be helpful in monitoring the progress of a patient.

[Computed tomographic diagnosis and differential diagnosis of malignant paranasal sinus tumors]. / Zur computertomographischen Diagnose und Differentialdiagnose maligner Nasennebenhöhlentumoren.

The CT appearances of malignant tumours of the paranasal sinuses are illustrated on the basis of 15 patients, and the differential diagnosis discussed. Malignant soft tissue tumours in the paranasal sinuses are characterised on CT by their non-homogeneous structure; they may destroy the bony margins of the sinus and infiltrate neighbouring regions in certain preferred directions, and they may enhance following the administration of contrast. Precise definition of the malignant tumour by CT permits their exact staging, may help to determine therapy and is valuable for serial observation. It remains to be seen, however, whether the improved radiological diagnosis results in improved prognosis of malignant tumours of the paranasal sinuses.

[Normal anatomic measurements in cervical computed tomograms]. / Anatomische Normalmasse im zervikalen Computertomogramm.

Radiodiagnostically relevant normal values and variations for measurements of the cervical region, the arithmetical average and the standard deviation were determined from adequate computer tomograms on 60 healthy women and men, aged 20 to 83 years. The sagittal diameter of the prevertebral soft tissue and the lumina of the upper respiratory tract were evaluated at exactly defined levels between the hyoid bone and the incisura jugularis stuni. The thickness of the aryepiglottic folds, the maximal sagittal and transverse diameters of the thyroid gland and the calibre of the great cervical vessels were defined. To assess information about laryngeal function in computerized tomography, measurements of distances between the cervical spine and anatomical fixed points of the larynx and hypopharynx were made as well as of the degree of vocal cord movement during normal respiration and phonation.

Secondary hypertension and neurofibromatosis: bilateral renal artery stenosis and coarctation of the abdominal aorta.

A 34-year-old white man with generalized neurofibromatosis was found to have severe renal vascular hypertension due to a coarctation of the abdominal aorta and bilateral renal artery stenosis with saccular aneurysms. Increased renal venous renin activity showed the active involvement of the renin-angiotensin system in maintaining the hypertension. Because the patient refused surgical treatment, antihypertensive treatment with Captopril, a specific inhibitor of the angiotensin converting enzyme was used, resulting in normal blood pressure being restored over an 18 month observation period.