[Ultrasound detection of pneumoperitoneum based on typical ultrasound morphology]. / Sonographischer Nachweis des Pneumoperitoneums anhand typischer Sonomorphologie.

The correspondence of sonography and radiography to figure out a pneumoperitoneum was studied in a group of 140 patients having undergone abdominal surgery. Sonography revealed 14 (82.4%) out of 17 radiographically positive patients. Because of the predominant collection of free air in the right upper quadrant, the ventrolateral liver surface represents the most important region in search of a pneumoperitoneum. In another 3 patients free peritoneal gas was diagnosed which was not revealed radiographically. The possibility to observe motion in real-time sonography repeatedly proved to be decisive for the certain diagnosis of free air (the shifting air under patient's movent and the immobility of the gas reflex under respiration). An observed "step" between the air in the costophrenic sinus and the abdominal gas reflex is considered to be an additional sonographic sign. These results justify combined evaluation of a suspected pneumoperitoneum by both plain film radiography and sonography prior to other imaging modalities.

[Sonography of the lower urogenital system]. / Sonographie des unteren Urogenitalsystems.

A suprapubic transvesical sonography of the lower urogenital tract performed by a radiologist is part of a complete investigation of the abdomen. The application of endosonographical methods is mainly subject-related in gynecology and obstetrics as well as in urology. The ranking rate of suprapubic transvesical sonography is compared with endosonographical methods, and, as indicated, also with CT und MRI. Concerning pathological-sonographical details, it is referred to the relevant literature. The diagnostic accuracy depends on the experience and ability of the investigator.

[Ultrasound image of the gallbladder fossa after cholecystectomy in the immediate postoperative period]. / Das sonographische Bild des Gallenblasenbettes nach Cholezystektomie in der unmittelbar postoperativen Periode.

70 patients clinically classified as n.a.d. were sonographically examined for evaluation of the gallbladder fossa within two weeks after cholecystectomy. Four marked signs were noted. In 35 patients (50%) we found homogeneous echogenic formations of triangular, band-like, or oval shape in the bed of the gallbladder. In 25 cases (35.7%) inhomogeneous structures were seen. In 6 cases (8.5%) cystic structures resembling the normal gallbladder were seen which were interpreted as representing seromas or liquified haematomas. In 4 patients (5.7%) the bed of the gallbladder was entirely normal. Whether the gallbladder bed was closed by sutures or not, had no statistically significant effect on ultrasound appearance.

[Idiopathic facial paralysis and magnetic resonance tomography (MRT)]. / Idiopathische Fazialisparese und Magnetresonanztomographie (MRT).

We investigated 15 patients with unilateral facial paralysis using gadolinium(Gd)-DTPA (diethylenetriamine pentaacetic acid) enhanced (magnetic resonance imaging (MRI). Eleven were idiopathic and 1 each was due to basal skill trauma, Lyme's disease, Foville's syndrome and herpes zoster oticus. Ten of 11 Bell's palsies showed a significant enhancement of the facial nerve on the paralysed side. In all cases enhancement was shown in the labyrinthine segment, in 9 in the meatal segment, in 8 in the mastoid segment and in 7 in the tympanic segment also. Follow-up Gd-enhanced MRI investigation was performed 3-11 months later in 8 patients. In 1 case with incomplete return of function after 3 months MRI enhancement was decreased. We could not find any correlation between the intensity of the Gd enhancement and the course, severity or outcome of Bell's palsy, or stapedius reflex audiometry. The mechanisms and aetiology of the Gd enhancement in Bell's palsy seem to be non-specific phenomena which are also found in post-traumatic facial lesions, for instance. Nevertheless, the ability to image the facial nerve in Bell's palsy provides a new means of examination in this disorder. In our opinion Gd-enhanced MRI is recommended in cases of recurrent or "atypical" Bell's palsy and in cases with total loss of electrical excitability, to exclude tumours. It is further suggested that MRI may provide valuable information concerning areas which may require surgical exploration or decompression.

[MRT of bladder carcinoma: tumor staging and gadolinium contrast behavior]. / MRT des Harnblasenkarzinoms: Tumorstaging und Gadoliniumkontrastverhalten.

33 patients with tumours of the urinary bladder were studied via MR, both with and without the paramagnetic contrast medium Gd-DTPA. Results were compared with the final pathological classification after TUER and bimanual palpation. The signal intensity ratio of tumour tissue/fat and tumour/muscle were calculated on T1 weighted images and after GD-DTPA and examined for their statistical significance. The increase in signal intensity of the tumours was statistically significant (Wilcoxon test p less than 0.01). There was no advantage for the T2 weighted images compared with Gd-contrasted enhanced T1 weighted images. MRI staging was correct in 28 out of 33 cases (accuracy 84.8%). Because of the relatively short acquisition time of T1 weighted images and the specific tumour enhancement, administration of Gd-DTPA proved to be of help in the staging of the carcinoma of the bladder. Two small tumours and regressive changes in central areas of tumours were recognised after Gd-DTPA.

[Differential diagnosis of the "fat leg"--a case report]. / Zur Differentialdiagnose des "Dicken Beins"--ein Fallbericht.

This is a report about a patient, who came to our hospital because of a painful thickening of her left calf. She was treated with Heparin 48,000 IU/24 hours. A crural vein thrombosis was suspected. Instead of improvement of the symptoms the diameter of the leg grew until the state of a complete Compartment-syndrome. After exact inspection (Sonography, Computertomogramm) we found a hematom of the calf, caused by a rupture of the tibial part of the gastrocnemius muscle. Fasciotomies and evacuation of the blood brought a restitutio ad integrum. Diagnostic methods and faults are discussed.

[Can ultrasound detect skeletal metastases?]. / Gelingt sonographisch der Nachweis von Skelettmetastasen?

78 radiologically certified skeletal metastases--osteolytic as well as osteoplastic--were examined via sonography. A defect of the cortex could be seen in 82%, a periostal reaction in 28.2% and a concomitant soft tissue tumorous formation in 79.4%. In proving a soft part component sonography is superior to the conventional x-ray. Our study shows that osseous metastases can be verified by sonography.

Surveillance strategy for intratesticular cysts: preliminary report.

We treated 15 patients with all sonographic criteria of a simple testicular cyst. Of the patients 6 were operated on and the diagnosis was confirmed histologically, while 9 did not undergo an operation but are under close observation (mean surveillance 11 months). All patients are without any detectable malignancy. The possibility of a surveillance strategy in simple intratesticular cysts is discussed.

Has ultrasound influenced the therapy concept of blunt scrotal trauma?

We present the ultrasonic diagnoses and treatment of 44 patients with blunt scrotal trauma (rupture of the testis, hematocele, intratesticular hematoma and hematoma of the scrotal layers). Purely intratesticular hematoma without any other accompanying injury also can be detected sonographically. When massive scrotal swelling is present ultrasound is valuable to determine the status of the underlying testis even if discrete fracture planes of the tunica cannot always be detected. To achieve best long-term results early surgical intervention should be performed in cases of rupture of the testicle and hematocele, while hematoma of the scrotal layers and purely intratesticular hematoma can be treated conservatively.

[Size relations of the spleen and lymph nodes in normal and pathologic processes]. / Grössenverhältnisse von Milzen und Lymphknoten bei normalen und krankhaften Zuständen.

63 spleens and 79 lymph node specimens, both normal and diseased, were measured in three planes. The ratio of length to width and to thickness was established to determine if characteristic changes in proportion - in connection with the expansion of the respective organs - are evident. The healthy spleens did not differ markedly from the diseased ones, whereas striking differences were obvious among the diseased lymph nodes. Lymph nodes involved in malignant disease appeared globular, whereas those involved in inflammatory disease showed a longish and flattened shape.

Impact of sonography on diagnosis of scrotal diseases: a multicenter study.

Scrotal ultrasound was carried out since 1980 in five centers. 1,971 cases presenting with pathological conditions of scrotal content were reviewed to asses limitations and possibilities of the method. Scrotal sonography was found to be a highly reliable method to distinguish between intra- and extratesticular lesions. The data presented reveal that sonography is not capable of differentiating reliably between benign and malignant lesions. In the decision-making process ultrasound is sometimes of great help to the urologist but surely no substitution for careful examination and history taking.

Sonographic appearance of benign intratesticular lesions.

58 patients with a purely intratesticular lesion were investigated with scrotal ultrasound. A pathognomonic echo pattern could be found for simple parenchymal cysts and hemangiomas only. The nature of all other lesions (chronic orchitis, hematoma, epidemoid cyst, testicular necrosis, abscess and tuberculosis) could not be defined solely on sonographic grounds.

Sonographic staging after nephrectomy for tumours.

Sonography for postoperative staging after malignant renal tumours was evaluated in this study based on multiple examinations in 63 patients. Sonography permits a critical examination of the liver, the abdomen in general, the retroperitoneal space, including the renal fossa and solitary kidney. Local recurrences after hypernephroma operation were found in 5.3% and after nephrectomy for renal pelvic carcinoma in 68%. Retroperitoneal lymph node metastases appeared in 17% of the patients operated on renal pelvic carcinoma and in 7.6% after hypernephroma operation. These data indicate that special attention should be drawn to the renal fossa after tumour nephrectomy. The higher incidence of recurrences in the renal fossa, and metastatic lymph node involvement in patients following nephrectomy for renal pelvic carcinoma compared with the situation after hypernephroma operation might be explained by the difference of the lymph drainage between the renal pelvis and renal parenchyma which, in addition, includes a separate ontogenetic development. The majority of secondary lesions in hypernephroma patients occur as lung and bone metastases which have been discovered by conventional X-ray examination. These data are not statistically evaluated in the study.

Sonography in blunt renal trauma.

In 27 patients with blunt renal trauma, sonography was used as diagnostic method. In principle, sonography was performed after the urogram. In 15 cases pathological findings were present: 5 subcapsular and perirenal hematomas; 3 ruptured kidneys and 1 renal pedicle injury; in 6 cases pre-existing lesions of the kidneys were present (1 cyst, 3 hydronephrotic kidneys and 2 tumors). A positive urogram and a pathological sonogram lead to the angiography in particular when the possibility of injury of other organs is suspected, or when urographically a nonfunctioning kidney simulates a lesion of the renal pedicle. The adoption of this diagnostic sequence is most economical, it provides the clearest findings and is the least irksome for the patients.

[Differential sonographic diagnosis in kidney failure. Uremia caused by tumor infiltration of both kidneys in malignant lymphoma]. / Beitrag zur sonographischen Differentialdiagnose der NIereninsuffizienz. Urämie durch Tumorinfiltration beid er Nieren bei malignem Lymphom.

Ultrasonography is in general an ideal addition to radiodiagnostic methods in diseases of the kidneys. In renal failure ultrasonography is an excellent independent diagnostic method, which can give good informations about the form, size and internal structure of the kidneys. The different causes of renal failure can be clarified. The typical sonographic patterns as in endstage kidneys, hydronephrosis, cystic dysplasia, acute and subacute glomerulonephritis are well known. A rare cause for renal failure is massive cellular infiltration of both kidneys in malignant systemic diseases of the lymphoreticular system. The sonographic picture of this condition is largely unknown and therefore two cases are demonstrated, which show considerable enlarged kidneys with a diminished irregular internal echo pattern.