Visceral artery aneurysms (VAA) are relatively rare disease patterns. With regard to the aetiology two different entities of VAA can be distinguished: (i) real VAA, where arteriosclerosis plays an important role, particular in elderly patients, and (ii) pseudo-aneurysms. Here, previous abdominal trauma or former inflammatory processes are considered to be the responsible factors for their occurrence. Most frequently, VAA are located in the splenic (60%) and common hepatic artery (20-50%). The common hepatic artery (80%) and the pancreatico-duodenal artery (75%) feature the highest rupture rates. Generally all VAA with a diameter exceeding 2 cm should be treated. Special attention has to be paid to young pregnant women (particularly multipara) who bear the highest risk of VAA rupture, especially during the third trimenon. Early therapy is essential to avoid fatal consequences for mother and foetus. Basically, interventional, endovascular (embolisation, stent) or surgical (resection with direct vessel anastomosis, graft interposition, aneurysmorraphy, ligature) therapy options exist. The choice of the intervention should be adapted to the patient's individual risk profile. In our own series of VAA (n=19; 1996-2007), we evaluated both interventional and surgical procedures as valid therapy regimens with regard to the patients clinical condition.
In contrast to B-mode sonography, RTE is able to detect and visualize peripheral, non-pleural adherent pulmonary lesions.
Retroperitoneal fibrosis represents a rare inflammatory disease. About two thirds of all cases seem to be idiopathic (= Ormond's disease). The remaining one third is secondary and may be ascribed to infections, trauma, radiation therapy, malignant diseases, and the use of certain drugs. Up to 15 % of patients have additional fibrotic processes outside the retroperitoneum. The clinical symptoms of retroperitoneal fibrosis are non-specific. In sonography retroperitoneal fibrosis appears as a retroperitoneal hypoechoic mass which can involve the ureters and thus cause hydronephrosis. Intravenous urography and MR urography can demonstrate the typical triad of medial deviation and extrinsic compression of the ureters and hydronephrosis. CT and MRI are the modalities of choice for the diagnosis and follow-up of this disease. The lesion typically begins at the level of the fourth or fifth lumbar vertebra and appears as a plaque, encasing the aorta and the inferior vena cava and often enveloping and medially displacing the ureters. In unenhanced CT, retroperitoneal fibrosis appears as a mass that is isodense with muscle. When using MRI, the mass is hypointense in T 1-weighted images and of variable intensity in T 2-weighted images according to its stage: it may be hyperintense in early stages, while the tissue may have a low signal in late stages. After the administration of contrast media, enhancement is greatest in the early inflammatory phase and minimal in the late fibrotic phase. Dynamic gadolinium enhancement can be useful for assessing disease activity, monitoring response to treatment, and detecting relapse. To differentiate retroperitoneal masses, diffusion-weighted MRI may provide useful information.
Zusammenfassung Ziel: Effizienz der Strahlenschutzmittel bez?glich der Augenlinsendosis des Untersuchers bei fluoroskopischen Interventionen. Material und Methoden: Ein Patientenphantom wurde an einer DSA-Anlage exponiert. Dosismessungen erfolgten mittels Ionisationskammer in Augenposition des Untersuchers. Die Messungen imitierten fluoroskopische Interventionen, wobei die Reduktion der Streustrahlung durch den tischmontierten Strahlenschutz (Untertisch-Vorhang und ?bertisch-Aufsatz) beurteilt wurde. Die Effizienz der deckenmontierten Bleiacrylglasscheibe wurde im Streustrahlungsfeld eines Quaderphantoms bestimmt. Die Schutzwirkung verschiedener Bleiglasbrillen und Bleiacrylglasvisiere wurde durch Thermolumineszenzdosimetrie an einem Kopfphantom in Direktstrahlung evaluiert. Ergebnisse: Die Exposition der Linse bei radiologischen Untersuchungen von ca. 110???550??Sv wird durch den Untertisch-Vorhang nur gering reduziert. Durch Vorhang plus Aufsatz kann die Linsendosis bei Interventionen am Abdomen in PA-Projektion etwa um den Faktor 2 reduziert werden. In?25?-LAO ergibt sich ein Reduktionsfaktor zwischen 1,2 und 5. Die AP-Projektion ergibt die h?chsten Dosiswerte, auch ist die Wirkung des tischmontierten Strahlenschutzes minimal. Die deckenmontierte Bleiacrylglasscheibe reduziert die Linsendosis bei optimaler Positionierung etwa um den Faktor 30.?Die Bleiglasbrillen und -visiere reduzieren die Linsendosis maximal um den Faktor 8???10. Je?nach Design der untersuchten Modelle ist die Schutzwirkung geringer, insbesondere f?r Strahlungen am Kopfphantom aus laterokaudaler Richtung. Teils werden sogar Erh?hungen der Linsendosis durch die Visiere beobachtet. Schlussfolgerung: Die Exposition der Augenlinse kann bei konsequenter Anwendung der Strahlenschutzmittel auch unterhalb der neuen Grenzwerte der ICRP gehalten werden.
We report two cases of inflammatory pseudotumors of the urinary bladder, one case of a chronic granulomatous pseudotumor (CGT) and one case of a pseudosarcomatous myofibroblastic (fibromyxoid) tumor (PMT). Both tumors resembled malignancies such as rhabdomyosarcomas regarding clinical appearance and imaging findings and represent rare urinary bladder tumors. The imaging findings on unenhanced and contrast-enhanced MRI as well as histological specimen are presented. Final diagnosis was made following elective surgery. Differential diagnosis of urinary bladder tumors as well as the imaging findings of these clinically comparable cases are discussed. Awareness of these benign lesions may prevent patients from inappropriate therapies such as chemotherapy or radiation therapy.
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