Die infantile zervikale Myelopathie

Background

Cervical myelopathy in childhood is a rare disease to which little attention is paid. On the basis of a case report clinical aspects of this medullary compression syndrome are discussed.

Patients and methods

A 6-year-old girl developed progressive scoliosis caused by an intraspinal tumor. An overview of ethiology, pathogenesis, diagnostics and symptoms of cervical myelopathy will be presented.

Results

The long history between the initial findings and final diagnosis shows that there are many difficulties related to spinal neurological syndromes. The atypical symptoms in relation to the presumptive diagnosis will be analysed within the framework of this case report.

Conclusions

The evaluation, differentiation and treatment of complex clinical conditions is an interdisciplinary requirement in clinical practice. The prognosis of cervical myelopathy depends on early diagnosis and treatment.     

Syndrome myofascial du muscle piriforme et sciatalgie persistante chez le lombalgique en rééducation

Background

Myofascial syndrome affecting the piriformis is quite common in rehabilitation patients with low back pain and may present as persistent sciatica.

Goals

Based upon a clinical case, define the symptomatology and treatment of myofascial piriformis muscle syndrome.

Results

Computerized tomography-controlled corticoid injections and specific rehabilitation relieve muscle contracture and pain, allowing the back pain program to be resumed.

Discussion

The physiotherapist’s knowledge of myofascial syndrome affecting the piriformis may help early diagnosis and treatment, thus avoiding unnecessary lumbar investigations.     

Frequency and clinical relevance of PET/CT incidentalomas

Rationale and objectives

To assess the frequency of clinically significant incidental CT findings on PET/CT.

Materials and methods

Reports of 345 cases of baseline standard skull base to thighs PET/CT exams done over the course of a 6 month period at an outpatient facility affiliated with a large tertiary care level 1 trauma medical center were retrospectively reviewed. Incidental CT findings were assigned a level of clinical significance on a scale of 1–5, from doubtful significance to very significant. CT findings already known from prior CT reports were not included. CT findings corresponding to PET findings were also excluded. A score of 3 or greater was considered significant and reportable.

Results

Out of 345 cases, 171 (50%) had a least one CT finding rated at or above a score of 3 on our scale of significance, while 96 (28%) were found to have at least one CT finding with score at or above 4, and 25 cases (7%) showed at least one CT finding rated 5.

Conclusion

A substantial percentage of baseline PET/CT studies contain previously undiagnosed, significant incidental findings on the CT images.     

Bevacizumab-induced perforation of the gastrointestinal tract: clinical and radiographic findings in 11 patients

Aim

To present the gastrointestinal (GI) complications associated with bevacizumab therapy and their findings on abdominal imaging studies.

Methods

A computerized search identified 11 patients with GI complications of bevacizumab therapy on abdominal CT (n = 11) and fluoroscopic GI contrast studies (n = 4) who met our study criteria (including five patients with ovarian cancer, five with colon cancer, and one with cervical cancer). The medical records and imaging studies were reviewed to determine the clinical and radiographic findings in these patients.

Results

All 11 patients had findings of GI perforation on CT, or CT and GI contrast studies. CT revealed a localized extraluminal collection containing gas, fluid, and/or contrast material in eight patients (73%) with focal perforation, and free abdominal air and fluid in three (27%) with free perforation The imaging studies also revealed seven fistulas, including two colovaginal, one rectovaginal, one enterocutaneous, one colocutaneous, one gastrocolic, and one colorectal fistula. Eight (73%) of the 11 patients died within 1 year of the development of GI perforation, and the perforation was felt to be the cause of death in four patients (36%).

Conclusion

Abdominal CT and fluoroscopic GI contrast studies are useful imaging tests for the diagnosis of potentially life-threatening GI perforation as a complication of bevacizumab therapy. When GI perforation is detected on abdominal imaging studies, treatment with bevacizumab should immediately be discontinued.     

Hepatic perivascular epithelioid cell tumor (PEComa): dynamic CT, MRI, ultrasonography, and pathologic features—analysis of 7 cases and review of the literature

Objective

To evaluate the dynamic CT, MRI, ultrasonography, and pathologic features of hepatic perivascular epithelioid cell tumor (PEComa), improving the understanding and diagnosis of the tumor.

Methods

A retrospective analysis of CT, MRI, ultrasonography, and pathologic features of 7 hepatic PEComas diagnosed by pathology during 1st January 2005 to 1st September 2011 in our hospital.

Results

The performance of dynamic CT, MRI, and ultrasonography revealed that lesions were regular masses with well-defined borders, the maximum diameters were 2.5–8.5?cm (mean?=?4?cm), density was homogeneous, contrast-enhanced CT and MRI showed the lesions were significantly and heterogeneously enhanced on arterial phase, less enhanced on portal venous phase, and slightly hypodense on delayed phase. One patient had multiple hepatic lesions and had delayed enhancement. There were no backgrounds of hepatitis and cirrhosis, enlarged lymph nodes, or distant metastases. Pathology showed the gross appearance of the tumor was smooth. Tumor cells were round or polygonal, with clear boundaries and clear membranes, and had abundant translucent cytoplasm. Nuclei were round, with medium size. Tumor cells were epithelial-like cells and arranged in dense sheets. Immunohistochemistry showed that most of them were positive in HMB45 and MelanA, S-100, SMA, while negative in CgA, Syn, CK, CD117, CD10, and CD34.

Conclusions

Dynamic CT, MRI, ultrasonography, and pathology of PEComa had some characteristics of benign tumor’s performance. Enhanced scan showed PEComa quickly enhanced on arterial phase and enhanced less on portal venous phase. Knowing these characteristics could help to improve the understanding and diagnosis of hepatic PEComa.     

Chronic diverticulitis vs. colorectal cancer: findings on CT colonography

Purpose

The purpose of this update article is to evaluate findings on CT colonography in patients with chronic diverticulitis and to compare the findings in patients with colorectal carcinoma.

Materials and methods

Different morphological criteria retrieved from a literature review were retrospectively analyzed in a series of 13 patients with proven chronic diverticulitis. The findings were compared with a series of 10 patients with colorectal carcinoma.

Results

Overall, the findings in chronic diverticulitis resemble the findings in acute diverticulitis. The advantage of virtual CT colonography in differentiating both entities relies in the combination of morphological features previously described on axial computed tomography and double contrast barium enema. The single strongest morphological feature pointing towards the diagnosis of chronic diverticulitis is the presence of diverticula in the affected segment. In the presence of diverticula in the affected segment, a long segment (??10?cm), thick fascia sign without adenopathies, mild bowel wall thickening, tapered margins, and distorted but preserved mucosal folds are likely to further improve accuracy of diagnosing chronic diverticulitis.

Conclusion

The single strongest morphological sign to differentiate chronic diverticulitis from colorectal cancer is the presence of diverticula in the affected segment.     

Discriminating renal nutcracker syndrome from asymptomatic nutcracker phenomenon using multidetector computed tomography

Purpose

To retrospectively evaluate the ability of computed tomographic (CT) findings to discriminate nutcracker syndrome (NCS) from asymptomatic nutcracker phenomenon (NCP) and to investigate the diagnostic value of CT findings in diagnosis of NCS.

Methods

From January 2014 to April 2015, 216 patients who underwent initial urographic CT were included. Initially, 216 patients were categorized as “nutcracker” or “normal,” based on the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients who satisfied both of these criteria were diagnosed with nutcracker. The nutcracker was then divided into “NCS” and “asymptomatic NCP” based on the presence of characteristic symptoms. CT findings in sagittal and axial scans of corticomedullary phase were evaluated. Multivariate analysis was used to identify significant factors among 30 NCS, 51 asymptomatic NCP, and 135 normal patients. Diagnostic performance and threshold using receiver operating characteristic (ROC) curve were calculated.

Results

A total of 131 males and 85 females, with mean age of 38.6 years (range 18–89 years), were included. Multivariate analysis demonstrated superior mesenteric artery (SMA)-aortic angle (p < 0.001) and visualization of a dilated collateral vein with reflux (p = 0.001) were independent factors for distinguishing NCS from asymptomatic NCP. The combination of SMA-aortic angle <25° and visualization of a dilated collateral vein with reflux provided the greatest diagnostic accuracy (area under the ROC curve, 0.841).

Conclusions

The combination of SMA-aortic angle and visualization of a dilated collateral vein with reflux in multidetector CT can be useful to differentiate NCS from asymptomatic NCP.

     

Diagnostic performance of somatostatin receptor PET/CT using 68Ga-DOTANOC in gastrinoma patients with negative or equivocal CT findings

Purpose

Contrast-enhanced CT (CECT) is a standard investigative procedure in the localization of gastrinomas. Small tumors are often missed and metastatic lesions may remain occult on CT. The purpose of present study was to prospectively evaluate the diagnostic performance of ⁶⁸Ga-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI³-Octreotide (⁶⁸Ga-DOTANOC) positron emission tomography/computed tomography (PET/CT) in gastrinoma patients with negative or equivocal CT findings.

Methods

Twenty-five patients (age 46.6 ± 13.3 years; male 60%) with clinical/biochemical diagnosis of gastrinoma and negative or equivocal findings on CECT were prospectively evaluated. All of them underwent ⁶⁸Ga-DOTANOC PET/CT which was evaluated by two nuclear medicine physicians in consensus. Combination of histopathology, serum gastrin, endoscopy, and follow-up imaging were taken as reference standard.

Results

⁶⁸Ga-DOTANOC PET/CT was positive in 17 patients and negative in 8 patients, yielding an overall detection rate of 68%. It was positive 13/20 patients who underwent baseline evaluation and in 4/5 post-treatment patients. Of the 11 patients who had a negative CT result, ⁶⁸Ga-DOTANOC PET/CT was positive in four cases (detection rate 36.4%), while it was abnormal in 13/14 patients who had equivocal CT findings (detection rate 92.8%). Diagnostic performance of ⁶⁸Ga-DOTANOC PET/CT was superior in patients with equivocal CECT findings than that in patients with negative CECT (P = 0.010).

Conclusion

⁶⁸Ga-DOTANOC PET/CT appears to be useful in patients with gastrinoma with negative or equivocal results on CECT, especially the latter group.     

Differential diagnosis between benign and malignant ulcers: 320-row CT virtual gastroscopy

Purpose

This study aims to assess the diagnostic accuracy of virtual gastroscopy obtained by 320-row computed tomography (CT) examination in differentiating benign from malignant gastric ulcers (GUs).

Materials and methods

49 patients (30 M, 19 F, mean age 58.6) with endoscopic and histological diagnosis of GU underwent CT examination. A hypotonizing drug was administered and gastric walls were distended by air in order to perform virtual endoscopy. Based on morphological features, GUs were subdivided into benign or malignant forms by two blinded radiologists. Interobserver agreement was evaluated using Cohen??s kappa (k) test. CT results were then compared with endoscopic and histological findings, having the latter as the reference standard.

Results

Thirty-five out of 49 patients (71%) were affected by malignant ulcers, while in the remaining 14 cases diagnosis of benign GU was made. Virtual gastroscopy showed diagnostic accuracy, sensitivity, and specificity values of 94%, 91%, and 100%, respectively, in differentiating benign from malignant ulcers. Almost perfect agreement between the two readers was found (k?=?0.86).

Conclusion

CT virtual gastroscopy improves the identification of GUs and allows differentiating benign from malignant forms.     

Spigelian hernia: CT findings and clinical relevance

Objective

The purpose of our study was to evaluate the clinical relevance of preoperative CT in distinguishing between the two subtypes of spigelian hernia (SH).

Materials and methods

We reviewed retrospectively the CT images of 35 patients. The patients were divided into two groups on the basis of the SH subtype: interstitial SH group (n = 15) and subcutaneous SH group (n = 20). Clinical characteristics of patients and CT findings were analyzed. Bowel ischemia on surgery was also noted.

Results

Sixteen right hernias and 19 left hernias were observed. Fifteen interstitial SH (43%) and 20 subcutaneous SH (57%) were found. No type of content showed a statistically significant association with one or other subtype of SH. Nine of the 26 patients presenting with SH with SB content showed signs of SBO on CT. Closed-loop SBO on CT was present in 5 of the 26 patients with SB content. An interstitial SH was observed in all of these 5 patients (p = 0.039). Surgery was performed on 10 patients. Bowel ischemia was found on surgery in 4 patients and showed no statistically significant association with a particular subtype of SH (p = 0.6).

Conclusion

Our study shows the importance of performing CT in SH. CT provides the diagnosis of SH, shows SH content, and demonstrates the presence of SBO or closed-loop SBO. Moreover, the distinction between the two subtypes of SH on CT appears to be of clinical relevance since closed-loop SBO is statistically associated with interstitial SH and the optimal surgical approach may differ.     

The clinical impact of subspecialized radiologist reinterpretation of abdominal imaging studies,with analysis of the types and relative frequency of interpretation discrepancies

Purpose

The primary objective of this study was to determine the clinical impact and value of abdominal imaging reinterpretations by subspecialized abdominal imagers.

Methods

Secondary interpretations for computed tomography (CT), magnetic resonance (MR), and ultrasound (US) abdominal studies performed outside our institution over a 7-month period were retrospectively compared to the primary (outside) interpretation, with interpretive differences recorded. Clinical notes, pathology and subsequent imaging determined ground truth diagnosis and the clinical impact of any interpretive discrepancies were graded as having high, medium, or little/no clinical impact. Interpretive comparisons were scored into categories: (1) no difference; (2) incidental findings of no clinical impact; (3) finding not reported; (4) significance of finding undercalled; (5) significance of finding overcalled; (6) finding misinterpreted; and (7) multiple discrepancy types in one report.

Results

398 report comparisons were reviewed on 380 patients. There were 300 CT, 60 MR, and 38 US examinations. The primary report had 5.0% (20/398) high clinical impact interpretive discrepancies and 7.5% (30/398) medium clinical impact discrepancies. The subspecialized secondary report had no high clinical impact discrepancies and 8/398 (2.0%) medium clinical impact discrepancies. In order of frequency, high and medium impact discrepancies in the primary report consisted of 50% overcalls, 26% unreported findings, 18% undercalls, 4% misinterpretations, and 2% multiple discrepancies.

Conclusions

Subspecialty review of abdominal imaging exams can provide clinical benefit. Half of the discrepancies in this series of abdominal reinterpretations were due to overcalls.     

Colorectal cancer in inflammatory bowel diseases: CT features with pathological correlation

Purpose

To describe CT features of inflammatory bowel disease (IBD)-related colorectal cancer and correlate the imaging findings with histopathological findings.

Materials and methods

CT imaging findings in 17 patients with IBD-related colorectal cancer were retrospectively evaluated. Imaging findings were correlated with surgical and histopathological findings. Univariate and multivariate analyses explored the relationships between CT and histopathological variables.

Results

Two different CT patterns were individualized including clearly visible soft tissue mass (8/17; 47%) (Type 1 tumor) or stenosis with marked circumferential thickening resembling inflammation (9/17; 53%) (Type 2 tumor). At univariate analysis, thickness of tumor-free colorectal wall at CT was greater in Crohn disease (median, 13 mm) than in ulcerative colitis (median, 7 mm) (P = 0.011). Significant association was found between presence of signet ring cells and Type 2 tumor at CT (6/9, 67% P = 0.009) and colonic dilatation proximal to tumor (5/6, 83%; P = 0.035). At multivariate analysis, free-fluid effusion was the single independent CT variable predictive for the presence of signet ring cells (odds ratio = 50; 95% CI 2.56–977.02; P = 0.01).

Conclusion

Colorectal cancer in IBD displays two main features on CT. Type 2 tumors and free-fluid effusion correlate with presence of signet ring cells. Knowledge of these findings is critical to help suggest the diagnosis.     

CT findings of gastric and intestinal anisakiasis

Purpose

To illustrate the CT findings of gastrointestinal anisakiasis.

Subjects and methods

The Institutional Review Board approving this retrospective study waived the requirement for informed consent. Review of our emergency department’s clinical records from September 2008 to January 2012 identified 41 consecutive patients who were diagnosed with gastrointestinal anisakiasis. 20 patients were diagnosed with gastric anisakiasis with endoscopically proven Anisakis larvae, and 21 patients were diagnosed with intestinal anisakiasis with positive test results for anti-anisakidae antibody and the presence of intestinal lesions on CT. Two radiologists retrospectively assessed the CT findings.

Results

The mean time delay from raw fish ingestion to symptom onset was 5.2 h (range 0.5–24 h) in gastric anisakiasis and 39 h (range 12–120 h) in intestinal anisakiasis. Gastric anisakiasis showed marked submucosal edema of the gastric wall (20/20 patients, 100%), increased attenuation of adjacent fat (19/20, 95%), and ascites (14/20, 70%) on CT. Intestinal anisakiasis showed marked submucosal edema of the intestine (21/21 patients, 100%) without showing complete intraluminal occlusion, ascites (21/21, 100%), increased attenuation of adjacent fat (19/21, 90%), and fluid collection in the distal segment of the constricted small intestine (13/21, 62%) on CT.

Conclusion

Severe submucosal edema with ascites is a characteristic finding of gastrointestinal anisakiasis when compared with other forms of gastroenteritis. When CT shows the typical findings of gastrointestinal anisakiasis, radiologists may suggest the possibility of clinically undiagnosed anisakiasis, especially in intestinal anisakiasis as the diagnosis is sometimes difficult due to the long interval between food intake and symptom onset.     

Retroperitoneal schwannomas in the anterior pararenal space: dynamic enhanced multi-slice CT and MR findings

Background

To evaluate the imaging features of schwannomas in the anterior pararenal space (APS), especially focusing on dynamic enhanced multi-slice CT (MSCT) and MR findings.

Patients and methods

Eight patients with pathologically proved retroperitoneal schwannomas in the APS underwent dynamic enhanced multi-slice CT (MSCT), while three of these patients also had a contrast-enhanced MR examination. The imaging findings were retrospectively reviewed.

Results

All eight cases exhibited forward displacement of the pancreas, and three cases showed lateral displacement and compression of the inferior vena cava. The tumors had round or oval shape with a maximal axial diameter of 4.0–12.3 cm (average, 6.7 cm). All eight tumors were solitary and well circumscribed. Of the eight retroperitoneal schwannomas in the APS, six exhibited a capsule with thickness of 1.0–2.0 mm, one showed punctate calcification, two displayed cystic degeneration, and three revealed a “target sign” on CT and MR. The tumors were hypo-dense on unenhanced CT images, hyper-intense on T2W images, and homogeneously hypo-intense on T1W images. All eight tumors exhibited gradual enhancement on dynamic enhanced CT or MR images. One case showed delayed enhancement. Heterogeneous enhancement was the dominant pattern occurring in seven out of eight tumors.

Conclusion

The imaging findings of schwannoma in the APS correspond with its pathological composition. Schwannoma should be included in the differential diagnosis of tumors in the APS.     

Epidermoid cyst in intrapancreatic accessory spleen: computed tomography findings and clinical manifestation

Objective

This study aims to assess retrospectively the imaging features of computed tomography (CT) and clinical characteristics of epidermoid cyst in intrapancreatic accessory spleen (ECIPAS).

Methods

Seven consecutive patients with pathologically confirmed ECIPAS were included. CT images and clinical data were analyzed. The CT features emphasized included the location, size, calcification, cystic features, surrounding accessory spleen, density, and enhancement of the lesions.

Results

Five patients were male and two were female with a mean age of 43.2?years ranging from 25 to 66?years. Most cases were incidentally detected. All lesions were situated in the pancreatic tail, wherein the mean size was 4.4?cm. The cyst appeared unilocular in four cases and multilocular in three cases. An accessory spleen surrounding the cyst was recognized in all seven cases, and the cystic wall of ECIPAS showed a contrast enhancement similar to that of the spleen during multiphasic scans.

Conclusion

ECIPAS is an extremely rare entity. The diagnosis of an ECIPAS should be considered when enhancing the cystic wall of the lesion in the pancreatic tail similar to that of the spleen during multiphasic scans.     

Hepatic pseudolymphoma: imaging–pathologic correlation with special reference to hemodynamic analysis

Objectives

To clarify radiological findings and hemodynamic characteristics of hepatic pseudolymphoma, as compared with the histopathological findings.

Methods

Radiological findings of ten histopathologically confirmed hepatic pseudolymphomas in seven patients were examined using US, CT, and MRI. Six patients also underwent angiography-assisted CT, including CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) to analyze hemodynamics.

Results

The nodules were depicted as hypoechoic on US, hypodense on precontrast CT, hypointense on T1-weighted images, and hyperintense on T2-weighted images. On contrast-enhanced CT/MRI, they showed various degrees of enhancement, and sometimes, perinodular enhancement was observed at the arterial dominant and/or equilibrium phase. On CTAP, the nodules showed portal perfusion defects, including some in the perinodular liver parenchyma. On CTHA, irregular bordered enhancement was observed in perinodular liver parenchyma on early phase, and continued until delayed phase. Some nodules had preserved intra-tumoral portal tracts. Histopathologically, the nodules consisted of marked lymphoid cells. In perinodular liver parenchyma, stenosis or disappearance of portal venules, caused by lymphoid cell infiltration in the portal tracts, was observed.

Conclusions

Hepatic pseudolymphoma showed some characteristic radiological findings including hemodynamics on CT, MRI, and angiography-assisted CT. These findings are useful in the differentiation from hepatocellular carcinoma and other tumors.     

Hepatic angiomyolipoma: CT and MR imaging findings with clinical–pathologic comparison

Objective

The objective of this study is to evaluate the clinical, pathologic, and computed tomography (CT) and/or magnetic resonance imaging (MRI) findings of hepatic angiomyolipoma (HAML) and to improve the diagnostic efficacy of the tumor.

Materials and methods

Clinical, pathologic, and imaging findings were retrospectively evaluated in 18 patients with HAML. Two patients underwent both CT and MRI, ten underwent CT alone, and six underwent MRI alone. Unenhanced and contrast-enhanced examinations were performed in all patients. Imaging characteristics, such as the lesion location, lesion diameter, presence of early draining veins, attenuation/signal intensity of the lesions on imaging, and enhancement pattern were reviewed.

Results

There were 3 male and 15 female patients. HAML was seen as a well-defined, solitary mass on imaging with medium size (mean diameter, 5.9 cm). Fat was detected in ten patients. Calcification was noted in two patients and cystic degeneration was seen in one patient. Hepatic cirrhosis and capsule were not detected in all patients. The mean attenuation values exceeded 120 hounsfield units (HU) in 11 patients (91.7%). Peripherally decreasing enhancement rim as well as early draining vein was seen in 15 patients (83.3%). The early draining veins were all hepatic veins. Tumor vessels were noted in all patients.

Conclusion

The presence of early draining vein, peripheral decreasing enhancement rim, and the absence of tumor capsule in the hypervascular hepatic tumor on CT and/or MRI together with normal alpha fetal protein may be helpful for the diagnosis of HAML in non-cirrhotic liver.     

Funktionelle Störungen des kraniomandibulären Systems und der Halswirbelsäule als differentialdiagnostisches Problem der idiopathischen Trigeminusneuralgie

Introduction

Unfortunately, sharp, severe pain in the area of distribution of the fifth cranial nerve is frequently termed trigeminal neuralgia, and no differentiation is made between typical and atypical neuralgia and other types of facial pain disorders. This can lead to inadequate treatment.

Clinical material and methods

From 1987 to 1993, 577 patients were referred to our clinic with the diagnosis “idiopathic trigeminal neuralgia”. Re-examination of these patients was based on a comprehensive history, behavioural and psychosocial assessment, general inspection of the head and neck, evaluation of the craniomandibular system and cervical spine, neurovascular, neurosensory and motor evaluation of cranial nerves, intraoral evaluation, head and cervical spine scans (CT and/or MRI), diagnostic anaesthetic injections, laboratory tests and/or response to therapy.

Results

The follow-up examinations and treatment results allowed confirmation of the diagnosis in only 55% of all cases. There were 82 patients (14%) with craniomandibular disorders, 54 patients (9%) with cervical spine syndrome and 18 patients (3%) with cervical and/or dental causality in addition to the trigeminal neuralgia.

Conclusion

The process of differential diagnosis is critical in trigeminal neuralgia, because an incorrent or missed diagnosis is one of the most frequent causes of treatment failure. As idiopathic trigeminal neuralgia, craniomandibular disorders or the cervical spine syndrome can involve similar symptoms and response to the use of medication, close interdisciplinary cooperation in the process of diagnosis is recommended.     

Validierung der deutschen Version der regionalen Schmerzskala zur Diagnose des Fibromyalgiesyndroms

Objective

Use of the American College of Rheumatology classification criteria for the clinical diagnosis of fibromyalgia syndrome (FMS) is under debate. The Regional Pain Scale (RPS) had been developed for the diagnosis of FMS in clinical practice and in survey settings (survey criteria of FMS). So far a German version has not been validated.

Methods

A total of 216 patients with FMS, 53 with active rheumatoid arthritis (RA) and 60 with depressive disorder, recruited from clinical institutions completed the RPS. Forty-three patients with FMS filled in the RPS within 8 weeks a second time.

Results

The intraclass coefficient of FMS diagnosis after 8 weeks was 0.78 (test-retest reliability). The 7-day interval of pain was criticized by physicians. The absence of some articular pain regions was criticized by patients (face validity). The concordance of FMS diagnoses to survey and ACR criteria was 84.7% (±1.1); 45.3% of the patients with RA and 38.3% of the patients with depressive disorder met the survey criteria of FMS (discriminant validity).

Conclusion

The RPS has good reliability and convergent validity, but limited discriminant validity. The RPS is suited as a screening instrument for the diagnosis of FMS in clinical practice.     

Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients

Purpose

To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis.

Materials and methods

Nineteen patients with small-bowel Anisakiasis and who underwent abdominal CT between 2005 and 2012 were enrolled in our study. All of these patients were diagnosed using either a serologic test for Anisakiasis (n = 18) or by pathology (n = 1). Their medical records were reviewed in order to determine the clinical findings. CT images were retrospectively reviewed by two radiologists to evaluate the characteristics of the involved bowel wall and the ancillary findings.

Results

All patients had presented with the acute onset of severe abdominal pain as well as a history of having recently eaten raw fish. The mean time interval from eating the fish to the onset of abdominal pain was 1.7 days. Eighteen patients were treated conservatively and experienced resolution of their symptoms within seven days of hospitalization. One patient underwent surgical exploration for presumed small-bowel ischemia. The sites of involvement included the ileum (16/19, 84%) and jejunum (3/19, 16%). All patients had circumferential bowel-wall thickening (mean, 0.8 cm) with an intermediate length of involved bowel (mean, 7.9 cm). Small-bowel obstruction occurred in 16 patients (84%). The target sign was present in 17 patients (89%), ascites, particularly in the perilesional area, in 16 patients (84%), and mesenteric edema in 15 patients (79%).

Conclusion

Small-bowel Anisakiasis should be considered in the differential diagnosis of acute abdomen in order to avoid unnecessary surgery when patients present with abdominal pain after having recently eaten raw fish, concentric bowel-wall thickening with the target sign in the ileum, perilesional ascites, as well as bowel obstruction seen on CT.