Non-invasive imaging in a rare case of main pulmonary artery aneurysm

Report of an incidental chest X-ray finding of a large vessel dilation at the root of the ascending aorta in a 65-year-old female patient while pre-operative routine diagnostic. Due to prior allergic reaction to iodine contrast agent, non-invasive imaging was performed with magnetic resonance imaging (MRI), where the rare finding of a large aneurysm of the left pulmonary artery was diagnosed. Initial considerations of a surgical intervention were turned down as no clinical symptoms or risk factors were apparent.     

Systemische Immunsuppression in Zeiten von COVID‐19: Müssen wir umdenken?

The current SARS‐CoV‐2 pandemic particularly endangers older people with pre‐existing cardiopulmonary and metabolic conditions. However, it is also currently under discussion whether patients under immunosuppressive therapy also have a higher risk of suffering a severe course of the COVID‐19 disease. In principle though, there is currently no data available for a general reduction or pause of immunosuppression in patients with autoimmune diseases because of the SARS‐CoV‐2 pandemic. However, since there is currently neither an effective therapy nor corresponding vaccination protection, the indication for a prolonged immunosuppressive therapy should be made with special care. In particular, immunotherapeutic agents that produce long‐term effects (e.g., rituximab) should be used with special caution. In contrast, immunomodulating substances that do not suppress antiviral immunity (e.g. systemic immunoglobulins, doxycycline), or that have intrinsic effects on SARS‐CoV‐2 (calcineurin inhibitors, chloroquine, hydroxychloroquine) may be useful alternatives.     

Komplette Thrombusregression nach Sorafenib-Therapie bei Nierenzellkarzinom mit Cavathrombus

A patient presented with a small primary renal cell carcinoma (RCC) and a tumor thrombus extending into the inferior vena cava and the bilateral pelvic vessels, which in itself represents an inoperable situation. Palliative therapy with a tyrosine kinase inhibitor (sorafenib) was started which initially showed no response. A re-staging examination after 13 months showed a complete regression of the tumor thrombus with consequent operability of the tumor. Tyrosine kinase inhibitors are an encouraging new approach to inoperable RCC and should be considered in neoadjuvant therapy for these patients.     

Treatment of severe lichen planus with mycophenolate mofetil

Lichen planus (LP) is an inflammatory skin disorder with a wide range of clinical appearances. The treatment of disseminated and especially erosive forms of LP is often difficult and disappointing. Activated T cells are important in the pathogenesis of LP as indicated by the dermal lymphocytic infiltrate leading to keratinocyte destruction and lesion formation. Similar histologic findings are present in graft-versus-host disease. Since T cells are key players in the development of both disorders and mycophenolate mofetil has been successfully introduced in the treatment of graft-versus-host disease, we have examined the therapeutic potential of this agent in 3 patients suffering from disseminated and erosive LP. Mycophenolate mofetil was well tolerated and induced complete remission in 2 patients, and substantial improvement in the third patient.     

Hepatic angiomyoma: CT and MRI findings

Angiomyoma is a benign tumor that arises from soft muscular tissue within the blood vessel wall. This lesion has been found in different organs. The preferential location of these tumors is the lower extremity. We describe the rare case of a hepatic angiomyoma and present the radiologic findings of computed tomography and magnetic resonance imaging.     

Color Doppler US findings in the diagnosis of arterial occlusive disease of the lower limb

Peripheral arterial occlusive disease (PAOD) of the lower limb is a widely spread disease at the present time. After clinical examination, which includes a comprehensive history of the patient, different imaging modalities are competitive in the exact assessment of PAOD. Besides digital subtraction angiography and MR -angiography, color Doppler US is an established imaging modality in the diagnosis of PAOD.
This article illustrates the typical color Doppler US findings in PAOD of the lower limb. Duplex images of normal and pathological findings are presented, and the limitations of the method are pointed out. Color Doppler US examination strategies in patients suffering of PAOD are outlined.     

Embolia cutis medicamentosa (Nicolau-Syndrom) nach intraartikulärer Injektion

Embolia cutis medicamentosa (Nicolau Syndrome) is a very rare complication of intramuscular injections which presents with extensive necrosis of the injected skin area. Intra-arteria and/or para-arterial injections after prior perforation of certain vessels are discussed as possible pathogenetic mechanisms. We describe the occurrence of embolia cutis medicamentosa after intra-articular injections into the knee.