Der Internist
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For many specific and nonspecific gastrointestinal symptoms, endoscopic diagnostic procedures play an important role. Gastroscopy and colonoscopy are easily available diagnostic and interventional procedures with low risk. The technical development of gastrointestinal endoscopy has led to an improvement in diagnostics and therapy. ⋯ Rare diagnoses usually require an individualized therapy. Unexpected diagnoses can take place during (not properly detected) or after an endoscopy (overlooked or newly appeared) occur. This overview deals with the question of how to minimize unexpected diagnoses and how to diagnose and treat incidental findings.
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A 72-year-old woman presented with abdominal pain after micturition. Abdominal ultrasound screening revealed ascites associated with acute renal failure. Paracentesis of the peritoneal fluid was performed. ⋯ Catheterization and antibiotic therapy resulted in an improvement of pain and closure of the hole in the urinary bladder wall. Several different disorders can induce a rupture of the urinary bladder. In this case, severe chronic constipation was the most probable causative disease.
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A 47-year-old man presented with subacute, low back pain and increased creatinine levels. A CT scan showed an extrinsic, bilateral compression of the ureters by a retroperitoneal mass with pronounced uptake of 18F-fluorodeoxyglucose in positron emission tomography. ⋯ The initiated corticosteroids led to a rapid clinical improvement and regression of the retroperitoneal mass. A relapse occurred after tapering of corticosteroids with a prompt response to increase of the dosage.
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Inflexible and flexible bronchoscopy represents a standard diagnostic procedure in pneumology. Besides lung carcinomas, which is the most frequent indication for diagnostic bronchoscopy, a plethora of clinical symptoms such as chronic persistent cough, hoarseness, unexplained dyspnea, hemoptysis, and suspicious findings on auscultation require further endoscopic evaluation. Moreover, bronchoscopy plays a central role in the diagnostic work-up of interstitial lung diseases and persistent lung infiltrates, in particular those of infectious origin (e.g., fungal, viral, tuberculous, and Pneumocystis jiroveci infections). ⋯ Since endoscopic evaluation is typically preceded by computed tomography (CT) of the chest, genuine incidental findings occur relatively seldom and usually account for pathological findings that have been missed on conventional imaging approaches. For instance, characteristic incidental findings include benign and malignant tumors in the area of the endoscopic access and central airways, anatomical variations and (vascular) malformations, tracheal and bronchial airway alterations, and aspirated objects. This review focuses on bronchoscopic findings that have either been completely missed by conventional imaging or differently interpreted due to its radiologic morphology.
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Most imported diseases can be well treated-provided the diagnosis is made in due time. For example, only the rapid and correctly performed treatment of falciparum malaria can impede severe complications and save the patient's life. ⋯ However, it has to be mentioned that evidence from clinical trials is often insufficient. Accordingly only few international guidelines for imported diseases exist.