Der Internist
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Abdominal imaging is an important component of the diagnostics of acute pancreatitis. In addition to the clinical features and the laboratory constellation, it serves to establish the diagnosis or the exclusion of other diseases and also the identification and assessment of the course of local complications and vascular changes that can arise during the course of acute pancreatitis. ⋯ A rational use of imaging is an important prerequisite for high quality and at the same time cost-effective patient care. This review summarizes the current importance of imaging in acute pancreatitis, with particular reference to the updated S3 guidelines on acute pancreatitis.
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Chronic pancreatitis is characterized by recurrent inflammatory episodes. The diagnosis is based on the detection of pathognomonic morphological alterations by ultrasound-based methods as well as computed tomography and magnetic resonance imaging. In addition, imaging techniques play an important role for the differential diagnostics of potential complications in patients with chronic pancreatitis and for regular monitoring of patients with increased cancer risk. This article summarizes the current guideline recommendations for medical imaging procedures in chronic pancreatitis.
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In the investigation of hypercalcemia of an 81-year-old female patient, the typical laboratory value constellation of primary hyperparathyroidism (pHPT) emerged. The staged imaging diagnostics with sonography of the neck, sestamibi parathyroid gland scintigraphy and C‑11-methionine positron emission tomography-computed tomography (PET CT) resulted in negative or inconspicuous findings for all procedures. The exploratory surgical resection of two hyperplastic epithelial bodies led to a normalization of calcium levels. Inconspicuous imaging findings do not exclude the diagnosis of pHPT.
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Atrial fibrillation is frequent and has severe sequelae, such as stroke, cardiovascular death and cardiac insufficiency. These sequelae can be effectively reduced by anticoagulants, a meticulous recognition and treatment of cardiovascular comorbidities and an early rhythm-preserving treatment. Catheter ablation leads to a better preservation of the sinus rhythm and in symptomatic patients to a better quality of life in comparison to treatment with antiarrhythmic agents. This should be included in the planning of early rhythm-maintaining treatment.
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In the European Union a disease is classified as rare if it affects no more than 5 out of 10,000 people. Currently, there are more than 6000 rare diseases, consisting of a large and heterogeneous number of different diseases that are complex in their symptomatology, multidimensional and therefore difficult to classify in everyday medical practice. ⋯ It also provides an overview of all German centers for rare diseases, which are a contact point for patients with an unclear diagnosis. The se-atlas serves as a compass through the heterogeneous amount of information on care facilities for rare diseases and provides low-threshold information for a broad user group, from affected persons to members of the medical care team.