Der Radiologe
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Endobronchial ultrasound (EBUS), one of the most important advances in pneumology in recent years, provides visualization of bronchial walls and parabronchial structures, extending the diagnostic spectrum of bronchoscopic techniques. Two different techniques are available: radial endobronchial ultrasound and the technique of ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). ⋯ EBUS-TBNA is particularly useful for the evaluation of hilar and mediastinal lymph nodes in cases of lung neoplasms with a sensitivity of 88% and specificity of 100%. EBUS therefore plays an important role in the new interdisciplinary guidelines on "prevention, diagnostics, therapy and aftercare of lung cancer".
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The case of an adolescent female patient with acute lymphoblastic leukemia and stroke-like hemiparesis demonstrates a typical manifestation of methotrexate-induced acute encephalopathy. This rare entity occurs both in children and adults and can result from intrathecal as well as high dose intravenous administration of methotrexate. Diagnosis can confidently be made using cerebral MRI including diffusion-weighted imaging (DWI), so that patients can be informed about the favorable prognosis.
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Ipsilateral occlusive or embolizing carotid artery stenoses are found in 20-30% of all cases of ischemic stroke. Several randomized studies revealed endarterectomy to be the gold standard in the therapy of severe symptomatic (NASCET, ESCT) and to some extent of asymptomatic carotid stenoses (ACAS, ACST). Stent angioplasty has been established as an alternative therapeutic option although non-inferiority of this procedure has not yet been proven. We provide an overview of both procedures as well of the state of current trials.
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The positive effects of sports on the cardiovascular and musculoskeleal systems are widely accepted. Nevertheless, sports also can cause injury and overuse leading to sport-specific problems, which are often a challenge in diagnosing and treatment. The history of the sport-related injury is crucial for further differential diagnosis. ⋯ MRT is the gold standard in the evaluation of interarticular and extra-articular sport-related pathologies, however, an exact clinical diagnosis allows a more effective investigation protocol. Profound knowledge of possible sport-specific injury and overuse patterns is necessary to detect lesions of the musculoskeletal system in active athletes and to use the fitting radiographic strategy for confirmation. The exact diagnosis is the prerequisite for initiating the appropriate treatment and a fast sports medical rehabilitation process.