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C Görg

Publications and source records attributed to C Görg.

At least 19 recordsLinked to original sources
PubMed2006

[The value of highest quality ultrasound as a reference for ultrasound diagnosis].

AIM: The aim of this study is to determine whether an additional ultrasound examination of DEGUM grade 3 (DEGUM 3) requested by examiners of DEGUM grade 1, 2 (DEGUM 1, 2) results in a diagnostic improvement. METHODS: From October 2000 till June 2003 our university internal medicine sonography unit examined 34 980 patients. In 211 cases DEGUM grade 1, 2 examiners requested a second opinion by DEGUM grade 3 examiners. 28 subjects were excluded because of unconfirmed diagnosis. Data of 183 patients with assured diagnoses were retrospectively analysed. We compared DEGUM 1, 2 findings with DEGUM 3 results regarding the accuracy of the firmed diagnosis. RESULTS: In 38.8 % (71 out of 183 subjects) the correct diagnosis was ascertained by DEGUM 1, 2. DEGUM 3 confirmed the correct diagnosis in 94.5 % (173 out of 183 subjects). DEGUM 3 changed 106 (57.9 %) findings of DEGUM 1, 2 and approved 77 findings (42.1 %). In total DEGUM 3 diagnosed incorrectly twice compared to DEGUM 1, 2. In comparison to the assured diagnosis DEGUM 3 diagnosed 10 subjects incorrectly. CONCLUSION: The reference ultrasound examination done by an examiner with DEGUM grade 3 significantly increases the diagnostic accuracy compared to the ultrasonic measurement done by DEGUM grade 1, 2 investigators.

Germany↗
PubMed2006

Transcutaneous contrast enhanced sonography of the chest for evaluation of pleural based pulmonary lesions: experience in 137 patients.

PURPOSE: Transcutaneous ultrasound enables visualization of pleural based lesions but with a poor correlation to specific pathology. Ultrasound contrast agents in conjunction with contrast specific imaging techniques are increasingly accepted in clinical use. Up to date there are no data about the use of contrast enhanced sonography (CES) in a large series of pleural based pulmonary lesions. MATERIALS AND METHODS: From August 2004 to August 2005, 137 consecutive patients with pleural based pulmonary lesions on B-mode sonography were studied by CES using a transcapillary second-generation contrast agent (SonoVue(R)). The following CES parameters were retrospectively evaluated. Time to enhancement (TE) of contrast agent after i. v. application was determined and classified as short TE (< = 6 sec) vs. delayed TE (> 6 sec). Extent of enhancement (EE) was evaluated during the arterial phase (2 - 30 sec) and the parenchymal phase (1 - 5 minutes) by using the normal splenic tissue as an in vivo reference, and classified in reduced EE (anechoic/hypoechoic) vs. marked EE (isoechoic/hyperechoic) during both phases. Homogeneity of enhancement (HE) was classified as homogeneous vs. inhomogeneous. 60 patients had histologically confirmed malignant lesions due to central lung cancer (n = 31), and peripheral malignant lesions (n = 29). 77 patients had benign pleural based lesions including pneumonia (n = 32), pulmonary embolism (n = 20), compression atelectasis (17), and other benign pleural based lesions (n = 8). RESULTS: Malignant and benign lesions did not vary significantly regarding TE, EE, and HE. However, there were highly significant differences in the ratio of short vs. delayed TE and reduced vs. marked EE between the six disease groups. Characteristic patterns were short TE with marked EE in all compression atelectasis cases and in 62 % of patients with pneumonia. Delayed TE and reduced EE was seen in all patients with pulmonary embolism and in 62 % of patients with peripheral malignant lesions. Central lung cancer and benign nodules did not present with such specific patterns. No significant differences in HE were seen between subgroups. CONCLUSION: Pulmonary lesions are characterized by different CES-patterns of arterial supply as evidenced by TE and EE which depends on underlying causes, but CES does not allow to distinguish benign from malignant pleural based lesions in general.

Adult↗
PubMed2006

Colour Doppler ultrasound patterns and clinical follow-up of incidentally found hypoechoic, vascular tumours of the spleen: evidence for a benign tumour.

Between January 1990 and January 2005, incidental hypoechoic, vascular tumours of the spleen were identified in 13 patients using B-mode and colour Doppler ultrasound (CDS). All lesions found were well demarcated, intrasplenically located, and ranged in size between 1 cm and 4 cm. The increased vascular pattern on CDS was confirmed in 9 of the 13 cases by contrast enhanced ultrasound (CES), while two patients showed reduced vascularity on CES. In 10 patients, lesions were confirmed by contrast enhanced CT. Histological examination was performed in three patients with the diagnosis of capillary haemangioma (n = 2) and hamartoma (n = 1). In the remaining cases, ultrasound follow-up was performed (range 4 months to 13 years) and demonstrated no evidence of tumour growth in all but one patient. During a 4 year follow-up, one lesion increased in size from 1.0 cm to 1.5 cm and in the same patient an additional 0.5 cm sized hypoechoic increased vascular lesion was also found. In the spleen a hypoechoic lesion with an increased vascular pattern incidentally found by ultrasound most likely indicates a benign tumour with capillary haemangioma/hamartoma as the most likely diagnosis. However, it should be emphasised that in all cases a careful ultrasound follow-up is warranted.

Adolescent↗
PubMed2005

Contrast enhanced sonography of focal splenic lesions with a second-generation contrast agent.

OBJECTIVE: Contrast enhanced sonography (CES) of second generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this study was to investigate the ability of a second generation contrast agent to enhance splenic lesions. METHODS: From October 2003 to September 2004, 46 consecutive patients with focal (peri-) splenic lesions on B-mode sonography were studied by CES using a transpulmonary second-generation contrast agent (SonoVue). Data were retrospectively evaluated. Diagnosis of the patients were infarction (n = 9), lymphoma (n = 7), metastasis (n = 6), injury (n = 4), haemangioma/splenoma (n = 6), accessory spleen (n = 3), cyst (n = 2), and unknown cause (n = 9). Diagnosed of splenic lesions was confirmed by histology (n = 5), contrast enhanced computed tomography (n = 25), MRI (n = 4), scintigraphy (n = 1), and follow up (n = 38). Extent of enhancement (EE) was evaluated during the arterial phase (5-30 s) and the parenchymal phase (3-5 minutes): EE of focal splenic lesions was determined using the surrounding splenic tissue as an in vivo reference, and classified as anechoic vs. hypoechoic vs. isoechoic vs. hyperechoic vs. mixed. The contribution of CES to the final diagnosis was classified as low, helpful or highly necessary. RESULTS: In all but one patient enhancement of normal splenic tissue occurred. During the arterial and parenchymal phase, lesions were found to have anechoic 10/10, hypoechoic 12/24, isoechoic 12/7, hyperechoic 7/0 and mixed enhancement 5/5, respectively. Value of CES for final diagnosis was low n = 24 (52%) (7 lymphomas, 6 metastases, 2 cysts, 9 unknown), helpful n = 9 (20%) (4 infarctions, 2 ruptures, 3 accessory spleens) and highly necessary n = 13 (28%) (5 infarctions, 2 ruptures, 6 haemangiomas/splenomas). CONCLUSION: Contrast-enhanced sonography is of diagnostic value in subgroups of patients with (peri-)splenic lesions (48%): including splenic infarction, splenic rupture, splenic haemangioma/splenoma, and accessory spleen.

Aged↗
PubMed2005

Colour Doppler ultrasound mapping of chest wall lesions.

Spectral curve-analysis of arterial flow signals (FS) in patients with pulmonary lesions is able to discriminate FS of bronchial arteries (BA) from FS of pulmonary arteries (PA). In patients with chest wall lesions a different FS from that of the BA/PA can be obtained. The aim of the study was to evaluate and characterize arterial supply of chest wall lesions using quantitative colour Doppler ultrasound (CDS). Between September 2002 and June 2003, 29 consecutive patients with chest wall lesions were examined by CDS. 16 lesions were located strictly to the chest wall (group I). 13 lesions had a chest wall lesion with pulmonary extension (group II). The following parameters were prospectively determined: (1) qualitative CDS (absence or evidence of vascularity); (2) quantitative CDS of intercostal or non-intercostal located arterial FS (resistive index (RI) and pulsatility index (PI)); (3) number of different arterial FS in one lesion using CDS-mapping. In a control group of 17 healthy volunteers quantitative measurement of RI and PI of the intercostal artery (ICA) was performed. 4 of 29 patients (14%) had no FS by CDS mapping. Quantitative CDS parameters of the control group were mean RI of ICA 0.88 (+/-0.056); mean PI of ICA 2.88 (+/-0.643); of group I mean RI of ICA 0.79 (+/-0.127) mean PI of ICA 1.93 (+/-0.641), and of group II mean RI of ICA 0.79 (+/-0.144), mean PI of ICA 2.1 (+/-1.015), mean RI of non-ICA 0.68 (+/-0.675) mean PI of non-ICA 2.5 (+/-2.506). Median RI as well as PI-value obtained within the chest wall (ICA) do not differ between group I, group II, and the control group. Within group II impedance measurements discriminates intercostal from non-intercostal arterial supply. In 29 patients 37 different arterial FS were obtained. None of the 16 patients in group I and 8 of the 13 patients in group II had 2 or more different FS. Lesions strictly located to the chest wall had an arterial supply characteristic for ICA by quantitative CDS. Chest wall lesions with pulmonary extension demonstrate a complex arterial supply by quantitative CDS.

Adolescent↗
PubMed2004

High-resolution ultrasonography in gastrointestinal graft-versus-host disease.

Gastrointestinal graft-versus-host disease (GVHD) is one of the main causes of therapy-related death after allogeneic hemopoietic stem cell transplantation. Early diagnosis and immediate treatment are probably essential for improving clinical outcome. High-resolution sonography allows the evaluation of single bowel wall layers throughout the small and large bowel. We report the sonographic findings of seven consecutive patients with histologically confirmed GVHD grade II-IV of the gastrointestinal tract. The patients were examined sonographically within the 1st week after onset of clinical symptoms. Dilatation of the colon and striking bowel wall thickening were early and common features in these patients. Sonography may become a useful tool for diagnosis of patients with gastrointestinal GVHD. Its role for preclinical diagnosis, grading of severity of disease, and guiding therapy of patients with gastrointestinal GVHD warrants evaluation in prospective studies.

Adult↗
PubMed2004

Lemierre's syndrome: the forgotten disease. An unusual presentation of sepsis.

A 19-year-old girl presented with a septical condition with fever of 40 degrees C, swelling of the right sternocleidomastoid region and abdominal pain. Except for a sore throat with pain strictly localized to the right side of her neck and fever over the last week there were no other clues in her past medical history. An abdominal ultrasound and MRT scan as well as a chest X-ray only showed non-specific findings. The diagnosis of Lemierre's syndrome was established by ultrasonographical detection of right jugular venous thrombosis and perivascular inflammation together with blood cultures positive for Fusobacteria. The patient recovered within days after treatment was initiated with metronidazol according to the antibiogram. Lemierre's syndrome is a life-threatening disease especially in an age group which is less frequently affected by septicaemia. A history of sore throat, Fusobacterium positive blood cultures and ultrasonographical detection of jugular venous thrombophlebitis together with the knowledge of the "forgotten disease" will lead the way to the diagnosis.

Adult↗
PubMed2004

Transcutaneous colour Doppler sonography of lung consolidations: review and pictorial essay. Part 1: pathophysiologic and colour Doppler sonographic basics of pulmonary vascularity.

Anatomically, the lung is characterised by a dual blood supply. The existence of a systemic bronchial arterial supply to the lung in addition to the pulmonary arteries was first described by Galen in the second century. From angiographic studies it is known that pulmonary lesions of different aetiologies are characterised by differences in arterial supply. Colour Doppler sonography makes it possible to classify pulmonary arteries by location, flow direction, and quantitative spectral curve analysis. This article will review pathophysiological and colour Doppler sonographic basics of pulmonary vascularity.

Humans↗
PubMed2004

Transcutaneous colour Doppler sonography of lung consolidations: review and pictorial essay. Part 2: colour Doppler sonographic patterns of pulmonary consolidations.

The first ultrasound examinations of the lung were performed 30 years ago. In contrast to abdominal ultrasound, lung examination by ultrasound is not established as a routine method, due to a nearly complete sound reflection by the bones of the thorax and the aerated lung. In the last years B-mode sonographic patterns of peripherally based pleural lesions have been described. Colour Doppler sonography (CDS) further extends the diagnostic potential of ultrasound in chest disease. This article will review qualitative and quantitative CDS patterns of different pulmonary lesions.

Humans↗
PubMed2004

[The value of B-mode and colour Doppler sonography in the diagnosis of focal splenic lesions].

AIM: In this comparative study we determined whether the use of colour Doppler sonography (CDS) vs. B-mode ultrasound in the diagnosis of focal splenic lesions improves diagnostic accuracy. Using ultrasound scans of focal splenic lesions, diagnostic accuracy in relation to the level of sonographic experience of the examiner was also measured. METHOD: Eight ultrasound examiners with different levels of sonographic experience were given clinical data and sonographic pictures (B-mode and CDS) of 63 patients in two separated sequences. After viewing the first sequence (B-mode), the examiners had to formulate a diagnosis which they could either confirm or change after viewing the second sequence (CDS). RESULTS: In the least experienced reviewer, diagnostic accuracy was 32 % in B-mode, compared to 35 % in CDS; the most experienced reviewer scored 72 % (B-mode) and 75 % (CDS). In none of the entities examined in this study the use of CDS resulted in a significant increase in diagnostic accuracy. CONCLUSION: The contribution of CDS in the (differential) diagnosis of focal splenic lesions is not significant. In routine ultrasound examination of the spleen, CDS is not necessary. Only with some very specific diagnostic questions CDS supplies a fast and reliable diagnosis. In focal splenic lesions, diagnostic accuracy of either B-mode and CDS is higher with experienced examiners.

Humans↗
PubMed2003

[Functional asplenia after severe varicella zoster-infection diagnosis by colour Doppler ultrasound].

Infiltrative, inflammatory or thromboembolic processes in the parenchyma of the spleen can cause a functional loss of the organ. This phenomenon is called functional asplenia and occurs as a complication especially in sickle cell disease, lupus erythematosus and after bone marrow transplantation. We present the case of a patient with Crohn's disease under immunosuppressive therapy who developed a spontaneous covered spleen rupture in the course of a septic shock with DIG due to a Varizella zoster infection. Later on, sonography showed a diminution of the spleen size. No flow signals could be derived by colour doppler measurements from the spleen. Because of the colour doppler findings we suspected a functional asplenia which was then verified by spleen scintigraphy and Howell-Jolly-Bodies in the blood count. Remarkably, the Crohn's disease remains in complete remission since the development of the functional asplenia (for 4 years now). The underlying pathomechanism remains unclear.

Adult↗
PubMed2003

[Focal lesions in the opacified lung: a sonographic pictorial essay].

Transcutaneous ultrasound of pleural lesions has been established as a method complementary to conventional X-ray examination. The opacified lung allows the sonographical investigation of the lung parenchyma for synchronous and metachronous focal lesions. The aim of the pictorial essay is to describe the sono graphic patterns and to discuss the differential diagnosis, as well as the pathological correlation of focal lesions in the opacified lung.

Aged↗
PubMed2003

Chronic recurring infarction of the spleen: sonographic patterns and complications.

PURPOSE: Splenic infarction is a major problem of splenic pathology but is characterized by a high tendency for complete healing. The purpose of this study is to describe frequency, sonographic patterns, and complications of chronic infarction (CI) METHODS: Between 1980-2001 550 patients with focal splenic lesions were diagnosed by ultrasound. Eighty patients had an acute infarction, and in 14 cases a chronic infarction was diagnosed and confirmed by cytohistology/splenectomy (n = 3) or sonographic follow-up examination (n = 11). All patients with Cl had been investigated by B-mode sonography and colour Doppler sonography (CDS). Data were retrospectively evaluated. RESULTS: Two types of Cl could be discriminated. Type I morphology (n =8) was predominantly found in homozygous sickle-cell anaemia (n= 6) and sonographically characterized by a small or normal sized spleen (n = 6), with diffuse enhanced echogenicity (n= 8), and foci with diminished echogenicity (n=5). Type II morphology (n = 6) was predominantly found in myeloproliferative diseases (n = 4) and characterized by an enlarged spleen with a homogeneous echotexture (n = 7), and a solitary (n = 6), triangular (n=4), hyperechoic (n=4) splenic foci near the splenic surface. On CDS CI were characterized by absent flow signals (n = 7) or by reduced flow signals (n= 7). Spontaneous splenic ruptures occurred as infarction related complications in 3 of 14 cases (21%). CONCLUSIONS: CI develops in 17.5% of patients with infarctions. It occurs predominantly in patients with sickle-cell anaemia and myeloproliferative disease. Two characteristic morphologic patterns were found and associated with an increased risk of spontaneous splenic rupture: Therefore sonographic follow-ups might be useful.

Acute Disease↗
PubMed2003

Spontaneous rupture of the spleen: ultrasound patterns, diagnosis and follow-up.

Spontaneous rupture of the spleen is an extremely rare complication usually of infectious diseases or disorders of the haematopoietic system and has been described mostly in case reports. The incidence, symptoms, causes, therapy, and prognosis are poorly defined. From July 1985 to January 2000 41 patients with spontaneous splenic rupture were diagnosed by abdominal ultrasound and confirmed by splenectomy (n=12), CT (n=15), and ultrasound follow up (n=26). An ultrasound grading system was retrospectively established based on the degree of splenic injury (grade 0-2=low grade injury, grade 3=high grade injury) and correlated with surgical procedures. 30 day mortality rate was studied in relation to underlying disorders, ultrasound grades and treatment decisions. 21 patients had underlying malignant disorders (group I) and 20 patients had benign diseases (group II). Between group I and II we observed a highly significant difference in 30 day mortality rates (n=7; 38.1% vs n=1; 5%, p<0.01), but no significant difference in high grade injury rate (n=3; 14.3% vs n=2; 10.0%; p=ns) and surgical treatment rate (n=5; 23.8% vs n=7; 35.0%; p=ns). Depending on ultrasound grades the surgical procedures were 0% for grade 0, 16.7% for grade 1, 30.4% for grade 2, and 60% for grade 3. There were no significant differences between patients, who died within the first 30 days (n=9) and those who survived more than 30 days (n=32) regarding high grade splenic injury rate (n=0; 0% vs n=5; 15.6%; p=ns), and surgical treatment rate (n=2; 22.2% vs n=10; 31.2%; p=ns). Spontaneous rupture of the spleen is an extremely rare event. It is associated with a high mortality rate within 30 days in patients with malignant disease. Sonomorphologic grading is helpful for treatment decisions. 30 day mortality rate is correlated with neither ultrasound grades, nor surgical treatment rates.

Adult↗
PubMed2002

[Gas: "Acoustic key" to the diagnosis].

Sonography is frequently used as the first-line technology to evaluate patients with acute abdominal disorders as well as for the exploration of abnormalities of superficial structures. However, gas often interferes with sonographic examination. This illustrated article describes the spectrum of sonographic appearances of various abnormal location of gas collections as a key for definite diagnosis.

Diagnosis, Differential↗
PubMed2002

Pictorial review: Colour Doppler ultrasound flow patterns in the portal venous system.

Doppler ultrasound is a well established method for assessment of the portal venous system to detect the direction of portal blood flow. It is helpful for non-invasive diagnosis of intra-abdominal portosystemic shunts, especially in patients with cirrhosis. Less attention has been paid to other influences on portal venous flow, e.g. tricuspid regurgitation, increased hepatic out-flow resistance, respiratory cycle. The aim of this pictorial review is to describe the spectrum of physiological and pathological Doppler ultrasound flow patterns in the portal venous system.

Adult↗
PubMed2001

Partially reversed intrasplenic venous blood flow detected by color Doppler sonography in two patients with hematologic diseases and splenomegaly.

We report on 2 patients with hematologic diseases (1 follicular lymphoma and 1 myeloproliferative syndrome) and splenomegaly who had partial intrasplenic portosystemic shunting demonstrated by color Doppler sonography. Intrasplenic venous blood flow was in the normal direction at the hilum of the spleen but in a reversed direction at the periphery of the spleen. This type of reversed intrasplenic flow pattern results in portosystemic shunting and might be detected more frequently when careful color Doppler mapping of the entire splenic parenchyma is performed in patients with portal hypertension. The clinical significance of this phenomenon, however, is still unclear.

Female↗