Der Internist
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All findings which arise in the context of radiological diagnostics, potentially affect the health of a subject but with no intention to detect the corresponding finding are considered to be incidental radiological findings (IF). The prevalence of IFs is increasing due to the wider use of modern imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT) in routine clinical practice and the inclusion of imaging, such as whole body MRI in large population-based cohorts. The reporting of radiological IFs can lead to further diagnostics and treatment. ⋯ The management of IFs in the setting of research studies differs depending on various factors, such as study design and health status of enrolled subjects. In general, IFs must be disclosed to the subject if the radiological IFs are potentially clinically relevant; however, subjects must also be protected from the consequences of false positive findings. This review article discusses radiological IFs in the setting of the clinical routine and research studies and provides a basic summary of the management recommendations for commonly occurring IFs.
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Acute pancreatitis is most frequently of biliary or alcoholic origin and less frequently due to iatrogenic (ERCP, medication) or metabolic causes. Diagnosis is usually based on abdominal pain and elevation of serum lipase to more than three-times the normal limit. Acute pancreatitis can either resolve quickly following an oedematous swelling or present as a severe necrotizing form. ⋯ Biliary pancreatitis requires causal treatment. In the case of cholangitis, stone extraction must be performed immediately; in the absence of cholangitis, it might be advisable to wait for spontaneous stone clearance. Timely cholecystectomy is necessary in all cases of biliary pancreatitis.
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Abdominal ultrasound is a common diagnostic procedure in internal medicine. The correct interpretation of incidental findings can be difficult at times and often results in expensive and sometimes invasive follow-up examinations. ⋯ To this end B-mode ultrasonography is complemented by color flow Doppler sonography and contrast-enhanced ultrasonography to add dynamic information on blood flow and vessel formation. This article presents frequent incidental findings of the major abdominal organs and vessels, and describes the sonographic and clinical management to find the correct diagnosis.
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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.