{"title":"[Acute bleeding-the role of radiology in diagnostics and therapy].","authors":"Thomas Helmberger","doi":"10.1007/s00117-024-01374-1","DOIUrl":"https://doi.org/10.1007/s00117-024-01374-1","url":null,"abstract":"","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Interventional radiology - Training and career opportunities].","authors":"Lisa Ullrich, Wibke Uller, Anne Frisch","doi":"10.1007/s00117-024-01382-1","DOIUrl":"10.1007/s00117-024-01382-1","url":null,"abstract":"","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tobias Albrecht, Valentin Burkhardt, Christian Offergeld
{"title":"[Trauma of the midface : Symptoms, diagnostics and treatment].","authors":"Tobias Albrecht, Valentin Burkhardt, Christian Offergeld","doi":"10.1007/s00117-024-01408-8","DOIUrl":"10.1007/s00117-024-01408-8","url":null,"abstract":"<p><p>Midface fractures present a clinical challenge in otorhinolaryngology due to their often complex injury pattern and nonspecific symptoms. Precise diagnostics, including differentiated imaging procedures, are required. Interdisciplinary consultation between otorhinolaryngology, maxillofacial surgery, neurosurgery, and ophthalmology is often necessary. When selecting radiographic modalities, radiation hygiene should be taken into account. Sonography provides a radiation-free imaging alternative for fractures of the nasal framework and anterior wall of the frontal sinus. The goal of treatment is to achieve stable and symmetrical reconstruction. Depending on the injury pattern, different osteosynthesis materials, individual access routes, and various surgical procedures can be used. In clinical practice, the management of midface fractures requires a multidisciplinary, flexible, and pragmatic approach based on the fracture pattern and clinical experience.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"52-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Surgical management of severe noncompressible torso and organ hemorrhages].","authors":"Marc Maegele","doi":"10.1007/s00117-024-01376-z","DOIUrl":"10.1007/s00117-024-01376-z","url":null,"abstract":"<p><strong>Background: </strong>Noncompressible torso hemorrhages (NCTH) are now recognized as the leading cause of preventable death in the context of severe military and civilian injuries. Approximately 20% of all trauma patients still die from uncontrolled bleeding associated with rapidly evolving disorders of blood coagulation function.</p><p><strong>Objective: </strong>Summary of recent advances in the field of nonsurgical and surgical management, presentation of current treatment concepts and future research directions.</p><p><strong>Material and methods: </strong>Selective literature review and analysis.</p><p><strong>Results: </strong>The concepts for the early treatment of NCTH have considerably evolved over the last decade. The updated definition of NCTH includes a combination of high-grade anatomic body trunk injury, hemodynamic instability, urgent need for hemorrhage control, and aggressive hemostatic treatment. The treatment concepts consider the following 3 aspects: controlling the source of bleeding (close the tap), maintaining organ perfusion and restoring hemostasis (fill the tank) and increasing the body's resistance to ischemia (upgrade the armor). New tools, well-established damage control concepts and early and aggressive therapeutic intervention for hemostatic failure have significantly improved the outcomes.</p><p><strong>Conclusion: </strong>Future research needs to refine and validate the current concepts for further clinical application.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"38-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dank an die Gutachter 2024.","authors":"","doi":"10.1007/s00117-024-01407-9","DOIUrl":"https://doi.org/10.1007/s00117-024-01407-9","url":null,"abstract":"","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Optimized imaging for suspected acute organ bleeding].","authors":"Jonathan Nadjiri","doi":"10.1007/s00117-024-01391-0","DOIUrl":"10.1007/s00117-024-01391-0","url":null,"abstract":"<p><strong>Clinical/methodological problem: </strong>Contrast-enhanced computed tomography (CT) is the standard procedure for diagnosing acute organ bleeding. It provides rapid, precise and comprehensive visualization of the bleeding situation, which is crucial in emergency situations.</p><p><strong>Radiological standard procedures: </strong>The examination is usually conducted in three phases: native, arterial and venous. These phases enable the precise identification and localization of the source of bleeding. The CT imaging is not only used to confirm the diagnosis but also aids in planning further treatment, facilitating targeted preparation for interventional radiologists, surgeons and endoscopists.</p><p><strong>Methodological innovations: </strong>The possibilities for use of the technique in CT have significantly advanced in recent years. High-resolution CT scanners provide detailed images, which are particularly useful for detecting small bleedings and traumatic injuries. Multi-energy CT provides additional advantages by enabling virtual native examinations and mono-energetic image reconstructions, which enhance the visibility of iodine-based contrast agents. These technologies improve the sensitivity for detecting bleeding and enable a better characterization of the source of bleeding.</p><p><strong>Recommendation for the practice: </strong>To optimize the CT diagnostics for bleeding, the use of a highly concentrated iodine contrast agent with a fast injection rate is recommended. Additionally, imaging data should be reconstructed with a slice thickness of 1-3 mm to achieve optimal diagnostic results. Multiplanar reconstructions are essential in all cases to ensure comprehensive imaging information. The combination of these advanced techniques and settings leads to improved diagnostics and treatment of acute organ bleeding.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"22-27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Management of internal bleeding : Guidelines of the American Association for the Surgery of Trauma (AAST) and World Society of Emergency Surgery (WSES)].","authors":"Christiane König, Gerhard Adam, Lennart Well","doi":"10.1007/s00117-024-01400-2","DOIUrl":"10.1007/s00117-024-01400-2","url":null,"abstract":"<p><strong>Background: </strong>Internal bleeding is a common and serious complication in trauma patients. The American Association for the Surgery of Trauma (AAST) and the World Society of Emergency Surgery (WSES) have developed comprehensive guidelines to standardize and optimize the care of these patients. In Germany, abdominal injuries are involved in around 20% of all polytraumas, often caused by falls or road traffic accidents. The liver and spleen are most frequently affected. Correct diagnosis and timely management are crucial for patient survival.</p><p><strong>Diagnosis and classification: </strong>Computed tomography (CT) is gold standard to assess organ injuries, while ultrasound (fokussiertes Assessment mit Sonographie für Trauma, FAST) provides a readily available, non-invasive diagnostic tool. Magnetic resonance imaging (MRI) is used for detailed soft tissue injuries. The AAST has developed a scoring system (Organ Injury Scale, OIS) to classify the severity of organ injuries. The WSES classifies the hemodynamic condition of the patient.</p><p><strong>Treatment: </strong>Spleen: Treatment decisions are based on hemodynamic stability. Unstable patients often require emergency surgery, while stable patients can be treated conservatively. In the presence of active bleeding, embolization is a treatment option. Liver: Stable patients with a positive blush (leakage of contrast medium) are treated angiographically. Unstable patients should undergo surgery with perihepatic packing and Pringle maneuver. Kidney: Conservative treatment for stable patients. Embolization is used for active bleeding. Unstable patients require surgical treatment. Gastrointestinal tract: Duodenal hematomas can be treated conservatively. Pancreatic injuries require conservative or surgical intervention depending on the severity and stability of the patient.</p><p><strong>Conclusion: </strong>These guidelines aim to improve the survival and outcome of trauma patients with internal bleeding.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"13-21"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Typical causes and clinical presentations of traumatic and nontraumatic soft tissue and organ haemorrhage in emergency departments].","authors":"Mark Michael, Björn Hossfeld, Michael Bernhard","doi":"10.1007/s00117-024-01384-z","DOIUrl":"10.1007/s00117-024-01384-z","url":null,"abstract":"<p><p>Acute bleeding often occurs in a wide variety of forms in clinical emergency medicine. In traumatic bleeding, soft tissue injuries to the head or extremities are common, while severe bleeding is less common in chest injuries or pelvic trauma. In nontraumatic emergencies, gastrointestinal bleeding is the leading cause, but many other bleeding entities are possible. Structured management helps to detect the critically ill patient, identify the possible source of bleeding and provide appropriate radiological diagnostics and therapy. Clinical examination, blood gas analyses and emergency ultrasound are crucial in the initial phase of diagnosis. Initially, symptomatic therapy is usually indicated to stabilize the patient, and then interventional or surgical care is indicated in the course of the disease, depending on the location of the bleeding. Volume and catecholamine therapy, coagulation management and emergency transfusion are important components of interdisciplinary emergency care, in addition to primary bleeding control, especially in the case of open injuries.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"4-12"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Management of anticoagulant-related soft tissue bleeding].","authors":"S Hopf-Jensen, S Müller-Hülsbeck","doi":"10.1007/s00117-024-01381-2","DOIUrl":"10.1007/s00117-024-01381-2","url":null,"abstract":"<p><strong>Background and objective: </strong>Spontaneous, severe, and life-threatening soft tissue bleeding (STB) in patients taking anticoagulants is associated with high morbidity and mortality due to the substantial blood loss and nonspecific clinical symptoms. The optimal management of these predominantly older patients with multiple comorbidities has not yet been unanimously clarified.</p><p><strong>Materials and methods: </strong>This work comprises a literature search and analysis of the pertinent retrospective studies and case series.</p><p><strong>Results: </strong>Structured diagnostic workup with contrast-enhanced computed tomography (CT) is essential for planning transarterial embolization (TAE). Contrast agent extravasation, the signal flare phenomenon, and the hematocrit effect are all indicative of active bleeding or an anticoagulant-related hematoma. For TAE, coils, particles, and liquid embolic agents can be used alone or in combination. A back door/front door embolization should be strived for.</p><p><strong>Conclusion: </strong>Transarterial embolization is the method of choice for managing anticoagulant-related localized or diffuse spontaneous soft tissue bleeding in the context of hemodynamic stabilization of the patient.</p>","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":" ","pages":"28-37"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mitteilungen des Berufsverbandes der Deutschen Radiologie.","authors":"","doi":"10.1007/s00117-025-01418-0","DOIUrl":"https://doi.org/10.1007/s00117-025-01418-0","url":null,"abstract":"","PeriodicalId":74635,"journal":{"name":"Radiologie (Heidelberg, Germany)","volume":"65 1","pages":"61-75"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}