Radiologicka Klinika

Hradec Králové, Czech Republic

Radiologicka Klinika

Hradec Králové, Czech Republic

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Flogelova H.,Detska Klinika | Staskova L.,Detska Klinika | Michalkova K.,Radiologicka Klinika
Cesko-Slovenska Pediatrie | Year: 2017

The risk factors for recurrent urinary tract infection vary by age and thus, the diagnostic and treatment approach should vary accordingly. Whereas the main risk factor in children under 2 years of age is vesicoureteral reflux, in girls able to control their voiding (older than 3 years of age), recurrent urinary tract infection is more frequently caused by lower urinary tract dysfunction. At this age, noninvasive urodynamic testing is preferred to voiding cystourethrography. The former comprises filling in an intake and voiding diary for 2-4 days, measuring bladder wall thickness and post-void residual volume, and uroflowmetry. Based on noninvasive urodynamic testing results, daily measures and/or medication therapy are recommended.

Navratilova K.,Detska klinika | Michalkova K.,Radiologicka klinika | Chudacek J.,1. chirurgicka klinika | Kopriva F.,Detska klinika
Pediatrie pro Praxi | Year: 2016

This case report describes the 14 year old adolescent, who was diagnosed with Marfan syndrome at the age of 12 years. This patient was admitted to our hospital with present complains of breathlessness, cough, chest pain and vertigo. The subsequent investigations led to the diagnosis of an unilateral spontaneous pneumothorax on the right, which was resolved through an active drainage. The patient was readmitted three days later with a new ipsilateral pneumothorax, a computerised tomography has shown subpleural bullae in the right lung. According to the decision of pneumologist surgical resection of identified bullae and pleurodesis were performed, which should be able to prevent the recurrent pneumothorax in identical localization. This case report highlights the importance of a correct therapeutic approach to the spontaneous pneumothorax, describes common risks of spontaneuos pnemothorax in patients wtih Marfan syndrome, diagnostic criteria of Marfan syndrome, last but not least the conditions related to Marfan syndrome, e.g. pectus excavatum or scoliosis and the ways of its possible prevention.

Mihal V.,Ustav molekularni a translacni mediciny | Maly T.,1. chirurgicka klinika | Michalkova K.,Radiologicka klinika
Pediatrie pro Praxi | Year: 2016

Handlebar injuries are one of the most common causes of abdominal injuries in children. Early diagnosis and optimal care without delay may help to reduce the morbidity of injuries to the internal organs. Children with abdominal handlebar injuries should be treated with great care. We describe a young girl presented after a bicycle accident having received a sharp blow from her handlebars to just below her left costal margin. She was admitted for observation and for her primary investigation. After becoming peritonitic, her pancreatic amylase and lipase increased to 3,57 μkat/l and 16,37. Axial CT scan showed transection of the pancreas. An endoscopic retrograde cholangio-pancreatography (ERCP) confirming ductal transection. In quest of bridging the pancreatic duct and securing drainage of pancreatic juice, a pancreatic stent was placed preoperatively. Due to complete transection of the pancreas body with simultaneous interruption of the pancreatic duct, distal pancreatectomy was performed with the spleen saving. The patient recovered well and 12 weeks later, after the stent was removed, there was no evidence of pancreatic stricture.

This article deals with the diagnostics of axillary lymph nodes and status of core-needle biopsy in the diagnostic algorithm of breast cancer. Ultrasonography is still considered as the basic method for investigation of lymph nodes. This article describes the normal appearance of lymph nodes and their suspicious or pathological appearance. Suspect and unclear findings of lymph nodes are followed by ultrasound-guided core-needle biopsy. The technical implementation of this biopsy is simple and safe with adequate knowledge and the awareness of possible complications. In case of unclear lymph nodes, their histological verification determines the following treatment.

Brtkova J.,Radiologicka Klinika | Jirickova P.,Multiscan Radiologicke Centrum
Ceska Radiologie | Year: 2012

Aim. To summarize and display the imaging findings in patients with different types of both frequent and less frequent types of tarsal coalition, to discuss the imaging protocols, differential diagnoses and give brief information on clinical findings and treatment. Method. The authors display CT, MRI and X-ray findings in 8 patients with the main types of coalition (talocalcaneal, calcaneonavicular), with a bilateral talocalcaneal coalition and in a patient with a complex synostosis. Results. The encountered findings were: narrowed or absent joint space, thinned irregular cortical line, adjacent oedema and sclerosis and an unusual shape of the involved bones. Secondary degenerative changes in the adjacent joints were often encountered. Depending on the type of coalition and on the projection, this diagnosis presents with X-ray findings, which are either prominent (in calcaneonavicular coalition and an oblique X-ray) or subtle and indirect (all other cases). In MRI and CT the diagnosis is much more obvious. The pathognomonic signs as well as secondary degenerative signs will be pointed out together with the appropriate imaging protocols. A differential diagnosis will be discussed. The findings of the authors will be correlated with the literature. Conclusion. It is necessary to be aware of the findings in tarsal coalition, in order to establish the diagnosis even in cases unsuspected by the clinitian. This is more challenging in plain X-rays, in CT and MRI it is mandatory to include the subtalar and tarsal joints in the examination of the ankle.

Kocova E.,Radiologicka Klinika | Elias P.,Radiologicka Klinika
Ceska Radiologie | Year: 2015

Incidence and prevalence of idiopathic pulmonary fibrosis are increasing. The integral part of diagnostics of idiopathic pulmonary fibrosis is high resolution computed tomography. Radiological image of idiopathic pulmonary fibrosis is usual interstitical pneumonia. On high resolution computed tomography are changes of typical usual interstitial pneumonia, possible usual interstitial pneumonia or signs which are not typical for usual interstitial pneumonia. There was made uniform scoring system which is quite simple and reproducible.

Maly R.,Subkatedra Angiologie I. Interni Kliniky | Chovanec V.,Radiologicka Klinika
Vnitrni Lekarstvi | Year: 2010

Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes me-PADtus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors reduce the likelihood of revascularisation in DM patients with PAD. A range of factors (higher age, arterial hypertension, smoking, obesity, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Diabetes control is an independent risk factor of PAD as every 1% increase of hemoglobin A1C is associated with 28% increase of PAD. There are different clinical signs of PAD in diabetic and non-diabetic patients. In addition to the history of claudications, PAD diagnostic criteria include the presence of murmur over the large arteries, signs of chronic ischemia on the skin and distal ulcerations and gangrene. Among the imaging techniques, non-invasive investigations including Doppler pressure measurement, ankle brachial pressure index, color duplex ultrasonography, plethysmography, transcutaneous tension measurement, MR and CT angiography are preferred. Ankle brachial pressure index measurement is the easiest and the main investigation technique. The key principles of PAD treatment in diabetic patients include modification of risk factors, pharmacotherapy and revascularisation interventions aimed at improving clinical signs and prevention of cardiovascular morbidity and mortality. Antiplatelet treatment may prevent PAD progression and reduce cardiovascular events in DM patients. Early diagnosis of PAD in DM patients, rigorous prevention and aggressive management of the risk factors may significantly impact on the high incidence of amputations and decrease cardiovascular morbidity and mortality.

Polak P.,Oddeleni klinicke hematologie | Husa P.,Oddeleni klinicke hematologie | Kerkovsky M.,Radiologicka klinika
Interni Medicina pro Praxi | Year: 2016

The authors present a clinical case of a secondary relapsing Salmonella-sepsis in a patient with systemic lupus erythematodes. A multilevel spondylodiscitis with paravertebral abscesses as a cause of the disease was diagnosed. The choice of antibiotics was complicated by allergy to co-trimoxazole and manifestations of postantibiotic colitis during the ciprofloxacin treatment. Meropenem and doxycyclin were used in the treatment without any other complications.

Mihal V.,Ustav Molekularni a Translacni Mediciny | Neklanova M.,Detska Klinika | Michalkova K.,Radiologicka Klinika
Pediatrie pro Praxi | Year: 2016

Whilst pituitary adenomas are the most common cause of a sellar mass, there is a number of other neoplastic, infection, inflammatory, developmental and vascular aetiologies that should by considered by the radiologist. Intracranial lipomas are rare developmental lesions that occur because of abnormal differentiation of embryogenic meninges. We describe and illustrate a 7-year-old boy with suprasellar lipoma associated with fever-induced convulsions in course of respiratory infection. Intracranial lipoma was demonstrated with magnetic resonance imaging.

The musculoskeletal system is one of the major regions, where changes caused by diabetes mellitus (DM) are often encountered causing severe impairment of the quality of patients' lives. These changes have therefore become an important focus of diagnostic and therapeutic procedures, with imaging methods - both plain radiography, computed tomography (CT), magnetic resonance imaging (MRI) and to a lesser extent ultrasound (US), being their cornerstones. In the article the images of musculoskeletal (MSK) manifestations of diabetes mellitus are presented, structured into changes directly caused by DM, metabolic consequences of DM, syndromes with increased coincidence with DM and septic complications. The CT, MRI and radiographic images of both initial and extensive changes are being displayed as well as evolution of the changes in a radiographic series. The concerning pathophysiologic remarks are only basic, as they are not the primary focus of radiodiagnostics. In conclusion it is stated, that imaging of the MSK system in diabetic patients is a large issue in radiologic units serving internal medicine departments, that the imaging methods should be applied specifically and that the radiologic findings influence further management of the patients in many respects, but also, that in some diagnostic questions, namely concerning septic complications of the diabetic foot, a fully reliable and unequivocal interpretation is not always possible.

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