A New Approach to Early Diagnosis?

A comprehensive overview of acute mesenteric ischemia was long overdue, because awareness of this complex disease entity, which clinicians often think about too late, especially in the intensive care setting, urgently needs improving (1). The authors mention the problems in capturing symptoms in critically ill patients in intensive care: analgesic sedation, mechanical ventilation, volume replacement, and vasopressor therapy rarely allow for targeted diagnostic evaluation. On the other hand increasingly ageing and comorbid patients would lead us to expect a higher estimated number of unknown cases of mesenteric underperfusion—but exact data are currently lacking.

The authors emphasize that urgent imaging (contrast-enhanced computed tomography/angiography) is the diagnostic method of choice. For ventilated, critically ill patients in intensive care, this requires huge efforts with an inherent (transport) risk. Furthermore, the incidence of contrast-induced renal failure with subsequent need for renal substitution treatment is some 16%, associated with longer-term intensive care and hospital treatment and higher mortality (2).

Contrast-enhanced ultrasound might offer an innovative diagnostic approach: injecting a contrast medium that is free from side effects (phospholipid coated, sulphur hexafluoride gas containing microbubbles as reflectors for ultrasound waves) increases the imaging resolution of vessels many times. Encouraging reports are available for the reliable diagnosis of complex vascular structures, for example, after surgery for abdominal aortic aneurysm (3), and a convincing prospective evaluation has been undertaken for the early detection of intestinal ischemia (4). Our own positive experiences have convinced us that contrast-enhanced ultrasound could replace “traditional” imaging—which is expensive and takes time, while also having a higher side effect profile—at least in some cases.

DOI: 10.3238/arztebl.2012.0710a

Prof. Dr. med. Thomas Bein

Klinik für Anästhesiologie

Klinik für Chirurgie

PD Dr. med. Karin Pfister

PD Dr. med. Piotr Kasprzak

Abteilung für Gefäßchirurgie

Prof. Dr. med. Hans Jürgen Schlitt

Klinik für Chirurgie

Prof. Dr. med. Bernhard M. Graf

Klinik für Anästhesiologie

Prof. Dr. med. Ernst-Michael Jung

Institut für Röntgendiagnostik

Universitätsklinikum Regensburg

thomas.bein@klinik.uni-regensburg.de

Conflict of interest statement

Dr Pfister has received delegate fees for attending a conference. She has also received travel and hotel expenses and a lecture honorarium from Bracco Altana.

Dr Kasprzak has received honoraria for preparing continuing medical educational events from Bracco Altana.

Professors Bein, Schlitt, Graf, and Jung declare that no conflict of interest exists.