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Phlebothrombosen stellen gefurchtete Komplikation bei Unfallverletzten dar, da sie fatale Lungenembolien verursachen konnen. Uber die Halfte der Betroffenen entwickelt uberdies im weiteren Verlauf ein postthrombotisches Syndrom (PTS). Neben der klinischen Einschatzung sollten dem Traumatologen auch die grundlegenden diagnostischen Methoden bekannt und die Deutung der internistischen Befunde gelaufig sein. Eine zentrale Rolle in der Diagnosestellung der Thrombose sowie auch in der Beurteilung funktioneller Einschrankungen spielt die farbcodierte Duplexsonographie. Weitere Informationen erbringen verschiedene phlebologische Verfahren. Die gutachterliche Beurteilung unmittelbarer, aber auch langfristiger Unfallfolgen erfordert haufig die Einordnung von Beinschwellungen. Nicht selten wird dabei ein PTS erstmalig diagnostiziert. Eine gefasmedizinische Zusatzbegutachtung ist haufig erforderlich. Die sozialmedizinische Wurdigung und versicherungsrechtliche Aspekte lassen dem Gutachter eine hohe Verantwortung zukommen.

Phlebothromboses represent alarming complications in accident victims since they can cause fatal pulmonary embolisms. More than half of those affected also develop post-thrombotic syndrome in the course of the illness. In addition to making clinical assessments, the traumatologist should also have fundamental knowledge about diagnostic methods and be familiar with interpreting internal findings. Colour-coded duplex sonography plays a central role in diagnosing thrombosis and in assessing functional limitations. Further information can be gathered from various phlebological procedures. The expert evaluation of the immediate, as well as the long-term consequences of an accident frequently require leg swelling to be classified. It is not uncommon for post-thrombotic syndrome to be diagnosed for the first time during this process. An additional vascular appraisal is often required. An appreciation of social-medical and insurance-related aspects means a high degree of responsibility is placed on the expert.

Atypical fibroxanthoma (AFX) is a rare, low-malignant, mesenchymal tumor of the dermis and is assigned to the group of fibrohistiocytic tumors. The tumor occurs especially in photodamaged skin on the scalp of elderly men. A clinical diagnosis is not possible due to a multitude of possible differential diagnoses (leiomyosarcoma, squamous cell carcinoma, spindle cell malignant melanoma, dermatofibrosarcoma protuberans). Immunohistochemical and histological examinations should be performed to confirm the diagnosis. The tumor shows a very good prognosis after complete excision. Micrographically controlled surgery is considered as the treatment of choice.

Aluminium salts are common adjuvants in all established inactivated vaccines. They are necessary to activate the humoral immune system. In the 1990s a Swedish study on an acellular vaccination against pertussis was started. Until 2013, 745 of 760,000 children with pruritic subcutaneous nodules were identified. In 77 % of these children a contact allergy to aluminium could be proven. Contact allergy to aluminium induced by vaccines causes pruritic subcutaneous nodules at the vaccination site. During infections of the upper respiratory tract the pruritus often escalates with inflammatory, erythematous and urticarial plaques.The use of solutions containing aluminium salts for specific immunotherapy is contraindicated in the case of contact allergy to aluminium. Intramuscular injections of inactivated vaccines can be employed to avoid granuloma formation.

A 28-year-old man presented with loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling. The tentative diagnosis of malignant lymphoma was made. To confirm the diagnosis, extirpation of a lymph node and a skin biopsy were performed. Systemic treatment with methylprednisolone resulted in an improvement of eczema and lymph node swelling. Because of the histological findings and clinical course, we diagnosed dermatopathic lymphadenopathy, also known as Pautrier-Woringer syndrome.

A 73-year-old man has been suffering from a pulmonary adenocarcinoma for three years. He has been treated with the EGF-inhibitor erlotinib for the past 18 months. While taking this medication he developed a progressive papulopustular rash on his face and trunk which later spread to his thighs. Topical treatment with methylprednisolone and nadifloxacin, as well as short courses of systemic doxycycline and ciprofloxacin, led to marked improvement and control of his skin condition.

A 25-year-old woman had suffered from a perianal ulcer for approximately 1 year. Topical and systemic treatments had been unsuccessful. Employing virologic and histologic techniques, we confirmed the diagnosis of an intraepithelial neoplasia. Anal intraepithelial neoplasia (AIN) is induced by carcinogenic human papillomaviruses. It can occur anywhere in the anogenital area. Because of its frequency, AIN is a crucial differential diagnosis for lesions of the anogenital area region failing to respond to standard therapies.