[Computed tomography imaging in ureteropelvic junction obstruction--case report]. / Przeszkoda w polaczeniu miedniczkowo-moczowodowym w obrazach wielorzedowej spiralnej tomografii komputerowej--opis przypadku.

Ureteropelvic junction obstruction (UPJO) is defined as an impedance in the normal flow of urine from the renal pelvis into the proximal ureter. This leads to an increase urine pressure in the pelvicalyceal system and as a consequence cause hydronephrosis and damage of renal parenchyma. Presence of anomalous vessels crossing the ureter (crossing vessels) is one of the many reasons of UPJ obstruction. We report a case of 32-year-old female patient with chronic abdominal pain and recurrent episodes of pyelonephritis in the past. Contrast enhanced URO-CT was performed in order to determine the cause of complaints. This examination revealed right pelvicalyceal system dilatation and ipsilateral UPJ obstruction. After urological consultation patient was qualified for surgery, which aimed to decompress right pelvicalyceal system by changing anatomical conditions between the ureter and presumably crossing vessels. We demonstrate in the described case the value of contrast enhanced computed tomography URO-CT) in the diagnostic process of UPJ pathology. A multitude of information that we obtain from URO-CT examination allows the surgeon to reveal the cause of abnormal urine flow and choose the optimal operating method to minimize the risk of adverse events (such as intraoperative bleeding from mutilated crossing vessels).

[Kartagener syndrome--case report]. / Zespól Kartagenera--opis przypadku.

INTRODUCTION: Kartagener syndrome is a very rare, congenital, cilia-related disease comprising a triad of bronchiectasis, sinusitis and situs inversus. It is diagnosed in about 50% patients with primary ciliary dyskinesia (PCD). CASE REPORT: The authors report a case of a 72-year old female patient with a history of chronic cough and expectoration of muco-purulent secretion. An X-Ray examination in Posterior-Anterior projection revealed an abnormal configuration of chest's organs. Diagnosis was complemented with Computed Tomography (CT) of chest and paranasal sinuses and laboratory tests as well. Compilation of clinical symptoms and test results led to the diagnosis of Kartagener syndrome. CONCLUSION: This case report shows the usefulness of diagnostic imaging in the diagnostic process of Kartagener syndrome, as well as during subsequent monitoring of the disease.

Dissociation between blood pressure and heart rate response to hypoxia after bilateral carotid body removal in men with systolic heart failure.

While the ventilatory response to hypoxia is known to be mediated by the carotid bodies, the origin of the haemodynamic alterations evoked by hypoxia is less certain. Bilateral carotid body removal (CBR) performed to treat congestive heart failure may serve as a model to improve our understanding of haemodynamic responses to hypoxia in humans. We studied six congestive heart failure patients before and 1 month after CBR [median (interquartile range): age, 58.5 (56-61) years old; and ejection fraction, 32 (25-34)%]. Peripheral chemosensitivity (hypoxic ventilatory response) was equated to the slope relating lowest oxygen saturation to highest minute ventilation following exposures to hypoxia. Likewise, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) slopes were calculated as slopes relating the lowest oxygen saturations to the highest SBP, DBP and HR responses. We found that CBR reduces the hypoxic ventilatory response (91%, P < 0.05), SBP (71%, P < 0.05) and DBP slopes (59%, P = 0.07). In contrast, the HR slope remained unchanged. The dissociation between the blood pressure and HR responses after CBR shows involvement of a different chemoreceptive site(s) maintaining the response to acute hypoxia. We conclude that carotid bodies are responsible for ventilatory and blood pressure responses, while the HR response might be mediated by the aortic bodies. The significant reduction of the blood pressure response to hypoxia after CBR suggests a decrease in sympathetic tone, which is of particular clinical relevance in congestive heart failure.

Giant keratocystic odontogenic tumor of the mandible - a case report.

BACKGROUND: The keratocystic odontogenic tumor (KCOT) is a relatively rare, benign neoplasm which develops in the maxilla or mandible, arising from the dental lamina or basal cells of the oral epithelium. It is often found incidentally and brings about late symptoms as it does not cause bone distension for a long time. CASE REPORT: The presented case is of a young woman with a giant keratocystic odontogenic tumor of the mandible. CONCLUSIONS: Despite its rare occurrence, it must be taken into consideration in radiological and clinical diagnostics. Due to the frequent recurrence of KCOT, patients are recommended to be kept under long-term and close radiological supervision.

A 128-slice CT scanner helpful in localising coronary sinus ostium during CRT-D implantation - case report.

BACKGROUND: Cardiac resynchronization therapy (CRT) has become a successful treatment option for symptomatic heart failure in patients with poor left ventricular (LV) systolic function and broad QRS complex in the surface electrocardiogram (ECG). CASE REPORT: In this report we present a case of a 70-year-old woman with advanced heart failure due to ischaemic heart disease who underwent an upgrade from VVIR stimulator (pacemaker, PM) to cardiac resynchronization therapy defibrillator (CRT-D). The first attempt was unsuccessful due to problems with inefficient cannulation of the orifice of the coronary sinus (CS). After performing a 3D reconstruction with a 128-slice CT scanner, it was possible to carry out the up-grade to CRT-D resulting in enormous clinical improvement. CONCLUSIONS: The case represents an example of the usefulness of 3D reconstruction with the 128-slice CT scanner used after failed CRT-D implantation due to difficulties with efficient cannulation of the coronary sinus orifice in a rare anatomical variant.

[Multifocal, bone manifestation of decompression sickness in a professional pilot: a case report]. / Wieloogniskowa, kostna manifestacja choroby dekompresyjnej u zawodowego pilota - opis przypadku.

Decompression sickness is a group of pathological processes occurring in the body, following its exposure to an excessive drop in atmospheric pressure. The paper presents a case of a 62-year-old patient with no substantial disease history, a long-standing professional military pilot who was diagnosed with multifocal, bone manifestation of decompression sickness during the diagnosis of right knee joint injury following a torsion injury. The case was presented to draw attention to the usefulness of occupational history in the process of diagnosing osteoarticular system diseases.

[Current opinions on clinical significance of carotid bodies]. / Obecne poglady na temat znaczenia klinicznego klebków szyjnych.

Carotid body (lat. glomus caroticum) is a small structure of the size of maximally 7 mm of height and 4 mm of diameter and 2 mm of thickness located bilaterally and posteriorly to bifurcation of the carotid artery into internal and external carotid artery. It is a cluster of chemoreceptors detecting changes in the composition of arterial blood flowing through it. Recent research studies show that significance of its function may be greater than it has been previously established in the aspect of cardiology and oncology. Currently, in cardiology journals the high concern is devoted to the influence of chronically increased activity of carotid bodies on the progression of heart failure. In oncology it has been found that carotid body paraganglioma originating from carotid body known also as chemodectoma is the most common paraganglioma in the region of head and neck. In the authors' opinion it seems reasonable to gather the novel data on carotid bodies and to conduct research studies in order to make methods of determination of their morphology and function more perfect. In the present study a summary of the up-to-date knowledge on carotid bodies as well as on their pathophysiology and physiology has been made.

Giant congenital malformation of the perirectal plexus in computed tomography imaging - case report.

BACKGROUND: Congenital arteriovenous malformation (AVM) in the pelvic area is uncommon in males. CASE REPORT: The described case is of a giant lesion of this type that caused recurrent hemorrhaging in the lower part of the gastrointestinal tract. Preliminary diagnosis of vascular pathology was made on the basis of an endoscopic examination that revealed numerous pulsating protuberances of the rectal wall, in which blood flow was identified by means of transrectal ultrasonography. Complementing the diagnostics with a CT revealed a considerable extent of malformation, as well as its morphology and anatomical relations with the surrounding tissues. RESULTS: Following a two-year follow-up period, the malformation did not progress or demonstrate any intensification of clinical symptoms, therefore the patient continues to undergo conservative treatment.

Case report: Unusual patient with dermatomyositis associated with SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a major challenge for clinicians. SARS-CoV-2 infection results in coronavirus disease 2019 (COVID-19), and it is best known for its respiratory symptoms. It can also result in several extrapulmonary manifestations such as neurological complications potentially experienced during the course of COVID-19. The association of dermatomyositis (DM) with COVID-19 pathogenesis has not been well-studied. This study aimed to present a previously healthy 37-year-old man, a soldier by profession, with symptoms of DM on the 4th day from the onset of COVID-19. The patient presented DM symptoms with both skin and muscle manifestations. The patient suffered from cough, fever, and fatigue to begin with, and reverse-transcription polymerase chain reaction (RT-PCR) reported positive for SARS-CoV-2 infection. The laboratory findings showed, intra alia, elevated muscle enzymes CK 8253 U/l (N: <145 U/l), a positive test for myositis-specific autoantibodies (anti-Mi-2), electrodiagnostic tests exhibited features of myopathy, with the presence of muscle and skin symptoms. The patient improved with corticosteroids and immunosuppressive agent therapy. In summary, the association between COVID-19 and the development of multi-system autoimmune disorders such as DM remains unclear. Nevertheless, viral infections such as SARS-CoV-2 may likely serve as a trigger.

Madelung's Disease as an Example of a Metabolic Disease Associated with Alcohol Abuse-Diagnostic Importance of Computed Tomography.

Madelung's disease is a rare metabolic disorder characterized by a symmetrical accumulation of nonencapsulated adipose tissue deposits, mainly around the head, neck and shoulders. Fat deposits can grow and put pressure on other organs causing a variety of symptoms, inter alia, dysphagia, breathing difficulties, neck stiffness and headache. Madelung's disease is often accompanied by other disorders such as diabetes, hypertension, hypothyroidism, or liver disease. In addition to somatic issues, mental health problems may also develop causing social exclusion and depression. Middle-aged men with a history of alcohol abuse are the most commonly affected. Various imaging techniques, including computed tomography (CT), are helpful in stating the diagnosis. This paper presents a case of a 33-year-old man with extensive adipose tissue overgrowth around neck and chest. CT-enhanced scans with multiplanar reconstruction (MPR) and volume rendering technique (VRT) reconstruction are also included.

Eagle's Syndrome as a Cause of Discomfort and the Subjective Presence of a Foreign Body in the Throat.

Eagle syndrome consists of symptoms resulting from the elongation and excessive calcification of the styloid process of the temporal bone and calcification of the ligaments associated with this process. The main symptoms of this syndrome are the feeling of a foreign body in the throat, dysphagia and pain localized in the temporomandibular region, neck and ear. The authors describe the case report of a previously healthy 39-year-old Caucasian male that complained of discomfort and foreign body sensation in his throat. Computed tomography (CT) showed the presence of an elongated styloid process bilaterally with clear predomination at the left side. The patient underwent laryngological and surgical consultation. Due to the lack of symptoms related to the compression of the carotid arteries, no surgery was recommended. In summary, Eagle's syndrome is a rare condition characterized by craniofacial pain or foreign body sensation that should be considered, especially if the pain is unilateral. CT imaging in his case was a perfect tool and enabled a suitable diagnosis of this rare syndrome.

[Giant aneurysm of posterior comunicating artery (PCoA) in cerebral panarteriography and CT angiography (CTA)]. / Olbrzymi tetniak tetnicy laczacej tylnej w obrazie panarteriografii naczyn mózgowych i angiografii metoda tomografii komputerowej (angio-TK).

We present a case of 32-year-old woman, who was admitted to the Department of Neurology in the emergency mode, due to: instantaneous pupillary dilation (mydriasis), ptosis of the left eyeball and double vision. We performed plain CT, panarteriography of cerebral vessels, CT angiography with RT3D (volume-rendered three-dimensional) reconstruction images. On the base of imaging studies the diagnosis of giant saccular aneurysm of the left posterior communicating artery was established. The patient was operated on and the giant aneurysm of left posterior communicating artery was clipped, confirming radiological diagnosis. During operation and postoperative period no complications were noted.

The cardiovascular health score and the volume of carotid body in computed tomography angiography in patients with arterial hypertension.

The cardiovascular health (CVH) score constitutes a reliable and measurable indicator of CVH proposed by the American Heart Association (AHA) calculated based on seven fundamental parameters, that is, smoking, body mass index, physical activity, healthy diet score, blood pressure, blood cholesterol, and fasting plasma glucose. The size and activity of carotid body (CB) play an important role in the pathogenesis of the cardiovascular system. The objective of this study was to define the relationship between the AHA CVH score and the volume of CB (VrCB+lCB) estimated based on computed tomography angiography (CTA) in patients with arterial hypertension. Studies were conducted on a group of 57 patients with arterial hypertension (age: 70.74 ± 8.21 years). The CVH score was calculated, and CTA of carotid arteries was carried out for all patients. The CB analysis was performed based on delayed phase imaging obtained from CTA of carotid arteries. Based on the CVH score value, CVH was determined as optimal (CVH score between 10 and 14 points), average (5 and 9 points), or inadequate (0 and 4 points). CVH score in the studied group of patients was 6.53 ± 1.81, whereas VrCB+lCB value was 38.58 ± 18.43 mm3. Patients with an inadequate CVH score (0-4 points) have statistically significantly higher VrCB+lCB, and they are fraught with VrCB+lCB ≥ median much more often than patients with an optimal CVH score (10-14 points). The receiver operating characteristic curve indicated a CVH score value of 6 as an optimal cutoff point to predict VrCB+lCB ≥ median. The CVH score ≤6 criterion indicates VrCB+lCB ≥ median with sensitivity of 58.6% and specificity of 71.4%. In the regression analysis, it was indicated that lower partial scores for physical activity, healthy diet score, and blood pressure in the AHA CVH evaluation constitute independent risk factors for higher VrCB+lCB. In the studied group of patients with arterial hypertension, an inversely proportional dependence between the CVH score and the size of CB is observed in CTA of carotid arteries.

Genetically determined enlargement of carotid body evaluated using computed angiotomography.

It has recently been established that carotid bodies play a significant role in the regulation of activities of the cardiovascular system as well as in the pathogenesis of arterial hypertension, heart failure and diabetes. Aim of study was to determinate the influence of polymorphisms within genes of the renin-angiotensin-aldosterone system (RAAS) on the volume of the carotid bodies (CB) in patients with hypertension (HTA). The study group consisted of 77 patients with HTA. All patients were genotyped for single-nucleotide polymorphisms of genes coding for: angiotensinogen: rs4762, rs5049, rs5051 and rs699; angiotensin-converting enzyme: rs4343; angiotensin receptor type 1 gene (AGTR1): rs5182 and rs5186; and the aldosterone synthase: rs1799998. The estimation of volumes of CB (VrCB+lCB) was based on computed tomography angiography. Among individuals with essential hypertension certain relationships were documented between rs5182 and rs5186 polymorphisms of AGTR1 gene and rs1799998 polymorphism of CYP11B2 gene on one hand and the volume of carotid bodies on one other. Patients carrying the C alleles within the rs5182 and rs5186 of AGTR1 gene was associated with higher values of VrCB+lCB. The carriage of the T allele in the rs5182 locus of the AGTR1 gene determine lower values of VrCB+lCB. In summary, in patients with HTA a higher volume of CB may be resulted from the presence of specific genotypes in RAAS.

[Posttraumatic aortic arch aneurysm: clinical and radiological presentation--case report]. / Pourazowy tetniak luku aorty: objawy kliniczne i radiologiczne--opis przypadku.

The case of a patient with posttraumatic aortic arch aneurysm is presented. Dilatation of the aorta is called aneurysm. The most frequent cause of aortic aneurysm is atherosclerosis (about 80%), trauma (can be subdivided into true (morphologically are aneurysms classifield as fusiform or saccular), false aneurysm (pseudoaneurysm), and aortic dissection. Posttraumatic aneurysms are often false aneurysms, grow very slowly, remain clinically undetectable. Clinical manifestations are caused by pression of aneurysm on adjacent structures. Aneurysm can be diagnosed by using chest X-rays, USG, spiral CT with use of angio option, MRI, MR angiography, aortography. The most important complication of aortic aneurysm is rupture.

[Coexistence of Takayasu's disease and atherosclerosis in computed tomography angiography examination--case report]. / Wspólistnienie choroby Takayasu i miazdzycy tetnic w obrazie angiografii metoda tomografii komputerowej--opis przypadku.

Takayasu disease is a syndrome of unknown etiology having an immunological basis and appearing mainly in young women. It leads to characteristic changes in arteries as confirmed by diagnostic imaging methods. The case of a 51-year-old woman with recognized Takayasu's disease and stenocardial complaints arising from atheroma of the coronary arteries is presented. Computed tomography angiography examination showed changes typical for both Takayasu's disease and atherosclerosis. The potential influence of the inflammation appearing in Takayasu's disease on atheroma is discussed. The clinical signs accompanying Takayasu's disease and diagnostic imaging methods for their detection are presented.

[Meningiomas of the anterior cranial fossa: clinical and radiological presentation--report of 2 cases]. / Masywne oponiaki przedniego dolu czaszki: prezentacja kliniczna i obraz radiologiczny --opis dwóch przypadków.

We reported two cases of the anterior cranial fossa meningiomas: cerebral falx meningioma and recurrence of olfactory groove meningioma. Since the tumors grow very slowly, they remain clinically undetectable during the early stages and can reach a very large size. Clinical manifestations are caused by pression of meningiomas on adjacent structures. The authors present possibilities of radiological examinations of intracranial tumors and treatment management. In the described cases meningiomas were diagnosed in CT examination with the use of angio option and reconstruction RT3D and MPR.

Exposure to Cigarette Smoke and the Carotid Arteries Calcification Index in Patients with Essential Hypertension.

The arteries calcification index is a quantitative, mathematically estimated parameter characterizing the total amount of calcium within atherosclerotic plaques in the walls of arteries. The objective is to determine a relationship between exposure to cigarette smoke and the carotid arteries calcification index in patients with essential hypertension. The tested group included 66 patients with essential hypertension: 19 active smokers (subgroup A), 20 non-smokers, environmentally exposed to cigarette smoke (subgroup B) and 27 persons without exposure to cigarette smoke (subgroup C). The tested group was subjected to computed tomography angiography of carotid arteries. Evaluation of the carotid arteries calcification indexes was conducted. The average value of the total calcification index of the carotid arteries (CAci) amounted to 368.28 ± 384.21. In subgroup A and B in relation to subgroup C, CAci was significantly higher. In summary, active and passive smoking in patients with essential hypertension may be associated with a higher calcification index of carotid arteries.