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.

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.

The risk of coronary artery disease estimated non-invasively in patients with essential hypertension environmentally exposed to cigarette smoke.

BACKGROUND: The relationship between environmental exposure of non-smokers to cigarette smoke and the coronary artery calcium scores has not been sufficiently documented. The aim of the study was to identify the relationship between environmental exposure to cigarette smoke and the risk of coronary artery disease (CAD) estimated non-invasively through measurement of coronary artery calcium score by computed tomography in patients with essential hypertension. MATERIAL AND METHODS: The study was conducted on 67 patients with essential hypertension, non-smokers environmentally exposed to cigarette smoke (group A) and on 67 patients with essential hypertension, non-smokers not exposed to cigarette smoke (group B), selected using the case to case. Environmental exposure to cigarette smoke was evaluated using a questionnaire. The risk of development of coronary artery disease was estimated non-invasively through measurement of coronary artery calcium score (CACS) by computed tomography. RESULTS: Group A was characterised by significantly higher CACS and left anterior descending (LADCS) calcium scores than group B. Compared to group B, group A had significantly higher percentage of patients with significant risk of CAD estimated on the basis of CACS values, and significantly lower percentage of patients with practically no risk of CAD estimated with the same method. Advanced age, peripheral artery diseases and environmental exposure to cigarette smoke are independent risk factors associated with increased CACS and LADCS values. In addition, higher BMI and hypercholesterolemia are independent risk factors for increased values of LADCS. CONCLUSIONS: In patients with essential hypertension environmental exposure to cigarette smoke may result in elevated risk of coronary artery disease estimated non-invasively through measurement of coronary artery calcium score by computed tomography.

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.

Exposure to Cigarette Smoke and the Morphology of Atherosclerotic Plaques in the Extracranial Arteries Assessed by Computed Tomography Angiography in Patients with Essential Hypertension.

The aim of the study was to determine the relationship between exposure to cigarette smoke and the morphology of atherosclerotic plaques in the extracranial arteries assessed by computed tomography angiography in patients with hypertension. The study included 61 hypertensive patients: 17 active smokers (group A), 18 non-smokers, declaring environmental exposure to tobacco smoke (group B), and 26 non-smokers, not declaring exposure to cigarette smoke (group C). The number of segments with plaques was significantly higher in group A compared to groups B and C. The number of segments with non-calcified and mixed plaques was significantly higher in group A and group B than in group C. A positive correlation between cigarette-years and the number of segments with atherosclerotic plaques was noted. In summary, both active smoking and environmental exposure to tobacco smoke appear to increase the number of segments of the extracranial arteries with non-calcified and mixed atherosclerotic plaques.

[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).

Primary cardiac lymphoma (PCL) - diagnostic difficulties.

Primary cardiac lymphoma (PCL) is the very rare disease that is associated with a high mortality rate. A prompt and proper diagnosis may affect the prognosis, and proper treatment may improve life expectancy. This report documents the case of a 74-year-old female with primary cardiac lymphoma. Unfortunately, the patient died from heart failure on her 23(rd) day in hospital.

Late Cardiac Tamponade as a Result of Parietal Pericardium Erosion.

Late onset cardiac tamponade is a rare and particularly challenging (both from diagnostic and management perspectives) complication of intracardiac lead implantation. We present a case of a late tamponade leading to cardiogenic shock, which occurred 1,164 days after implantable cardioverter-defibrillator (ICD) implantation. Open repair revealed unusual and, to our knowledge, not yet reported mechanism of the disease. A pressure sore caused by an ICD lead was found in the parietal layer of pericardium with no visible damage to the visceral layer. Conservative management in the described clinical scenario could be fatal, thus awareness of this pathomechanism of tamponade is critical.

MRI-based evidence for myocardial involvement in women with hypereosinophilic syndrome.

PURPOSE: The aim of the study was to assess the presence and spectrum of cardiac abnormalities identified by cardiac magnetic resonance (CMR) in women with hypereosinophilic syndrome (HES) of undefined etiology, who present with normal electrocardiography (ECG) and transthoracic echocardiography (TTE) and no history of heart disease. METHODS: Ten women (mean age, 48 ± 14 years) with HES of undefined etiology, normal ECG and TTE, and no history of heart disease underwent CMR. RESULTS: CMR showed cardiac abnormalities in 6 subjects. Five patients had nonischemic late gadolinium enhancement (LGE) lesions within the left ventricular (LV) myocardium, and 3 patients demonstrated CMR evidence of myocardial inflammation. The LV ejection fraction was 68.5 ± 5.7%, and the end-diastolic volume index was 62.7 ± 14.7 mL/m(2). The maximum measured blood eosinophil count correlated with LVLGE volume (r = 0.80, P = 0.006) and was 11374 ± 6242 cells/µL and 4114 ± 2972 cells/µL (P = 0.047) in patients with and without LGE lesions, respectively. The actual blood eosinophil count in subjects with and without CMR evidence of myocarditis was 1058 ± 520 cells/µL and 354 ± 377 cells/µL (P = 0.04), respectively. CONCLUSIONS: Despite normal ECG, TTE, and absence of history of heart disease, women with HES of unknown etiology frequently demonstrate cardiac abnormalities on CMR, the presence and extent of which are related to blood eosinophil count.

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.

[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.

Ruptured splenic artery aneurysm (SAA) as a complication of acute pancreatitis - case report.

The study presented a case of a 29 year-old male patient with a pseudoaneurysm of the splenic artery as a complication of acute pancreatitis. The pseudoaneurysm was incidentally diagnosed during control angio-CT. The patient underwent immediate surgery due to deterioration of his clinical condition. During laparotomy the pseudoaneurysm, spleen and part of the pancreatic tail were excised. The postoperative course proved uneventful and the patient was discharged from the hospital after seven days.

[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.

Vertebroplasty with methacrylate bone cement and radiotherapy in the treatment of spinal metastases with epidural spinal cord compression. Preliminary report.

Background. The choice of treatment method for metastases to the spine remains an unresolved and controversial question. The major complication in disseminated neoplastic disease compression of the spine and nervous elements. Vertebroplasty performed jointly with palliative radiotherapy has been proposed as a procedure to treat metastases complicated by cancer infiltrations in the vicinity of the spine. Material and methods. We examined 21 patients treated since May 2004. Vertebroplasty was performed by surgery using acrylic cement, followed by palliative radiotherapy. Results. Outcome was assessed by clinical examination, neurological evaluation, and other methods, such as X-ray, CT scan, and MRI. All patients showed prompt relief of pain and substantial improvement in mobility. No complications or side effects were observed in connection with the joint palliative treatment. Conclusions. Vertebroplasty is an effective method and works to help stabilize spinal fractures. Satisfactory results were obtained using palliative treatment. The use of acrylic cement made it possible to perform radiotherapy safely with an optimum margin of healthy tissues, which enhances treatment. These initial results point to the need for further clinical collaboration between neurosurgeon and radiotherapist.

[A case of para-cerebral abscess as a complication of middle ear purulent inflammation]. / Przypadek ropnia przymózgowego jako powiklanie ropnego zapalenia ucha srodkowego.

We reported the case of para-cerebral abscess in the left temporal region, being a complication of exacerbation of chronic middle ear inflammation with cholesteatoma. Computed tomography was performed, which helped in the diagnosis. The patient was treated conservatively by aimed antibiotic therapy. We performed surgery of the middle ear, with abscess removal through trepan apertura attaining good results. We have presented principles of diagnostic and therapeutic procedures which help in prevention of intracranial complications in ear diseases.