IntroductionCoronary artery atherosclerosis presents characteristic patterns of plaque distribution despite systemic exposure to risk factors. We hypothesized that local hemodynamic forces induced by the systolic compression of intramuscular septal perforators could be involved in atherosclerotic processes in the left anterior descending artery (LAD) adjacent to the septal perforators’ origin. Therefore we studied the spatial distribution of atherosclerosis in coronary arteries, especially in relation to the septal perforators’ origin.Material and methods64-slice computed tomography angiography was performed in 309 consecutive patients (92 male and 217 female) with a mean age of 59.9 years. Spatial plaque distribution in the LAD was analyzed in relation to the septal perforators’ origin. Additionally, plaque distribution throughout the coronary artery tree is discussed.ResultsThe coronary calcium score (CCS) was positive in 164 patients (53.1%). In subjects with a CCS > 0, calcifications were more frequent in the LAD (n = 150, 91.5%) compared with the right coronary artery (RCA) (n = 94, 57.3%), circumflex branch (CX) (n = 76, 46.3%) or the left main stem (n = 42, 25.6%) (p < 0.001). Total CCS was higher in the LAD at 46.1 (IQR: 104.2) and RCA at 34.1 (IQR: 90.7) than in the CX at 16.8 (IQR: 61.3) (p = 0.007). In patients with calcifications restricted to a single vessel (n = 54), the most frequently affected artery was the LAD (n = 42, 77.8%). In patients with lesions limited to the LAD, the plaque was located mostly (n = 37, 88.1%) adjacent to the septal perforators’ origin.ConclusionsWe demonstrated that coronary calcifications are most frequently located in the LAD in proximity to the septal branch origin. A possible explanation for this phenomenon could be the dynamic compression of the tunneled septal branches, which may result in disturbed blood flow in the adjacent LAD segment (milking effect).

PurposeSacrococcygeal teratomas (SCT) can be detected in ultrasonography as early as in the first trimester. Currently, prenatal ultrasonography enables a thorough examination of tumors, but it is not always sufficient. The purpose of this study was to determine the most important features of SCTs in fetal magnetic resonance imaging and to confront them with postnatal computed tomography (CT).Case reportBetween 2009 and 2013, 5 cases of sacrococcygeal teratomas were diagnosed in our hospital using fetal magnetic resonance imaging (3 female and 2 male infants). Three of the affected newborns underwent postnatal CT before surgery. In each case, tumor size, its content, mass effect, and classification according to the Altman’s criteria were determined and compared with other features. Fetal magnetic resonance imaging (MRI) and postnatal CT were in excellent agreement with respect to tumor classification using the aformentioned criteria. MRI better characterizes tumor content and its extent compared to ultrasound, and enables a precise structural assessment of the central nervous system. Postnatal CT is complementary to fetal MRI and optional.ConclusionsFetal MRI may help in the prenatal diagnosis of SCTs as it overcomes the limitations of obstetric ultrasound. Postnatal computed tomography is useful in determining tumor vascularity or calcifications, and it can depict the surrounding bone structures.

StreszczeniePodstawowym badaniem służącym do diagnozowania dzieci z różnego typu zaburzeniami oddychania jest zdjęcie radiologiczne klatki piersiowej. Mimo wciąż malejącej roli, jaką odgrywa radiologia klasyczna w diagnostyce obrazowej, zdjęcie RTG jest zasadniczo nadal jedyną dostępną metodą obrazowania patologii płucnych u noworodków. Natomiast w sytuacjach, gdy klasyczna metoda wydaje się niewystarczająca, należy rozważyć wykonanie tomografii komputerowej. W artykule opisano wybór grupy noworodków, u której wykonanie TK było wskazane. Przy wyborze należało uwzględnić wiele czynników. Najistotniejszym kryterium był stan ogólny noworodka oraz korzyść płynąca z badania, która musi przewyższać czynniki ryzyka i konsekwencje pochłonięcia dużej dawki promieniowania jonizującego. Celem pracy było określenie wskazań do wykonania tomografii komputerowej klatki piersiowej u dzieci w okresie noworodkowym na podstawie materiału pochodzą-cego z ośrodka, w którym pracują autorzy artykułu. Na podstawie przeprowadzonych badań wyciągnięto wnioski zawarte w pracy. Słowa kluczowe: noworodki, zdjęcie RTG klatki piersiowej, tomografia komputerowa klatki piersiowej.Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 295 DIAGNOSTIC IMAGING AbstractAn X-ray of the thoracic cage is a fundamental examination in children with disorders of various origin. Despite the constantly decreasing role of classic radiology in imaging diagnostics, the X-ray photograph still remains the only method available in practice for imaging lung pathologies in neonates. The aim of the work is to define the indications for performing CAT scanning of the thoracic cage in children in the neonatal period on the basis of our own material. We analysed a group of neonates referred for thoracic cage CAT scanning. Out of 10 people examined, 8 were boys, and 2 were girls. Respiratory disorders or the presence of auscultatory phenomena were an indication for making an X-ray in neonates in whom a CAT scan of the thoracic cage was done. All neonates from the examined group had an X-ray only as a result of above-mentioned indications. On the basis of a classic X-ray photograph, it was not possible to differentiate the flaccidity of the diaphragm with diaphragmatic hernia; the suspicion of presence of patent emphysema ventricle also needed to be confirmed. In one neonate, X-ray gave the image of an enlarged cone of the heart, and in the subsequent one, the image of persistent atelectasis of the right lower lobe. On the basis of the centre's experience, we may draw the conclusions that the basic indication for performing CAT scan examination in neonates is the suspicion of anatomical irregularity mentioned in the paper.

SummaryBackground:Neoplastmatic diseases constitute about 1% diseases in children in Poland, what makes about 1200 new incidents during one year. Fast diagnosis in those illnesses is crucial in treatment results. The point of this work was to value usefulness of CT and MRI in diagnostics of neoplasmatic diseases in children.Material/Methods:The retrospective study involved 121 children examined in CT and MRI because of suspicion or during treatment of neoplasmatic disease. Together 184 CT and 119 MRI examination were performed. Eventually in 106 children neoplasmatic disease was diagnosed. In 16 cases neoplasm was excluded.Results:In the analyzed group of patients acute lymphoblastic and non lymphoblastic leukemia was diagnosed in 68 children (55.7%); among them mycosis was identified after radiological examinations in 7 cases (10.3%). 8 children (6.6%) with non Hodgkin lymphoma and 11 (9%) with Hodgkin lymphoma were examined. Nephroblastoma was found after MRI and CT in 6 cases (4.9%). Presence of tumors, that were classified histopatologically as PNET, was confirmed in 4 children. In 15 cases after MRI and CT neoplasmatic disease was excluded.Conclusions:Depending on the kind of sickness MRI and CT may fulfill basic or subsidiary role in diagnostic and estimating the progress of treatment in neoplasmatic diseases among children.