The role of fasciae in Civinini-Morton's syndrome.

This study evaluates the pathogenetic role of the perineural connective tissue and foot fasciae in Civinini-Morton's neuroma. Eleven feet (seven male, four female; mean age: 70.9 years) were dissected to analyse the anatomy of inter-metatarsal space, particularly the dorsal and plantar fasciae and metatarsal transverse ligament (DMTL). The macrosections were prepared for microscopic analysis. Ten Civinini-Morton neuromas obtained from surgery were also analysed. Magnetic resonance images (MRIs) from 40 patients and 29 controls were compared. Dissections showed that the width of the inter-metatarsal space is established by two fibrous structures: the dorsal foot fascia and the DMTL, which, together, connect the metatarsal bones and resist their splaying. Interosseous muscles spread out into the dorsal fascia of the foot, defining its basal tension. The common digital plantar nerve (CDPN) is encased in concentric layers of fibrous and loose connective tissue, continuous with the vascular sheath and deep foot fascia. Outside this sheath, fibroelastic septa, from DMTL to plantar fascia, and little fat lobules are present, further protecting the nerve against compressive stress. The MRI study revealed high inter-individual variability in the forefoot structures, although only the thickness of the dorsal fascia represented a statistically significant difference between cases and controls. It was hypothesized that alterations in foot support and altered biomechanics act on the interosseous muscles, increasing the stiffness of the dorsal fascia, particularly at the points where these muscles are inserted. Chronic rigidity of this fascia increases the stiffness of the inter-metatarsal space, leading to entrapment of the CDPN.

Anomalous origin of the coronary arteries in children: diagnostic role of three-dimensional coronary MR angiography.

When the anomalous origin of coronary arteries (AOCA) is suspected in children (especially athletes), due to signs and symptoms of myocardial ischemia or on the basis of echocardiographic assessment, three-dimensional coronary magnetic resonance angiography (3D-CMRA) can be proposed for the fine morphological evaluation of coronary branches anatomy and course. We tested the diagnostic potential of CMRA angiography in a prospective study on AOCA in young patients. Between July 2005 and June 2008, 15 patients aged 6-29 years (mean age, 13.5 years+/-5.6 S.D.; median, 14) with clinical and echocardiographic suspicion of AOCA underwent CMRA (1.5 T), 3D whole-heart, free-breathing technique, without the use of contrast medium and beta-blockers, with a mean examination time of 30 min. We acquired a second scan of all patients to ameliorate the quality of the acquisition and to improve our experience. AOCA was confirmed by 3D-CMRA in 8 out of 15 cases (53%) and three different anatomical variants were demonstrated, that is, ectopic origin of the left circumflex artery arising from the right coronary artery with retro-aortic course in four cases, single coronary artery arising from the right sinus of Valsalva with interarterial course in one case, ectopic right coronary artery arising from the left sinus of Valsalva with interarterial course in one case; in two patients without anomalies of origin of the coronary arteries, elongated LMCA with angulation of the proximal segment of the left circumflex artery was present. When AOCA is suspected particularly in children (especially athletes), CMRA without the use of contrast medium is an effective diagnostic technique, which is useful to clarify the spatial position of the anomalous course of the main coronary branches in order to suggest the most convenient management of the disease. CMRA does not need contrast medium, needles, and beta-blockers; is repeatable in the same examination without the exposure to X-rays; allows a parent to stay near the child; and needs low collaboration in low-stress conditions.

Multidetector computed tomography and 2- and 3-dimensional postprocessing in the evaluation of congenital thoracic vascular anomalies.

OBJECTIVE: We report examples of congenital anomalies of the thoracic vessels studied with multidetector computed tomography (MDCT), with special respect to bidimensional (2D) and 3-dimensional (3D) postprocessing. METHODS: Nonselected patients with vascular and nonvascular disorders underwent chest MDCT with the use of a 16-row scanner. Postprocessing was done to obtain 2D and 3D postprocessing images. CONCLUSION: MDCT with 2D and 3D postprocessing is helpful in evaluating complex vascular congenital anomalies of the chest.

Multi-slice computed tomography and the detection of anomalies of coronary arteries.

OBJECTIVES: Congenital anomalies of the coronary arteries, even if rare, may have sudden death or myocardial infarction as the first clinical manifestations: thus, it is clear that an early diagnosis has a paramount importance for patients at risk. We present a set of cases advocating the use of multi-slice computed tomography (MSCT) in the detection of coronary artery anomalies. The majority of cases had previously undergone conventional coronary angiography, which, despite being considered the gold standard for the diagnosis of the coronary artery pathologies, often yielded incomplete results. METHODS: In 439 consecutive patients examined over 22 months by MSCT for the study of heart and coronary arteries, 11 were diagnosed for anomalous coronary artery. All patients were symptomatic for one or more of the following: chest pain, dyspnoea, palpitations, myocardial infarction and resuscitated cardiac arrest. Eight patients had previously undergone a coronary angiography. RESULTS: In the selected patients, seven different types of coronary anomalies were found by MSCT examination. In all cases, this technique was able to recognize the origin of the anomalous coronary artery, its three-dimensional course and its spatial relationship with the adjacent structures, even when conventional coronary angiography was performed but was unable to provide sufficient information for a correct and complete diagnosis. CONCLUSIONS: MSCT is an accurate technique for detecting coronary artery anomalies and visualizing their three-dimensional origin and course, and their relationship with the great vessels. It may be considered as the first-choice imaging modality when an anomalous coronary artery is suspected.

[Role of multidetectori compted tomography angiography and three-dimensional post-processing in a case of a Valsalva graft in aortic valve repair and replacement with the Cabrol procedure]. / Ruolo dell'angio-tomografia multidetettore e del post-processing tridimensionale in un caso di ectasia aortica corretta secondo la tecnica di Cabrol.

Patients with combined valvular-aortic disease undergo surgical reconstruction of the aortic root with a valved composite graft. Two of the techniques used to replace the aortic valve and ascending aorta are Bentall and Cabrol procedures. Cabrol surgical procedure uses a Dacron tube that enables coronary artery revascularization. Graft limb occlusion may however occur. Digital subtraction angiography, magnetic resonance angiography and multidetector computed tomography angiography are useful imaging methods for the evaluation of surgical-related complications. We report the case of a patient treated by the Cabrol technique, who was studied with contrast-enhanced multidetector computed tomography angiography to evaluate long-term post-surgical complications and coronary vessels patency.

Noninvasive evaluation of a fistula between a giant coronary aneurysm and coronary sinus performed via multidetector row computed tomography.

Coronary artery fistula (CAF) is an uncommon anomaly of congenital and rarely iatrogenic etiology. Most of the patients are asymptomatic, and the anomaly is incidentally recognized during a coronary angiography performed for other reasons. Also, coronary artery aneurysms are rare. We report a case of CAF associated with a giant aneurysm evaluated using multidetector row computed tomography.