Scimitar syndrome of atypical, rare drainage of venous vessel to the superior vena cava. A case report.

Scimitar syndrome is a rare and complex congenital anomaly characterized by partial or complete anomalous pulmonary venous return from the right or left lung into the inferior vena cava, through drainage into the hepatic vein, right atrium or left atrium. The syndrome is commonly associated with hypoplasia of the right lung and right pulmonary artery. We present an 11-year-old female with atypical and rare type of scimitar syndrome. The girl has had cough for 2 months before admission, without fever or abnormalities on medical examination. X-ray films revealed inflammatory and atelectatic changes with mediastinal shift to the right. CT and CT angiography - hypoplasia of the right lung with no visible interlobar fissures. No areas of consolidation in the pulmonary parenchyma. Mediastinum shifted to the right. Single wide venous vessels draining the upper part of the right lung entering the superior vena cava. In our patient, clinical symptoms are mild, but a thorough physical examination could have helped diagnose the syndrome earlier.

Multiscale extraction of hypodensity in hyperacute stroke.

BACKGROUND: Stroke is a syndrome characterized by a sudden neurological deficit caused by cerebral ischemia. Computed tomography (CT) plays a crucial role in the evaluation of stroke patients even though it is not sufficient enough to extract the hypodense area corresponding to the infracted cerebral tissues in hyperacute stage. Careful selection of patients for thrombolytic therapy is fundamental to improve safety and efficacy; therefore the authors propose an additional, wavelet-based post-processing method for extracting hypodensity in CT scans in hyperacute stroke patients. MATERIAL/METHODS: A retrospective evaluation of 52 sets of examinations conducted in patients admitted with symptoms suggestive of stroke was undertaken by four radiologists unaware of the final clinical findings. All of the selected cases were considered as having no direct signs of hyperacute ischemia in the localization corresponding with clinical manifestation and follow-up studies. In the first stage, only CTs performed at admission were evaluated; a month later the same scans were reevaluated with additional use of a "stroke monitor". All sets were evaluated independently. Follow-up CT exam and/or the clinical picture confirmed or excluded the diagnosis. RESULTS: Higher AUC values were found for the "stroke monitor"-aided radiological diagnosis for all the radiologists and the differences were significant for all subgroups (p<0.05) apart from the subgroup in which CT scans of patients with significant cerebral atrophy were excluded. CONCLUSIONS: Combining the results of CT and the "stroke monitor" provided a better diagnosis of stroke, especially in atrophic brains. Planned prospective studies will allow evaluation of the impact on the further treatment of hyperacute stroke patients.

Trigeminal nerve - artery contact in people without trigeminal neuralgia - MR study.

BACKGROUND: Neurovascular conflict is regarded as the most common cause of idiopathic trigeminal neuralgia. It is suspected that a blood vessel in contact with the root entry zone of a trigeminal nerve causes its irritation. The aim of the study was to evaluate how signs of neurovascular conflict can be found in people without trigeminal neuralgia MATERIAL/METHODS: The study was conducted retrospectively. The authors analyzed MR examinations of 60 patients (120 nerves), aged 22-77 years, who did not have trigeminal neuralgia or related symptoms. Nerve-artery contact at the root entry zone of a trigeminal nerve, nerve deformation, and atrophy were searched for in angio-3D-TOF images (slice thickness: 1 mm). RESULTS: Contact between a trigeminal nerve and an artery was found in 30 cases (25% of nerves). The blood vessel was parallel to the nerve root in 14 cases (11.7%) and crossed it at a right or acute angle in 15 cases (12.5%). Contact between artery and atrophic nerve was found in one case. Modeling of the trigeminal nerve by an artery was not found. CONCLUSIONS: Contact between a trigeminal nerve root and an artery in the prepontine cistern is a frequently seen anatomical variant. Therefore, detection of such a variant is not equivalent to finding the cause of a patient's complaints.