Bilateral double-layered patella in a patient with advanced knee osteoarthritis

Double layered patella (DLP) is a rare anomaly of the patella that may go undiagnosed, especially in patients with progressive knee dysfunction and early degenerative changes. Clinical symptoms such as motion-dependent pain and anterior knee pain most typically occur in adolescents or young adults; however, gradually increasing pain and early generalised degenerative changes have also been seen in patients over 40 years old. Diagnosis of DLP could be difficult, especially in cases with coexisting arthrosis. DLP is considered to be pathognomonic for the diagnosis of multiple epiphyseal dysplasia and usually coexists with other anomalies seen in this syndrome, such as hip dysplasia. In extremely rare cases, DLP can occur as a solitary disorder. The prevalence of such cases, however, is unknown, and they could be easily misdiagnosed. Computed tomography and magnetic resonance imaging are the most sensitive radiological methods used in DLP diagnosis. This case report presents a case of a bilateral DLP incidentally found in a 47-year-old patient with advanced arthritis referred for arthroplasty because of increasing symptoms of knee joint failure with no other abnormalities recorded. An important goal of our case study is to raise the awareness of this abnormality with radiologists and orthopaedic surgeons.

Coronary artery fistulas morphology in coronary computed tomography angiography

BACKGROUND

The aim of the study was to evaluate coronary artery fistulas (CAFs) in coronary computed tomography angiography (coronary CTA) and verify whether there is correlation between the fistula's morphology and other cardiac functional findings and clinical data.

MATERIALS AND METHODS

A group of 14,308 patients who were diagnosed in coronary CTA was retrospectively analysed. Achieved data were related to referrals.

RESULTS

Coronary artery fistula frequency was 0.43% in the examined population. The assessment of coronary artery disease was the most frequent indication for the examination. In 2 out of 3 cases the diagnosis of CAFs was incidental. Fistulas to cardiac chambers were significantly shorter than those to other vascular structures (19.9 vs. 61.8 mm, respectively, p = 0.001). Pulmonary trunk was most often the drainage site. Fistulas with singular supply and drainage constituted the majority. The new morphologic classification of CAFs was introduced with linear, spiral, aneurysmal, grid-like and mixed types. Most numerous was the spiral type group. Patients with aneurysmal fistulas had a tendency for wider diameter of aorta and pulmonary trunk. Smallest left ventricle fraction was observed in gridlike fistulas (48.0%, comparing to 59.2% for all patients with fistulas, p = 0.001). Concomitant abnormalities were found in 13.1% of CAFs patients.

CONCLUSIONS

Computed tomography angiography has proven to be a useful tool in CAFs detection and morphological assessment. Proposed classification may simplify the predictions whether fistula has a significant influence on cardiac function; however, further studies are needed.

Supernumerary renal vessels: analysis of frequency and configuration in 996 computed tomography studies

BACKGROUND

Number, course and division pattern of renal vessels is highly variable. Variant renal vasculature is of high interest in nephrectomy for the renal transplantations, both in deceased and living donors. The purpose of the study was to analyse the frequency of supernumerary renal vessels in a large cohort of patients undergoing the multiphase abdominopelvic computed tomography (CT), as well as analyse the possible patterns of coexisting supernumerary arteries in veins.

MATERIALS AND METHODS

A retrospective analysis of abdominopelvic CT studies within 1 year period was performed. In each study, number of renal arteries and veins was recorded. Course of left renal vein was classified into normal, retro- or periaortic. For statistical analysis of normal distribution data, t-Student test was used. Chi-square test was used for frequency of variant vessel distribution. Pearson correlation coefficient was used for the analysis of coexistence of supernumerary vessels.

RESULTS

996 patients were included in the analysis, male to female ratio: 481:515 (48%:52%). Mean age was 57.9 ± 14.7 years. Single renal arteries were observed in 73% of cases, while single renal veins in 95%. Circumaortic or retroaortic courses of left renal veins were observed in 10% of cases. Number of renal vessels has been compared in patients with and without supernumerary vessels. In patients with supernumerary left renal artery, significantly more right renal vessels were observed. In patients with supernumerary right renal vein, mean number of all remaining vessels was significantly higher.

CONCLUSIONS

Supernumerary renal vessels are a frequent finding in abdominal CT studies. Finding a supernumerary vessel should increase awareness of possible other supernumerary renal vessels.

Anatomical variations of the coeliac trunk in the homogeneous Polish population

BACKGROUND

The abdominal vessels show a number of abnormalities and pathologies knowledge of which is important during open as well as laparoscopic surgeries. One of the most common vessels which pattern has many variations is the coeliac trunk. The present study was undertaken on homogeneous population to assess morphology of the coeliac trunk and to evaluate the possible variability of its branches.

MATERIALS AND METHODS

Standard abdominal multidetector computed tomography examinations were performed on a total of 1569 patients diagnosed by 2 radiologists independently; in case of doubts common assessment was performed.

RESULTS

The coeliac trunk followed the classic pattern in 92.7% of the cases (1455/1569 of patients). The gastrosplenic trunk was detected in 4.1% of cases (64/1569); the hepatosplenic trunk in 2.2% of cases (34/1569); the coeliac-mesenteric trunk was observed in 0.5% of cases (8/1569); the hepatogastric trunk in 0.2% of cases (4/1569); the splenomesenteric trunk was detected in 0.1% of cases (2/1569). In the next 0.1% the coeliac trunk was absent. The hepatosplenomesenteric and the coeliac-colic trunk were not observed in the study population.

CONCLUSIONS

Vascular anatomical abnormality is usually asymptomatic hovewer, its preoperative knowledge is helpful to reduce complications like vascular bleeding when dissecting the hapato-pancreatic region. The coeliac trunk and its branches can be fast and easy evaluated in computed tomography exams performed due to various symptoms from abdominal cavity.

Fatty foci within the heart and the accompanying changes in the coronary arteries diagnosed in electrocardiogram-gated multislice computed tomography of the heart

BACKGROUND

The purpose of our study was to analyse the relationship between fatty foci within the heart and the accompanying changes in the coronary arteries supplying the relevant heart chambers in a large group of patients referred to multi-slice computed tomography with electrocardiogram-gating examinations (ECG-MSCT) for various clinical reasons.

MATERIALS AND METHODS

The ECG-MSCT examinations of 1,830 consecutive patients were analysed. The examinations were performed using 8-row (1,015 patients) and 64-row (815 patients) MSCT, in pre- and postcontrast scanning. In the group of patients with fatty foci within the heart the concomitant changes in the coronary arteries were assessed. It was analysed: the type of changes in the arteries; the relationship between the locations of the fatty deposits and the occurrence and type of changes in the coronary arteries.

RESULTS

In 200 (10.9%) subjects fatty foci within the heart (112 men; 88 women; mean age 57.8) were detected. The distribution of the fat was as follows: right ventricle (RV) - 32.5%, left ventricle (LV) - 22.0%, biventricular - 45.5%. One hundred and seventy-two patients had concomitant changes in the coronary arteries. In patients with normal coronary arteries, significantly more often fatty deposits were localised within RV. Fat was primarily located subendocardially in the LV in patients with atherosclerosis in the left anterior descending artery (p < 0.001), in the right coronary artery (RCA) (p = 0.003), and in the left circumflex artery (LCX) (p < 0.001). Subpericardial locations of fatty deposits in RV significantly correlated with RCA bridging (p < 0.02); the subpericardial location of fat in LV significantly correlated with LCX bridging (p = 0.001).

CONCLUSIONS

Fatty replacement of the myocardium is common, occurring in up to 10% of diagnosed patients and the majority of this group had concomitant changes in the coronary arteries. However, in the group of patients without changes in the coronary arteries, the fatty deposits locate themselves significantly more frequently within the RV.

Volumetric reconstruction of the right ventricle improves reproducibility of interventricular septum bowing in patients with pulmonary embolism

Bowing of the interventricular septum (IVS) is a sign of severe pulmonary embolism(PE); however, it is affected by high interobserver variability. The aim of the study was to evaluate the application of volumetric reconstructions of the right ventricle for assessment of IVS position regarding its accuracy in identifying right ventricular dysfunction, as well as interobserver agreement in evaluating this sign.IVS bowing was evaluated with multiplanar reformations (MPR) and volumetric reconstruction (VR, volume rendering) by 2 observers. The accuracy of IVS bowing sign was better for VR-based assessment; however, it was not significantly better than the MPR-based evaluation. Interobserver agreement was found to be fair (kappa = 0.381) for the MPR-based grading of IVS position as normal orabnormal, while it was significantly better for the VR method (kappa = 0.629,p < 0.001). The VR-based method may improve utilisation of IVS bowing sign inpatients with PE.

Anatomical variances and dimensions of the superior orbital fissure and foramen ovale in adults

The aim of the study was the retrospective morphological analysis of selected structures of the middle cranial fossa, i.e. foramen ovale and superior orbital fissure, in relation to the external head and cranial diameters in adults from the Lublin region (Poland). The study was performed on data collected during computed tomography examinations of 60 individuals (age 20-30 years), without any cranial or brain abnormalities. Based on the post-processing reconstructions, 3-dimensional views of the skull and head were obtained. The length and width of both structures, as well as thickness of the frontal, temporal, and occipital squamae, were measured. The morphology of the ovale foramina and superior orbital fissures were checked. The length and width of the skull and head were the only parameters that significantly differed between males and females. The thickness of the frontal and temporal squama was insignificantly lower in males than in females. Almond and oval shapes were the most typical for the foramen ovale. The superior orbital fissure was found as a wide form - with or without accessory spine originating from its lower margin or as a laterally narrowed form. The length and width of the foramen ovale were insignificantly higher in males than in females. The same results were found for the area of the right superior orbital fissure. The thickness of the frontal and occipital squamae influenced the thickness of the temporal squama. The analysed individuals had asymmetrical, oval, or almond-shape ovale foramina. Unlike the seldom visible laterally narrowed form of the superior orbital fissure, a wide form with or without accessory spine was the most commonly observed. The diameters of both superior orbital fissures and ovale foramina indicated the asymmetry of the neurocranium.

Nuclear mapping in parathyroidectomy: the impact on operative time

BACKGROUND

Precise intraoperative localization and identification of hyperactive parathyroid tissue remains one of the most challenging tasks for surgeons performing parathyroidectomies. Among a few adjuvant methods tested recently, a novel technique called nuclear mapping may become a real breakthrough in parathyroid surgery. It is based on intraoperative detection of radioactivity after previous intravenous administration of 99mTc Sestamibi, which is accumulated in hyperactive parathyroid tissue. The purpose of this study was to assess the impact of nuclear mapping on operative time in parathyroidectomy.

METHODS

The study was conducted as a retrospective univariable and multivariable analysis of clinical factors potentially influencing the operative time in a group of 27 patients undergoing parathyroidectomy.

RESULTS

Univariable analysis revealed that nuclear mapping was associated with significant reduction in operative time (79.4 +/- 62.2 min vs. 135.8 +/- 49.2 min; p = 0.0186); whereas, bilateral neck exploration, partial sternotomy and reoperative neck prolonged the procedure by mean 70.7 +/- 12.9 min (p = 0.0035); 100,9 +/- 50.36 min (p = 0.0154) and 73.3 +/- 22.8 min (p = 0.0081), respectively. Multivariable analysis using a multiple regression model identified nuclear mapping, sternotomy and reoperative neck as independent variables significantly influencing the duration of parathyroidectomy.

CONCLUSIONS

Nuclear mapping is an efficient intraoperative adjuvant technique facilitating localization of hyperactive parathyroid tissues in vivo and instantly confirming their identity ex vivo. It guides the surgeon throughout the parathyroidectomy and is associated with significant reduction in operative time.

Application of rapid prototyping techniques for modelling of anatomical structures in medical training and education

Rapid prototyping has become an innovative method of fast and cost-effective production of three-dimensional models for manufacturing. Wide access to advanced medical imaging methods allows application of this technique for medical training purposes. This paper presents the feasibility of rapid prototyping technologies: stereolithography, selective laser sintering, fused deposition modelling, and three-dimensional printing for medical education. Rapid prototyping techniques are a promising method for improvement of anatomical education in medical students but also a valuable source of training tools for medical specialists.

Quadricuspid pulmonary valve complicated with aneurysm of pulmonary trunk diagnosed with ECG-gated computed tomography

Quadricuspid pulmonary valve (QPV) is an uncommon congenital defect reported in the general population with a frequency of up to 0.25%. The defect usually does not cause severe clinical complications and its presence frequently remains clinically silent. Moreover, there are several difficulties in visualization of pulmonary valve using basic diagnostic modalities such as echocardiography. Therefore, in the majority of cases, QPV is detected accidentally during cardiac procedures or post mortem. The authors present a case of QPV complicated with aneurysm of the pulmonary trunk, diagnosed with computed tomography in 70-year-old woman. Although the patient had undergone transthoracic echocardiography examinations several times in the past, only computed tomography allowed the detection of the anomalous valve. In addition, the examination confirmed aneurysm of the pulmonary trunk. To the best of our knowledge, this is the first case of QPV diagnosed in vivo with computed tomography.

The course of the cystic artery during laparoscopic cholecystectomy

Proper recognition of the particular structures that form the triangle of Calot is essential for the proper and safe performance of laparoscopic cholecystectomy. Proper recognition, ligation, and cut of the cystic duct and cystic artery with branches (dorsal and ventral) remain an integral condition for the removal of the gallbladder. Calot's triangle, as an orientation structure, determines the most common location of the cystic artery. The triangle of Calot is one of the most variable regions of the abdomen in terms of anatomy. The aim of this study was to evaluate how important for surgery is the detailed anatomical recognition of the main branches of the cystic artery in Calot's triangle during laparoscopic cholecystectomy. Relations of the main branches of the cystic artery were evaluated in 88 patients that underwent laparoscopic cholecystectomy at the Department of General Surgery of the District Specialistic Hospital of Lublin. The anatomical relations of cystic duct and artery were classified into typical and variant types. Significantly more frequently variants of cystic artery were observed in women. However, the time of the procedure was not significantly related with the type of cystic artery.

Spiegelian hernia - - anatomy, diagnosing and imaging difficulties-report of 2 cases

Spiegelian hernias account for less than 1% of all hernias diagnosed in the adult population. The most important factors in the proper diagnostic process are detailed physical examination combined with imaging procedures. Two cases of Spiegelian hernias are presented. The anatomical background of the pathology, as well as diagnostic procedures and surgical treatment, is discussed.

ECG-gated multi-slice computed tomography in the detection of atrial septal aneurysms

An atrial septal aneurysm (ASA) is an uncommon cardiac abnormality. Clinical manifestation of this abnormality remains unclear: some authors have suggested an association between ASA and arrhythmias or between ASA and cerebral ischaemia. A major role in the diagnosis of ASA to date has been played by transoesophageal echocardiography and transthoracic echocardiography. The purpose of this paper is to present the role of multi-slice computed tomography with ECG gating in the detection and analysis of ASA.

How to reliably evaluate middle ear diseases? Comparison of different methods of post-processing based on multislice computed tomography examination

CONCLUSIONS

Multislice computed tomography (MSCT) virtual endoscopy was useful in evaluating mainly post-traumatic and postoperative cases. In other pathological conditions axial images and MPR reformations were most useful.

OBJECTIVES

Evaluation of cross-sectional images, multiplanar 2-D reformations, 3-D reconstructions and virtual endoscopy (VE) in assessment of the middle ear in inflammatory diseases, trauma, otosclerosis and tumours. Comparison of each method and correlation with surgical findings.

MATERIALS AND METHODS

Investigations were carried out in 80 patients with middle ear pathology. In each case MSCT of the petrous bone was performed. In addition to cross-sectional native scans, frontal and sagittal images were achieved using MPR reconstructions. 3-D volume rendering (VR) and VE images were also generated. The value of native scans information, 2-D, 3-D reconstructions and VE of the tympanic cavity structures was assessed in comparison to intraoperative findings.

RESULTS

MPR reconstructions were most useful in the assessment of skull base trauma, skull base tumours and in cases of chronic middle ear inflammation. Highly vascularized tumours, disruption of ossicular chain and stapes prosthesis were best evaluated on 3-D reconstructions. Axial images proved to be the best for otosclerosis interpretation.

Arteria lusoria in patients with a normal and a right-sided aortic arch diagnosed with multi-slice computed tomography: a report of two cases

A retro-oesophageal course of the right subclavian artery is referred to as "arteria lusoria". It may be related to severe compression of the trachea and oesophagus, typically resulting in impaired swallowing. The paper presents two patients with arteria lusoria, which in one patient was an aberrant right subclavian artery and in the other an aberrant left subclavian artery, originating from the right-sided aortic arch. In both cases the diagnosis was made with multi-slice computed tomography. The embryology of the anomalies and clinical status of the patients is discussed. Arteria lusoria should be considered in differential diagnosis in patients with dyspnoea and dysphagia. Multi-slice computed tomography allows this anatomical variant to be reliably visualised.

Differentiation between cholesteatoma and inflammatory process of the middle ear, based on contrast-enhanced computed tomography imaging

Objective: to assess the usefulness of delayed post-contrast computed tomography (CT) examination for the detection of residual or recurrent cholesteatoma after canal wall up tympanoplasty.

Study design and setting: This prospective, non-randomized study, set within an academic medical centre, included 17 consecutive patients who had undergone canal wall up tympanoplasty for cholesteatoma, with possible recurrence. Pre-contrast CT scans and delayed post-contrast images were compared with second look surgical findings.

Results: A residual or recurrent cholesteatoma was found in eight of the 17 patients at revision surgery and was correctly diagnosed on post-contrast CT images in six patients (75 per cent). In the two misdiagnosed cases, cholesteatoma pearls smaller than 2.5 mm were not seen on post-contrast CT. The sensitivity of the imaging test was 75 per cent, the specificity was 60.1 per cent, the positive predictive value was 88.1 per cent and the negative predictive value was 81.8 per cent.

Conclusion: Computed tomography with delayed post-contrast images is a sensitive imaging modality for the detection of residual cholesteatoma. If proven reliable, this method of non-invasive imaging could spare the patient unnecessary revision surgery.

Changes in cerebral hemodynamics after carotid stenting: evaluation with CT perfusion studies

PURPOSE

To determine changes in cerebral perfusion parameters, based on CT perfusion imaging, in patients after unilateral transluminal angioplasty and stent placement.

MATERIAL AND METHODS

74 patients with symptomatic high - grade internal carotid artery stenosis (>70%) were studied with CT perfusion imaging before and - on average - 70 hours and 172 days after carotid stent placement. There were 50 patients with unilateral carotid artery stenosis and 24 with stenosis and accompanying contralateral internal carotid artery occlusion. CT examination was performed using a multidetector helical CT scanner (Light Speed Ultra Advantage, GE Healthcare, USA). Maps showing the absolute values of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were generated.

RESULTS

In a group with unilateral carotid artery stenosis perfusion deficits were present in 84% of patients, ipsilaterally to stenosis. MTT elongation was noted (6.2-6.8s) together with decreased values of CBF (40-46ml/100g/min) and slightly increased CBV (3.2ml/100g). In this group, 3 days after stenting, 30% of patients had perfusion deficits, and after 6 months only 6%. In a group with carotid artery stenosis and contralateral artery occlusion severe perfusion deficits were noted in both hemispheres and they were present in 100% of patients. 6 months after stenting hypoperfusion was observed only in 17% of patients.

CONCLUSIONS

Brain perfusion deficits, observed in a majority of patients with carotid artery stenosis tend to improve considerably after carotid artery stenting, in long - term follow up.

An unusual crossed course of separately originating left circumflex and left anterior descending arteries with concomitant anomalies found in multi-slice computed tomography

Coronary artery anomalies occur in approximately in 1-2% of the population. The split origin of branches of the left coronary artery is a relatively common anomaly, usually with no significant observable impairment of cardiac function. The application of multi-slice computed tomography (MSCT) for cardiac imaging is increasing and becoming, along with other techniques, a recognised method of examination of the coronary arteries. In the case presented we observed in an ECG-gated MSCT the anomalous origin and proximal course of the arteries of the left sinus of Valsalva. The ostiae of both coronary arteries were located unusually: the ostium of the LAD was found posterior to the ostium of the LCx. Because of this, the proximal part of the LAD crossed the proximal part of the LCx superiorly. Furthermore, muscular bridges were found in the middle part and in the first diameter branch of the LAD. To our knowledge, this is the first case of a crossed course of the LCx and the LAD to be presented in the literature. Applications of MSCT in coronary imaging are presented in comparison with other diagnostic imaging methods. The advantages and limitations of MSCT as a diagnostic tool for anomalies of the coronary arteries are discussed.

Types and patterns of contrast enhancement of hepatic tumours (hepatoma, hemangioma and metastasis) with dynamic computed tomography

Dynamic sequential computed tomography (d-CT) of the liver was performed in 69 patients with histopathologic findings of hepatoma (HCC), 62 patients with hemangioma and in 78 patients with proved 134 liver metastases. Dynamic enhancement in hepatoma, hemangioma and metastases was analysed during the nonequilibrium phase (30-150s) and delayed equilibrium phase (2,5-7 min) using the following classification of tumour: totally hyperdense, centrally hyperdense, mixed density, totally isodense and totally hypodense. In the early examination phase 14 (19%) HCC were totally hyperdense or peripherally hyperdense, and 40 (57%) HCC were totally hypodense. In the early phase 49 (79%) hemangiomas were peripherally hyperdense. In the early nonequilibrium examination phase 62% metastases were hypodense. In the delayed phase 94% HCC were totally hypodense. Hemangiomas in the delayed phase were totally hyperdense and totally isodense (17/29). In the equilibrium examination phase 97% metastases were hypodense. The contrast enhancement pattern of hepatomas, hemangiomas and metastases seen in dynamic CT scanning is useful in diagnosis of these tumours.

[Importance of dynamic computed tomography in detecting and evaluating liver cavernous hemangioma]

Dynamic sequential computed tomography (d-CT) was performed in 83 liver hemangiomas in 71 patients. In study group single lesions were present in 62 patients, 9 patients had two or more. In early phase (30-150 s) (79%) hemangiomas were peripherally hyperdense. In the delayed phase (2-7 min) 27% were totally hyperdense, 48% were isodense and 18% were of mixed density. We conclude that the contrast enhancement pattern of hemangiomas seen in dynamic computed tomography is useful in detecting and in differential diagnosis of these tumors.

[Intervertebral discitis caused by staphylococcal sepsis]

The aim of the study was to present the intervertebral discitis of L5-S1 region and adjoining vertebrae in the course of staphylococcal sepsis. A 51-year-old man was treated in hospital because of sudden very strong pain in a lumbar-sacral region of spine with irradiation towards both legs. The patient had general symptoms of infection. The diagnosis of intervertebral discitis of L5-S1 region was made on the basis of magnetic resonance imaging and computed tomography. In case of radicular symptoms accompanied by very strong back pain, intervertebral discitis should be considered during diagnostic investigation.

Idiopathic hypoparathyroidism with intracranial calcifications and dominant skin manifestations

Presented here is an unusual case of a 41-year-old man with idiopathic hypoparathyroidism strongly connected with dermatological, ophthalmological and neurological disorders. Since the age of 4 he had been treated ineffectively for mycosis resulting in complete baldness and atrophic nail plate changes. At the age of 35 he was diagnosed with idiopathic hypoparathyroidism. He underwent surgery twice due to bilateral cataract. CT scans of the head demonstrated numerous symmetrically located calcifications in both frontal lobes, subcortical nuclei, the paraventricular region, brain fornix, and both cerebellar hemispheres. The neuropsychological examination demonstrated the occurrence of psychosensory disorders under the form of hallucinations accompanied by a sense of fear and anxiety. It seems essential to investigate the parathyroid gland for any sign of pathology, especially amongst patients with severe dermatological and/or neuropsychological symptoms. Early diagnosis and treatment of patients with hypoparathyroidism may prevent the development of many serious complications or at least result in marked improvement of neurological manifestations.

[Ultrasound contrast agents]

The article discusses the achievements in ultrasound diagnostics with of contrast agent. Agents which change echogenicity of blood and organ-specific agents as well as three generations of contrast medium were shown. The significance of applied contrast medium in differential diagnostics of hepatic focal lesion was indicated.

[One hundred years of teaching stomatology in Poland]

The development of teaching stomatology in Poland during the loss of independence, between the two World Wars and after the Second World War has been presented in this study. Stomatology was a specialization practised by physicians who were educated in diseases of teeth and oral cavity. Nowadays stomatology is the department of the Faculty of Medicine at all Medical Universities. Dentists are licensed to practise dentistry and to get specialization grades and university degrees.

[Pulmonary embolism as a complication of nephrotic syndrome--case report and therapeutic management]

A case of a 41-year-old man, who was treated due to severe steroid and immunoresistant nephrotic syndrome is described. During the pulsed steroid therapy the patient underwent a pulmonary embolism and developed the post-infarction cavern and abscess of the lung. In this study the case history, complications, diagnostic procedures and therapeutic management were described. The probable mechanism of the described complications was carefully discussed.

[Diagnosis of temporal bone paraganglioma]

On the basis of 7 cases of temporal bone paraganglioma diagnosis of this tumor is presented. Apart from aural symptoms cranial nerves palsy may appear. Computer tomography, magnetic resonance imaging and subtraction angiography are essential investigations.

[Diagnosis of dental caries based on intra-oral roentgenograms]

On 238 intra-oral roentgenograms there were assessed carious process, shape, size, extent and depth of defects as well as the possibility of complications in teeth which were not treated. There were assessed 277 defects, out of which 194 in upper teeth and 83 in lower ones. In all the teeth of the maxilla and of the mandible there was found the greatest number of amorphic defects and semilunar contact surfaces. There were also observed a lot of defects in radiciform cementum, thus, often under the gingivae. These are sites difficult for access for clinical examination. That is why radiologic examination is often conclusive in localizing carious process and in accurate diagnosing in the case of pulpitis going on.