Background. Patients with haematogenous and non-bacterial osteomyelitis have similar clinical symptoms (pain in the nidus area, soft tissue swelling, fever) and laboratory signs (increased erythrocyte sedimentation rate, leukocyte count, C-reactive protein concentration). The criteria for distinguishing these two states are not determined.Objective. Our aim was to determine diagnostic criteria to differentiate haematogenous and non-bacterial osteomyelitis.Methods. The study included data of patients under the age of 18 years with non-bacterial or haematogenous osteomyelitis hospitalised to two clinical centres from 2009 to 2016. The diagnosis was established and re-verified according to archival data (medical history) and after two years of observation (at least once a year). Clinical, anamnestic and laboratory data (haemoglobin, leukocytes, leukocyte formula, platelets, ESR and C-reactive protein, CRP) as well as the results of radiation diagnostics (X-ray, CT scan, MRI or osteosyntigraphy) obtained at the disease onset were taken into account as potential diagnostic criteria.Results. Out of 145 patients with non-bacterial or haematogenous osteomyelitis, the diagnosis was re-verified in 138, of them non-bacterial osteomyelitis — in 91, haematogenous osteomyelitis — in 47. The following criteria had the highest diagnostic value for establishing cases of non-bacterial osteomyelitis: detection of bone destruction foci surrounded by osteosclerosis area [sensitivity (Se) 1.0; specificity (Sp) 0.79]; absence of fever (Se 0.66; Sp 0.92); the number of bone destruction foci > 1 (Se 0.73; Sp 1.0); CRP 55 mg/L (Se 0.94; Sp 0.73); negative results of bacteriological examination of the material from the bone destruction focus (Se 1.0; Sp 0.67).Conclusion. Diagnostic criteria for differentiation of non-bacterial and haematogenous osteomyelitis have been described. Further research on the efficacy of using these criteria to reduce the risk of diagnostic errors, decrease the diagnostic pause, reduce the risk of non-bacterial osteomyelitis complications is needed.

Purpose: To evaluate the impact of CT scan protocol parameters on patient dose and image quality for optimization of protocols for newborn patients. Materials and methods: Three anatomical areas (chest, abdomen and combined chest + abdomen area) of a newborn PH-50 Newborn Whole-Body Phantom (Kyoto Kagaku Co, LTD, Japan) were scanned on Ingenuity 128 CT scanner (Philips) using different scan parameters. The values of weighted CT dose index (CTDIvol) and dose length product (DLP) were used as dose characteristics and the noise of CT image was chosen to estimate the image quality. The noise was determined in the soft tissues in the areas of shoulder girdle and diaphragm in images with the reconstruction kernel B, as well as in lung tissue of lung apices for images with the reconstruction kernel YC for chest and chest + abdomen; and in soft tissues (for reconstruction kernel B) in the area of the diaphragm for abdomen. Results: The analysis of the impact of tube voltage and dose right index (DRI) on dose characteristics and image quality made it possible to determine the optimal parameters of CT protocols for selected CT department: chest – 80 kV at DRI -– 19, abdomen – 100 kV at DRI – 22, chest + abdomen – 120 kV at DRI – 22. These protocol parameters provide an effective dose of newborn patients – 1.4, 1.7 and 2,8 mSv for chest, abdomen and chest + abdomen scans, respectively. Conclusion: The impact of different scan parameters (tube voltage and DRI) of chest, abdomen and chest + abdomen protocols on patient dose and image noise was evaluated. The study allowed setting optimized protocol parameters to improve the image quality.

Федеральное государственное бюджетное образовательное учреждение высшего образования «Северо-Западный государственный медицинский университет имени И. И. Мечникова» Министерства здравоохранения Российской Федерации, Санкт-Петербург, Россия 2 Федеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской Федерации, Санкт-Петербург, Россия 3 Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Детская городская больница № 1», Санкт-Петербург, Россия Добавочное легкое является очень редким пороком развития. Течение в раннем возрасте чаще бессимптомное, но иногда добавочное легкое может иметь опасные для жизни клинические проявления. В этих случаях показано раннее хирургическое лечение. Описаны собственные клинические случаи с гистологической верификацией диаг ноза «Добавочное легкое», сроки и алгоритм постнатального лучевого обследования, метод лечения. Ключевые слова: врожденные пороки легких, добавочное (третье) легкое