SA Journal of Radiology - Volume 14, Issue 2, 2010
Volume 14, Issue 2, 2010
Author Jan LotzSource: SA Journal of Radiology 14 (2010)More Less
Is computed tomography of the brain necessary in patients with clinically suspected depressed skull fracture and no focal neurological deficit? : original articleSource: SA Journal of Radiology 14, pp 28 –30 (2010)More Less
Objective. The objective of the study was to determine whether computed tomography (CT) of the brain is necessary in all head trauma patients with clinically suspected depressed skull fractures, Glasgow Coma Scale (GCS) scores of 13 and above, and no focal neurological deficits.
Design. A retrospective descriptive analysis was undertaken of patients of all ages who presented at the trauma unit of the Pelonomi Hospital Complex in Bloemfontein with GCS of 13 to 15, depressed skull fracture, no clinical focal neurological deficit, and who also underwent CT of the brain. Data were obtained from patients' files, and radiological reports and were analysed by the Department of Statistics, University of the Free State.
Results. One hundred and thirty-one patients were included in the study, of whom 56 (42.7%) were found to have substantial intracranial pathology as determined by CT. Twenty-four (18.3%) of these patients had a GCS of 13, of whom 6 (25%) had normal CT scans and 18 (75%) intracranial pathology. Twenty-eight (21.37%) of the 56 patients with intracranial pathology had a GCS of 14, of whom 11 (39.3%) had normal CT scans and 17 (60.7%) intracranial pathology. A GCS of 15 was determined in 79 (60.3%) of the 131 patients, of whom 58 (73.4%) had normal CT scans and 21 (26.6%) intracranial pathology.
Conclusion. Based on our findings, CT imaging of the brain in patients with a clinically suspected depressed skull fracture despite any clinical neurological deficit and a GCS of 13 or more is warranted in our setting. The likelihood of injury on CT correlated inversely with the GCS.
Multimodality imaging and interventional management of a complex congenital vascular malformation : case reportAuthor Aadil AhmedSource: SA Journal of Radiology 14, pp 32 –46 (2010)More Less
Hepatic vascular lesions are not an uncommon finding in children, and represent the most common benign liver tumours to present in infancy. We present a case of a complex vascular malformation with an intrahepatic component suggestive of a venous/arteriovenous malformation as well as a large extrahepatic lesion. The extrahepatic mass was present in both sub- and supra-diaphragmatic locations, with features of a congenital haemangioma. In view of the clinical presentation and different imaging appearances, this case was felt to be interesting in its radiological workup, management and eventual unusual pathology.
Author V. DahyaSource: SA Journal of Radiology 14, pp 37 –38 (2010)More Less
We report on a male neonate born at 37 weeks' gestation with severe respiratory distress immediately after birth. The child was cyanosed, requiring high oxygen pressures and continuous positive airway pressure. The pulmonary pattern on the earliest radiographs was difficult to definitively diagnose but, with serial radiographs, it became clear that the radiographic pattern was that of pulmonary venous congestion (pulmonary oedema). However, at no stage during serial radiographs over 8 days was the cardiothoracic ratio (CTR) greater than 60%. This suggested a likely specific diagnosis - infra-cardiac totally anomalous pulmonary venous drainage (TAPVD) with obstruction. An echocardiogram confirmed an atrial septal defect (ASD) and suggested anomalous pulmonary venous drainage, but the pulmonary veins were incompletely visualised owing to acoustic window limitations. Multidetector computed tomography (CT) of the thorax confirmed infra-cardiac TAPVD with common venous channel obstruction at the oesophageal hiatus. CT was used instead of MRI because of the unstable clinical condition of the patient, enabling rapid diagnosis and minimising time out of the intensive care unit. After the definitive diagnosis was made, surgical correction was attempted. Unfortunately, the patient died of respiratory failure shortly after surgery.
Source: SA Journal of Radiology 14, pp 39 –41 (2010)More Less
Macrodystrophia lipomatosa (MDL) is described as a rare, non-hereditary, congenital condition presenting with localised macrodactyly and a proliferation of mesenchymal elements. There is in particular a marked increase in fibroadipose tissue. We describe 2 young patients presenting to our department in a 6-month period, with a history of disproportionately large limbs since birth. While our first case demonstrated all the typical features of MDL, our second case failed to demonstrate osseous gigantism, but all other features of MDL were present. An extensive search of the literature failed to yield any cases described without osseus gigantism; but at the same time, the other radiological features failed to fit in with any other causes of focal gigantism, and the most appropriate diagnosis appears to be MDL. We therefore concluded that this may be a case of a rare, atypical MDL that was arrested or frustrated and so failed to demonstrate full expression of the syndrome.
Author Bradley M. TiplerSource: SA Journal of Radiology 14 (2010)More Less
For the past 10 years I have been lecturing on America's radiation phobia. Obviously, I am not doing a good job, because it is growing. What I find particularly distressing is the problem's growth among radiologists. Recently, phobic radiologists have been publishing and lecturing like rabbits on Viagra.
Author D.J. EmbySource: SA Journal of Radiology 14 (2010)More Less
To the Editor : The editorial in the March 2010 issue of the SAJR by Professor Lotz draws attention to 'a unilateral process instituted by the HPCSA to embark on opening the diagnostic use of ionising radiation to all medical disciplines'. This is a reckless and alarming prospect.
Source: SA Journal of Radiology 14 (2010)More Less
Please refer to page 21 of the March 2010 issue of the SAJR (http://www.sajr.org.za/index.php/sajr/article/viewFile/422/354) for the clinical details and images. We congratulate Dr Richard de Villiers of Drs Van Wageningen and Partners in Somerset West for his precise diagnosis, for which he receives an award of R1 000 from the RSSA. Dr Misser elaborates below on the condition and its radiological signs.
Source: SA Journal of Radiology 14 (2010)More Less
A 46-year-old woman presented with progressive back pain and lower limb weakness. The following MRI images were obtained. We invite readers to describe the findings and provide the most appropriate clinical diagnosis. Please submit your response to firstname.lastname@example.org before 2 August 2010. The winning respondent will receive a R1000 award from the RSSA. A detailed diagnosis will appear in the next issue of the SAJR.
Source: SA Journal of Radiology 14, pp 46 –47 (2010)More Less
Another 'first' is the RSSA/SGR (Society of Gastrointestinal Radiologists) gastrointestinal radiology course to be held on 7 - 9 August 2010 at the Spier Estate a few kilometres outside Stellenbosch in the Western Cape. The long weekend of 7 - 9 August was chosen to allow more delegates the opportunity to attend.
RSSA/Stoller Sports Medicine : Cape Town
RSSA/Leuven Ear Imaging Course : Stellenbosch