SA Journal of Radiology - Volume 15, Issue 4, 2011
Volume 15, Issue 4, 2011
Author Jan LotzSource: SA Journal of Radiology 15 (2011)More Less
The SAJR took a major step towards international recognition when Eric Stern, Editor of GO RAD, extended an invitation to the editorial board to join a 2-year-old consortium of 30 continental/multinational/national society journals. Eric Stern is a professor of radiology at the University of Washington, USA, and specialises in thoracic imaging. GO RAD (Global Outreach-Radiology - www.isradiology.org/gorad) is a global outreach programme of the International Society of Radiology. Their aim is greater global exchange of radiological knowledge and a positive influence on healthcare, by providing a vehicle for worldwide dissemination of appropriate peer-reviewed published educational and scientific content for radiologists and related healthcare providers.
Source: SA Journal of Radiology 15, pp 108 –115 (2011)More Less
Background. Peer-reviewed literature demonstrates increasing support for the use of focused abdominal sonography in trauma (FAST) in the setting of blunt trauma, one study demonstrating the sensitivity and specificity of FAST for the detection of free fluid to be 0.64 - 0.98 and 0.86 - 1.00, respectively, compared with abdominal CT. Utilising ultrasound in trauma triage increases efficiency and cost-effectiveness and reduces reliance on CT, compared with using CT alone. There is little evidence to support relying solely on a negative FAST and physical examination for patient management.
Method. A retrospective descriptive study of 172 adult patients who received FAST for the evaluation of blunt abdominal trauma between 22 July 2007 and 21 January 2008 at Tygerberg Hospital was performed. Ultrasound findings were correlated with CT scan findings, operative findings if managed surgically, clinical outcomes whether managed surgically or conservatively, as well as postmortem findings in deceased patients.
Results. FAST was negative in 147 (85.5%) patients. Twenty-four (16.3%) of these patients died from all-cause mortality, none of which was due to intra-abdominal injury.
Seven patients with negative FAST underwent CT scan owing to change in clinical course, and 3 patients with negative FAST underwent laparotomy owing to change in clinical course, with positive findings in 2 patients - a bowel injury requiring resection (not seen on CT) and a diaphragmatic rupture seen on CXR. A negative FAST was shown to be an excellent predictor for the absence of significant intra-abdominal trauma.
The mortality rate among 25 FAST positive patients was 24% (N=6). Only one of these patients (with a splenic rupture) was suspected to have died from abdominal pathology.
Estimation of annual occupational effective doses from external ionising radiation at medical institutions in Kenya : original articleSource: SA Journal of Radiology 15, pp 116 –119 (2011)More Less
This study details the distribution and trends of doses from occupational radiation exposure among radiation workers from participating medical institutions in Kenya, where monthly dose measurements were collected for a period of one year (January to December 2007) using thermoluminescent dosimeters. A total of 367 medical radiation workers were monitored, comprising 27% radiologists, 2% oncologists, 4% dentists, 5% physicists, 45% technologists, 4% nurses, 3% film processor technicians, 4% auxiliary staff, and 5% radiology office staff. The average annual effective dose for all subjects ranged from 1.19 to 2.52 mSv. Among these workers, technologists received the largest annual effective dose. The study forms the initiation stage of wider, comprehensive and more frequent monitoring of occupational radiation exposures and long-term investigations into its accumulation patterns, which could form the basis of future records on the detrimental effects of radiation, characteristic of workers in the medical sector, and other co-factors in a developing country such as Kenya.
Uterine and tubal anatomical abnormalities in infertile women : diagnosis with routine hysterosalpingography prior to selective laparoscopy : original articleSource: SA Journal of Radiology 15, pp 120 –122 (2011)More Less
Objective. To assess the findings and usefulness of hysterosalpingography (HSG) as a routine investigation in the fertility workup prior to selective laparoscopy.
Design. Descriptive retrospective study.
Setting. A university hospital in the north of Jordan.
Subjects. All patients who underwent hysterosalpingography in the period 1 January - 31 December 2008.
Outcome measures. Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings.
Results. During the study period, 281 infertile women underwent HSG with no post-procedural complications. The mean (SD) age was 31.5 (5.9) years. Mean (SD) duration of infertility was 4 (3.4) years. Infertility was reported as primary and secondary in 119 (42.3%) and 162 (57.6%), respectively. Altogether, 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. In only one woman were peritubal adhesions diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4%) were referred for laparoscopy. Eight (17.3%) of them were treated with unilateral salpingectomy, and 28 (60.8%) with bilateral salpingectomy. Salpingolysis was performed on 7 (15.2%) women; 3 (6.7%) women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61%, and the positive predictive value 71%. Of the total of 281 women, 30 (10.7%) conceived within 1 - 11 months after HSG.
Conclusion. The very high abnormal predictive value of HSG in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.
Author Werner S. HarmseSource: SA Journal of Radiology 15, pp 123 –126 (2011)More Less
Objective. Renal length determination is common in everyday radiology practice. However, a normal range of kidney sizes may not apply to people of all body habitus. This study investigates this relationship in order to determine normal ranges in relation to body habitus. A secondary aim was to evaluate the relationship of renal size to gender and race.
Methods. Kidney lengths were measured on oblique coronal reformatted CT images of 514 patients who received routine abdominal CT scans for conditions unrelated to renal pathology. The patients had normal serum creatinine levels, no history of renal disease, no renal masses, and normal-appearing kidneys on CT. Weight, height, race and gender of the patients were recorded.
Results. The mean renal length was 108 mm with a standard deviation of 9.82 mm. Statistical analysis demonstrated a relationship between kidney size and body weight and height, both individually and collectively. The most accurate prediction model was 'kidney size = 49.18 + 0.21 x weight + 0.27 x height', with a R2-value of 0.32. Additionally, kidneys were generally larger in the white population than in the black, and also in males than females.
Conclusion. Normal renal size varies according to patients' body habitus. This variation can be expressed as a function of body weight and height, which can be represented by a nomogram and used as an easy reference in clinical practice.
Source: SA Journal of Radiology 15, pp 127 –128 (2011)More Less
Malignant melanoma (MM) is an unpredictable tumour that can metastasise to any organ, and is well known for its widespread dissemination. The incidence of metastases to the gastro-intestinal (GI) tract is well documented; this, however, is a late manifestation of the disease with an overall poor prognosis. Most GI metastases are asymptomatic and are only discovered on postmortem, with the majority in the small bowel. The presenting symptoms are usually of obstruction or intussusception; GI bleeding is also common. Fistula formation with the small bowel is rare; ours is believed to be the second case documented.
Source: SA Journal of Radiology 15, pp 129 –130 (2011)More Less
Leiomyosarcoma (LMS) is an uncommon malignant tumour of smooth muscle origin. It arises in the gastro-intestinal tract, retroperitoneum, urinary bladder, uterus and soft tissue. Peritoneal leiomyosarcomatosis (PL) is defined as a peritoneal dissemination of a primary sarcoma. We present a case of leiomyosarcomatosis with widespread dissemination including involvement of both breasts.
Source: SA Journal of Radiology 15, pp 131 –133 (2011)More Less
Introduction. Cystic and cavitatory pulmonary lesions are abnormalities encountered on chest computed tomography (CT). Malignant lesions, including metastases, rarely present as cystic lesions; we report on two such cases: a man with advanced carcinoma of the left testis, and a woman with epithelioid trophoblastic tumour.
Discussion. The lungs are the most common site for metastases from non-pulmonary neoplasms. The appearance of cystic lesions in the lung in malignancy is rare and predisposes to spontaneous pneumothoraces. Multiple cystic lesions occur commonly in bronchus carcinoma and also sarcoma, bladder cancer and, less commonly, lymphoma and metastasis. Both chemotherapy and immune suppression can induce cavitation in malignant lesions. Tumour necrosis and tumour infiltration of air-containing spaces with a check-valve mechanism are postulated for causing these cystic lesions. Spontaneous resolution is the rule. Close follow-up is recommended as these spaces may become infected.
Conclusion. CT is the mainstay of diagnostic imaging in cancer patients. Cystic lung lesions are caused by a diverse array of pathological processes, and are rare in metastatic disease.
Source: SA Journal of Radiology 15, pp 134 –136 (2011)More Less
Oculodentodigital dysplasia (ODDD), also known as oculodentoosseous dysplasia, is an extremely rare autosomal dominant disorder with high penetrance, intra- and interfamilial phenotypic variability, and advanced paternal age in sporadic cases. The incidence of this disease is not precisely known, with only 243 cases reported in the scientific literature, suggesting an incidence of around 1 in 10 million people. It is marked mainly by eye abnormalities, craniofacial dysmorphism, dental anomalies, hand and foot malformations, various skeletal defects, and mildly delayed mental development. Neurological changes may appear earlier in each subsequent generation. This case report describes a radiological diagnosis of ODDD based on physical appearance, clinical features and radiographic findings in a 16-year-old girl.
Upper abdominal visceral injury resulting from blunt trauma to the pelvis : a specific variant of shockwave injury? : case seriesAuthor D.J. EmbySource: SA Journal of Radiology 15, pp 137 –138 (2011)More Less
Two patients who sustained severe blunt injury to the pelvis without external injury to the upper abdomen or lower chest, yet who were found to have a ruptured solid upper abdominal viscus, are reported. The first patient on delayed arrival revealed clinical features suggestive of intra-abdominal bleeding and was found to have a grade 3 ruptured spleen. With the second patient, upper abdominal injury (in this instance, a pancreatic laceration) was not initially suspected owing to the absence of clinical evidence of injury to the abdomen. It is postulated that both the splenic and pancreatic injuries were the result of a shockwave propagated through the abdomen following the severe external impact to the pelvis.
Source: SA Journal of Radiology 15 (2011)More Less
The dural tail sign was first described by Wilms in 1989, as a postcontrast linear thickening of the meninges that resembles a tail extending from a mass on T1-weighted MR imaging. The sign consists of a tapering rim ranging from 0.5 to 3.0 cm in length with an inner surface that is either smooth or slightly nodular.
Experiences of using a single post-contrast CT scan of the urinary tract after triphasic contrast injection : pictorial essayAuthor P.C. PretoriusSource: SA Journal of Radiology 15, pp 140 –145 (2011)More Less
I was alerted to an article in Radiology Vol. 255 No. 2 (May 2010) by a colleague. The article, entitled 'Kidney and urinary tract imaging: Triple-bolus multidetector CT urography as a one-stop shop - Protocol design, opacification, and image quality analysis', clearly describes the technique, while the quotation below, from the article, summarises the findings:
'We have shown that triple-bolus multidetector CT urography allowed visualization of renal parenchymal, excretory, and vascular contrast-enhancement phases in a single dose-efficient acquisition and provided sufficient opacification of the UUT, with simultaneous and adequate image quality of renal parenchyma and vascular anatomy.'
The main emphasis on this technique is to reduce the number of unnecessary CT scans when assessing the urinary tract. Our previous protocol for scanning the urinary tract for pathology included four phases: a pre-contrast, corticomedullary, nephrographic and delay excretory phase.
Source: SA Journal of Radiology 15, pp 150 –151 (2011)More Less
Please refer to page 101 of the September 2011 issue of the SAJR (also available online at http://www.sajr.org.za/index.php/sajr/article/view/610/459) for the presentation details. We congratulate Dr S Moosa (Department of Radiology, 2 Military Hospital, Wynberg, Cape Town) for a well-researched and comprehensive diagnosis, for which he receives an award of R1 000 from the RSSA. Dr Misser elaborates below on the condition and its imaging.
Source: SA Journal of Radiology 15 (2011)More Less
An early neonate presented with stridor, and the following images were obtained. Figs 1 and 2 are axial post-contrast CT angiogram images at the level of the aortic arch. Note a nasogastric tube in situ. Figs 3 and 4 are volume-rendered 3D reconstructions of the CT angiogram from the level of the aortic root to the great vessels. Fig. 5 is a coronal reformatted image through the abdomen. Fig. 6 is a virtual bronchoscopy image of the tracheobronchial tree.