SA Journal of Radiology - Volume 16, Issue 3, 2012
Volume 16, Issue 3, 2012
Author Nishentha GovenderSource: SA Journal of Radiology 16 (2012)More Less
Source: SA Journal of Radiology 16, pp 82 –83 (2012)More Less
Usefulness of lateral radiographs for detecting tuberculous lymphadenopathy in children - confirmation using sagittal CT reconstruction with multiplanar cross-referencingSource: SA Journal of Radiology 16, pp 87 –92 (2012)More Less
Background. Diagnosis of pulmonary tuberculosis (PTB) in children remains difficult. Lateral chest radiographs are frequently used to facilitate diagnosis, but interpretation is variable. In this study, lateral chest radiographs (CXRs) are evaluated against sagittal CT reconstructions for the detection of mediastinal lymphadenopathy.
Aim. To correlate suspected lymphadenopathy on lateral CXR with sagittal CT reconstructions and determine which anatomical group of lymph nodes contributes to each lateral CXR location.
Methods and materials. Thirty TB-positive children's lateral CXRs were retrospectively reviewed for presence of mediastinal lymphadenopathy in 3 pre-determined locations in relation to the carina: retrocarinal, subcarinal and precarinal. Findings of the CT sagittal reconstructions were then correlated with the CXRs for the presence of lymphadenopathy in the same 3 pre-determined areas across the width of the mediastinum. Axial and coronal CT cross-referencing confirmed the position of the lymphadenopathy.
Results. The most frequent locations for lymphadenopathy were the subcarinal (28) and right hilar (25). Sensitivity and specificity values of the CXRs were moderate, with the precarinal region having the best sensitivity and specificity for presence of lymphadenopathy. Contribution to each zonal group on lateral CXR were from multiple anatomical lymph node sites.
Conclusion. The precarinal zone on CXR had the best specificity and sensitivity, and represented mainly subcarinal and right hilar lymph node groups. Attention should be paid to this area on lateral CXRs for detecting lymphadenopathy in children with suspected PTB.
Source: SA Journal of Radiology 16, pp 94 –99 (2012)More Less
Glioblastoma multiforme (GBM) is a class of devastating, highly aggressive central nervous system tumours. While the classical appearance is easily recognisable, several variations occur. We present 6 cases of confirmed GBM that illustrate the unusual findings in histological subtypes, early presentation and spread on MRI imaging.
Source: SA Journal of Radiology 16, pp 100 –101 (2012)More Less
Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly that presents with myocardial ischaemia or infarction and/or cardiac failure in infants. It is associated with a mortality rate of 90% within the first year of life. Surgical correction to re-establish a two-coronary artery perfusion system is the treatment of choice, once patients are medically stable.
Source: SA Journal of Radiology 16, pp 102 –103 (2012)More Less
Aortic stenosis (AS) is the most commonly encountered valvular disease in developed countries. Once symptomatic, this disease carries a dismal prognosis. Patients unfit for surgical valve replacement may require transcatheter aortic valve implantations (TAVI). We present a complication of this novel approach where a prosthetic valve is delivered through the femoral artery by means of a Retroflex delivery system developed by Edwards Lifesciences.
Unilateral axillary adenopathy with unremarkable breast imaging - differential diagnoses : case reportSource: SA Journal of Radiology 16, pp 104 –106 (2012)More Less
Unilateral axillary adenopathy may be caused by a wide range of both benign and malignant aetiologies. While the most common cause is inflammation, infection or trauma of the breast, thoracic wall or arm, a significant proportion of cases are due to occult malignancy. In female patients particularly, breast malignancy must be excluded with mammography and ultrasound. Local inflammation, infection or trauma of the thoracic wall or arm should also be sought when deciding the most appropriate recommendation for management. This case report outlines the most significant pathologies and discusses the need to rule out sinister pathology, even when a benign local cause is evident.
Source: SA Journal of Radiology 16, pp 107 –110 (2012)More Less
Background. Since its inception almost 20 years ago, functional magnetic resonance imaging (fMRI) has greatly advanced our knowledge of human brain function. Although the clinical applications of fMRI are still limited, there have recently been encouraging advances for its use in pre-operative functional cortical mapping to identify potentially eloquent areas prior to neurosurgery.
Objectives. We explore the potential use of this emerging technique by presenting a neurosurgical case study, as performed at the Cape Universities Brain Imaging Centre (CUBIC), Tygerberg, Cape Town. We conclude with a brief summary of the potential pitfalls of this technique, as well as cautionary guidelines based on our experience.
Methods and results. A 22-year-old male patient from Tygerberg Hospital underwent the successful resection of an anaplastic astrocytoma after fMRI presurgical planning at our facility. The subject was able to leave the ward unassisted.
Conclusion. If consideration is given to the many limitations of this emerging technique, fMRI can be useful in aiding the neurosurgeon in pre-operative planning of his surgical approach.
Source: SA Journal of Radiology 16, pp 111 –113 (2012)More Less
Ankylosing spondylitis is a debilitating disease that is one of the seronegative spondylarthropathies, affecting more males than females in the proportion of about 6:1 in the age group 15 - 35 years of age. Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray findings are florid spondylitis (Romanus lesions), florid diskitis (Andersson lesions), early axial ankylosis, enthesitis, syndesmophytes and insufficiency fractures. Typical radiological abnormalities are pointed out on conventional X-rays and reviewed for early diagnosis and prompt treatment of patients at risk.
Source: SA Journal of Radiology 16, pp 114 –115 (2012)More Less
The sandwich sign refers to the sandwiching of mesenteric vessels and fat by enlarged mesenteric nodes on cross-sectional imaging, commonly occurring in lymphoma, but not specific to lymphoma. The sign is radiologically indistinguishable from post-transplant lymphoproliferative disorders. The radiological significance of the sandwich sign is in suggesting the diagnosis of lymphoma so that appropriate treatment may be initiated early as the tumour has a rapid growth pattern.
Source: SA Journal of Radiology 16, pp 116 –117 (2012)More Less
Alexander disease (fibrinoid leucodystrophy; originally described by Alexander in 1949) is a rare, fatal, nonfamilial leucoencephalopathy caused by astrocyte dysfunction characterised by missense mutation in the genes coding for glial fibrillary acidic protein (GFAP). It typically presents with frontal preponderance of white matter abnormalities and macroencephaly. We report a case of leucoencephalopathy with macroencephaly that shows characteristic MRI features of Alexander disease.
Source: SA Journal of Radiology 16, pp 118 –119 (2012)More Less
We congratulate Dr Qonita Said-Hartley, consultant radiologist at New Somerset Hospital, Cape Town, for a most detailed diagnosis for which she receives an award of R1 000 from the RSSA. The two runners-up - Dr Kamila Padia and Dr Marc Jordaan - warrant honourable mention. Dr Misser elaborates below on the condition and its imaging. Please refer to page 79 of the June 2012 issue of the SAJR (http://www.sajr.org.za/index.php/sajr/article/view/729/566) for the presentation details (a 39-year-old man with subacute dyspnoea and intermittent cough) and images. The previously published and two new images appear below.
Experiences of using a single post-contrast CT scan of the urinary tract after triphasic contrast injection : correspondenceAuthor Phil PretoriusSource: SA Journal of Radiology 16, pp 122 –123 (2012)More Less
In my article entitled 'Experiences of using a single post-contrast CT scan of the urinary tract after triphasic contrast injection' that was published in the SAJR Vol. 15, No. 4 (December 2011), I emphasised that we had not gained experience in this technique with renal pathologies such as pyelonephritis and small renal tumours. At a CT congress in South Africa last year, an international speaker and expert in CT also raised his concern about missing small renal tumours when questioned about this technique. I have had further experience since, and would like to share the following 2 cases, suggesting that this technique will demonstrate these 2 pathologies adequately.