SA Journal of Radiology - Volume 17, Issue 4, 2013
Volume 17, Issue 4, 2013
Author Razaan DavisSource: SA Journal of Radiology 17 (2013)More Less
Clinicians and epidemiologists at McMaster University in Canada coined the term 'evidence-based medicine' in 1988. The Scottish physician Dr Archibald Leman Cochrane (1909 - 1988) was a pioneer of evidence-based medicine; the Cochrane Library database of systemic reviews was named after him. Knowledge exchange occurs between researchers and the users of research, whereby research is used to change policy and planning or practice and systems. The translation of best evidence integrated with healthcare practices conduces to saving money and lives.
Endovascular therapy for acute tumour-related obstruction of the superior vena cava using a self-expanding Nitinol stent : original articleSource: SA Journal of Radiology 17, pp 123 –127 (2013)More Less
Objective. To evaluate, in a retrospective study, the clinical efficacy and safety of the self-expanding Nitinol stent in the superior vena cava to alleviate upper venous congestion.
Method. In 22 patients (15 men, 7 women), a tumour-related compression of the superior vena cava was diagnosed by spiral CT after intravenous application of contrast medium. Clinically, acute superior vena cava syndrome was found in all patients. Histologically, a bronchial carcinoma was present in 14/22, a lymphoma in 6/22, and mediastinal lymphnode metastases (1 breast carcinoma, 1 malignant melanoma) in 2/22. After a transfemoral approach, cavography was initially performed. The degree of stenosis was classified according to the Stanford classification. In accordance with the degree of stenosis, a self-expanding Nitinol stent was placed.
Results. Endovascular stent implantation was conducted without complications in all patients. A marked improvement in acute symptoms was observed clinically within 24 hours in all patients. In the follow-up period of up to 2 years, there were no cases of stent migration. In 7/22 patients, the CT follow-ups revealed tumour progression (3/7 after 3 months, 2/7 after 6 months, and 2/7 after 12 months) with evidence of residual stenosis caused by tumour growth through the stent mesh. During the follow-up period, 15/22 patients died (mean survival 6.4 months).
Conclusion. Self-expanding Nitinol stents provide endovascular therapy for superior vena cava syndrome, having a high radial expansive force and the facility to be placed precisely, and alleviating acute, life-threatening symptoms in the palliative situation.
Adrenal lesions encountered in current medical practice - a review of their radiological imaging : review articleSource: SA Journal of Radiology 17, pp 128 –138 (2013)More Less
Modern radiological technology has transformed the way that adrenal lesions are currently investigated. The contemporary radiologist has been catapulted to the forefront in the management of adrenal disease. With the increasing use of cross-sectional imaging, adrenal lesions are being serendipitously discovered in radiological studies undertaken for non-adrenal-related conditions - the so-called adrenal 'incidentaloma'. This review discusses the imaging modalities available for characterising these lesions, highlighting current concepts and controversies in differentiating benign from malignant pathology. The article also provides a brief overview of the spectrum of adrenal pathology commonly encountered in the adult population.
Source: SA Journal of Radiology 17, pp 139 –140 (2013)More Less
Paragangliomas are rare catecholamine-secreting neuro-endocrine tumours that can arise from sympathetic or parasympathetic tissue. Any manipulation of these tumours, without appropriate medical therapy, can result in excess catecholamine release leading to a catecholamine crisis. Neuro-endocrine tumours must be considered prior to interventional biopsy of an unknown soft-tissue mass, and appropriate biochemical investigations should be performed in suspected cases to prevent catastrophic complications.
Source: SA Journal of Radiology 17, pp 141 –142 (2013)More Less
Kupffer and Bessel-Hagen coined the term torus palatinus in 1879 for a benign osseous protuberance arising from the midline of the hard palate. Tori are present in approximately 20% of the population and are occult until adulthood. Recent advances in modern radiology have led to improved evaluation and diagnosis of tori.
Source: SA Journal of Radiology 17, pp 143 –144 (2013)More Less
Although schistosomiasis (bilharzia) is one of the most common parasitic infections in humans, schistosomal infection of the nervous system is rare. This report is of an unusual case of primary cerebral schistosomiasis and describes its magnetic resonance imaging appearance.
Source: SA Journal of Radiology 17, pp 145 –146 (2013)More Less
Congenital coronary artery anomalies are uncommon. Dual left anterior descending coronary artery (LAD) is defined as the presence of two LADs within the anterior interventricular sulcus (AIVS), and is classified into four types. Type IV is a rarely reported subtype and differs from the others, with a long LAD originating from the right coronary artery (RCA). Dual LAD is a benign coronary artery anomaly, but should be recognised especially before interventional procedures. With the increasing use of multidedector computed tomography (MDCT), it is essential for radiologists to be aware of this entity and the cross-sectional findings.
Source: SA Journal of Radiology 17, pp 147 –148 (2013)More Less
Mucopolysaccharidoses (MPS) represents a heterogeneous group of inherited lysosomal storage disorders characterised by defective degradation of long-chain complex carbohydrates called glycosoaminoglycans (GAGs). To date, 11 distinct types of MPS have been described, each as a result of deficient enzymatic activity of specific lysosomal hydrolase. The most common types are Hurler and Hunter syndromes. We report a case of a child presenting with macrocephaly, clinically suspected to be due to hydrocephalus. An MRI (3 Tesla) brain study demonstrated the cribriform pattern in the brain caused by dilated perivascular spaces, which is a diagnostic clue for the presence of MPS.
Source: SA Journal of Radiology 17, pp 149 –153 (2013)More Less
Source: SA Journal of Radiology 17, pp 154 –156 (2013)More Less
We congratulate Dr Saifullah Khalid, Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, for her excellent diagnosis, for which she receives the award of R1 000 from the RSSA. Notable second-place entries were made by Drs Aadil Ahmed, Samuel Manikkam, Jacqueline du Toit, Phil Harries-Jones and Shaun Scheepers. Drs Misser et al. elaborate below on the images and findings. Please refer to page 116 of the August 2013 issue of the SAJR (http://dx.doi.org/10.7196/SAJR.934) for the presenting details and the investigative images.
Source: SA Journal of Radiology 17, pp 156 –157 (2013)More Less
A 38-year-old woman presented with a painful left paramedian infra-umbilical abdominal wall mass. She was a keen athlete and otherwise well. The following ultrasound images and MRI sequences (after gadolinium administration) were obtained. Describe the relevant imaging findings and formulate the most appropriate clinical diagnosis. Please submit your response to email@example.com not later than 15 January 2014. The winning respondent will receive a R1 000 award from the RSSA. A detailed diagnosis and discussion will be presented in the next issue of the SAJR.