bluuebunny/crossref_metadata_2025 huggingface dataset:
Histo-pathological correlation of BI-RADS 4 lesions on mammography with emphasis on microcalcification patterns.
Authors: Ismail F , Holl J , Lockhat Z , Akande H J
Published: May 2014

A retrospective study of 20 patients with Breast Imaging Reporting and Data System (BI-RADS) 4 lesions was undertaken. These patients were classified as BI-RADS 4 lesions due to presence of a mass (clinical or on mammography), architectural distortion and microcalcifications (MC). In some patients, the pattern of MC was benign but there were other features that were suspicious of malignancy. A comparison was made with the histological diagnosis in order to compare the radiological appearance of benign and malignant microcalcification patterns with the final histology. The study design included retrospective analysis of patients with MC on digital mammography who underwent biopsy. An analysis of the histology was then undertaken. Other factors in the history and physical examination were also considered. Results showed that although the study was not statistically significant due to limited study population, interesting trends are determined in assessing calcification patterns using the Breast Imaging Reporting and Data System (BI-RADS) classification system, since some lesions that were thought to have benign calcification patterns were actually malignant and vice versa. Further study in this field is required.
Management of hemorrhage secondary to a pseudoaneurysm of the gastroduodenal artery
Authors: Nejmeddine Affes , Ahmed Guirat , Khalil Ben Salah , Issam Beyrouti , Henda Ketata
Published: May 2014

We report a case of a 31-year-old male patient with chronic pancreatitis and hematemesis secondary to gastroduodenal artery pseudoaneurysm. No evidence-based guidelines exist regarding the optimal treatement modality of this affection. The authors, in reference to a case emphasize the value of the celiac arteriography to diagnostic confirmation and transcatheter embolisation.
Imaging of appendicitis
Authors: Gajjar Himal , Levy Anthony
Published: May 2014

Appendicitis is one of the commonest causes of abdominal pain requiring surgery. Early diagnosis and management are essential to reduce morbidity and mortality. Imaging is valuable in the diagnosis of cases that are clinically atypical. Imaging also allows evaluation of the complications of appendicitis. In certain circumstances, conservative treatment of complicated appendicitis with percutaneous drainage is appropriate.
Conjoined twins with a horseshoe kidney
Authors: Modi M , Kramer L
Published: May 2014

Conjoined twins are rare variants of monozygotic twins. There are many types of conjoined twins, and they are usually classified at the point at which they are fused. Our patient fitted into a thoraco-omphalopagus type, where there was fusion of the thorax as well as mid-trunk [3]. The most common type of renal fusion anomaly is the horseshoe kidney. It consists of 2 distinct functioning kidneys on each side of the midline, and they are more likely to be connected at the lower poles [4]. We describe here a 30 year-old patient who presented to the antenatal clinic of Chris Hani Baragwanath hospital in Soweto, South Africa at 34+ weeks gestation. Foetal magnetic resonance imaging revealed thoraco-omphalopagus conjoined twins with complex thoracic and abdominal structures, including a horseshoe kidney that was confirmed on post-natal computed tomography.
CPD Questinnaire
Authors: Fani Gertrude
Published: May 2014

N/A
Trans-abdominal ultrasonic findings correlated with CD4+ counts in adult HIV-infected patients in Benin, Nigeria
Authors: Igbinedion B O-E , Marchie T T , Ogbeide E
Published: May 2014

Objective: The objective of this study is to document the abdominal ultrasound findings in HIV infected patients and compare it with their CD4+ count. Patients and method: 300 confirmed HIV positive patients had abdominal ultrasonography done at the University of Benin Teaching Hospital from November 2007 to January 2008. Each patient’s sonographic findings were correlated with their CD4+ category using the WHO’s HIV classification index. Result: Splenomegaly, hepatomegaly, renomegaly, hyperechoic splenic parenchyma, increased renal echogenicity and lymphadenopathy are among the common sonographic findings. However, few of these findings correlated statistically with the CD4+ count. Conclusion: The versatile diagnostic tool, ultrasound, should continue to be an important imaging equipment in several impoverished communities. In the evaluation of HIV infected patients, its use is invaluable and should be promoted.
Cover
Authors: Tillemans Siobhan
Published: May 2014

N/A
Contents page
Authors: Tillemans Siobhan
Published: May 2014

N/A
A digital thumbs-up for PACS & RIS
Authors: Schultze Otto
Published: May 2014

N/A
Some aspects of computed tomography in Russia
Authors: Jargin S V , Jargin E E
Published: May 2014

None
Role of abdominal ultrasound in the context of the HIV/AIDS epidemic
Authors: Emby D J , Igbinedion Reply by B O-E
Published: May 2014

N/A
Report on the RSSA Neuroradiology and Body Imaging Advances Congress, Sandton, 28-30 August 2009. RSSA/Leuven ear imaging course
Authors: Stoker Aisne
Published: May 2014

N/A
Cover
Authors: Griffin Clinton
Published: May 2014

N/A
Contents
Authors: Lotz Jan
Published: May 2014

N/A
A metal foreign body pulmonary embolism
Authors: Joubert C J
Published: May 2014

This Pictorial Interlude demonstrates the migration of metal shrapnel from the pelvis to the left lung.
Bilateral periventricular nodular heterotopia – neonatal cranial ultrasound.
Authors: Horn A R , Nel A , Urban M F
Published: May 2014

A female neonate was delivered at 30 weeks’ gestation to a mother with suspected bilateral periventricular nodular heterotopia (PNH) on computed tomography brain scan. Antenatal ultrasound (US) performed at 28 weeks’ gestation showed mild lateral cerebral ventricle dilatation, but no other fetal anomalies. Clinical examination revealed mild dysmorphic features: facial and skull asymmetry, square-shaped ears, and long tapering fingers. Chromosomal analysis showed a 46XX karyotype.
Neurofibromatosis revisited: A pictorial review
Authors: Khan Nausheen , Van de Werke Irma , Ismail Farzanah
Published: May 2014

Neurofibromatosis (or von Recklinghausen disease) is a hereditary condition due to mesodermal and neuroectodermal dysplasia, eponymously named after the researcher who reported it in 1882. The disorder is transmitted as an autosomal dominant condition, but 50% of cases arise as spontaneous mutations. The incidence falls within the range 1:2 000 - 1:4 000, and has no gender bias. We present a series of images produced by different modalities that show lesions and pathologies that are characteristic of the disease.
Cranial MIR: findings and diagnosis
Authors: Misser S K
Published: May 2014

N/A
Imaging of a rare disorder: macrodystrophia lipomatosa
Authors: Suleman Farhana Ebrahim , Kisansa Margaret
Published: May 2014

Macrodystrophia lipomatosa (MDL) is described as a rare, non-hereditary, congenital condition presenting with localized macrodactyly and a proliferation of mesenchymal elements. There is in particular a marked increase in fibroadipose tissue(1).

We describe two cases presenting to our department in a six 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 although the 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 related syndromes and the most appropriate diagnosis appears to be MDL. Thus we concluded that this may be a case of a rare, atypical MDL that was arrested or frustrated and therefore failed to demonstrate full expression of the syndrome.
Radiologists and radiographers must remain the custodians of diagnostic radiation
Authors: Emby D J
Published: May 2014

Comment on the SAJR Editorial in March 2010 issue
Abdominal imaging - findings and diagnosis
Authors: Misser S K
Published: May 2014

N/A
Musculoskeletal diagnosis - new case
Authors: Misser S K
Published: May 2014

N/A
CPD questionnaire
Authors: Fani Gertrude
Published: May 2014

N/A
MRI determination of the vertebral termination of the dural sac tip in a South African population: clinical significance during spinal irradiation and caudal anaesthesia
Authors: Cilliers A , Schulenburg D H , Janse van Rensburg J
Published: May 2014

Abstract

Knowing where the dural sac (DS) ends is important, especially when placing the portal fields during craniospinal irradiation (CSI) and performing caudal anesthesia. The purpose of this investigation was to determine the level of termination of the DS in relation to the spine in a group of South African patients using magnetic resonance imaging (MRI). We retrospectively reviewed the lumbosacral MR Imaging of 309 patients in each case identifying the tip of the DS. This level was recorded in relation to the adjacent vertebral body i.e. upper-, middle- and lower third and adjacent intervertebral disc. The overall mean of the DS position was at the middle third of S2. A notable percentage (13.9%) of patients had a DS level lower than the lower third of S2 and (15.2%) patients had a DS level higher than the S1-S2 intervertebral disc. This study failed to demonstrate a difference in the DS termination level, compared to the levels reported in various international studies; nor is there a statistical difference between gender, race and age. Our study shows that routine placement of the portal field at the lower border of S2 adequately treats the majority of CSI patients. However some patients (13.9%) will be undertreated and some patients (15.2%) will be overradiated. Using spinal MRI to establish the lower border of the CSI portal field will however benefit patients by ensuring adequate coverage of the entire neuroaxis as well as minimizing late gonadal toxicity due to overradiation.
Extramedullary haematopoeisis causing spinal cord compression
Authors: Ismail F , Huang L , Lockhat Z , Ellemdin S , Van der Linde L
Published: May 2014

Extramedullary haematopoeisis (EMH) is a rare cause of spinal cord compression. However, in a patient with a haematological disorder and in particular thalassaemia, EMH with paraspinal masses should be considered and imaging planned appropriately.
The fallacy of comparing diagnostic radiation with background radiation; and the need to learn from past mistakes
Authors: Emby D J
Published: May 2014

The subject of radiation exposure for diagnostic purposes is currently a ‘hot’ topic, and it is appropriate that the debate around this issue is given exposure in the pages of the SAJR. I would like to comment on a few of the points raised by Dr Tipler in his article that appeared in the June 2010 SAJR.
Beware the bifid rib!
Authors: Scheepers Shaun , Andronikou Savvas
Published: May 2014

A 4-year-old girl was referred to Tygerberg Academic Hospital with a long-standing history of an asymptomatic anterior chest wall ‘lump’. On physical examination, a bony mass was palpated in relation to the anterior aspect of the left 4th rib. Plain radiography demonstrated anterior widening of the left 4th rib. Fearing a sinister cause, a multidetector computed tomography (MDCT) examination of the chest, with 3D reconstruction and volume rendering, was performed. A congenital bifid left 4th rib was demonstrated.
A case of extensive synovial involvement by tophaceous gout
Authors: Khan Nausheen , Van de Werke Irma , Ismail Farzanah , Levay Peter F
Published: May 2014

Gout is the most common form of microcrystal arthropathy that results in deposition of uric acid crystals in and around the joints and soft tissues. The most common cause is decreased uric acid clearance by the kidneys. The radiological manifestations of gout are generally well known and have remained unchanged. We describe a case of chronic tophaceous gout with diffuse extensive involvement of synovium around the knees bilaterally.
Macrodystrophia lipomatosa – MR imaging of a rare congenital anomaly: review of 3 cases
Authors: Aga Pallavi , Parashari Umesh C , Parihar Anit , Singh Ragini , Kohli Neera , Yadav Rajesh
Published: May 2014

Macrodystrophia lipomatosa (MDL) results from progressive overgrowth of all the mesenchymal elements, with a disproportionate increase in fibro-adipose tissue. This rare congenital abnormality occurs most frequently in the distribution of the median nerve in the upper, and medial plantar nerve in the lower, extremity.

Excess of unencapsulated fibro-adipose tissue on magnetic resonance imaging (MRI) is virtually diagnostic and can differentiate this entity from other diseases with similar presentations. Involvement of the ulnar aspect of the hand, though rare, has been described; however, the lateral aspect of the foot as seen in our second case has not been reported, to the best of our knowledge.
Echinococcal disease of the bone: An unusual cause of a pathological fracture
Authors: Goodier Matthew , Rubin Grace
Published: May 2014

Echinococcosis is caused by the larva of the tapeworm, Echinococcus granulosus or Echinococcus multiloccularis and is endemic in many rural areas of Southern Africa. Echinococcosis of the bone is an unusual manifestation of echinococcal disease and a rare cause of a lytic lesion of bone. This report describes a 30-yr old female who presented with an Echinococcal cyst of the right radius complicated by a pathological fracture.
The hilum overlay sign in a child
Authors: Van Wyk M J , Mahomed N
Published: May 2014

A 9-month-old girl presented with a 1-month history of coughing. A chest X-ray (CXR) was performed, and the antero-posterior view demonstrated the hilum overlay sign. Furthermore, there was absence of the azygo-oesophageal line and bilateral paraspinal lines. The lateral CXR revealed a posterior mediastinal mass. Subsequently, a computed tomogram of the chest confirmed a posterior mediastinal mass, with calcifications and intraspinal extension consistent with neuroblastoma. Histological analysis confirmed this mass as a neuroblastoma.
Cardiological diagnosis
Authors: Misser S K
Published: May 2014

N/A
Musculoskeletar case - new
Authors: Misser S K , Mercouris P
Published: May 2014

N/A
Molecular Imaging
Authors: Sperryn Clive
Published: May 2014

N/A
SAMSIG seeks growth
Authors: Velleman Mark
Published: May 2014

N/A
Imaging features of a rare case of scapuloiliac dysostosis (Kosenow syndrome) in an ambulatory child
Authors: Joseph John , Narayanan Harish , Varghese Jacob , Babu Harish , Praveen A
Published: May 2014

Scapuloiliac dysostosis, also known as pelvis-shoulder dysplasia and Kosenow syndrome, is a rare skeletal dysplasia described first by Kosenow et al. in 1970. The main components of the syndrome are varying degrees of bilateral iliac and scapular hypoplasia. Various other skeletal abnormalities including exaggerated lumbar lordosis, and clavicular, vertebral, rib and long bone anomalies and extra-skeletal abnormalities, most commonly those of eye and ear, have also been reported. We report the plain radiography, CT and MRI findings of an interesting case of the syndrome.
Gorlin syndrome - an incidental radiographic detection
Authors: Shetty Shishir Ram , Veena K M , Chatra Laxmikanth , Shenai Prashanth , Rao Prasanna Kumar , Chandra Jagadish
Published: May 2014

Gorlin-Goltz syndrome (also known as nevoid basal cell carcinoma syndrome) was first reported in 1894, but described by Gorlin and Goltz in 1960 as a distinct entity consisting of ectodermal and mesodermal abnormalities. It is an hereditary autosomal dominant disease with a prevalence estimated in various studies to be between 1/57 000 and 1/256 000, and a male:female ratio of 1:1. We describe in brief the important radiological features of an accidentally detected case of Gorlin syndrome in the form of a pictorial interlude.
PACS: Do clinical users benefit from it as a training adjunct?
Authors: Van Heerden J , Lockhat Z , Bam D , Fletcher L , Sommerville J
Published: May 2014

Background. Over the past four years, Steve Biko Academic Hospital has been in the process of implementing and refining the use of a picture archiving and communications system (PACS). As part of a post-implementation refining process, it is necessary to evaluate user-perceptions in order to improve on good system qualities and correct flaws.

Aim. The aim of this study was to assess whether medical clinicians perceived PACS as a positive adjunct to training and teaching opportunities – specifically those opportunities related to radiological image viewing and interpretation as part of patient case discussions.

Method. Standardised questionnaires with ‘free text’ and ‘option selection’ questions were distributed to clinicians who, as part of their training, rotated at Steve Biko Academic Hospital (where a PACS is in place) as well as other teaching hospitals without a PACS. Between February 2009 and May 2009, approximately 400 questionnaires were distributed. As a result of constant academic rotations, leave schedules of medical staff and posts vacated, questionnaires could not be distributed to the entire target population that was estimated to be in the region of 550 medical clinicians (comprising senior medical students, interns, medical officers, registrars and consultants). Of the 400 questionnaires distributed, 189 completed questionnaires were returned. Completion of the questionnaires was voluntary and anonymous.

Results and conclusion. Although a PACS relates specifically to the archiving and retrieval of radiological images and reports, it became clear from the feedback received from medical clinicians (who are ward-based, theatre-based or clinic-based users of a digital system) that many other factors, such as lack of adequate hardware and sub-optimal personal IT proficiency, contributed to some of the negative PACS-related perceptions and ‘lost teaching opportunities’ reported. Negative comments specifically related to PACS as a training adjunct included the frustrations associated with PACS downtime (especially during the period in 2009 when many electrical power cuts were experienced nationwide, resulting in network interruptions) and slow image retrieval during peak work-flow times. The advantages of PACS as a positive training adjunct were highlighted in the areas of multi-site viewing and consultation, the possibility of image manipulation and measurement tools, and better overall image quality. Clinicians felt that their training experience was also enhanced because of better patient follow-up made possible by access to all previous radiological imaging of a particular patient. Of the clinicians who completed the questionnaires, 63.5% felt that the PACS at Steve Biko Academic Hospital contributed positively to their training by creating more overall learning opportunities than other training environments without a PACS.
Rupture of an ovarian artery aneurysm following normal vaginal delivery
Authors: Van Schouwenburg F , Lameen H
Published: May 2014

A 30 year-old woman presented at the casualty department 12 days after having given birth to a healthy baby via normal vaginal delivery. She complained of increasing pain and a mass in her right flank. There were no complaints of nausea, vomiting, dysuria or abnormal bowel habits.

On examination, the patient was acutely distressed, in severe pain and was anaemic with an Hb of 5 g/dl. Her blood pressure was 151/71 mmHg and her pulse rate 125/minute. Physical examination revealed a severely distended abdomen with features of peritonitis.

An abdominal ultrasound revealed a large abdominal fluid collection and a CT scan was therefore requested. A contrast-enhanced CT scan demonstrated a large homogenous retroperitoneal fluid collection in the right flank, with a 25mm rounded, intensely enhancing focus located close to the inferior border of the collection. The collection displaced the bowel to the left and inferiorly, and the liver, superiorly.

The differential diagnosis included a ruptured ovarian artery aneurysm. As soon as the patient was stable, she was taken for ovarian artery embolization that was successfully accomplished. The patient recovered well in the ward.
The RSSA and CME
Authors: Lotz Jan
Published: May 2014

The RSSA and CME
Cognitive decline and depressed level of consciousness in AIDS: Diagnosis
Authors: Els H , Andronikou S
Published: May 2014

Cognitive decline and depressed level of consciousness in AIDS: Diagnosis
Iatrogenic injury of an aberrant right posterior sectoral bile duct
Authors: Cantrell John
Published: May 2014

A 34-year-old woman presented with a history of a previous laparoscopic cholecystectomy, followed within a few days by a formal laparotomy for a suspected bile duct injury. Approximately one week after the laparotomy, she developed a sinus on the anterior abdominal wall that was draining bile. She was then referred to our institution for further management. The earlier surgery was done at another hospital, and these details were not clear.

A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts.

A week later, an endoscopic retrograde cholangiopancreatography (ERCP) examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts. These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy. This duct now drained into the gallbladder fossa, causing the collection and draining sinus.
The fat halo sign
Authors: Mahomed Nasreen , Sewchuran Tanusha
Published: May 2014

N/A
Radioactive news
Authors: Mercouris P , Scheepers S
Published: May 2014

Radioactive news
Arm pain after syncope: Diagnosis
Authors: Misser S K
Published: May 2014

Quiz case
CPD Questionnaire
Authors: Fani Gertrude
Published: May 2014

CPD Questionnaire
Estimation of annual occupational effective doses from external ionising radiation at medical institutions in Kenya
Authors: Korir Geoffrey K , Wambani Jeska S , Korir Ian K.
Published: May 2014

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.
Metastatic melanoma to the small bowel complicated by fistula formation
Authors: Khan Nausheen , Van de Werke Irma , Ebrahim Zaeem Ismail , Ismail Farzanah
Published: May 2014

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.
The radiological appearance of metastatic cystic lesions
Authors: Barnardt Pieter , Du Toit Jacqueline
Published: May 2014

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.
Paediatric neuropathology: Diagnosis
Authors: Misser S K , Roos J F
Published: May 2014

Paediatric neuropathology: Diagnosis
Paediatric congenital vascular disorder
Authors: Misser S K , Narsai J N
Published: May 2014

Paediatric congenital vascular disorder
‘Board exams’ for South African Radiology registrars - level the playing field
Authors: Andronikou Savvas
Published: May 2014

N/A
Tolosa-Hunt syndrome
Authors: Barnard Benjamin Wybrand
Published: May 2014

Tolosa-Hunt syndrome (THS) is a rare disorder indicated by recurrent painful ophthalmoplegia caused by non-specific inflammation of the cavernous sinus or superior orbital fissure (SOF). The disease shares histopathological features with idiopathic orbital pseudotumour; however, owing to its anatomical location, it produces characteristic clinical manifestations.1 Recurrent retro-orbital pain, with palsies of the third, fourth or sixth cranial nerves as well as the first and second divisions of the trigeminal nerve, are typical. Clinically, immediate response to steroid therapy is a hallmark of the condition. The clinical presentation of THS has a wide differential diagnosis, and timely and appropriate imaging – as an adjunct to pertinent laboratory investigations – can greatly assist clinicians with early accurate diagnosis and management.
Fetal MRI for characterising a variety of posterior fossa anomalies suspected on 3rd trimester ultrasound examination – a short series of four cases
Authors: Ranchod Amaresh Indravadan , Andronikou Savvas , Modi Mala
Published: May 2014

Fetal MRI is increasingly being used to more accurately assess abnormalities detected on screening ultrasound. This procedure is more pertinent when the initial ultrasound is done late in the third trimester and when the abnormality involves the posterior fossa of the brain. Four cases with a variety of unusual posterior fossa anomalies are presented.
Another view of IRIYA 2011
Authors: Matzdorff Robert
Published: May 2014

N/A
Magnetic resonance imaging of the breast: A clinicial perspective
Authors: Edge Jenny , Boeddinghaus Irene
Published: May 2014

The role of magnetic resonance imaging (MRI) in screening for breast cancer and its use after the diagnosis of breast cancer is discussed. The topic is enormous, with over 5 000 papers published in the last 10 years. In this précis, we focused on articles that examine its clinical relevance. We did not look at economic factors.
A rare cause of coffee-ground vomiting: Retrograde jejunogastric intussusception
Authors: Gangadhar Kiran
Published: May 2014

Retrograde jejunogastric intussusception is a well-recognised, rare, but potentially fatal long-term complication of gastrojejunostomy or Billroth II reconstruction. Only about 200 cases have been reported in the literature to date. Diagnosis of this condition is difficult in most cases. To avoid mortality, earlydiagnosis and prompt surgical intervention is mandatory. Since gastrojejunostomies with vagotomy are on a declining trend, it is extremely rare to come across such a complication. We report on such a patient who presented with haematemesis.
ALCAPA: The Al Capone of coronary artery anomalies
Authors: Ismail Farzanah
Published: May 2014

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.
Ventricular perforation as a complication of percutaneous valve replacement
Authors: De Jager Cornelis , Norval Ivan L , Tynan Jennifer R
Published: May 2014

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.
Multi-detector computer tomography venography (MDCTV) as a diagnostic tool in the management of patients with atypical, complicated and/or recurrent varicose veins
Authors: Lawson Andrew , Rischbieter Paul , Owen Jeanine , Peedikayil Tushar , Beningfield Steve
Published: May 2014

Aim. To evaluate the role of multi-detector computer tomography venography (MDCTV), compared with conventional venography, as a diagnostic tool in the management of patients with atypical, complicated and/or recurrent varicose veins.

Materials and methods. Retrospective review of 21 patients who had undergone both MDCTV and conventional transfemoral or transpopliteal venography between January 2008 and April 2011 for the management of recurrent varicose veins and/or chronic venous ulcers. MDCTV was performed using a 16-slice CT scanner. Spiral acquisition was commenced 180 seconds after intravenous injection of 150 ml of 350 mmol/l iodinated contrast medium. A reconstruction interval of 1.5 mm was used. Conventional venography was performed by the resident vascular surgeon and was followed by stenting or coiling where appropriate.

Results. MDCTV and venography were compared in 21 patients (6 male, 15 female; average age 55 years, range 33 - 78 years); 8 also underwent endovascular iliac vein stenting. The area under the receiver operator curve (ROC) for percentage iliac vein stenosis determined on MDCTV versus venography was 0.75. Four (19%) false-positive iliac vein stenoses were reported on MDCTV. Ten patients underwent gonadal vein coil embolisation. Gonadal vein size >5.2 mm (range 1 - 11 mm) on MDCTV predicted significant venographic reflux requiring coil embolisation. Three (30%) patients who underwent embolisation did not have gonadal vein enlargement on MDCTV.

Conclusion. MDCTV plays an important adjunctive role in the diagnostic workup of patients with complex venous disease. The findings at MDCTV correlate well with conventional venography.
Flake-shaped rice bodies
Authors: Kichari J R , Bezooijen R
Published: May 2014

Rice body formation is a common complication of rheumatoid arthritis but can also occur without any underlying systemic disorder. MRI is the modality of choice for discriminating this pathology from synovial chondromatosis.
Perinatal lethal osteogenesis imperfecta
Authors: Moosa Shahida
Published: May 2014

Osteogenesis imperfecta (OI) is a heterogeneous group of genetic bone disorders that are characterised by decreased bone mass, increased bone fragility and susceptibility to fractures. The severe, perinatal lethal form (Type II) (OMIM 166210) is characterised by bone fragility, with perinatal fractures, severe bowing of long bones, undermineralisation, and death in the perinatal period owing to respiratory insufficiency. The overall prevalence of OI Type II is unknown. There are three subtypes of OI Type II (A, B and C) that are characterised by different radiological features, and may be caused by different genetic faults. Two fetuses with OI Type IIA are presented.
Abdominal imaging
Authors: Beningfield S. , Scholtz P.
Published: May 2014

Dr S Misser was erreneously listed as an author for this manuscript.
The role of imaging in the evaluation of extraskeletal Ewing’s sarcoma
Authors: Barnardt Pieter , Roux Francois
Published: May 2014

Primary bone tumours account for 5% of all adolescent and child cancers. When Ewing’s sarcoma arises in soft tissue rather than bone, it is referred to as extraskeletal Ewing’s sarcoma (ESS). Computed tomography (CT) scanning and magnetic resonance imaging (MRI) features of Ewing’s sarcoma are non-specific, and a radiological differential diagnosis should be considered. Ewing’s sarcoma is confirmed by features on histological analysis. In young people who present with soft-tissue tumours, ESS should be considered. In the management of patients with tumours, imaging techniques are useful for biopsy guidance, evaluating the possibility of resection, and tumour response to treatment.
Transitional cell carcinoma developing in a bladder diverticulum: Early diagnosis by computed tomography
Authors: Shah Jeshil R.
Published: May 2014

Computed tomography confirmed a left-sided narrow neck urinary bladder diverticulum, with wall thickening, in a 56-year-old man. These findings were initially detected on ultrasonographic investigation. Transitional cell carcinoma was confirmed histologically. There is an increased incidence of neoplastic transformation in urinary bladder diverticuli, and therefore an early search for subtle imaging signs should be implemented.
Percutaneous thrombin injection for pseudoaneurysm treatment
Authors: Bydawell Gareth
Published: May 2014

Pseudoaneurysm of the femoral artery is a well-documented complication following arterial access. There are several treatment options, but percutaneous injection of thrombin, using ultrasound guidance, has become increasingly popular worldwide and is the therapy of choice in most vascular centres. This short review highlights the procedure and provides step-by-step guidance for radiologists who are interested in performing thrombin injection.
CPD questionnaire
Authors: Davis Razaan
Published: May 2014

No abstract available.
A tale of two embolisations
Authors: Van Wyk Matthys Johannes , Loggenberg E
Published: May 2014

Chronic pulmonary tuberculosis may present as massive haemoptysis. Haemoptysis usually originates from the bronchial artery but the pulmonary artery might be the culprit vessel in recurrent haemoptysis. We present a case where bronchial artery embolisation had to be augmented by pulmonary artery coil embolisation for a Rasmussen's aneurysm after recurrent haemoptysis. In cases where recurrent haemorrhage occurs, sources other than the bronchial artery should be considered.
The impact of the digital revolution on the SAJR
Authors: Davis Razaan
Published: May 2014

No abstract available.
Quality management systems in radiology
Authors: Korir Geoffrey K. , Wambani Jeska S. , Korir Ian K. , Tries Mark , Mulama Beatrice M.
Published: May 2014

Background: The use of X-ray imaging is ever increasing in proportion to the need for radiological services and technological capabilities. Quality management that includes patient radiation dose monitoring is fundamental to safety and quality improvement of radiological services.Objective: To assess the level of quality management systems in X-ray medical facilities in Kenya.Methods: Quality management inspection, quality control performance tests and patient radiation exposure were assessed in 54 representative X-ray medical facilities. Additionally, a survey of X-ray examination frequency was conducted in 140 hospitals across the country.Results: The overall findings placed the country’s X-ray imaging quality management systems at 61±3% out of a possible 100%. The most and the least quality assurance performance indicators were general radiography X-ray equipment quality control tests at 88±4%, and the interventional cardiology adult examinations below diagnostic reference level at 25±1%, respectively.Conclusions: The study used a systematic evidence-based approach for the assessment of national quality management systems in radiological practice in clinical application, technical conduct of the procedure, image quality criteria, and patient characteristics as part of the quality management programme.
Imaging of disease progression in a case of idiopathic moyamoya
Authors: Chacko A. , Smal J. , Lubbe E. , Adroos N.
Published: May 2014

Moyamoya is a rare cerebrovascular disease characterised by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. We report on the progression of the disease in a 3-year-old boy, confirmed to have idiopathic Moyamoya disease, over 6 ensuing years, using serial magnetic resonance imaging with MR angiography. Comparison is also made with conventional angiography at the last visit. Characteristic imaging appearances of asymmetric narrowing of the internal carotid arteries (especially the supra-clinoid portion) with numerous collateral vessels around the brainstem especially within the ambient and quadrigeminal plate cisterns are demonstrated with progression.
Obstetric ultrasound − its risks and the cost of addressing them
Authors: Howarth Graham Robert , Bown Stephanie
Published: May 2014

Until recently, obstetric claims (which are invariably high-value) used to be clustered around problems related to labour. However, a second group of high-value claims is emerging: those related to missed abnormaltities. The value of claims is now so high that a single individual is unable to compensate a claimant adequately, and indemnity is therefore essential. Although such claims are relatively rare, indemnity costs are high as the claims are large. The high value of obstetric claims, including those for missed abnormalities, is reflected in the cost of indemnity for obstetricians and those performing antenatal ultrasound.
Oncology imaging: Diagnosis
Authors: Misser S.K. , Royston D.D. , Heslop L.V.
Published: May 2014

No abstract available.
CPD questionnaire
Authors: Chacko Anith
Published: May 2014

No abstract available.
Multi-detector computed tomography radiation doses in the follow-up of paediatric neurosurgery patients in KwaZulu-Natal: A dosimetric audit
Authors: Sikwila Christopher T. , Amod Khatija , Cupido Brindley D. , Sabri Ali
Published: May 2014

Background: Multi-detector computed tomography (MDCT) is the preferred modality for follow-up of paediatric neurosurgery patients. Serial imaging, however, has the disadvantage of an ionising radiation burden, which may be mitigated using the ‘as low as reasonably achievable’ (ALARA) principle. Objectives: The primary objectives were to determine the radiation dose exposure in paediatric patients subjected to MDCT imaging following neurosurgery and to compare these values with references in current literature. Our secondary objective was to assess the relationship between radiation dose and clinical scenario.Method: Retrospective descriptive data were collected from all paediatric postsurgical patients (n = 169) between the ages of 0 and 12 years who had their first followed-up scan in the year 2010 and were followed up for six months or less. Dose-length product (DLP) and current-time product were collected from the picture archiving and communication system. Demographic data including radiology reports were collected from the hospital information system. The effective doses (ED) were calculated from the corresponding DLP using age-adjusted conversion factors. For purposes of comparison with other studies, median dosimetric values were calculated and the children were grouped into three age ranges, namely younger than 3 years, 3–7 years and 8–12 years old.Results: The highest median radiation doses were noted in patients being followed-up for intracranial abscesses (1183 mGy cm) in the 8–12 year age group, most of whom were female. The lowest radiation doses were for intracranial shunt follow-ups (447 mGy cm). Median values for DLP, ED and current-time product (mAs) were comparable to reference doses in all three age groups. However, our study showed a much broader distribution of values with higher upper limits relative to reference values. Indications for follow-up included shunts (n = 110; 65%), intracranial abscess (n = 31; 18%), subdural haematoma (n = 13; 8%) and tumour (n = 6; 4%). Head trauma only accounted for 5% of the cases.Conclusion: The median radiation doses measured were comparable to values in literature and therefore deemed acceptable. The wider dose distributions of all three dosimetric parameters (DLP, ED and mAs) were attributed to inappropriate use of scan length and reference effective mAs. Adherence to recommended scan length protocols should be encouraged. Evaluation of the current use of reference effective mAs is needed and will require a separate study to determine the smallest value that can be used without compromising image quality. Further dose reductions could be achieved by omission of unenhanced scans in the follow-up of intracranial abscesses. It is recommended that diagnostic reference levels specific to South African clinical scenarios be developed to make local dosimetric audits more relevant.
Head and neck imaging
Authors: Misser Shalendra K.
Published: May 2014

No abstract.
Radiofrequency ablation
Authors: Scholtz Leonie
Published: May 2014

No abstract available.
The storm of progress
Authors: Scholtz Leonie
Published: May 2014

No abstract available.
Vascular malformations Part 1 - normal and abnormal vascular development
Authors: Duncan Ian C.
Published: May 2014

No abstract available.
Bilateral low-density lesions in the internal capsule, with confirmed cryptococcus meningitis and CNS toxoplasmosis in immunocompromised patients
Authors: Lockhat Zarina , Van de Werke Irma , Van der Walt Betsie
Published: May 2014

No abstract available.
Large fibroadenoma mimicking malignancy
Authors: Smal Janet
Published: May 2014

No abstract available.
Is the routine use of intravenous contrast justified in the work-up of adult-onset seizure patients with a normal pre-contrast brain scan?
Authors: Stipp J. , Holl J. , Scholtz L.
Published: May 2014

The indications for the administration of intravenous contrast media to adult patients presenting with first time seizures and a normal pre-contrast study are not clear. A retrospective audit of such patients was done and compared with the post-contrast study. In our study sample of 205 patients all the post-contrast scans were reported as normal, indicating that contrast can be omitted if the precontrast study was normal. This only applies to computed tomography, and magnetic resonance imaging was not included.
Treatment optimisation using external beam radiation in gynaecological cancers
Authors: Sharma V. , Majeed U. , Joseph D. , Lindikile S. , Madhoo N. , Copelyn H. , Kotzen J. , Mohiuddin M. , Donde B. , Van der Merwe D.
Published: May 2014

The majority of patients with gynaecological cancers present with advanced stages in which external beam radiation forms a major component of the treatment. These patients undergo simulation for treatment planning prior to radiation. Currently the lower extent of the disease is evaluated by vaginal examination and marked using a lead wire on the anterior abdominal wall in the pelvic region. A 2 cm margin inferior to this level is used as the lower border of the treatment field. The suggested modified technique includes the placement of an indigenously designed perspex vaginal obturator with graduations at 1 cm distance from its tip. Following vaginal examination the obturator can be inserted into the vagina and fixed at the predefined length using a fixation device. The radio-opaque markers can be seen even in the lateral films. Twentyfive consecutive patients underwent the procedure and the differences between the two methods of marking the lower border were calculated. The external lead wire was inferior to the internal obturator in 19 patients (76%) ranging from 0.5 cm to 3 cm (median 1.5 cm, mean 1.37 cm). It was at the same level in 4 patients (16%) and 1 cm superior to the internal obturator in 2 (8%). With the modified technique using the internal obturator application for delineating the lower border of vaginal disease or vault, it was possible to decrease the length of field thereby reducing the chances of treatment-related toxicity, especially groin and vulval reactions, as well as avoiding treatment interruptions.
Pulmonary artery aneurysm
Authors: Misser S.K. , Maharajh J.M.
Published: May 2014

No abstract available.
Comparison of sonourethrography and retrograde urethrography in the evaluation of anterior urethral strictures
Authors: Khan N. , Modishi H.M , Tsatsi L.D.R. , Kahloon A. , Segone A.
Published: May 2014

Radiographic retrograde urethrography (RUG) has traditionally been the preferred technique used by urologists to image the anterior urethra. Since originally described by McAninch et aL in 1988, ultrasonic imaging of the urethra has evolved into a powerful and clinically useful tool for the accurate delineation of urethral pathology. However the posterior urethra cannot be assessed reliably using this technique. Sonourethrography has proved to be more accurate than conventional radiographic urethrography in measuring stricture length throughout the anterior urethra. The objective and purpose of this study was to assess the efficacy of sonourethrography in the evaluation of anterior urethral strictures and also to explain its many advantages over traditional imaging technique.
A case of bilateral persistent sciatic arteries
Authors: Boroto K. , Scheepers P.A. , Khan N.
Published: May 2014

No abstract available.
A case of idiopathic hypertrophic pachymeningitis
Authors: Minné C. , Khan N.
Published: May 2014

No abstract available.
A case of popliteal artery entrapment
Authors: Scheepers P.A. , Khan N. , Vermeulen W.J.N
Published: May 2014

No abstract available.
Hypertensive encephalopathy with CT confirmatin in four children with acute renal disease
Authors: Andronikou S. , Patel M. , Sinclair P. , McCulloch M
Published: May 2014

Hypertensive encephalopathy (HE) isa clinical syndrome that occurs infrequentlyin children and is oftenunderdiagnosed. We review fourpatients with HE and describe theirclinical presentation and radiologicalfindings on computed tomography(CT). Our cases demonstrate typicalfeatures on CT and correlate clinicallywith the syndrome of HE. Promptrecognition of the syndrome aids inearlier diagnosis and treatment, andhence proves beneficial to the patient.
CT and MRI findings in Lhermitte-Duclos disease
Authors: Bayat M.R.H. , Sarawan J,
Published: May 2014

Lhermitte-Duclos disease (LDD) is arare cerebellar lesion of uncertain origin.It is linked to an autosomal- dominantphakomatosis known asCowden’s disease in 40% of patients.The MRI features of LDD are almostunique and can be considered diagnostic.We report on a patient whopresented with the typical MRI featuresof the above disease, and discussthe imaging features, pathology andgenetics.
The hyperdense middle cerebral artery sign in a polycythaemic child
Authors: Douis H. , Andronikou S. , Jadwat J.
Published: May 2014

No abstract available.