Profil échographique des nodules thyroïdiens au centre hospitalouniversitaire de Bouaké (Cote d'ivoire) / Ultrasound Profile of thyroid spheres at the University Hospital of Bouaké (Côte d'Ivoire)

Introduction : l'échographie est l'examen de première intention dans l'exploration morphologique de la thyroïde. Elle constitue un excellent outil diagnostique et pronostique dans les thyropathies nodulaires. Objectif : déterminer le profil des nodules thyroïdiens à l'échographie selon la classification EU-TIRADS. Matériel et méthodes : étude transversale descriptive réalisée dans le service de radiologie du CHU de Bouaké durant une année. Nous avons inclus tous les comptes rendus d'échographie thyroïdienne des patients ayant des nodules thyroïdiens. Les données ont été analysées à l'aide du logiciel Epi Info 7. Résultats : Au total, 60 patients présentaient des nodules sur 97 reçus pour thyropathies soit 60,8%. L'âge moyen était de 45,6 ans [13-82 ans]. Legenre féminin prédominait avec 82,7%. La tuméfaction cervicale antérieure était la principale indication dans 72%. Le volume thyroïdien était augmenté chez 63%des patients avec un volume moyen de 71 cm3. Il s'agissait de nodule solitaire dans 46,55%. Les nodules spongiformes prédominaient dans 32%. Les nodules étaient solides dans 29,8% et mixtes dans 16,5.%. L'hypo-échogénicité était retrouvée dans 44,8% des cas de nodules solides. Les lésions étaient classées EU-TIRADS 2 dans 58,8%, EU-TIRADS 3 dans 23,5%, EU-TIRADS 4 dans 14,7% et EU-TIRADS 5 dans 2,9%. Conclusion : la caractérisation et la classification des nodules thyroïdiens constituent une étape importante pour la prise en charge des patients. Ces nodules dans notre étude sont essentiellement d'allure bénigne (EU-TIRADS 2 et 3) avec une prédominance féminine. Un arbre décisionnel tenant compte des éléments cliniques et cytopathologiques servirait davantage pour d'éventuelles chirurgies.

Introduction: Ultrasound is the first-line examination in the morphological exploration of the thyroid. It is an excellent diagnostic and prognostic tool in nodular thyropathy. Objective: to determine the profile of thyroid nodules on ultrasound according to the EU-TIRADS classification. Material and methods: descriptive cross-sectional study carried out in the radiology department of the University Hospital of Bouaké during one year. We included all thyroid ultrasound reports of patients with thyroid nodules. Data were analysed using Epi Info 7 software. Results: A total of 60 patients had nodules out of 97 referred for thyropathy (60.8%). The mean age was 45.6 years [13-82 years]. Females predominated with 82.7%. Anterior cervical swelling was the main indication in 72%. Thyroid volume was increased in 63% of patients with a mean volume of 71 cm3. Solitary nodules were present in 46.55%. Spongiform nodules were predominant in 32%. The nodules were solid in 29.8% and mixed in 16.5%. Hypoechogenicity was found in 44.8% of solid nodules. Lesions were classified as EU-TIRADS 2 in 58.8%, EU-TIRADS 3 in 23.5%, EU-TIRADS 4 in 14.7% and EU-TIRADS 5 in 2.9%. Conclusion: The characterisation and classification of thyroid nodules is an important step in the management of patients. In our study, these nodules are essentially benign (EU-TIRADS 2 and 3) with a female predominance. A decision tree taking into account the clinical and cytopathological elements would be more useful for possible surgery.

Point-of-care utrasound use over six-month training period in Rwandan district hospitals

Introduction: Point-of-care ultrasound (POCUS) is an effective diagnostic technology in resource-limited settings. There is increasing interest in introducing ultrasound training in such environments, but few reports describing long-term follow-up and impact of a POCUS program in a resource-limited setting. We introduced a POCUS program in Rwanda, and sought to determine the number and type of ultrasounds performed, the impact of a remote quality assurance (QA) program, and the effect of POCUS on patient management. Methods: Seventeen Rwandan physicians underwent a ten-day training course in POCUS in Kigali, Rwanda. Post-course, participants tracked the ultrasounds they performed using a cloud-based storage system, recorded clinical impressions,and received periodic QA with on-site proctoring over a six-month follow-up. Remote QA to evaluate image quality was performed by five emergency ultrasound fellowshiptrained clinicians. Images were graded on a scale of 0­4. (0=no meaningful image, 2= adequate, 4= outstanding). Trainees also documented how POCUS changed clinical management. Results: Over six months, 1158 ultrasounds were performed and logged by fifteen participants at eleven regional hospitals. 590(50.9%) had matched images and interpretations available for review. Abdominal ultrasound was the most frequently performed application (19.7%), followed by liver (14.6%), obstetrics (14.5%), renal (12.4%),and spleen (11%). Across all applications, the mean score was 2.5 (SD± 0.11, 95% confidence interval, 2.39­2.54). Ultrasound result in a management change in 84% of cases. Major changes in management related to medication choice (42.4%), admission (30%), transfer to a higher level of care (28.1%), and performance of procedures (23.3%). Conclusions: During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51% of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its accuracy. This study was designed to ascertain the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children. Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi-Araba, Lagos, over a 12 month period was performed. The pre-operative clinical and ultrasound findings were compared with the findings on surgical exploration. Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11 years). Forty-six (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasound evaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specificity of 33.3%, PPV of 95.7% and a NPV of 16.7%. Conclusion: Ultrasound assessment is beneficial in pre-operative evaluation of children with undescended testes

Ultrasound in diagnosis of hepatic pathologies a review of two years experience in university of Nigeria teaching hospital; Enugu; Nigeria

We have tried to evaluate the diagnostic yield of abdominal sonology for detection of liver pathologies by reviewing the ultrasonic findings in our department over a period of two years. Analysis of 879 patients that underwent abdominal sonography between 2001 and 2002 revealed relative incidences of liver; renal; splenic; pancreatic and cholecystic pathologies. 43 cases out of those clinically suspected to have pathology related to liver; were ultrasonically negative. Evaluation of the 289 patients with positive ultrasound findings for liver pathology revealed that 46

Diagnosis of unilateral single system ectopic ureter in girls in the era of magnetic resonance urography (MRU)

Objective: The ectopic ureter frequently drains an ectopic dysplastic or hypoplastic kidney. The present study aims at defining the role of MRU in establishing the diagnosis of this anomaly. Patients and Methods: Between February 1996 and March 2000; 11 girls presented or were referred to our department for management of urinary incontinence. Their age at presentation ranged from 4-9 years (mean 6.5 years). Radiological work up included abdominal ultrasound (US); excretory urogram (IVU); voiding cystourethrography (VCUG); 99 m technetium-dimercaptosuccinic acid (99m Tc-DMSA) renal scan; enhanced spiral computed tomography (CT) and magnetic resonance urography (MRU). Results: Ultrasound showed evidence of a solitary kidney with failure to visualize a contralateral kidney in 7/11 patients. In the remaining 4 patients (36.4); US revealed a pelvic kidney in two and a pelvic cystic mass in another two patients. IVU revealed only one functioning renal unit in all cases. None of the patients showed vesicoureteral reflux on VCUG. On 99m Tc-DMSA ; a single kidney was seen in 9/11 patients and ectopic pelvic kidneys with normal contralateral kidneys in 2/11 patients. The 7 patients; in whom US and 99m Tc-DMSA scan had failed to localize the kidney; underwent CT scanning which visualized a pelvic hypoplastic kidney with a normal contralateral kidney in 2/7 patients. The remaining 5 patients underwent MRU that disclosed a normal kidney with a contralateral lumbar hypoplastic kidney in one and a pelvic ectopic kidney in four. The patients were managed by nephrectomy (n=9) and ureteroneocystostomy (n=2). Conclusions: A single system ectopic ureter should be suspected in all girls with continuous urinary dribbling after the age of successful toilet training. With the inclusion of MRU into radiological workup; dysplastic or hypoplastic kidneys can be accurately localized. MRU is indicated for the diagnosis and for therapeutic planning in such cases

The use of ultrasound in the management of bells's palsy: case studies

Four cases of bell's palsy were managed using low intensity continous ultrasonic energy. Two cases reported for treament within two weeks of the onset; one case within one week of onset while the last case was about six months old. Average of five treatments were given over a two week period; using 0.5 -0.8 watts/cm2 for five minutes over the mestoid process region. Feldene gel was used as couplant. All cases recovered spontaneously