Pattern of chest computerized tomography scan findings in symptomatic RT-PCR positive COVID-19 patients at the Korle Bu Teaching Hospital, Ghana

Background: Chest Computerized Tomography (CT) features of Corona Virus Disease 2019 (COVID-19) pneumonia are nonspecific, variable and sensitive in detecting early lung disease. Hence its usefulness in triaging in resource-limited regions. Objectives: To assess the pattern of chest CT scan findings of symptomatic COVID-19 patients confirmed by a positive RTPCR in Ghana. Methods: This study retrospectively reviewed chest CT images of 145 symptomatic RT-PCR positive COVID-19 patients examined at the Radiology Department of the Korle Bu Teaching Hospital (KBTH) from 8th April to 30th November 2020. Chi-Squared test was used to determine associations among variables. Statistical significance was specified at p≤0.05. Results: Males represent 73(50.3%). The mean age was 54.15±18.09 years. The age range was 5 months-90 years. Consolidation 88(60.7%), ground glass opacities (GGO) 78(53.8%) and crazy paving 43(29.7%) were the most predominant features. These features were most frequent in the elderly (≥65years). Posterobasal, peripheral and multilobe disease were found bilaterally. The most common comorbidities were hypertension 72(49.7%) and diabetes mellitus 42(29.2%) which had significant association with lobar involvement above 50%. Conclusion: The most predominant Chest CT scan features of COVID-19 pneumonia were GGO, consolidation with air bronchograms, crazy paving, and bilateral multilobe lung disease in peripheral and posterior basal distribution

Alvarado score and computerized tomography scan as impact indicator in intervening negative appendectomy rate

Background: The objective of this study is to study the impact of combined use of Alvarado score and computed tomography (CT) scan on negative appendectomy rate.Methods: This prospective observational study comprising of patients presenting with clinical features of appendicitis admitted to department of general surgery, VIMSAR, Burla from November 2017 to October 2019, where Alvarado score and ultrasonography (USG) findings are mismatching each other. Alvarado scores calculated and categorized in 2 groups as negative (score <4) and positive (score ≥4). These patients were also subjected to USG and categorized as negative (USG -ve) and positive (USG +ve). Those patients having discrepancy in both the findings were subjected to CT scan. On histopathological examination, inflamed appendix in 63 (97%) patients and non-inflamed in 2 (3%). Rest patients were either discharged (both -ve) or operated (both +ve). Results: Total 84 patients showed discrepancy between Alvarado score and USG findings and are subjected to CT scan abdomen and pelvis. CT scan was positive for appendicitis in 65 cases (where appendectomy done) and negative for appendicitis in 19 cases (where the diagnosis is different). patient. Thus, negative appendectomy (NAR) is 3% in this study.Conclusions: Alvarado score and ultrasonography could not be used as absolute tool in doubtful and equivocal cases, where combined use of CT scan with Alvarado score and USG has definitely has an edge by diagnosing the differentials and reducing NAR followed by reduction in cost and length of hospital stay.

Comparison of Imagiology with Operative Findings in a Case of Intestinal Obstruction

Introduction: The diagnosis of intestinal obstruction is a team work of radiologist and clinician. Acute abdominal conditionsrequire precise radiological diagnosis to achieve excellent results to reduce morbidity and mortality.Aims and Objectives: This study aims to study the various radiographical, ultrasonographic, and contrast-enhancedcomputerized tomography (CECT) findings associated with intestinal obstruction and to study the various causes of intestinalobstruction.Methodology: A prospective study of 50 patients admitted to the Mahatma Gandhi Memorial (MGM) Hospital, Warangal, duringthe period of November 2017–September 2019 with the diagnosis of intestinal obstruction.Results: A clinical study of 50 cases of intestinal obstruction was done at Osmania hospital at Hyderabad during November2017–September 2019. Intestinal obstruction whether in small bowel or large bowel occurs nearly in equal ratio in both sexes.Conclusion: Intestinal obstruction remains still a common and important surgical emergency. Obstruction due to adhesionsincreasing in incidence due to increased abdominal and pelvic surgeries. X-ray erect abdomen and ultrasonography abdomenare able to diagnose intestinal obstruction, but CECT has more sensitivity and specificity in diagnosing the intestinal obstruction.It also helps in the management of the intestinal obstruction.

Fractura de cuello femoral en trauma de alta energía: ¿podemos confiar en la tomografía computarizada multicorte? caso clínico / High energy femoral neck fracture: can we trust the computerized tomography scan? case report

Las fracturas asociadas de diáfisis y cuello femoral son lesiones infrecuentes. A pesar de ser una asociación conocida, es pasada por alto entre un 19-31% de las veces. A continuación presentamos un caso de una fractura de diáfisis femoral en la cual la tomografía computarizada inicial no evidenció ningún rasgo a nivel del cuello femoral; sin embargo, este rasgo se hizo presente en las imágenes de control. Existen diversos exámenes para reconocer las fracturas de cuello femoral asociadas a diáfisis femoral, como la radiografía y la tomografía computarizada. Sin embargo, a pesar de estas imágenes, pueden no ser diagnosticadas. Con este caso reafirmamos la necesidad del uso de imágenes preoperatorias e intraoperatorias en pacientes con fracturas de diáfisis femoral de alta energía y que la tomografía computarizada multicorte de ingreso puede no evidenciar fracturas mínimamente desplazadas del cuello femoral.

Simultaneous fractures of the neck and shaft of the femur are uncommon injuries. Despite it being a known combination, it is overlooked in between 19 and 31% of cases. This case report describes a femoral shaft fracture in which the initial computed tomography did not show the femoral neck fracture, although it was present in the follow-up images. There are different imaging techniques to recognise femoral neck fractures associated with femoral shaft fractures, such as radiography and computed tomography. However, despite these images, they cannot be diagnosed. This case re-affirms the need for using imaging techniques before and during the operation in patients presenting with high energy femoral shaft fractures, in order to look for an associated femoral neck fracture. Although the use of fine-cut computed tomography scan may improve the diagnostic accuracy of this test, some femoral neck fractures will still go under-diagnosed.

Primary hepatic neuroendocrine tumor: An unusual cystic presentation.

Primary neuroendocrine tumors of the liver are exceedingly rare and unlike metastatic neuroendocrine tumor rarely cause carcinoid syndrome. There are only about 60 such cases reported in the current literature. We present a case of a 57-year-old male with a primary hepatic neuroendocrine tumor which presented as cystic mass and successfully resected. The case presented required meticulous radiological, histopathological, and immunohistochemical work-up to rule out an occult extrahepatic malignancy with hepatic metastasis to confirm the primary nature of hepatic tumors. Here we intend to put forward a review of the current literature regarding the diagnosis, pathology, and management of this disease.

Evaluation of extensions of sinonasal mass lesions by computerized tomography scan.

Introduction : Cross-sectional imaging has had a significant impact on the management of the sinonasal malignancy. Staging of these lesions has been closely monitored by dependence on computerized tomography (CT) scan and now in small proportion with MRI. The objective of the study was to evaluate the reliability of CT scan in assessing the extensions of the sinonasal mass lesions and their impact on tumor staging. Materials and Methods : All cases of sinonasal lesions were reviewed retrospectively from June 2001 to May 2006 (five years) at KMIO, Bangalore. Only those cases that had CT scan reports and Histopatholgy Examination (HPE) reports were included in the study. All the cases, which were subjected to radiotherapy prior to surgery, were excluded from the study. There were a total of 38 cases with slight male preponderance. Tumor staging was done according to the sixth edition of TNM classification of malignant tumors. Two observers evaluated all the cases (Blinded Study) and sensitivity, specificity, positive predictive value, negative predictive value and predictive accuracy were estimated. Results : The relation between the CT scan findings and HPE reports was high. Though false positivity was noted more in the ethmoid sinuses, significant impact on tumor staging was noted with false positivity of the nasopharynx. Also, false positivity was noted with orbital wall/content extensions, resulting in unnecessary exenterations of the orbit. However, CT scan reliably predicted infratemporal fossa extension in the absence of trismus. False negativity was noted more often in soft palate, indicating the need of using MRI for delineation of tumor extension. Thus, we conclude that judicious use of CT scan in all cases and MRI in selected cases will translate into better tumor-free resections and improves survival.

A Study on the Incidence and Patterns of Early and Late Seizures after Head Injury

Post-traumatic seizure is a known consequence of head trauma and a major public problem. But the surveillance study of this problem in our country is very rate. The purpose of the current study was to determine the incidence, clinical patterns and the outcome of the post-traumatic seizure in our institute. A retrospective review of management in 5053 patients with head injury was performed in our department between 1983 and 1992. In our series, the frequency of post-traumatic epilepsy was 254 patients, giving 1 5.0% incidence rate(early seizure occurred in 2.2% and late seizure occurred in 2.8% of patients). Of these, the records of 203 patients who received follow-up care for at least 2 years was reviewed. The first early epileptic attack occurred within 24 hours of injury in one third of the cases(33.3%), and the first late epileptic attack occurred within 1 year was about two thirds of the cases(64.6%). On CT scan findings, the early epilepsy had a higher incidence in scans that showed diffuse brain swelli ng and the late epilepsy had a higher incidence in subdural and intracerebral hematoma. 57.5% of early seizure were focal type, and 55.2% of late seizure were generalized convulsive seizure. The outcome of severe head injury patients with early seizure was better than that of late seizure group. The severity of head injury was related to the occurrence of late post-traumatic seizure.Development of new antiepileptic drugs, increasing knowledge of preventing post-traumatic sequelae and demand for surgical treatments have allowed the reduction of the incidence of the post-traumatic seizures. But further survey or study is recommanded in order to achieve more improvement in the management of post-traumatic seizures.

Clinical Analysis of Posterior Fossa Tumors

We have experienced 56 cases of posterior fossa tumors which were diagnosed with clinical symptoms, angiography, brain computerized tomography scan and/or operative and pathologic findings at the department of neurosurgery of Catholic University Medical College from January 1983 to December 1987. The results were summarized as follows: 1) Cerebellar astrocytomas were the most common posterior fossa tumors(21%). 2) The male to female ratio of posterior fossa tumors was equal. The astrocytoma and hemangioblastoma were frequent in male, but brain stem glioma, acoustic neuroma and meningioma were more frequent in female. 3) The posterior fossa tumors were more frequent in younger persons. 4) The most common duration symptoms were within 3 months(39%) and the common clinical features were headache(73%), nausea and vomiting(48%). In neurological examination, cerebellar signs were present in most cases(63%). 5) In brain computerized tomography scan, low density(46%) and contrast enhancement(63%) were common features and in vertebral angiography, mass effect(93%) in posterior fossa tumors. 6) The most postrior fossa tumors showed relatively good prognosis(61%) but mortality rate was high(30%).

Clinical Analysis of Posterior Fossa Tumors

We have experienced 56 cases of posterior fossa tumors which were diagnosed with clinical symptoms, angiography, brain computerized tomography scan and/or operative and pathologic findings at the department of neurosurgery of Catholic University Medical College from January 1983 to December 1987. The results were summarized as follows: 1) Cerebellar astrocytomas were the most common posterior fossa tumors(21%). 2) The male to female ratio of posterior fossa tumors was equal. The astrocytoma and hemangioblastoma were frequent in male, but brain stem glioma, acoustic neuroma and meningioma were more frequent in female. 3) The posterior fossa tumors were more frequent in younger persons. 4) The most common duration symptoms were within 3 months(39%) and the common clinical features were headache(73%), nausea and vomiting(48%). In neurological examination, cerebellar signs were present in most cases(63%). 5) In brain computerized tomography scan, low density(46%) and contrast enhancement(63%) were common features and in vertebral angiography, mass effect(93%) in posterior fossa tumors. 6) The most postrior fossa tumors showed relatively good prognosis(61%) but mortality rate was high(30%).