The accuracy of ultrasonography in the diagnosis of breast pathology in symptomatic women.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of total cancer cases and 14% of cancer deaths worldwide. The developing countries are catching up with this trend. Breast ultrasound when properly performed and interpreted, is an indispensable tool in breast imaging. The early diagnosis and treatment of breast masses reduces the morbidity and mortality associated with delayed diagnosis of breast carcinoma. The use of breast ultrasound is gaining ground in recent time, this is due to current advances in ultrasound technology which permit greater spatial and contrast resolution and shortened scan time. OBJECTIVE: To determine the sensitivity, specificity and positive predictive value of ultrasound in the detection of palpable breast masses and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology, or histopathology. METHODS: Breast ultrasound scanning was done in 100 patients with signs and symptoms of breast lesion referred from the Surgical out Patient Clinic to the Radiodiagnosis Department of Lagos University Teaching Hospital (LUTH). Histology reports were collected from either the case note or Morbid Anatomy department to correlate the findings with ultrasound diagnosis. RESULTS: The mean age was 41.7 +/- 11.34 (18-59) years. Symptoms of breast lesion were highest in the age group 41-50 years 38 (38%), and least in 18-20 years 4 (4%). When the use of ultrasonography was compared with the histopathology report in the diagnosis of breast lesion in the studied population, the sensitivity was 100%, specificity (96.6%), accuracy (97%), posting predictive value (PPV) 81.3%, and negative predictive value (NPV) 100%. The accuracy, specificity and PPV however decreased with increasing age. CONCLUSION: Ultrasonography of the breast is useful in the diagnosis of breast lesions, because of the high sensitivity, specificity and diagnostic value it exhibited with histopathologic findings.

Duplex ultrasonographic findings in patients with suspected DVT.

OBJECTIVES: To highlight the usefulness of duplex ultrasonography in assessing patients with clinical features suggestive of DVT in this environment. PATIENTS AND METHODS: A total of seventy patients (44 males and 26 females, aged 15-85 years) with a clinical diagnosis of deep venous thrombosis (DVT) were seen between September 2005 and September 2007 in the Radiodiagnosis Department of the Lagos University Teaching Hospital, and a private Multi-specialist hospital both in Lagos, Nigeria. They had bilateral lower extremity venous duplex ultrasonographic examination performed on them. The common femoral vein, superficial femoral vein, proximal deep femoral vein, proximal greater saphenous vein, popliteal vein and posterior tibial veins were evaluated with compression sonography in the transverse plane. Grey scale, colour and pulsed Doppler imaging of the venous segments were observed. RESULTS: The sonographic abnormalities observed included frozen valves, venous reflux, venous dilatation with echogenic thrombus, absence of Doppler signals and narrowed, thick walled veins. It was observed that 30 (42.3%) patients had acute DVT, 11 (15.7%) had chronic venous disease (CVD), while 10 (14.3%) had incompetence of the superficial venous system. Acute DVT was the commonest pathology observed. CONCLUSION: Duplex ultrasonography should be performed on all patients with a clinical diagnosis of DVT in order to rule out other differential diagnoses.

Medical audit of diagnostic mammographic examination at the lagos university teaching hospital (luth), Nigeria.

PURPOSE: We studied the performance of diagnostic mammography in predicting malignancy among patients presenting with signs and symptoms of malignancy. MATERIALS AND METHODS: 310 patients who presented to the surgical out-patients of the Lagos University Teaching Hospital with signs and symptoms of breast cancer, between January 2002 and December 2003 had mammographic evaluation with a dedicated mammography unit. The mammographic appearances were prospectively classified using the BI-RADS assessment categorisation, and histological confirmation following surgical excision was correlated with mammography. RESULTS: The overall sensitivity of mammography in the study was 82.8% (CI 78.6 - 87%) while specificity, Positive predictive value (PPV) and accuracy were 90.7% (CI 87.5-93.9%), 69.97% (CI 46.6 - 74.8%), and 89% (CI 85.5-92.5%) respectively. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased. CONCLUSION: Diagnostic mammography is useful in characterising breast lesions. This study analyses the performance of mammography and shows that the resultant specificity is high, however it may have to be used in conjunction with needle biopsy to achieve improve sensitivity and avoid unnecessary benign surgical biopsies.

Isolated dextrogastria: a case report.

BACKGROUND: Isolated dextrogastria is a rare congenital anomaly in which the stomach is right-sided while the intestines, the organs in the chest, and the other organs in the abdomen are in normal situs. The importance of recognising the spectrum of situs anomalies is because the altered anatomy associated with these anomalies may result in misdiagnosis. OBJECTIVE: To report a case of isolated dextrogastria in an 18-year old woman who was seen during pre-university admission medical examination. METHODS: The routine chest X-ray of a young woman as a part of pre-admission medical examination showed the gastric air bubble under the right diaphragm rather than on the left. She was then subjected to further clinical and radiological evaluation. FINDINGS: The personal, past and family histories were uneventful as was the physical examination. Trans-abdominal ultrasonography showed a normal-sized and a normally sited liver in the right hypochondrium with normal gall bladder, and normally sited left and right lobes of the liver. The liver echo pattern was normal. The stomach was found below the lower border of the right lobe of the liver. The kidneys and the spleen were normal in number, position, size and architectural pattern. A barium meal showed a well-defined and a well developed stomach with a reverse J shape and duodenal C loop that was reversed in shape. CONCLUSION: The practice of the radiographer is always placing the marker before exposing the film instead of marking the radiograph after processing, which is the key to accurate identification of situs anomalies need emphasis.

Isolated dextrocardia with bilateral undescended testis and bilateral polydactyl of the hands and feet: a case report.

The incidence of dextrocardia with or without situs inversus is rare though the true incidence in Nigeria is not known. Plain films are the preliminary investigations of choice in diagnosis of situs anomalies. The aim of this case report is to emphasise the importance of recognition of the spectrum of situs anomalies, because the altered anatomy associated with these anomalies may result in confusing imaging findings, misdiagnosis and difficulties with treatment when seen in conjunction with acquired abnormalities of the chest and abdomen. This study also aim to emphasise the need for accurate placement of radiographic markers by the radiographers before exposure of the films as the key for identification of situs anomalies. The case of dextrocardia without situs inversus diagnosed in a 4-month old baby boy who also had bilateral undescended testis and bilateral polydactyl of hands and feet is presented. The imaging modalities for assessment of situs anomalies are discussed.

Fibular hemimelia: a case report.

Fibular hemimelia is the congenital absence of the fibula and it is the most common congenital absence of long bone of the extremities. Shortening of the extremity is obvious at birth with leg-length discrepancy. On plain radiograph of the leg and foot, significant fibular deficiency (hypoplasia) or absence of the fibula can be seen. In this case report, a 6-month-old baby boy with fibular hemimelia is presented. The radiological diagnosis and differential diagnosis are discussed. The treatments which include repeated corrective osteotomies and leg-lengthening surgery are costly and associated with residual deformity.

Safety Awareness in Selected X-ray Diagnostic Centres in Surulere and Ikeja Local Government Areas of Lagos State; Nigeria

Background: Health hazards are associated with exposure to ionizing radiations such as x-rays. Many private x-ray diagnostic clinics in Lagos State operate with inadequate safety and protection devices; which make the conditions unsafe to patient and environment. Objective: To assess the working conditions; protection measures put in place; safety awareness and attitudes of both employees and employers to safety and protection in radiodiagnostic centers in Surulere and Ikeja Local Government Areas.Methodology: Questionnaires were used for collecting information on socio-demographic data; occupational history; activities; working conditions; knowledge and experience of radiation hazards in x-ray centers. Interviews were conducted with Heads of Departments and Radiologists using the checklist adapted from the International Atomic Energy AgencyResults: 88.9 of the participating centers had adequate space and some safety assessment performed prior to installation of the facility. 81.5 had few basic protection devices. Only 40.7employed adequate and qualified staff while 25.9 provided personnel training and 22.2 had quality control programme. 14.8 had radiation protection programme. 60.2of respondents were aware of health hazards associated with radiation exposures; 57.8 of which were males. Conclusion : Operation conditions in most private diagnostic centers are below standard due to grossly inadequate provision of safety and protection devices. Employment of qualified staff and continuous education need be emphasized and enforced

Role of computed tomography in the management of adult brain tumours.

BACKGROUND: Neuroradiologic imaging has revolutionised the management of brain tumours through precise presurgery diagnosis and accurate definition of the extent of disease. This report attempts to evaluate our five years of clinical experience with intracranial CT scanning in the management of adult brain tumours. MATERIALS AND METHODS: The study included 160 adults with demonstrable brain tumours on CT imaging between 1997 and 2001. Surgical confirmation and histologic typings were recorded. All CT scans were carried out on Siemens Somatom AR.T scanner. A complete CT examination includes pre- and post-contrast examination done at 5 to 10 mm slice thickness and 10 mm interval from the base of skull to the vertex. All scans were viewed and documented in soft tissue and bone windows and multiplanar reconstruction appropriate for optimum visualisation of the areas of interest. All CT scans of the study population were analysed by age, sex, symptomatology, type and location of tumour. RESULTS: There were 92 males and 68 females with a mean age of 48 +/- 0.68 years. Headache accounted for 41.2% of the presenting symptoms while cerebral hemispheric tumours are more frequently (60.6% ) encountered. Gliomas are the commonest group (68.8% ). CONCLUSION: CT examination has improved the management of patients with brain tumours in our teaching hospital and will continue to remain the mainstream neuroradiologic imaging technique for a very long time.

Comparison of the accuracy of trans-abdominal sonography (TAS) and transperineal sonography (TPS) in the diagnosis of Placenta Praevia.

BACKGROUND: Although the incidence of Placenta Praevia (PP) is low, its association with increased perinatal and maternal morbidity and mortality underscores the imperative of accurate pre-labour diagnosis. OBJECTIVE: To compare through a prospective study, the accuracy, sensitivity and specificity of Trans-Abdominal Sonography (TAS) and Trans-Perineal Sonography (TPS) in the diagnosis of Placenta Praevia and to determine the causes, if any, of avoidable diagnostic errors. METHODS: During the study period from 1999 to 2001, 133 patients were evaluated by TAS and TPS. The age ranged from 19-41 years while the gestational age ranged from 20-weeks to term. All had examination with 3.5 MHz mechanical sector real-time scanner (Siemens high-resolution Sonoline SL-1 ultrasound machine). The accuracy of TAS and TPS in diagnosing PP was then compared with surgical outcome in each patient. RESULTS: Out of the 133 patients diagnosed to have PP early on in pregnancy, 41 (30.8%) had persistent praevia till delivery, while in 92 (69.2%), the placenta converted to a normal location. The diagnosis at delivery confirmed the TPS diagnosis in 40 of 41 cases, while TAS diagnosis was confirmed in 39 of 41. TPS did not predict the delivery diagnosis in 1 patient where it ruled out a PP, TAS did not predict the delivery diagnosis in 2 patients who were believed not to have a clinically significant placenta praevia. In 1 patient TAS suggested PP but delivery diagnosis showed a normal placental implantation. The overall accuracy, specificity and sensitivity for TPS and TAS were 99.3%, 100%, 99.2% and 97.7%, 98.9%, and 95.1% respectively. CONCLUSION: TPS is a safe, accurate and rapid technique, which complement TAS for evaluation of patients with PP. In patients who decline this method however, graded bladder distension, Trendelenburg and traction scanning and determination of the absence of focal uterine contraction, which distorts the lower uterine segment, are techniques, which significantly improve the diagnosis of PP by TAS.

Informed consent: the radiologist administering radiological contrast media

This study represents the understanding and practice of radiologists in Nigeria in obtaining informed consent from patients before administering radiological contrast media. 120 questionnaires were sent to radiologists practicing in Nigeria. 78(65%) responded, 60(76.9%) of the respondents understood informed consent to mean informing a patient about a procedure and obtaining consent to carry out the procedure. Whereas for consent to be informed it must include the nature of the procedure, purpose, risks and benefits. 52(66.7%) obtained either written or verbal consent while 26(33.3%) neither informed patient nor obtained consent. However, all respondents understood that failure to obtain consent may result in possible litigation by patient or relative while 69(88.5%) requested for a specific policy regarding informed consent. It is concluded that the radiologist in Nigeria does not fully understand the concept of informed consent. A specific policy should be made by the appropriate professional body in Nigeria as to what constitutes the requirements of a truly informed consent since there are simply no guidelines for now. Also informed consent forms, simple enough for patients to understand should be designed. These will assist the individual specialist in the conduct of their practice

Melorheostosis of Leri: report of a case in a young African.

UNLABELLED: Melorheostosis of Leri is a non-familial condition of hyperostosis of the cortical bone that usually presents unilaterally in long bones of the upper and lower limbs, but may also present in vertebra, ribs, skull and jaw. The incidence of this disease is quite rare, only about 300 cases have been reported worldwide. We present a case, which may be the first documented case in sub-Saharan Africa. CLINICAL PRESENTATION: S.K. is a 14 year old male student who presented to the hospital with an 18 month history of persistent pain in the joints of the right upper limb and a limb length discrepancy since birth which has worsened with growth. Examination revealed generalised hypoplasia of the right upper limb with shortening of the limb and atrophy of the muscles, also hypoplasia and contracture of the thumb was observed. The radiographs of the limb showed multiple areas of dense hyperostosis and scleroderma, which showed a linear distribution along the radial half of the bones. CONCLUSION: In children presentation of melorheostosis, is more likely be as limb length discrepancy, deformity or joint contractures which may be seen before radiographic evidence of any bony changes. Improvement in imaging techniques will therefore result in early diagnosis and greater success with conservative management. Also the increased frequency of tumours necessitates long-term follow up. KEYWORDS: melorheostosis, scleroderma.