Polyhydramnios: a warning sign in the prenatal ultrasound diagnosis of foetal malformation?

PURPOSE: To propose polyhydramnios seen during prenatal diagnosis as a warning sign of foetal malformation. PATIENTS AND METHODS: A retrospective multicentre study over a three-year period carried out in Ivory Coast and Burkina Faso. We reviewed 3903 obstetric ultrasound reports. All cases of foetal malformation and polyhydramnios were counted. The instances of foetal malformation associated with polyhydramnios were compared to those of foetal malformation without polyhydramnios and to polyhydramnios only. RESULTS: A list of 72 cases of polyhydramnios was made (equating to 1.8%). In 55 cases (76.4%), polyhydramnios was combined with foetal malformation. These were lethal abnormalities in 33 cases and non-lethal in 22 cases. In 17 cases, polyhydramnios was not associated with any foetal malformations and in eight cases, foetal malformation was discovered in the absence of polyhydramnios. Polyhydramnios had a positive predictive value of 76.4% for the presence of foetal malformation. The negative predictive value was 99.8%. Sensitivity was 87.3% and specificity was 99.5%. CONCLUSION: Polyhydramnios is a highly sensitive and specific sign for prenatal diagnosis of foetal malformation. If it is identified, then this should lead to a very careful search for foetal malformation.

The diagnostic value of indirect ultrasound signs during acute adult appendicitis.

PURPOSE: To evaluate the diagnostic value of indirect ultrasound signs during acute appendicitis. PATIENTS AND METHODS: Our retrospective study lasted 5 years, from May 2005 to April 2010. It concerned 620 cases of appendectomy performed following prior ultrasound examination of the right iliac fossa (RIF). In 448 cases, ultrasonography clearly showed the appendix, which was inflamed. The presence of indirect signs of appendix inflammation without visualisation of the appendix was confirmed by ultrasound examination in 160 cases. In 12 cases, the appendix was not visualised nor were there any indirect signs on the ultrasound image. The indirect signs involved were hypertrophy of the peritoneal fat (HPF), pain caused by compression on exploration of the right iliac fossa, and localised hypokinesia in the digestive loops (LHL). We compared the results found by ultrasonography with the operative and anatomical pathology reports. RESULTS: The positive predictive value of the indirect signs of appendicitis on the ultrasound scan was 95.8% if the three indirect signs were associated, 87.5% for the association of pain and HPF, 45.8% for the association of pain and LHL, and 25% if there was just pain. The negative predictive value of the indirect signs of appendicitis on the ultrasound scan was 57.2% if the three signs were associated, 65.9% for the association of pain and HPF and 60.7% for the association of pain and LHL, with 83.3% for pain alone. The sensitivity of the indirect signs was 83.9% if the three signs were associated, 31.8% for the association of pain and HPF, 50% for the association of pain and LHL, and 50% if there was just pain. The specificity of the indirect signs was 85.7% if the three signs were associated, 96.7% for the association of pain and HPF, 56.7% for the association of pain and LHL, and 62.5% if there was just pain. CONCLUSION: When tomodensitometry cannot be performed and the appendix is not visible on ultrasound examination, indirect ultrasound signs must be systematically sought, particularly in populations in which appendicitis are highly prevalent.

Grossesse et risques d'irradiations en radiodiagnostic : etat des connaissances des usagers au CHU de Yopougon

Objectifs : Evaluer l'etat des connaissances des usagers et des professionnels de la sante sur les risques d'irradiation de la femme enceinte au cours des explorations radiologiques et l'observation de l'application des regles de radioprotection relative a la femme enceinte par les utilisateurs de rayons X. Materiel et methodes : Notre etude prospective; realisee au CHU de Yopougon; a dure 6 mois. Nous avions interroge 60 femmes en grossesse ou susceptibles de l'etre; 30 medecins prescripteurs non radiologues; 29 techniciens d'imagerie medicale et 21 aides soignants sur les risques d'irradiation et les mesures de protection de la femme enceinte avant et pendant la realisation d'un examen radiologique utilisant les rayons X. Resultats : 73;68des medecins prescripteurs n'avaient pas de culture en radioprotection chez une femme enceinte ou en age de procreer. 93;10des patientes enceintes ou en age de procreer ignoraient l'existence des rayons X en radiodiagnostic et leur nocivite pour une femme enceinte ou susceptible d'etre enceinte. 80des manipulateurs de radiologie respectaient pas les regles elementaires de radioprotection. Conclusion : La sensibilisation des usagers des rayons X sur les risques d'irradiations chez une femme enceinte ou susceptible de l'etre est necessaire au CHU de Yopougon

[Ultrasound and epidemiological features of ectopic pregnancy in a suburb of Abidjan (Cote d'Ivoire)]. / Profil echographique et epidémiologique des grossesses extra-utérines dans une banlieue d'Abidjan (Côte d'Ivoire).

OBJECTIVE: The aim of our study was to describe current ultrasound and epidemiological features of ectopic pregnancy in Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: This prospective study was carried out over a 24-month period (February 2006 to January 2008) at Nanglé Medical Clinic, i.e., a private clinic located in Abidjan's Yopougon suburb. RESULTS: A total of 32 cases of ectopic pregnancy were discovered by suprapubic and/or endovaginal ultrasound scan. The estimated frequency of ectopic pregnancy was 1.7%. Mean patient age was 26.2 years. The main risk factors were prior history of abortion (32%) and adnexal infection (20%). Most patients (52.5%) were nulliparous. The most frequent indication for ultrasound scan was metrorrhagia. Diagnosis of ectopic pregnancy was made at the ruptured stage in 65.6% of cases and nonruptured stage in 34.4%. The presenting lesions was hematosalpinx in 40.6% of cases and embryonate ectopic gestational sac in 31.3%. Salpingectomy and salpingorrhaphy were successful in 65.6% and 34.4% of cases respectivlely. CONCLUSION: In Abidjan, ectopic pregnancy involves young nulliparous women with a prior history of abortion and adnexal infection. Ultrasound allowed early diagnosis and, consequently, tube preservation in 34.4% of cases.

[Results of the thoracic radiography profile of 247 candidates at the recruiting office of a land-transport society in Abidjan, Cote d'Ivoire]. / Resultats du bilan radiographique thoracique de 247 candidats a l'embauche dans une Societe de Transport Terrestre a Abidjan (Cote D'Ivoire).

The purpose of this prospective study done from May to July 2007 was to show the interest of systematic chest X-Ray of future bus conductors. The main abnormalities were big heart, parenchymal lesion and pleural effusion.

Resultats du bilan radiographique thoracique de 247 candidats a l'embauche dans une societe de transport terrestre a Abidjan (Cote d'Ivoire)

A partir d' une etude prospective realisee sur une periode de 3 mois nous rapportons les resultats de la radiographie thoracique systematique dans le cadre d'un bilan d'embauche dans une societe de transport en commun. Les principales anomalies retrouvees sont representees par la cardiomegalie; les lesions parenchymateuses et pleurale. Notre etude se propose de preciser l'interet medical de la radiographie thoracique systematique dans le bilan d'embauche en milieu tropical

[A rare etiology of praevia barrier by the non gravid uterus in a duplex uterus (didelphys): ultrasound findings]. / Une étiologie rare d'obstacle praevia par l'utérus non gravide sur utérus double (didelphe): apport de l'échographie.

The Authors report a rare case of praevia barrier from a duplex uterus (didelphys). A 30 Year old pregnant woman was admitted for ultrasound examination. Her past history included two cesarean sections with a stillborn infant in one case and a live infant with psychomotor retardation in the other case. Third trimester ultrasound examination was consistent with a 36-37 weeks gestation. A 9.1 by 5.8 cm retro-cervical praevia mass was also noted deep in the pelvis. The mass was similar in appearance to myometrium. Elective cesarean section performed at 38 weeks of gestation delivered a normal healthy 2950 g male infant and revealed a second non gravid uterus corresponding to the mass seen at ultrasound. Pelvic examination confirmed a diagnosis of uterus didelphys (uterus duplex bicornis bicollis with vaginal septum) separated by a sagittal partition. The post-operative course was uneventful. Praevia barrier by a half uterus in a patient with duplex uterus is a rare condition that can easily be detected by careful ultrasound examination thus preventing complications at delivery.

[A rare cause of pulmonary metastasis: benign metastazing leiomyoma]. / Une étiologie rare de métastases pulmonaires: le léiomyome bénin métastasiant.

The authors report a rare cause of pulmonary metastasis of a benign tumor, uterine leiomyoma, observed in a black African woman. Plain chest radiograph showed multiple pulmonary nodules. These features were confirmed at CT. Transbronchial and surgical lung biopsies were consistent with pulmonary metastases from benign uterine leiomyoma. Hormonal treatment was instituted and resulted in regression of nearly all lesions at one year. Benign metastazing leiomyoma is a rare condition, in spite of the high rate of uterine leiomyoma in black African women.

[The value of ultrasound in the diagnosis of thyroid diseases in Mauritania (171 cases)]. / Apport de l'échographie dans le diagnostic de la pathologie thyroïdienne en Mauritanie: à propos de 171 cas.

We investigated thyroid abnormality in Mauritania by carrying out a prospective ultrasound study of 171 patients. One hundred and thirty four patients underwent thyroid hormone determination (T3, T4 and TSH) and 123 had complementary plain film X rays of the chest and neck. These ultrasound examinations accounted for 3.8% of all ultrasound examinations performed over the study period. Thyroid abnormalities were more frequent in young adults aged 20 to 40 years (67.4%) and in women (83%) in Mauritania. Thyroid diseases affected people from savanna and mountain regions in particular. Diffuse goiters were the most frequent problem (76.3%) and most were multinodular or heterogeneous forms with necrosis or hemorrhage. One case of homogeneous diffuse goiter was found to be an infiltrating vesicular adenocarcinoma with metastatic adenopathy. Nodular goiters were mostly cystic, with septation (51.9%) and could be mistaken for hydatid cysts, which are endemic to the region. Further study of these aspects of thyroid diseases in Mauritania are required.

[Pleuropulmonary staphylococcal infection in newborn infants]. / Staphylococcie pleuro-pulmonaire du nouveau-né.

Pulmonary pleural staphylococcal infection is common in sub-Saharan Africa. It is rare in temperate zones and occurs in different epidemiological conditions. In African regions, very few staphylococcal infections are hospital-acquired, with most cases resulting from infection in everyday life. Pulmonary pleural staphylococcal infection typically affects infants. The frequency of neonatal forms is unknown. We describe here in the epidemiological, clinical and therapeutic characteristics of a case of pulmonary pleural staphylococcal infection in a newborn. The symptoms of our patient were typical, involving predominantly mechanical and hematological problems. The prevention of infection in very young children and early treatment of such infections could reduce the morbidity of this disease.

[Renal insufficiency with AIDS: ultrasonographic aspects]. / Insuffisance rénale associée au SIDA: aspects échographiques.

UNLABELLED: Renal pathologic changes in AIDS involve various factors and can also occur in several other forms of renal disease. Renal sonography was prospectively performed in 31 patients with laboratory evidence of AIDS and renal insufficiency. All patients included in this study were without clinical manifestations (group II of the CDC) and without risk factors of AIDS. AIM: to characterize renal pathologic changes underlying the sonographic findings in these patients. Sonographic evaluation included determination of renal sizes and renal echogenicity according to standard grading system. Sonography showed normal-sized or enlarge-sized kidneys. Enlarged kidneys were generally due to increased thickness rather than length or width; small-sized kidneys were not observed. Grading echogenicity showed: grade 0 in 3 patients, grade I in none, grade II in 11 patients and grade III in 17 patients. In six patients, we found "spotted" echostructural figure due to several hypoechoic and rounded zones. Echogenicity increased with the severity of renal insufficiency. Our study suggests that renal abnormalities are varied and can occur in all stages in the course of the disease. The particular "spotted" figure associated with enlarged size at the expense of thickness of kidneys must draw radiologist's attention to the probability of AIDS lesions. Further studies with large populations must be performed to confirm our observations.

[Hepatocellular carcinoma (HCC) observed in Abidjan: aspects and role of ultrasonography]. / Carcinomes hépatocellulaires (CHC) observés a Abidjan: aspects et place de l'échographie.

In this retrospective study, we define the localization and ultrasound appearances of hepatocellular carcinomas observed in Abidjan. The study included 31 inpatients (23 males and 8 females), aged from 24 to 76 years (mean, 47.4). All patients had serum alphafetoprotein dosage and 21 patients had cytologic examination. Diagnosis was based on a high level of serum alpha-fetoprotein (> 500 ng/ml), with or without cytological proof. Tumor characteristics (size, number, echogenicity, nodular or diffuse form) and associated extratumoral signs were noted. Ultrasound identified 19 cases of small tumors (size < 5 cm), and 12 large tumors (size > or = 5 cm). The tumor forms were mostly nodular and multiple (24 cases), solitary nodule (3 cases), diffuse or infiltrative (4 cases). The liver was heterogeneous with hyperechoic tumoral nodules (16 cases), hypoechoic tumoral nodules (5 cases), hyperechoic and diffuse form (4 cases), and 2 cases of mixed form. We have noted a particular form in 4 cases represented by a heterogeneous liquid-like mass simulating tropical abscesses. Ascites (12 patient) was the most common extratumoral sign. Portal vein invasion or thrombus was rare (3 patients). Of the 31 patients, ultrasound was abnormal in all cases, alpha-fetoprotein test was positive in 12 cases (57.14%) and negative in 9 cases (42.8%). Cytological test was positive in 17 cases (80.95%), and negative in 4 cases (19.04%). Alphafetoprotein and cytologic tests were both positive in 8 cases and, nonconcordant in 13 cases; in 4 cases alphafetoprotein was positive while cytological tests were negative and, in 9 cases alphafetoprotein was negative while cytological tests were positive. Two negative tests were never observed. In Abidjan, hepatocellular carcinomas are commonly small or large, multinodular and hyperechoic tumors contrasting with the small nodular and hypoechoic tumors usually reported in western series. Ultrasound associated with cytologic examination, appears to us to be more usefulness than alphafetoprotein dosage in the diagnosis of hepatocellular carcinoma.

[A rare etiology of abdominal calcifications: lithopedion]. / Une étiologie rare de calcifications abdominales: le lithopédion.

We report a case of a rare and particular cause of abdominal calcifications represented by the lithopedion. We describe different radiologic appearances observed by: abdominal plain film, echography and CT. It appeared to us that abdominal plain film alone is sufficient for diagnosis and undertaking surgery. Echography and CT are helpful, especially for complementary evaluation.

[Ultrasonography of amebic liver abscesses. Proposal of a new classification]. / Echographie des abcès amibiens du foie. Proposition d'une nouvelle classification.

The different classifications used for amebic liver abscesses seem to be usually without direct therapeutic benefit. Echographic assessment was used to propose a new classification of amebic liver abscesses. This report is a prospective study conducted over 3 years and concerning 118 patients involved by 119 amebic liver abscesses. They were 109 males and 9 females aged from 13 to 68 years (mean, 36 years). All cases were correctly diagnosed by clinical and ultrasound findings, aspect of the pus, course under treatment and rarely by serologic examinations (3 patients). Patients were followed up with clinical and sonographic examinations as requested. Our classification was based on the initial echographic examination findings, the therapeutic indications and the type of healing obtained. In total, 93 abscesses (80, 67%) were treated by medical therapy alone and 26 cases (21, 84%) by combined US-guided evacuation and medical therapy. In the 119 abscesses, 112 (94, 11%) completely recovered with reconstitution of a normal liver parenchyma. In the remaining 7 cases (5, 88%) the abscesses persisted for several months (12 to 36 months). Our study suggests that ultrasonographic features of amebic liver abscesses can be segregated in three forms: noncollected form which needs to be treated by medical therapy alone, collected form which can be treated medically or by association with US-guided evacuation, and the healing forms. This classification appears to us to be simple but very precise, reliable and useful especially for therapeutic indications of amebic liver abscesses.

[Fontanel ultrasonography of purulent meningitis in children in Abidjan (Ivory Coast)]. / Echographie transfontanellaire dans les méningites purulentes de l'enfant à Abidjan (Côte d'Ivoire).

A prospective study of 100 newborns and young babies suffering from purulent meningitis was carried out over a period of 11 months in the radiology department of CHU in Treichville. All the children included in the study were hospitalised in the pediatric department of the CHU. We found cerebral complications in 76% of cases. The most frequent complication was ventricular dilation which occurred in 82.6% of cases. Pericerebral bleeding occurred in 9.3%, cerebral ischemia in 3.5%, brain abscesses in 2.3% and ventriculitis in 2.3% of cases. Our study demonstrated the two important uses of trans-fontanelle ultrasound scans in the study of meningitis: (i) in diagnosis, for the detection of cerebral complications; (ii) in treatment, interventional use of ultrasound makes it possible to evacuate intra-cranial septic fluids.

[Ultrasonography of changes in the retroperitoneal vessels and perivascular spaces during retroviral infection: preliminary results]. / Modifications échostructurales des vaisseaux et des espaces périvasculaires rétropéritonéaux au cours de l'infection rétrovirale: résultats préliminaires.

The abdomen in patients with acquired immunodeficiency syndrome (AIDS) is subject to various damage. In AIDS patients, manifestations in the retroperitoneal region, including apparent changes in the pancreas, kidney and lymph nodes, have been well described in the radiological literature. However, abnormalities of the vessels and perivascular spaces have not been well investigated in this syndrome. We performed abdominal sonography in 10 patients who were seropositive for HIV. They had no history of known risk factors such as drug abuse or homosexuality. Also, 4 healthy male controls were examined for comparison. Our aim was to demonstrate and to characterize the pathological changes of the retroperitoneal vessels and perivascular spaces from sonographic observations. The sonographic evaluation included determination of the morphologic and dynamic aspects of the aorta, vena cava and superior mesenteric vessels. The echostructure of the perivascular spaces was analyzed. In this prospective and preliminary study, we have not considered the presence of an AIDS condition. We have precisely analyzed the upper umbilical areas. In all cases, there were supposed to be the same landmarks. The sonographic scans were obtained through the left renal and mesenteric vessel areas, essentially through axial scans. In all 10 patients, sonography showed at least two abnormalities. Three patients had abnormal echostructural changes in all the sites. The images showed echostructural disorganization with poor definition and "fuzzy" and "dirty" aspects of the retroperitoneal vessels and perivascular spaces. The aorta was normal in 2 patients and abnormal in 8 patients with diminished hyperechography and regularity of the aortal wall. The aortic diameter was smaller than 1.5 cm in 7 cases, with a significant attenuation of the beating of the aorta. Despite these abnormalities, the aorta had a normal left paramedian position ahead of the rachis. The inferior vena cava was normal in 1 case and abnormal in 9 cases with diminished hyperechography and regularity of the wall. The vena cava position was normal in 4 cases, displaced in 6, and laminated in 3. The superior mesenteric vessels were abnormal in 8 cases, with poorly defined aims in 6, an indefinite position in 2, and spreading in 2. Adenopathy was present in 6 patients, multiple in 5 and singular in 1 case. A retrocaval location was always observed. A perivascular infiltration and thickening was noted which was diffuse in 6 cases and micronodular in 1 case. From our observations, we conclude that these echostructural changes could be related to AIDS. However, further studies are necessary to confirm these observations and to determine if this sonographic pattern may be seen during the course of the disease. This is the first study to our knowledge which stressed the echostructural changes of the retroperitoneal vessels and perivascular spaces in patients with AIDS.

[Ultrasound scanning of abdominal contusions in children: experience at the Yopougon CHU (Ivory Coast)]. / Exploration échographique des contusions abdominales chez l'enfant: expérience du CHU de Yopougon (Côte d'Ivoire).

Ultrasound scans were used to study 23 cases of abdominal contusion in children, between January 1992 and December 1993. Thirteen boys and 10 girls were studied. They were all aged between 4 and 14 years, with a mean age of 6 years. The main causes of their injuries were road accidents (12 cases) and play (11 cases). Ultrasound scans were normal in 6 patients and pathological in 17 patients. The most frequently observed injuries were visceral effects (12 cases), almost always associated with hemoperitoneum. In three cases, hemoperitoneum was detected in the absence of visceral effects. The spleen (4 cases) and the liver (4 cases) were the most frequently injured organs. The other injuries detected included renal hematoma, bladder rupture and parietal hematoma. Diagnosis on the basis of ultrasound scans was found to be incorrect in three cases where diagnosis was repeated after the scan. One case involved a blocked perforation of the rectum, one a benign cyst and the other a mesenteric cyst. Despite these misdiagnoses, ultrasound scanning is a highly sensitive and specific method for examination of contusions in children. It is very useful and often sufficient for accurate diagnosis, particularly in units with only modest technical support.

[Saccoradiculography: contribution and indications in lumbar pathology in Abidjan (Ivory Coast)]. / Saccoradiculographie: apport et indications dans la pathologie lombaire à Abidjan (Côte d'Ivoire).

Radiculography is used a great deal in our region and is often the only method available for examination of the lumbar spine. However, there has been little evaluation of the effectiveness of radiculography for lumbar diseases. To determine its value and indications in lumbar diseases we studied 322 patients who underwent radiculography. We studied 223 patients retrospectively and 99 patients prospectively. Radiculography had a sensitivity of 100%, a specificity of 86%, a positive predictive value of 92.7% and a negative predictive value of 100%. We found that the diagnostic accuracy of radiculography was higher if the examination was requested by a neuropathologist, if the patient had been ill for more than 2 months or had cauda equina syndrome, acute root pain, paralysis or debilitation. Such precise indications make it possible to avoid excessive examination and to make the best use of radiculography, particularly in areas without CT and MRI facilities. However, the examination should always be performed by a neuroradiologist or a physician with several years' radiculography experience.

[Subcutaneous and soft tissue involvement associated with AIDS: ultrasonographic aspects. Apropos of 3 cases]. / Atteintes sous-cutanées et des parties molles associées au SIDA: aspects échographiques. A propos de trois cas.

Subcutaneous and soft tissue involvement is frequent in AIDS patients. Although the relevant clinical characteristics have been extensively described in the literature, there has been little work on the radiological features. We therefore report three cases of AIDS with subcutaneous and soft tissue involvement: two cases of pyomyositis and one case of non-Hodgkin's lymphoma. All three were black African men and were aged 22, 28 and 41 years. They were diagnosed as suffering from AIDS and were HIV1 and HIV2 positive. Diagnosis was established using needle puncture and histological (lymphoma) and bacteriological (pyomyositis) examination. We report ultrasound scan findings. The features of the pyomyositis differed from those usually observed in immunocompetent patients. The lymphoma nodules were similar to those described in the literature. They were hypoechoic and homogeneous, with no necrotic center. We believe that subcutaneous and soft tissue infectious involvement, for example pyomyositis, is more frequent in tropical regions than tumors (Kaposi's sarcoma, lymphoma) which are more frequent in Europe. This soft tissue involvement can be considered to be part of the particular picture which is "tropical AIDS".