Sonographic analysis of adult polycystic kidney disease: retrospective data from South-East Nigeria.

BACKGROUND: Autosomal dominant polycystic kidney disease (APKD), an inheritable multisystem disease characterized by intrarenal and at times extrarenal disease, has been studied extensively among Caucasian populations. Despite the fact that being black is a risk factor for progressive disease, there is paucity of local published data. As a result, true local incidence and peculiarities in clinical and sonographic characteristics are unknown. AIM: To present data from 19 patients diagnosed with APKD in a medium-sized facility over a 16-year period. MATERIALS AND METHODS: A retrospective search was done on the ultrasound registers for patients who had undergone abdominal ultrasound in 16 years (1997-2013). Of the 29 sonographic diagnoses of bilateral PKD made, only 19 had complete records and were included in the study. Data extracted were- age, sex, working diagnosis, renal size, diameter of renal cysts, presence or absence of extrarenal cysts, family history of renal cystic disease, blood pressure at diagnosis, and patient outcome. RESULTS: A total of 19 diagnoses of APKD were made- 12 males and seven females with a sex ratio of 1:0.6. Total mean age was 54.8 years (range 31-79 years)- 40.1 years for females and 57.2 years for males. In 89.5% of cases, no family history of APKD was obtained. Only six (31.6%) patients were hypertensive at presentation and three patients (16%) were already in renal failure. Ultrasound showed a mean renal size of 88.92 cm² for the right kidney and 98.97 cm² for the left. Mean cyst diameter was 3.46 cm (range 2.08-4.85 cm). Only one patient had documented extrarenal cystic disease. Two patients were lost to renal failure and congestive cardiac failure. CONCLUSION: APKD appears to be uncommon in our environment; however, more studies may be elucidatory. Standard sonographic protocol for collecting data from patients with APKD is needed.

Sonographic Analysis of Adult Polycystic Kidney Disease: Retrospective Data from South-East Nigeria

Background: Autosomal dominant polycystic kidney disease (APKD); an inheritable multisystem disease characterized by intrarenal and at times extrarenal disease; has been studied extensively among Caucasian populations. Despite the fact that being black is a risk factor for progressive disease; there is paucity of local published data. As a result; true local incidence and peculiarities in clinical and sonographic characteristics are unknown.Aim: To present data from 19 patients diagnosed with APKD in a medium-sized facility over a 16-year period.Materials and Methods: A retrospective search was done on the ultrasound registers for patients who had undergone abdominal ultrasound in 16 years (1997-2013). Of the 29 sonographic diagnoses of bilateral PKD made; only 19 had complete records and were included in the study. Data extracted were- age; sex; working diagnosis; renal size; diameter of renal cysts; presence or absence of extrarenal cysts; family history of renal cystic disease; blood pressure at diagnosis; and patient outcome.Results: A total of 19 diagnoses of APKD were made- 12 males and seven females with a sex ratio of 1:0.6. Total mean age was 54.8 years (range 31-79 years)- 40.1 years for females and 57.2 years for males. In 89.5 of cases; no family history of APKD was obtained. Only six (31.6) patients were hypertensive at presentation and three patients (16) were already in renal failure. Ultrasound showed a mean renal size of 88.92 cm 2 for the right kidney and 98.97cm 2 for the left. Mean cyst diameter was 3.46 cm (range 2.08-4.85cm). Only one patient had documented extrarenal cystic disease. Two patients were lost to renal failure and congestive cardiac failure.Conclusion: APKD appears to be uncommon in our environment; however; more studies may be elucidatory. Standard sonographic protocol for collecting data from patients with APKD is needed

Sonographic Evaluation of Cervical Length Changes during Normal Pregnancy

This study was aimed to establish reference values of cervical length in normal pregnancy. We studied a cross-sectional sample of 144 pregnant women by transabdominal sonography. The inclusion criteria were sonographic confirmation of gestational age; the absence of any risk factors for preterm birth; and uncomplicated pregnancy. Cervical length was measured in a straight line. Height; age and weight of patients were also obtained. There was a relationship between gestational age and cervical length; which could be described with a linear regression (R = 0.44; P0.05). Our study shows an increase in cervical length with gestational age. Reference ranges constructed for the whole gestational period could be more clinically applicable and useful than a single cut off value for more efficient prevention and management of preterm birth

Transverse thoracic diameter in frontal chest radiographs of an adult Nigerian population.

BACKGROUND: Normal standards for thoracic dimensions that are available in our environment are often based on studies conducted on Caucasians. Application of such published data to a Nigerian population may lead to erroneous conclusions in terms of clinical implication. OBJECTIVE: Our study aimed to establish age and sex specific transverse thoracic diameter (TD) for our environment. SUBJECTS AND METHODS: The TD of 303 males and females aged between 20 and 93 were obtained in a cross sectional study at a tertiary hospital. RESULTS: The mean values for the 20-39, 40-59 and the 3 60-year-old males were 29.6, 29.0, 27.8 cm respectively. The corresponding values for females were 26.3, 27.1 and 25.1 cm. Males had significantly larger thoracic diameter than females. The largest mean TD in males and females were in the 20-39 and 40-59 age groups respectively. The TD had a significant positive correlation with weight, height, body mass index and body surface area. The best correlations were with body surface area and weight. CONCLUSIONS: Nigerians have a smaller TD than Caucasians. Smaller TD in Nigerians is likely to be responsible for their high cardiothoracic ratios in comparison with Caucasians or Asians.

Relationship between sonographic renal length and renal parenchymal thickness in normal adult southeast Nigerians.

AIM: To determine the relationship between sonographic renal parenchymal thickness (RPT) and renal length (RL) in normal adult Nigerian. STUDY DESIGN: The RL and RPT of 309 normal subjects within the age range of 18-80 years were measured sonographically and prospectively. Correlation was performed between RL values and RPT usingPearson Linear 'r' test RESULTS: The range of RL value were 8.5-12.9 cm and the corresponding mean were 10.33 +/- 0.7 cm and 10.45 +/- 0.63 cm for the right and left kidneys respectively. The range of values for the RPT was 1.40-2.4 and the corresponding mean values were 1.91 +/- 0.20 cm and 1.95 +/- 0.19 cm for the right and left kidneys respectively. There was a strong positive correlation between RPT and RL (r = 0.72 and 0.77 for the right and left kidney respectively. However for RL values above 11.0 cm the RPT values fluctuated. CONCLUSION: From this study, for RL above 11.0 cm there was no relationship with RPT. The study suggests that for our population groups, kidneys with RL lower than 8.5 cm and RPT of 1.40 cm or less should not be biopsied in contrast to webb's criteria.

Fibrodysplasia ossificans progressiva in a Nigerian: a case report.

A case offibrodysplasia ossificans progressiva in a 3-year and 10-month-old Igala boy is presented. It was characterized by progressive ossification of connective tissue and muscles of the neck and chest. Characteristic digital anomalies particularly microdactyly of the hallux and pollex, hallux valgus, and clinodactyly were also noted. The 2nd to 5th metacarpals had epiphyses at both the proximal and distal ends instead of only at the proximal ends. Although the patient presented in the first year of life, the diagnosis was not made until in his fourth year of life. Early diagnosis of the disease is important in order to avoid all forms of trauma that may worsen the prognosis.

Transverse thoracic diameter in frontal chest radiographs of an adult Nigerian population

Background: Normal standards for thoracic dimensions that are available in our environment are often based on studies conducted on Caucasians. Application of such published data to a Nigerian population may lead to erroneous conclusions in terms of clinical implication. Objective: Our study aimed to establish age and sex specific transverse thoracic diameter (TD) for our environment.Subjects and methods: The TD of 303 males and females aged between 20 and 93 were obtained in a cross sectional study at a tertiary hospital. Results: The mean values for the 20-39; 40-59 and the 3 60 year-old males were 29.6; 29.0; 27.8cm respectively. The corresponding values for females were 26.3; 27.1 and 25.1cm . Males had significantly larger thoracic diameter than females. The largest mean TD in males and females were in the 20-39 and 40-59 age groups respectively. The TD had a significant positive correlation with weight; height; body mass index and body surface area. The best correlations were with body surface area and weight. Conclusions: Nigerians have a smaller TD than Caucasians. Smaller TD in Nigerians is likely to be responsible for their high cardiothoracic ratios in comparison with Caucasians or Asians

Relationship between sonographic renal length and renal parenchymal thickness in normal adult southeast Nigerians

Aim: To determine the relationship between sonographic renal parenchymal thickness (RPT) and renal length (RL) in normal adult Nigerian. Study design: The RL and RPT of 309 normal subjects within the age range of 18 - 80years were measured sonographically and prospectively. Correlation was performed between RL values and RPT using Pearson Linear `r' test Results: The range of RL value were 8.5-12.9cm and the corresponding mean were 10.33+ 0.7cm and 10.45+ 0.63cm for the right and left kidneys respectively. The range of values for the RPT was 1.40 - 2.4 and the corresponding mean values were 1.91+ 0.20cm and 1.95+ 0.19cm for the right and left kidneys respectively. There was a strong positive correlation between RPT and RL (r = 0.72 and 0.77 for the right and left kidney respectively. However for RL values above 11.0cm the RPT values fluctuated. Conclusion: From this study; for RL above 11.0cm there was no relationship with RPT. The study suggests that for our population groups; kidneys with RL lower than 8.5cm and RPT of 1.40cm or less should not be biopsied in contrast to webb's criteria

Transverse cardiac diameter in frontal chest radiographs of a normal adult Nigerian population.

BACKGROUND: The possibility of racial differences in heart dimensions has not been extensively investigated in our environment. Cardiac diameter is known to correlate with some anthropometric parameters. Our study was aimed at providing age and sex, specific normal standards of cardiac diameter in an adult Nigerian population. The data were correlated with various anthropometric parameters. METHODS: The transverse cardiac diameter of 303 males and females aged between 20 and 93 years were measured in normal frontal chest radiographs. RESULTS: The mean values for the 20-39, 40-59 and the > or = 60 year-old males were 13.3, 13.9 and 13.7cm respectively. The corresponding values for the females were 12.0, 13.4 and 13.6cm. The range was from 10.5 to 16.2cm in males and 9.5 to 15.7cm in females. Males had larger mean transverse cardiac diameter than females. The cardiac diameter showed a significant positive correlation with age, weight, body surface area, body mass index but not with height. The strongest correlation in males and females was with body mass index. The mean cardiac diameter of females in our study tended to be larger than the values for Caucasian females. CONCLUSION: The strong correlation between the cardiac diameter and body mass index suggests that the cardiac diameter is principally dependent on the body build.

Normal sonographic renal length in adult southeast Nigerians.

The renal lengths of 200 adults with normal renal and cardiac status were measured sonographically in the supine position to establish normative values of renal length for the locality and to correlate them with some anthropometric parameters. The ranges of normal kidney length obtained were 8.3 -12.8 cm and 8.0- 12.5 cm for the left and right kidneys respectively. The mean renal lengths of males were slightly higher than those of females. Renal length correlated positively with subject weight and not with the height or age of patients. This study was able to establish a normogram of renal length for the locality, with mean renal length of 10.6 cm and 10.3 cm for the left and right kidneys respectively. The renal lengths obtained showed no racial dependence. The positive correlation with body weight seems to substantiate the longer lengths of male kidneys versus female kidneys. The study also established a confidence interval of difference between right and left kidneys for the different age groups that could prove invaluable in making critical decisions on size differences in unilateral renal disease.

Radiologic management of impacted coin in the oesophagus--a case report.

The incidence of swallowed foreign body is high in children and young adults. The common age of occurrence is below 10 years of age. It is a well known paediatric emergency often requiring urgent oesophagoscopy. Majority of swallowed foreign bodies (FBs) are impacted at sites known conventionally as constrictions. The commonest FB swallowed by children is coins; by adults - bones, fish bones and large bolus of meat, and in the older age group - dentures. The most common presenting symptoms are drooling of saliva, dysphagia and odynophagia. The anatomic proximity of the upper airway and oesophagus permit the development of respiratory symptoms like cough and stridor. Long standing foreign body impaction with weight loss, consolidated lungs and failure to thrive are documented presentations of FB in the oesophagus. We present a case of a 20 year old male who inadvertently swallowed a coin which got impacted at the thoracic inlet - one of the conventional areas of constriction. He presented late with cough, stridor, odynophagia and weight loss. The presentation of weight loss that could arise from unduely prolonged odynophagia rather than from complications like fistula, empyema thoracis or ominous predisposing lesions like malignancy was noted. The case highlighted the oddity of an adult swallowing a coin, its impaction in the, oesophagus of an apparently healthy adult and the non-surgical retrieval of the FB by fluoroscopic guidance.

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

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

Sonographic splenic sizes in normal adult nigerian population

This study aimed to establish ultrasonic splenic dimensions which can be used as normogram for adult Nigerians. 250 adult subjects were scanned prospectively using a 3.5MHZ ultrasound sector probe. The splenic length; width and thickness were btained in the supine position and the weight calculated using Downey's formula. Differences in splenic dimensions were determined using Z test; while the relationship between the splenic dimension and the subjects age; BMI; and height were analysed using Pearson Moment Correlation. The normal splenic sizes obtained ranged from 9.9 -11.5cm (length - L); 6.0-7.5cm (Width W) and 4.0- 4.5cm (thickness -T). The splenic dimensions for males were 11.1 + 0.7cm (L); 7.3 + 0.2cm (w) and 4.2+ 0.2cm (T). The corresponding values for females were 10.6 + 0.7cm; 6.8 + 0.5cm and 4.2 + 0.2cm respectively; thus showing a statistically significant difference between the males and females (P 0.05). A poor correlation was shown to exist between splenic dimensions and age but splenic weight increased with body weight (r0.05); the maximum splenic weights t occurred in the 4 decade in Nigerians nd and in the 2 decade in Caucasians. This finding appears to bear credence to existing opinion by Chauhan et al that splenic recession rather than splenomegaly is prevalent in adults living in endemic falciparum zones. Statistically significant differences between splenic length and weights of the sexes have been established by the study. The good correlation between subject height and splenic length portends profound options of predicating subjects splenic size and matching his ultrasound values with this predicted splenic length (SPL = 1.2 + 0.063)

Aortic arch diameter in frontal chest radiographs of a normal Nigerian population.

BACKGROUND: The objective of our study was to establish age, sex, weight and height specific nomogram of radiographic aortic arch diameter in a normal adult Nigerian population. METHODS: The aortic arch diameter of 303 normotensive males and females aged between 20 and 93 years were measured in normal posteroanterior chest radiographs. RESULTS: The mean values for the 20-39, 40-59 and the > or = 60 year-old males were 5.3, 5.5 and 6.3 cm respectively while the corresponding values for females were 4.9, 5.3 and 5.9 cm. The aortic arch diameter increased progressively with age in both sexes and was larger in males than in females. It correlated better with body mass index than with weight, height or body surface area. The proportion of males and females below the age of sixty that had aortic arch diameter of > or = 6.0 cm ranged from 0.9 to 9.7%. For the > or = 60 year-old, the proportion was 30% for females and 70% for males. CONCLUSION: The study showed that whereas radiographic aortic arch diameter seemed to be a good index of systemic hypertension for the under sixty it is not so for the > or = 60 year-old.

Relationship between umbilical vein diameter (UVD) and growth parameters in Nigerian foetuses

The intrahepatic diameter of the umbilical vein of 350 normal and singleton fetuses were measured sonographically to establish the relationship between umbilical vein diameter (UVD) and fetal growth parameters. Foetuses from 17 weeks to 40 weeks were evaluated sonographically in mothers who had no history of chronic illness or abnormal liquor volumes. The least squares method was used to fit mean UVD values against G.A. Pearson Moment Correlation analysis was also performed between the mean UVD and the other established growth parameters (BPD and AC) obtained concurrently. There was a steady increase in the foetal UVD with gestational age which is expressed by the equation. GA = 2.36 + 4.84 UVD. The fastest growth rate of the UVD occurred in the last 10 weeks of gestation with a maximum mean value of 9.85 + 0.71mm. The UVD correlated strongly and positively with both BPD and AC

Vertebral bone collapse in sickle cell disease: a report of two cases.

We describe two female children both nine years of age with sickle cell anaemia and compression deformity of three successive lumbar vertebrae in one child and collapse of one lumbar vertebra in the other. Management for the two children included analgesics, antibiotics and application of a lumbar jacket for stabilisation of the spine. In both patients the vertebral bodies remodelling with re-generation of the tissue. This report is being made to highlight the improved chances of response with early detection and adequate management.

Clinicians opinion on errors in ultrasound reports in South Eastern Nigeria

This study investigated clinicians opinion on common errors in ultrasound reports in South Eastern Nigerian. 238 clinicians from speicialities of internal medicine, surgery, general practice and obstetric/gynaecology selected through stratified random sampling were invloved in ths survey. A questionnaire with four response options ranging from 'very often' to 'never' were used to obtain respondents opinion on the frequency of their observation of common errors in ultrasound reports. The commonest errors identified by respondents were conflicting report (3.73 + 0.62) and missed diagnosis (3.66 + 0.69). On a 4 point scale clinicians indicated that irrespective of the common errors, the ultrasound report was still helpful. The overall mean rating of the clinicians on the extent of common errors in ultrasound report is 2.77 + 0.29. The response indicates that ultrasound reports in the locality are associated with significant errors