SA Journal of Radiology最新文献

Urgent investigation is crucial for infants with bilious vomiting, potentially indicating bowel obstruction. Upper gastrointestinal fluoroscopy aids diagnosis, but is not without its challenges. This case report describes a rare case of neonatal intestinal malrotation and mid-gut volvulus with an additional complication of congenital peritoneal encapsulation.

Contribution: This case study offers insights into associated diagnostic challenges and underscores the value of utilising fluoroscopy in diagnosing complex gastrointestinal conditions.

Thyroid gland vascular proliferations pose a challenge to pathologists, radiologists and surgeons. This is illustrated in the case of a 36-year-old woman who underwent a diagnostic thyroid lobectomy for a suspected follicular neoplasm according to cytology. Histological diagnosis confirmed a follicular adenoma as well as a cavernous haemangioma or venous malformation.

Contribution: Thyroid vascular lesions are rare. Evolving nomenclature and application of the International Society for the Study of Vascular Anomalies classification are discussed. Pertinent radiological clues are highlighted to pre-empt the diagnosis and avoid potential surgical complications.

Plasma cell neoplasia has a wide presentation of disease (localised or systemic) according to the International Myeloma Working Group. Radiological imaging identifies plasmacytomas as solitary lesions or part of multiple myeloma. We present a rare case of a 21-year-old female who presented with a skull-base tumour.

Contribution: A head and neck plasmacytoma with further lytic bone lesions was confirmed on imaging. This article presents and discusses the clinical, CT, MRI, positron emission tomography (PET)-CT, histology and laboratory findings.

This report describes a rare case in which double calcifications of the acetabular labrum and rectus femoris occurred concomitantly in a middle-aged female patient who was treated successfully with surgical intervention via hip arthroscopy.

Contribution: This case highlights the existence of various types of calcifications around the acetabulum, with a proposed new classification system for acetabular and periacetabular rim ossifications.

Heterotaxy syndrome, also known as situs ambiguous, is a spectrum of pathology due to loss of the normal right-to-left asymmetry of the thoraco-abdominal organs. This report describes the case of a 39-year-old female, previously well, who presented with bowel obstruction. CT showed features of left isomerism, with malrotation and volvulus.

Contribution: Heterotaxy syndrome consists of cardiac and non-cardiac manifestations. Imaging studies play a crucial role in the individualised management of the patient.

Leptomeningeal dissemination is a rare manifestation of pilocytic astrocytoma. It may occur with higher-grade tumours like medulloblastoma, ependymoma and high-grade glioma, but is extremely rare with low-grade glioma. There has been a growing number of reported cases documenting leptomeningeal dissemination of pilocytic astrocytoma in the medical literature.

Contribution: Description of a World Health Organization (WHO) Grade I suprasellar pilocytic astrocytoma with leptomeningeal dissemination in the brain and spinal cord which showed progression of the leptomeningeal nodules without tumour upgrading on long-term follow-up.

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital malformation characterised by arteriovenous fistulas between primitive choroidal arteries and the median prosencephalic vein, the embryonic precursor to the vein of Galen. Endovascular techniques have changed the management of these patients with improved prognosis. An eight-month-old with VGAM managed by endovascular embolisation using ethylene vinyl alcohol copolymer (EVOH) developed a chemical abscess - a rare complication. It was managed conservatively and showed promising clinical outcome.

Contribution: Chemical abscesses following EVOH embolisation are scarce - with imaging differentials, which include brain abscess and onyx granuloma. Knowledge and successful identification of this entity are essential as its management as prognoses differ. Chemical abscess is managed conservatively and has a good prognosis.

Background: Diagnostic reference levels (DRLs) are an important metric in identifying abnormally high radiation doses in diagnostic examinations. National DRLs for CT colonography do not currently exist in South Africa, but there are efforts to collect data for a national DRL project.

Objectives: This study investigated radiation doses for CT colonography in adult patients at a large tertiary hospital in South Africa with the aim of setting local DRLs.

Method: Patient data from two CT scanners (Philips Ingenuity and Siemens Somatom go.Top) in the period March 2020 - March 2023 were obtained from the hospital's picture archiving and communication system (PACS) (n = 115). Analysis involved determining the median computed tomography dose index-volume (CTDI_vol) and dose-length product (DLP) values. The findings were compared with DRLs established internationally.

Results: Ingenuity median CTDI_vol was 20 mGy and DLP was 2169 mGy*cm; Somatom median CTDI_vol was 6 mGy and DLP was 557 mGy*cm. Ingenuity exceeded the United Kingdom's (UK) recommended DRLs by 82% and 214%, respectively. Somatom median CTDI_vol and DLP were 45% and 19% lower than UK NDRLs.

Conclusion: Somatom's tin filter and other dose reduction features provided significant dose reduction. These data were used to set DRLs for CT colonography at the hospital; CTDI_vol: 6 mGy and DLP: 557 mGy*cm.

Contribution: In addition to informing radiation protection practices at the level of the institution, the established local DRLs contribute towards implementing regional and national DRLs.

Rosai Dorfman disease is a rare but benign and self-limiting disorder. A case of Rosai Dorfman disease in a 16-year-old female with classic radiological and pathological findings is presented. T2W hypointense signal of the soft tissue masses was a distinguishing MRI feature.

Contribution: Rosai Dorfman disease is often overlooked in the differentials of lymphadenopathy and soft tissue masses on account of its rarity. This case report comprehensively discusses the imaging approach to this rare disorder.

The glenoid labrum deepens the glenoid fossa and allows for the attachment of the long head of the biceps tendon and the glenohumeral ligaments, contributing to the stability of the glenohumeral joint. The superior labrum is a common site of labral injury, especially in athletic activities involving overhead activity. The acronym SLAP (superior labrum anterior to posterior or anteroposterior) lesion was introduced by Snyder and colleagues in 1990 to describe superior labral tears. The article will review the optimal technique to image the glenoid labrum, covering normal labral anatomy with special emphasis on the anatomic variants of the labrum that can be mistaken for SLAP tears by means of colour illustrations, magnetic resonance imaging and correlative arthroscopy images.

Contribution: The illustrated review functions as a crucial radiological guide for both radiologists and orthopaedic surgeons. The combination of illustrations, MR and correlative arthroscopic images enhances the comprehension of normal labral anatomy and its variants. The review underscores the significance of understanding anatomic variations that may be misinterpreted as pathology. This understanding is vital in guiding orthopaedic management for patients, ensuring appropriate treatment strategies.