Pub Date : 2022-05-19eCollection Date: 2022-01-01DOI: 10.4102/sajr.v26i1.2386
Ranjit Singh, Mitchell P Wilson, Florin Manolea, Bilal Ahmed, Christopher Fung, Darryn Receveur, Gavin Low
Background Hepatocellular carcinoma (HCC) can be diagnosed non-invasively, provided certain imaging criteria are met. However, the recent Liver Imaging Reporting and Data System (LI-RADS) version 2018 has not been widely validated. Objectives This study aimed to evaluate the diagnostic accuracy and reader reliability of the LI-RADS version 2018 lexicon amongst fellowship trained radiologists compared with an expert consensus reference standard. Method This retrospective study was conducted between 2018 and 2020. A total of 50 contrast enhanced liver magnetic resonance imaging (MRI) studies evaluating focal liver observations in patients with cirrhosis, hepatitis B virus (HBV) or prior HCC were acquired. The standard of reference was a consensus review by three fellowship-trained radiologists. Diagnostic accuracy including sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) and area under the curve (AUC) values were calculated per LI-RADS category for each reader. Kappa statistics were used to measure reader agreement. Results Readers demonstrated excellent specificities (88% – 100%) and NPVs (85% – 100%) across all LI-RADS categories. Sensitivities were variable, ranging from 67% to 83% for LI-RADS 1, 29% to 43% for LI-RADS 2, 100% for LI-RADS 3, 70% to 80% for LI-RADS 4 and 80% to 84% for LI-RADS 5. Readers showed excellent accuracy for differentiating benign and malignant liver lesions with AUC values > 0.90. Overall inter-reader agreement was ‘good’ (kappa = 0.76, p < 0.001). Pairwise inter-reader agreement was ‘very good’ (kappa ≥ 0.90, p < 0.001). Conclusion The LI-RADS version 2018 demonstrates excellent specificity, NPV and AUC values for risk stratification of liver observations by radiologists. Liver Imaging Reporting and Data System can reliably differentiate benign from malignant lesions when used in conjunction with corresponding LI-RADS management recommendations.
{"title":"Diagnostic accuracy and inter-reader reliability of the MRI Liver Imaging Reporting and Data System (version 2018) risk stratification and management system.","authors":"Ranjit Singh, Mitchell P Wilson, Florin Manolea, Bilal Ahmed, Christopher Fung, Darryn Receveur, Gavin Low","doi":"10.4102/sajr.v26i1.2386","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2386","url":null,"abstract":"Background Hepatocellular carcinoma (HCC) can be diagnosed non-invasively, provided certain imaging criteria are met. However, the recent Liver Imaging Reporting and Data System (LI-RADS) version 2018 has not been widely validated. Objectives This study aimed to evaluate the diagnostic accuracy and reader reliability of the LI-RADS version 2018 lexicon amongst fellowship trained radiologists compared with an expert consensus reference standard. Method This retrospective study was conducted between 2018 and 2020. A total of 50 contrast enhanced liver magnetic resonance imaging (MRI) studies evaluating focal liver observations in patients with cirrhosis, hepatitis B virus (HBV) or prior HCC were acquired. The standard of reference was a consensus review by three fellowship-trained radiologists. Diagnostic accuracy including sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) and area under the curve (AUC) values were calculated per LI-RADS category for each reader. Kappa statistics were used to measure reader agreement. Results Readers demonstrated excellent specificities (88% – 100%) and NPVs (85% – 100%) across all LI-RADS categories. Sensitivities were variable, ranging from 67% to 83% for LI-RADS 1, 29% to 43% for LI-RADS 2, 100% for LI-RADS 3, 70% to 80% for LI-RADS 4 and 80% to 84% for LI-RADS 5. Readers showed excellent accuracy for differentiating benign and malignant liver lesions with AUC values > 0.90. Overall inter-reader agreement was ‘good’ (kappa = 0.76, p < 0.001). Pairwise inter-reader agreement was ‘very good’ (kappa ≥ 0.90, p < 0.001). Conclusion The LI-RADS version 2018 demonstrates excellent specificity, NPV and AUC values for risk stratification of liver observations by radiologists. Liver Imaging Reporting and Data System can reliably differentiate benign from malignant lesions when used in conjunction with corresponding LI-RADS management recommendations.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":" ","pages":"2386"},"PeriodicalIF":0.9,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40394727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pancreatic pseudocyst is a common complication that can occur following acute or chronic pancreatitis. Commonly, they are peripancreatic in location. Rarely, they can extend to the mediastinum, and further extension to the neck is even rarer. A 55-year-old man who presented with neck stiffness and dysphagia and on imaging, was found to have a cystic lesion in the neck. Aspiration of the lesion revealed raised amylase levels suggestive of a pancreatic pseudocyst.
{"title":"Cervical extension of pancreatic pseudocyst: An unusual cause of neck stiffness and dysphagia.","authors":"Sneha Harish C, Rashmi Dixit, Sapna Singh, Anjali Prakash","doi":"10.4102/sajr.v26i1.2385","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2385","url":null,"abstract":"<p><p>Pancreatic pseudocyst is a common complication that can occur following acute or chronic pancreatitis. Commonly, they are peripancreatic in location. Rarely, they can extend to the mediastinum, and further extension to the neck is even rarer. A 55-year-old man who presented with neck stiffness and dysphagia and on imaging, was found to have a cystic lesion in the neck. Aspiration of the lesion revealed raised amylase levels suggestive of a pancreatic pseudocyst.</p>","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":" ","pages":"2385"},"PeriodicalIF":0.9,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40394728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saumya Pandey, Nitin Agarwal, V. Gupta, Ashok K Sharma, A. Aggarwal, Sunita Gupta, Ram Krishan
Intraductal papillary neoplasm of the bile duct (IPN-B) is a rare preinvasive intraductal pathology of the biliary tract. It should be differentiated from other more common benign or malignant causes of biliary obstruction and dilatation such as calculi or cholangiocarcinoma because the management and prognosis of this condition differs significantly. This case report describes a case of IPN-B in a 45-year-old female patient who presented with non-specific complaints of chronic abdominal pain without jaundice for three months.
{"title":"Diagnosing rare intraductal biliary neoplasms – Intraductal papillary neoplasm of the bile duct: A case report with typical imaging findings","authors":"Saumya Pandey, Nitin Agarwal, V. Gupta, Ashok K Sharma, A. Aggarwal, Sunita Gupta, Ram Krishan","doi":"10.4102/sajr.v26i1.2387","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2387","url":null,"abstract":"Intraductal papillary neoplasm of the bile duct (IPN-B) is a rare preinvasive intraductal pathology of the biliary tract. It should be differentiated from other more common benign or malignant causes of biliary obstruction and dilatation such as calculi or cholangiocarcinoma because the management and prognosis of this condition differs significantly. This case report describes a case of IPN-B in a 45-year-old female patient who presented with non-specific complaints of chronic abdominal pain without jaundice for three months.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"5 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89016800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A sellar spine is a rare osseous projection from the dorsum sellae, resulting in variable compression of sellar and suprasellar structures and varied clinical presentations. CT is the diagnostic modality of choice, while variable signal intensity on MRI may mimic a pituitary microadenoma. A patient presented with hypoprolactinaemia and puerperal alactogenesis due to a sellar spine diagnosed on CT Brain. Neurosurgical and endocrine review and pituitary MRI were recommended with subsequent loss to follow-up.
{"title":"Sellar spine: A rare Bony variant of the Sella Turcica","authors":"Luke D. Metelo-Liquito, Thandi E. Buthelezi","doi":"10.4102/sajr.v26i1.2371","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2371","url":null,"abstract":"A sellar spine is a rare osseous projection from the dorsum sellae, resulting in variable compression of sellar and suprasellar structures and varied clinical presentations. CT is the diagnostic modality of choice, while variable signal intensity on MRI may mimic a pituitary microadenoma. A patient presented with hypoprolactinaemia and puerperal alactogenesis due to a sellar spine diagnosed on CT Brain. Neurosurgical and endocrine review and pituitary MRI were recommended with subsequent loss to follow-up.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"C-31 11","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72595010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Suleman, Moipone N. Vilakazi, M. Bida, Richard Edwards
Giant cell tumour (GCT) arising from the soft tissues of the breast is a rare disease with only eight cases previously reported in the literature. We present a case of histologically proven GCT of the breast, which demonstrated recurrence a few months after resection.
{"title":"Primary giant cell tumour of the breast with recurrence: A rare case report","authors":"F. Suleman, Moipone N. Vilakazi, M. Bida, Richard Edwards","doi":"10.4102/sajr.v26i1.2393","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2393","url":null,"abstract":"Giant cell tumour (GCT) arising from the soft tissues of the breast is a rare disease with only eight cases previously reported in the literature. We present a case of histologically proven GCT of the breast, which demonstrated recurrence a few months after resection.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"14 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87164371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Bilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UGI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UGI workflow steps. Objectives A digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital. Method A retrospective study was conducted from 01 May 2012 – 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UGI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the ‘approval’, ‘waiting’, ‘study’ and ‘reporting’ times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p < 0.05). Results Thirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median ‘total time’ from physician request to report distribution was 107 min (interquartile range [IQR]: 67−173). The median ‘approval’ (6 min; IQR: 1–15) and ‘reporting’ (38 min; IQR: 17–91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter ‘approval’ times. The neonatal ‘waiting’ time was significantly longer than that for older patients (p = 0.02). Conclusion The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.
{"title":"A digital audit of emergency upper gastrointestinal fluoroscopy workflow in children with bilious vomiting","authors":"Bradley C. Messiahs, R. Pitcher","doi":"10.4102/sajr.v26i1.2300","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2300","url":null,"abstract":"Background Bilious vomiting in children requires an urgent evaluation with upper gastrointestinal (UGI) fluoroscopy as it may herald life-threatening midgut malrotation with volvulus (MMWV). There are no published data available on the duration of time-critical UGI workflow steps. Objectives A digital audit of workflow in emergency UGI contrast studies performed on children with bile-stained vomiting at a large South African teaching hospital. Method A retrospective study was conducted from 01 May 2012 – 31 May 2019. A customised search of the institutional radiology information system (RIS) defined all children with bilious vomiting who underwent emergency UGI fluoroscopy. Extracted RIS timestamps were used to calculate the median duration of the ‘approval’, ‘waiting’, ‘study’ and ‘reporting’ times. One-way analysis of variance and Chi-squared tests assessed the association between key parameters and the duration of workflow steps, with 5% significance (p < 0.05). Results Thirty-seven patients (n = 37) with median age 0.8 months were included, of whom 20 (54%) had an abnormal C-loop. The median ‘total time’ from physician request to report distribution was 107 min (interquartile range [IQR]: 67−173). The median ‘approval’ (6 min; IQR: 1–15) and ‘reporting’ (38 min; IQR: 17–91) times were the shortest and longest workflow steps, respectively. Abnormal C-loops (p = 0.04) and consultant referrals (p = 0.03) were associated with shorter ‘approval’ times. The neonatal ‘waiting’ time was significantly longer than that for older patients (p = 0.02). Conclusion The modern RIS is an excellent tool for time-critical workflow analyses, which can inform interventions for improved service delivery.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"531 14","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72550417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johan Sothmann, S. Adam, G. V. van Tonder, Razaan Davis, L. J. van Rensburg
Bilateral acute hearing loss is rare, and the aetiology is poorly defined. Less common treatable pathologies such as otosyphilis must be part of the differential diagnosis and should be actively excluded. We present a case of a 23-year-old woman who developed acute bilateral hearing loss due to otosyphilis, confirmed on audiometry and laboratory tests. In this article, the CT, MRI and clinical findings are presented and discussed.
{"title":"Otosyphilis: A rare cause of acute bilateral sensorineural hearing loss in a HIV-negative patient","authors":"Johan Sothmann, S. Adam, G. V. van Tonder, Razaan Davis, L. J. van Rensburg","doi":"10.4102/sajr.v26i1.2351","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2351","url":null,"abstract":"Bilateral acute hearing loss is rare, and the aetiology is poorly defined. Less common treatable pathologies such as otosyphilis must be part of the differential diagnosis and should be actively excluded. We present a case of a 23-year-old woman who developed acute bilateral hearing loss due to otosyphilis, confirmed on audiometry and laboratory tests. In this article, the CT, MRI and clinical findings are presented and discussed.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"86 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89765405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Undiagnosed pulmonary embolism carries high mortality and morbidity. Computed tomography pulmonary angiogram (CTPA) is the diagnostic method of choice for accurate diagnosis. Inadequate contrast opacification is the second most common cause of indeterminate CTPAs. Objectives Audit the adequacy of CTPA contrast enhancement and determine whether inadequate enhancement is affected by the size and site of the intravenous cannula, flow rate, contrast volume, contrast leakage and day shift versus after hours services. Method Retrospective and prospective audits of the adequacy of contrast enhancement of CTPAs at the Charlotte Maxeke Johannesburg Academic Hospital were conducted using the Royal College of Radiologists guidelines (≤ 11% of studies with < 210 HU). Protocol variables were collected prospectively from questionnaires completed by radiographers performing the CTPAs. Adequate versus inadequate groups were analysed. Results A total of 63 (retrospective) and 130 (prospective) patients were included with inadequate contrast enhancement rates of 19% (12/63) and 20.8% (27/130), respectively. The majority of CTPAs were performed during the day 56.2% (73/130) with a 20G cannula 66.2% (86/130) in the forearm 33.8% (44/130) injecting 100 mL – 120 mL contrast 43.1% (56/130) at 3 mL/s 63.1% (82/130). The median flow rate (3 mL/s) and contrast volume (80 mL) were identical in both adequate and inadequate groups, while the remaining variables showed no statistical difference. Conclusion The rate of inadequately enhanced CTPAs in this study was high. The protocol variables did not have a significant influence on the rate of inadequate enhancement. Further research, particularly using flow rates > 4 mL/s, is required for protocol optimisation.
{"title":"An audit of the adequacy of contrast enhancement in CT pulmonary angiograms in a South African tertiary academic hospital setting","authors":"Derik J. Basson, H. Moodley","doi":"10.4102/sajr.v26i1.2350","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2350","url":null,"abstract":"Background Undiagnosed pulmonary embolism carries high mortality and morbidity. Computed tomography pulmonary angiogram (CTPA) is the diagnostic method of choice for accurate diagnosis. Inadequate contrast opacification is the second most common cause of indeterminate CTPAs. Objectives Audit the adequacy of CTPA contrast enhancement and determine whether inadequate enhancement is affected by the size and site of the intravenous cannula, flow rate, contrast volume, contrast leakage and day shift versus after hours services. Method Retrospective and prospective audits of the adequacy of contrast enhancement of CTPAs at the Charlotte Maxeke Johannesburg Academic Hospital were conducted using the Royal College of Radiologists guidelines (≤ 11% of studies with < 210 HU). Protocol variables were collected prospectively from questionnaires completed by radiographers performing the CTPAs. Adequate versus inadequate groups were analysed. Results A total of 63 (retrospective) and 130 (prospective) patients were included with inadequate contrast enhancement rates of 19% (12/63) and 20.8% (27/130), respectively. The majority of CTPAs were performed during the day 56.2% (73/130) with a 20G cannula 66.2% (86/130) in the forearm 33.8% (44/130) injecting 100 mL – 120 mL contrast 43.1% (56/130) at 3 mL/s 63.1% (82/130). The median flow rate (3 mL/s) and contrast volume (80 mL) were identical in both adequate and inadequate groups, while the remaining variables showed no statistical difference. Conclusion The rate of inadequately enhanced CTPAs in this study was high. The protocol variables did not have a significant influence on the rate of inadequate enhancement. Further research, particularly using flow rates > 4 mL/s, is required for protocol optimisation.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"6 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77765054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The incidence of concurrent traumatic brain injury (TBI) and cervical spine injury (c-spine) is relatively high, with a variety of risk factors. Objectives The purpose of this study was to determine the incidence and related factors associated with combined cranial and c-spine injury in TBI patients by assessing their demographics and clinical profiles. Method A retrospective study of patients attending the Trauma Centre at the Inkosi Albert Luthuli Hospital as post head trauma emergencies and their CT brain and c-spine imaging performed between January 2018 and December 2018. Results A total of 236 patients met the criteria for the study; 30 (12.7%) patients presented with concurrent c-spine injury. Most TBI patients were males (75%) and accounted for 70% of the c-spine injured patients. The most common mechanism of injury with a relationship to c-spine injury was motor vehicle collisions (MVCs) and/or pedestrian vehicle collisions (70%). The risk factors associated with c-spine injury in TBI patients were cerebral contusions (40%), traumatic subarachnoid haematomas (36%) and skull fractures (33.3%). The statistically significant intracranial injury type more likely to have an associated c-spine injury was diffuse axonal injury (p = 0.04). Conclusion The results suggest that concurrent TBI and c-spine injury should be considered in patients presenting with a contusion, traumatic subarachnoid haematoma and skull fracture. The high incidence of c-spinal injury and more than 1% incidence of spinal cord injury suggests that c-spine scanning should be employed as a routine for post MVC patients with cranial injury.
{"title":"Concurrent cranial and cervical spine injuries by associated injury mechanisms in traumatic brain injury patients","authors":"Pilasande Hlwatika, T. Hardcastle","doi":"10.4102/sajr.v26i1.2321","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2321","url":null,"abstract":"Background The incidence of concurrent traumatic brain injury (TBI) and cervical spine injury (c-spine) is relatively high, with a variety of risk factors. Objectives The purpose of this study was to determine the incidence and related factors associated with combined cranial and c-spine injury in TBI patients by assessing their demographics and clinical profiles. Method A retrospective study of patients attending the Trauma Centre at the Inkosi Albert Luthuli Hospital as post head trauma emergencies and their CT brain and c-spine imaging performed between January 2018 and December 2018. Results A total of 236 patients met the criteria for the study; 30 (12.7%) patients presented with concurrent c-spine injury. Most TBI patients were males (75%) and accounted for 70% of the c-spine injured patients. The most common mechanism of injury with a relationship to c-spine injury was motor vehicle collisions (MVCs) and/or pedestrian vehicle collisions (70%). The risk factors associated with c-spine injury in TBI patients were cerebral contusions (40%), traumatic subarachnoid haematomas (36%) and skull fractures (33.3%). The statistically significant intracranial injury type more likely to have an associated c-spine injury was diffuse axonal injury (p = 0.04). Conclusion The results suggest that concurrent TBI and c-spine injury should be considered in patients presenting with a contusion, traumatic subarachnoid haematoma and skull fracture. The high incidence of c-spinal injury and more than 1% incidence of spinal cord injury suggests that c-spine scanning should be employed as a routine for post MVC patients with cranial injury.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"2008 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86224205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background A high incidence of thromboembolic phenomena has been widely reported in patients with coronavirus disease 2019 (COVID-19) pneumonia. There is, however, a paucity of data detailing the incidence and characteristics of pulmonary emboli (PE) in COVID-19 patients in the South African setting. Objectives To describe the incidence and characteristics of PE confirmed by CT pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia admitted to a tertiary hospital in the Western Cape, South Africa. Methods This was a retrospective-, descriptive study of all adult patients with COVID-19 pneumonia confirmed by polymerase chain reaction (PCR) undergoing CTPA for suspected PE while admitted to Groote Schuur Hospital. The study period was from 01 April 2020 to 30 September 2020. Results The study cohort consisted of 116 patients, 59% being female, of whom 29% were pregnant or in the postpartum period. The median age for both genders combined was 49.5 years. The overall incidence of PE was 19%, with 20% in our subset of pregnant and postpartum patients. The majority (64%) of PE’s were reported as being segmental in anatomical location. Conclusion The noteworthy cohort included patients with pulmonary tuberculosis (PTB), HIV as well as pregnant and postpartum patients. The overall incidence of PE was 19% with no significant differences in demographics, comorbidities or D-dimer levels between patients with or without PE. The importance of a high clinical index of suspicion together with the role of CTPA in diagnosing PE in hospitalised COVID-19 patients is emphasised.
{"title":"A retrospective review of CT pulmonary angiogram confirmed pulmonary emboli in COVID-19 patients admitted to Groote Schuur Hospital, Cape Town","authors":"Petri Ahlers, Mariam Q. Said-Hartley","doi":"10.4102/sajr.v26i1.2280","DOIUrl":"https://doi.org/10.4102/sajr.v26i1.2280","url":null,"abstract":"Background A high incidence of thromboembolic phenomena has been widely reported in patients with coronavirus disease 2019 (COVID-19) pneumonia. There is, however, a paucity of data detailing the incidence and characteristics of pulmonary emboli (PE) in COVID-19 patients in the South African setting. Objectives To describe the incidence and characteristics of PE confirmed by CT pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia admitted to a tertiary hospital in the Western Cape, South Africa. Methods This was a retrospective-, descriptive study of all adult patients with COVID-19 pneumonia confirmed by polymerase chain reaction (PCR) undergoing CTPA for suspected PE while admitted to Groote Schuur Hospital. The study period was from 01 April 2020 to 30 September 2020. Results The study cohort consisted of 116 patients, 59% being female, of whom 29% were pregnant or in the postpartum period. The median age for both genders combined was 49.5 years. The overall incidence of PE was 19%, with 20% in our subset of pregnant and postpartum patients. The majority (64%) of PE’s were reported as being segmental in anatomical location. Conclusion The noteworthy cohort included patients with pulmonary tuberculosis (PTB), HIV as well as pregnant and postpartum patients. The overall incidence of PE was 19% with no significant differences in demographics, comorbidities or D-dimer levels between patients with or without PE. The importance of a high clinical index of suspicion together with the role of CTPA in diagnosing PE in hospitalised COVID-19 patients is emphasised.","PeriodicalId":43442,"journal":{"name":"SA Journal of Radiology","volume":"36 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87232756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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