BackgroundThyroid nodules are prevalent worldwide. Detection rates are increasing because of the use of ultrasonography. Ultrasound has become the first-choice imaging modality in evaluating nodules. The decision to perform an US-guided fine-needle aspiration (FNA) is based on a nodule’s sonographic features. Thus, it is essential to accurately risk stratify thyroid nodules so that they are appropriately referred for FNA.ObjectivesThe aim of this study was to correlate the ultrasound imaging features of thyroid nodules with FNA cytology and surgical histopathology results, and to risk stratify patients using the American Thyroid Association (ATA) classification for each imaging characteristic with the likelihood of the nodule being malignant.MethodRetrospective analysis of a thyroid ultrasound database at Chris Hani Baragwanath Academic Hospital, over the period 2015–2017. Frequencies and percentages were used to summarise the data. Univariate logistic regression analyses were used to assess the accuracy of sonographic features in predicting the histologically determined diagnosis for thyroid tumours.ResultsA total of 113 nodules underwent FNA, of which 104 were diagnostic. The best three ultrasound features that pose a higher risk for malignancy are absent halo, presence of microcalcifications and hypoechoic appearance. No single nodule feature is an absolute indicator for malignancy. There is a high agreement between ATA classification and cytopathology or histology when nodule features are grouped into clusters. Agreement between the ATA classification and cytopathology/histology was 86.7% with a kappa of 0.714. The agreement between the cytopathology FNA results and lobectomy histopathology was 98.8% with a kappa of 0.973.ConclusionThis study contributes to the paucity of data available for sub-Saharan Africa and provides reassurance that our results are consistent with international studies. The study confirms that the usage of a thyroid nodule classification system improves characterisation and increases accuracy in detecting thyroid malignancies, thus sparing many patients the morbidity of unnecessary thyroid surgery.

Page kidney is a rare phenomenon that can present with hypertension. The presence of a subcapsular perirenal collection causes parenchymal compression leading to renal hypoperfusion. Subsequent activation of the renin–angiotensin–aldosterone system results in an increase in systemic blood pressure. The causes of renal subcapsular collections are varied, with most cases being secondary to post-traumatic haematomas. We present the case of a young hypertensive patient, treated as primary hypertension with persistently uncontrolled blood pressures. This was despite good treatment adherence. On further investigation, imaging identified the presence of bilateral subcapsular collections. This case illustrates the importance of a thorough workup in a young hypertensive patient with refractory hypertension. Given that Page kidney is curable, timeous intervention can save the patient from unnecessary medications and the morbidity of uncontrolled blood pressures.

Chronic Thrombo-Embolic Pulmonary Disease (CTEPD) is usually a silent disease representing a small group of patients who at some stage had suffered a thrombo-embolic event in which the individual may or may not have been aware of. It is estimated that this syndrome develops in approximately 3.8% of patients having suffered an acute Pulmonary Embolus (PE) thus representing a pool of patients estimated in the literature to be in the vicinity of 19,000 [1] It has further been documented that this condition is seriously underdiagnosed and is thought to represent in excess of 100,000 individuals in the United States with CTEPD which potentially could be “cured”. Highlight:

Intussusception happens when a portion of bowel telescopes into the adjacent bowel segment. It is a rare condition in the adult population, particularly in the young adult, and poses a diagnostic dilemma to the attending clinician because of its variable clinical presentation. Radiological imaging is important in the early diagnosis, and it allows prompt surgical management to avoid severe complications, particularly bowel ischaemia and necrosis. This case report describes the clinical and multimodality radiological findings of an ileocolic intussusception secondary to a mucosa-associated lymphoid tissue (MALT) lymphoma in a young adult patient.