BackgroundThoracic vascular injuries following blunt chest trauma are the second leading cause of trauma-related deaths. Multi-detector computed tomography (MDCT) is the imaging modality of choice in detecting these injuries.ObjectivesTo determine the spectrum of vascular injuries detected on MDCT imaging in patients who sustained blunt chest trauma, and to assess the various types of management options and patient outcomes.MethodWe retrospectively reviewed archived medical records of polytrauma patients who presented with blunt chest trauma and confirmed vascular injury on MDCT and vascular intervention images between May 2015 and August 2018 at Inkosi Albert Luthuli Central Hospital.ResultsThirty-nine patients with vascular injury findings were analysed. The injury spectrum comprised: 15 aortic injuries (AI), 19 non-aortic injuries (NAI), 4 combined (AI and NAI) and 1 aorto-venous injury. A majority of males (69%) with an overall mean age of 39 years constituted the study cohort. The commonest injury mechanisms included motor vehicle collisions (61%) and pedestrian accidents (28%); the remaining 11% were shared amongst motorbike accidents or falling from a moving train or a height. The subclavian artery (36%) was the most common anatomical location in the NAI and the frequent imaging finding was vessel occlusion (55%). The most common imaging findings in AI were the indirect signs (20.5%) followed by a grade III injury (15.4%). Six patients with a grade III AI were successfully managed with endovascular repair.ConclusionA thorough knowledge of blunt vascular injury spectrums and imaging manifestations is critical when interpreting MDCT scans. Awareness of the mechanism of injury will trigger a high index of suspicion and probe a search for a vascular injury.

BackgroundThe incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established.ObjectivesTo determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital.MethodsA retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared.ResultsFifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity.ConclusionIn our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial.

Background: Patients with obstructive jaundice require a stepwise approach to investigation and management. Ultrasound (US) is the initial screening modality of choice and has been shown to be accurate in demonstrating the presence of dilated bile ducts, as well as the level and cause of obstruction. For adequate radiological communication to the clinician, degree of bile duct dilatation, level of obstruction, appearance of the transition zone and cause of obstruction must be reported. However, without a structured reporting method, much of this information may be omitted.Objectives: The aim of the study was to investigate the adequacy of US findings in patients with obstructive jaundice, as documented, without standardised reporting.Methods: A retrospective chart review of 130 US reports of adult patients presenting at Grey’s Hospital US Department with a clinical assessment of obstructive jaundice was conducted. Data for the period January to December 2013, were analysed. US reports of patients with dilated bile ducts were assessed for report adequacy by looking at four important clinical factors, that is, the degree of bile duct dilatation, the level of obstruction, the appearance of the transition zone and the cause of the obstruction.Results: A report adequacy score was assessed in 79 patients with dilated bile ducts; however, two reports were excluded because of obscuration by gas. There was a high level of report inadequacy (38%) without the use of a structured reporting template. The level of obstruction was the most common component missing from the reports (25%), followed by the appearance of the transition zone (18%) and cause of obstruction (12%).Conclusion: We propose the use of an US report template for obstructive jaundice patients in order to ensure comprehensive reporting. Structured radiological reporting will improve the method of communication between clinicians and radiologists, thus improving the quality of patient care.

Background: Tuberculosis (TB) is a worldwide infectious disease burden, especially in non-developed countries, with increased morbidity and mortality among human immunodeficiency virus (HIV)-infected patients. Extrapulmonary TB is rare and renal TB is one of the commonest manifestations. The end result of renal TB is end-stage renal disease; however, this can be avoided if the diagnosis is made early. The diagnosis of renal TB is challenging because of the non-specific presentation and low sensitivity of clinical tests. Although the sequel of TB infection in the kidney causes varying manifestations depending on the stage of the disease, multidetector computed tomography (MDCT) is capable of demonstrating early findings. We performed a 20-year scoping review of MDCT findings in renal TB to promote awareness.Aim: To identify specific MDCT imaging characteristics of renal TB, promote early diagnosis and increase awareness of the typical imaging features.Methods and material: We searched published and unpublished literature from 1997 to 2017 using a combination of search terms on electronic databases. We followed the Joanna Briggs Institute guidelines.Results: A total of 150 articles were identified, of which 145 were found through electronic search engines and 5 were obtained from grey literature. Seventy-nine articles that fulfilled our inclusion criteria were reviewed. These included original research, case reports, literature review, organisational reports and grey literature.Conclusion: Multidetector computed tomography can reproduce images comparable with intravenous excretory urography; together with advantages of being able to better assess the renal parenchyma and surrounding spaces, it is important in suggesting the diagnosis of renal TB and clinicians should consider including MDCT when investigating patients with recurrent urinary tract infection not responding to usual antimicrobial therapy.

Alexander disease, also known as fibrinoid leukodystrophy, is a rare leukoencephalopathy which occurs due to a mutation in the glial fibrillary acid protein (GFAP) gene. Magnetic resonance imaging (MRI) has proven to be highly sensitive in making the diagnosis. Typical MRI findings, in combination with positive genetic blood analysis, confirm the diagnosis.