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   Table of Contents - Current issue
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January-June 2020
Volume 27 | Issue 1
Page Nos. 1-74

Online since Friday, March 13, 2020

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ORIGINAL ARTICLES  

Intracardiac echogenic focus: Its importance during routine prenatal ultrasound screening in a black African population p. 1
Janet Adetinuke Akinmoladun, Bosede Adebayo, Ademola Joseph Adekanmi
DOI:10.4103/wajr.wajr_25_18  
Background: Intracardiac echogenic focus (ICEF) is defined as a small bright structure within the fetal heart with similar or greater echogenicity to the surrounding bone. The cause of ICEF is unknown, although it is generally believed to be a normal variant. However, several authors have reported a possible association between an ICEF and chromosomal abnormalities, while some others have found an association with structural cardiac anomalies. There are presently no data on this subject in sub-Saharan Africa about the possible correlation with other anomalies. Materials and Methods: This was a prospective, cross-sectional, hospital-based study in a native West African population that spanned 5 years and 5 months. All the pregnant women who presented for routine prenatal ultrasound screening for fetal anomaly between 18 and 22 weeks' gestation age during the study period were included in the study. The prevalence and pattern of ICEF and correlations with cardiac anomalies were determined. Results: In this study, 1.986 fetuses were evaluated for ICEF. The prevalence of ICEF was 2.2%, and more commonly (38.6%) seen in fetuses of mothers aged 30–34 years. Twenty-five percent (25%) occurred in fetuses of mothers that are older than 35 years. Most cases (65.7%) occurred in mothers that had no risk factors for the cardiac anomaly. Majority of the ICEF were solitary and within the left ventricle (95.5% and 93.2%, respectively). About 2.3% of the ICEF were biventricular. Among those that had further echocardiographic evaluation, 15% had major structural cardiac defects. Conclusion: A left ventricular ICEF may not indicate a normal variant in all cases. We propose the addition of detailed fetal echocardiography to rule out structural cardiac anomalies.
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Clinico-radiologic correlates of oral and maxillofacial radiographs: A 3-year study of 156 patients in a Nigerian teaching hospital p. 7
Otasowie D Osunde, Kelvin U Omeje, Akinwale A Efunkoya, Ibiyinka O Amole, Benjamin I Akhiwu
DOI:10.4103/wajr.wajr_1_18  
Background: Any discrepancy between clinical and radiographic information may have dire consequences on the optimal care of patients. Aim: The aim of this study was to determine the correlation between the clinical and radiographic findings in oral and maxillofacial surgery patients. Materials and Methods: This was a retrospective study of all patients with plain radiographic views of the oral and maxillofacial region, seen at a Nigerian Teaching Hospital, over a 3-year study period. The radiographs and patients' case files were retrieved and demographic, clinical as well as radiographic information were obtained. Radiographic information obtained included source and types of the radiographs, patients' bio-data, side and site of the pathology, clinical indication, labeling on the radiograph as well as interpretation errors in form of missed diagnosis other than missed fractures. The data were analyzed using SPSS version 13. Cohen's kappa agreement test was done between clinical and radiographic information.P <0.05 was considered significant. Results: Radiographs from 156 patients aged 8–80 years, mean (standard deviation), 37.9 (19.22) years, were reviewed. There were 102 males and 54 females. Trauma (n = 54; 34.6%) was the most common indication for radiographs. “Transposition” of side of the lesions accounted for 9 (5.8%) of the cases. Radiographic “transposition” was significantly associated with facial fractures, temporomandibular joint ankylosis, and impacted mandibular third molars (likelihood ratio: χ2 = 16.930; df = 10;P = 0.03). There was some disagreement between clinical and radiographic information with regard to side (kappa = 0.788;P = 0.001). Conclusion: Discrepancies in the side of lesions, between clinical and radiographic information, were observed in this study. Adequate care should be taken by clinicians and radiologists to minimize errors in radiographs.
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Factors influencing the use of palliative external beam radiotherapy for advanced breast cancer patients in the University College Hospital, Ibadan p. 12
Hassan Ibrahim, Adamu Abdullahi
DOI:10.4103/wajr.wajr_27_18  
Background: PRT (palliative RT [PRT]) has been proven as an effective treatment modality for symptom relief in advanced breast cancer patients; however, access to this treatment in Nigeria is determined by some demographic factors. Materials and Methods: We retrospectively collected data from records of patients treated with PRT for advanced breast cancer between January 1, 2005, and December 31, 2009, at the University College Hospital Ibadan, Nigeria. Patients' Socio-demographic factors, tumor characteristics and RT treatment received were evaluated. Data obtained were analyzed using Statistical Package for Social Sciences version 20.0 (Chicago, IL, USA) statistical software. National population data on 2006 census were used to determine age-corrected values for metastatic sites and socioeconomic status (SES) of the patients. Results: Five hundred and eighty-four patients' data between 2005 and 2009 were considered eligible and reviewed. Their ages ranged between 20 and 89 years, with a mean age of 45 years, with only 0.7% being male patients. The commonly affected age groups demanding for PRT were between 40 and 59 years, which accounted for 7.6 persons/100,000 populations. Breast cancer predominantly metastasizes to the bone, affecting 11.4 persons/100,000 populations, within the age range of 50–79 years. Pain associated with other symptoms accounted for more than half (66.6%) of the presenting complaints that demand the use of PRT for effective relief. Majority of the patients referred for PRT were from low SES and fell within the age range of 30–49 years, with 7.02 persons/100,000 populations. Conclusion: Age is a predictive factor of pattern of breast cancer metastasis and rate of PRT utilization. Majority of the affected age groups (40–59 years) demanding for PRT were of low- and middle-SES. Therefore, there is a need for more RT machines in the country with effective national health insurance coverage on cancer patients to aid affordability.
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Doppler ultrasound evaluation of blood flow patterns of the uterine arteries in pre- and postmenopausal women with cervical cancer and controls in Zaria p. 18
Ibrahim Muhammad Zaria, Iliyasu Garba, Chom Nuhu Dung, Ibinaiye Philip Oluluke, Lawal Suleiman
DOI:10.4103/wajr.wajr_13_19  
Background: Cervical cancer remains an important health issue, especially in the developing countries that account for about 85% of the world burden of cervical cancer. Finding a role for Doppler ultrasound in the evaluation of these patients may reduce the cost and improve access to management. Aim: The study aimed at evaluating the Doppler flow parameters in pre- and postmenopausal patients with cervical cancer when compared to normal controls in a teaching hospital in Nigeria. Methodology: This is a prospective case–control observational study conducted over a period of 7 months (August 2016–February 2017) in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Eighty-one patients with cervical cancer and 81 age-matched controls had a transabdominal Doppler ultrasound examination of the main uterine arteries. The data were analyzed using SPSS version 20.0, Chicago, Illinois, USA. Statistical differences in the uterine artery indices between two groups were tested, andP < 0.05 was considered as statistically significant. Results: The mean resistive index (RI) and pulsatility index (PI) of the patients were 0.64 ± 0.12 and 1.26 ± 0.31, respectively, and of controls were 0.88 ± 0.08 and 2.60 ± 0.56, respectively. These showed significantly lower values in patients than the controls (P < 0.0001). The mean end-diastolic velocity (EDV) was significantly higher in patients than the controls (P < 0.0001). There was, however, no significant difference in the mean peak systolic velocity (PSV) in patients and controls (P = 0.97). Both premenopausal patients and controls had significantly lower RI and PI and significantly higher PSV and EDV compared to their postmenopausal counterpart. Conclusion: The findings showed that significant differences exist in the uterine artery Doppler flow parameters in patients with cervical cancer compared to the healthy controls and that these parameters are influenced by menopausal status of the women and the size of the cervical mass. Hence, Doppler helps in staging, prognosticating, and posttreatment evaluation of patients with cervical cancer.
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Chest radiographic findings of pulmonary tuberculosis in human immunodeficiency virus-seropositive patients in a teaching hospital in Kano Northwest, Nigeria p. 27
Mohammed Sani Umar, Sunday Victory Daniel, Mohammed Abba Suwaid, Geofrey Luntsi, Jibrin Yusuf, Joseph Dlama Zira, Auwal Abubakar, Charbel Saade, Mustapha Barde
DOI:10.4103/wajr.wajr_33_18  
Background: Tuberculosis (TB) is one of the most common infections to occur in the course of human immunodeficiency virus (HIV) infection and remains a global emergency despite substantial investment in health services. Aim: This study aims to determine the spectrum of chest X-ray findings in patients with HIV/TB coinfection. Materials and Methods: A retrospective cross-sectional study of the clinical and radiographic features of pulmonary TB (PTB) in 244 confirmed HIV-seropositive patients aged 9 months to 80 years. Descriptive statistics was employed in analyzing mean percentages and frequencies. Level of statistical significance between clinical findings, radiographic findings, age group, and gender was determined using z-test. Statistical significance was set atP ≤ 0.05. Results: The study constituted of 104 (42.62%) males and 140 (57.38%) females with mean age of 31.62 ± 16.93 years. The major clinical features among HIV-related PTB patients in this study are cough in 56.6% patients, chest pain in 11.44% patients, weight loss in 10.26% patients,P < 0.05. Chest X-rays with normal findings were found in 60.0% patients, while primary patterns of PTB such as reticulonodular opacities occurred in 16.61% patients, typical post primary patterns such as background cystic/fibrotic changes were found in 3.39% patients, and miliary pattern in 2.73% patients. The age group 26–38 years was frequently involved in TB coinfections in both sexes,P < 0.001. The percentages of males and females with TB infection were 40.98% and 56.15%, respectively. Conclusions: Normal chest X-rays constitute the major findings; primary and postprimary patterns of PTB account for the least findings with the age group 26–38 years as the most occurring (91, 37.30%). Females were more frequently involved in TB coinfection. The preponderance of normal radiographs does not exclude the presence of TB coinfection.
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Acute toxicity to radical combination treatment in human immunodeficiency virus-positive cervical cancer patients: Experience from a resource-constrained center p. 33
Abdullahi Adamu, Muhammad Inuwa Mustapha, Ayodeji Tajudeen Olasinde, Campbell Babatunde Oladapo
DOI:10.4103/wajr.wajr_43_18  
Background and Purpose: To determine acute toxicity to radical combination treatment in invasive cervical cancer patients seropositive to human immunodeficiency virus (HIV). Subjects and Methods: This is a retrospective review of HIV-seropositive patients managed for invasive cervical cancer between January 2012 and December 2017 at the radiotherapy and oncology center of our institution. Patients' sociodemographics, disease characteristics, and acute treatment-induced toxicity were extracted from their clinical case notes and were studied. Results: A total of 83 confirmed HIV patients with histologically diagnosed invasive cervical cancer were studied. Their median age at presentation was 37.8 years. The most common presenting symptom of cervical cancer was copious foul-smelling vaginal discharge accounting for 39.8%. Sixty-three (85.6%) patients presented with Eastern Cooperative Oncology Group performance status of 0 and 2 and 74 (89.2%) patients presented with International Federation of Gynecologists and Obstetricians Stage 2B and above. Seventy-four (89.2%) patients had access to highly active antiretroviral therapy. Fifty-five (66.3%) patients were started on radical chemoradiation of which 28 (50.1%) completed prescribed external beam radiotherapy. Thirteen (15.7%) patients were treated symptomatically to control symptoms of cervical cancer. Concurrent chemoradiation appears to be poorly tolerated with 25 (71.4%) of the patients in this arm of treatment developing either Grade 3 or 4 toxicities. Grade 3 hematologic and gastrointestinal tract (GIT) toxicity was seen in 17.9% and 25% of the patients, respectively, while 21.4% of the patients presented with Grade 4 skin toxicity, leading to treatment delays and interruptions. There was excellent symptomatic relief in patients treated with palliative intent. Conclusions: Radiotherapy and chemotherapy are effective modalities of treatment in a selected group of these set of patients with good control of symptoms related to cervical cancer. Palliative radiotherapy is also effective in patients with poor performance status in relieving symptoms of cervical cancer. Further research needed to be done to identify the optimum management of these patients with radiotherapy and/or chemotherapy to reduce treatment-induced toxicity, thereby minimizing treatment interruptions and delays which ultimately will improve their overall outcome.
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Multimodality imaging approach to blunt abdominal trauma in a tertiary care center in North India p. 40
Annu Kharbanda, Mukta Mital, Sonal Saran, Sameer R Verma
DOI:10.4103/wajr.wajr_7_19  
Background: Evaluating patients who have sustained blunt abdominal trauma (BAT) remains one of the most challenging and resource-intensive aspects of acute trauma care. This study was conducted to evaluate the correlation of ultrasonography (USG) and computed tomography (CT) in detecting the visceral injuries with the assessment of their diagnostic indices. X-ray was done in cases of suspected bowel injuries. Materials and Methods: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Imaging and Interventional Radiology, at CSS Hospital, Subharti Medical College, Meerut, Uttar Pradesh, India, for 2 years. Eighty-two patients of BAT were evaluated using investigations such as X-ray (wherever required), USG, and CT scan during the study. Results: Majority of the patients were from the age group of 21 to 40 years with predominance of male (69.5%). Hemoperitoneum associated with visceral injuries were the major findings detected by both USG (70.7%) and CT (81.7%). Sensitivities of USG for the detection of spleen, liver, kidney, and pancreatic injuries were 95%, 94%, 66.6%, and 40%, respectively, while the sensitivity of CT for the detection of liver, spleen, kidney, and pancreas was 100%. Conclusion: CT is highly sensitive, specific, and accurate in detecting the presence or absence of injury in BAT and defining its extent. However, USG still remains the initial investigation of choice.
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Cranial computed tomography imaging of patients with stroke in a tertiary facility p. 46
Hadijat Oluseyi Kolade-Yunusa, Ibrahim Adamu Yaro, Lawal Yusuf
DOI:10.4103/wajr.wajr_2_19  
Background: Neuroimaging plays an important role in stroke management by providing information to accurately triage patients, expedite clinical decision with regard to treatment, and in improving outcomes in patients presenting with stroke. The aim of this study is to determine the spectrum of computed tomography (CT) findings in patients with stroke with respect to the type of lesion, location, and possible risk factors. Materials and Methods: This was a retrospective study with data compiled from medical files and cranial CT scan images of 148 patients clinically diagnosed with stroke conducted over a period of 36 months from the Department of Radiology, University of Abuja Teaching Hospital. Results: There were 148 patients with complete data who were clinically diagnosed with stroke. From cranial CT findings, 56.1% of patients studied had cerebral infarct, 41.2% hemorrhage, and 2.7% normal findings. The gender distribution of cranial CT findings was not statistically significant (P = 0.09 for males andP = 0.07 for females). The parietal lobe was the most affected site for hemorrhage and infarcts accounting for 31.1% and 49.4%, respectively. The cerebellum was the least affected site. The two most commonly documented risk factors identified in this study were hypertension and diabetes mellitus accounting for 61.9%. Conclusion: Cerebral infarct was the most common computed tomographic finding among patients with stroke, and the parietal lobe was the most common location for infarct and hemorrhage. Hypertension was a major risk factor for stroke. CT is an important imaging modality for diagnosis, differentiating infarct from hemorrhage in stroke management.
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Utility of ultrasound elastography in evaluation of thyroid nodules and correlation with cytology p. 52
Vikrant Kanagaraju, S Sukithra, N Jayaprakash, B Devan
DOI:10.4103/wajr.wajr_12_19  
Background: Ultrasound elastography (USE) has emerged as a potentially useful tool in the evaluation of thyroid nodules. The aim of this study was to assess the efficacy of elastography in differentiating benign from malignant thyroid nodules with fine-needle aspiration cytology (FNAC) analysis as reference standard. Materials and Methods: This was a cross-sectional prospective study carried out at a tertiary care center in South India between May 2014 and March 2015. Consecutive patients with solid nodule in the thyroid gland on conventional ultrasound (US) underwent USE, followed by US-guided FNAC of the thyroid nodule. The findings of B-mode images and USE were correlated with cytology. Statistical analysis was performed using SPSS version 24. Descriptive statistics were presented as mean ± standard deviation. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of USE were calculated. Results: A total of sixty patients with sixty solid thyroid nodules were enrolled in the study. The mean age of the patients was 48.27 ± 16.10 years. About 83.3% were females. The frequency of benign nodules on cytopathologic analysis was 60% (n = 36). Seventy-five percent of the malignant lesions had irregular or poorly defined borders with lobulated margins on US. The sensitivity, specificity, positive predictive value, and negative predictive value of USE were 91.7%, 77.77%, 73.33%, and 93.3%, respectively, with FNAC as reference standard. Higher elastography scores were found to be significantly associated with malignant cytology (P = 0.0001). Conclusion: Elastography, with its fairly high diagnostic accuracy and correlation with malignant cytology, can be an effective noninvasive adjunctive tool in distinguishing benign from malignant thyroid nodules.
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Radiotherapy treatment of spinal metastases in Ibadan: A 9-year review p. 58
Abbas Adesina Abdus-Salam, Adeniyi Adedayo Olabumuyi, Ajibike Ayomide Orekoya, Mutiu Alani Jimoh
DOI:10.4103/wajr.wajr_8_19  
Background: Metastatic spinal tumors signify disease progression and result in poor quality of life of patients. We are likely to see an increasing burden of spinal metastases due to the global trend of increasing cancer survival. Objective: The objective of this study was to review the pattern of presentation and radiotherapy of metastatic spinal tumors in the Radiation Oncology Department, University College Hospital, Ibadan, Nigeria. Materials and Methods: The radiation therapy records of all patients who received spinal irradiation between January 2007 and December 2015 were retrieved. The extracted data are patients' sociodemographic, clinicopathologic, and treatment factors which include the radiation dose given and retreatment dose. Results: Majority (91.7%) of the patients who had radiotherapy to the spine had metastatic spinal tumors. Male patients accounted for 69.1% of the cases and females accounted for 30.1% resulting in a male–female ratio of 2.23:1. Close to half (45.8%) of the patients were elderly. Prostate cancer (57.3%) and breast cancer (18.8%) were the most common primary sites. The most common involved spinal site was the thoracic region. In all age groups, fewer patients received a short radiotherapy treatment course (totaling 15 Gy or less and within a duration of 1 week) versus long radiotherapy treatment course (other radiation schedules not meeting criteria for short). Conclusion: A high index of suspicion of metastatic spinal cancer is required, particularly for breast and prostate cancers. The authors recommend that more elderly patients should be treated with short-course radiotherapy.
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CASE REPORTS Top

Radiological aspects of musculoskeletal complications in three hemophilic patients with long-term follow-up p. 63
Ousmane Aminata Bah, Jawad Mesrar, Alpha Abdoulaye Balde, Abarchi Habibou Boube, Mamadou Oury Bah, Lantam Sonhaye, Douraied Ben Salem, Mar Garetier
DOI:10.4103/wajr.wajr_26_18  
Objective: The objective of the study is to describe the radiological aspects of musculoskeletal complications of hemophilia found in three patients. Patients and Methods: It is a retrospective review of clinical and radiological records of three known and followed hemophilic patients, whose radiological examinations were carried out and archived on the Picture Archiving and Communication System of the University Hospital. Results: The three patients were male with severe hemophilia A, using recombinant factor VIII replacement therapy on demand, followed during 10 years. Joint bleeding was the most frequent complication. We found hemarthrosis at ultrasound in two patients (one after a minor trauma of the knee and one after repeated traumas of the ankle) and at magnetic resonance imaging (MRI) in the three patients (three in the knee and two in the ankle) and chronic arthropathy in two patients (two in the knee and one in ankle. The muscular lesions detected at ultrasound were hematomas of the left soleus muscle, right vastus medialis muscle, and right rectus abdominis muscle. Conclusion: Bleeding in hemophilic patients affects both muscles and joints, with long-term consequences for the joints. Medical imaging was very useful for the detection and follow-up of joint and muscle lesions in these three patients, based on ultrasound and MRI with T2* sequence.
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Incidental discovery of situs inversus totalis in a 72-year-old man p. 68
Bukunmi Michael Idowu, Tolulope Adebayo Okedere, Stephen Olaoluwa Onigbinde
DOI:10.4103/wajr.wajr_41_18  
Situs inversus totalis (SIT) which is also known as dextrocardia with situs inversus is a congenital anomaly of lateralization or sidedness. Although dextrocardia of itself is detectable on obstetrics sonography, it frequently goes undetected and these individuals are often diagnosed later in life. This is a case of SIT in a 72-year-old man, who has had normal life expectancy by Nigerian standards, detected incidentally on imaging evaluation for unrelated complaints. He presented with features of chest infection and intestinal obstruction. While on admission, he was also diagnosed with systemic hypertension and diabetes mellitus. He had no features of Kartagener's syndrome. SIT could be suspected clinically, but a definitive diagnosis often requires imaging. Medical personnel must always maintain a high index of suspicion for this relatively uncommon condition with a profound impact on administration and/or interpretation of clinical, investigative, and resuscitative procedures as well as management of ailments.
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Tumor-induced osteomalacia as a paraneoplastic syndrome of a sinonasal neoplasm in Indian female p. 72
Punit Pushkar Mahajan, Nirav Thaker, Sunila Jaggi, Inder Talwar
DOI:10.4103/wajr.wajr_1_19  
A rare case of oncogenic osteomalacia as a paraneoplastic syndrome of a sinonasal neoplasm detected incidentally on a positron emission tomography-computed tomography scan performed to find the cause of multiple axial and appendicular skeletal fractures. The neoplasm was later proven to be a hemangiopericytoma on histopathology with complete reversal of clinical symptoms, biochemical abnormalities, and decreased bone density on the postoperative follow-up.
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