BackgroundThe advantages of multi-detector computed tomography (MDCT) have made it the imaging modality of choice for some patients with suspected cardiothoracic disease, of which pulmonary embolism (PE) is an exponent. The aim of this study was to assess the incidence of PE in patients with clinical suspicion of acute PE using MDCT in a sub-Saharan setting, and to describe the demographic characteristics of these patients.MethodsConsecutive records of patients who underwent MDCT pulmonary angiography for suspected acute PE over a two-year period at the Radiology Department of a university-affiliated hospital were systematically reviewed. All MDCT pulmonary angiograms were performed with a 16-detector computed tomography (CT) scanner using real-time bolus tracking technique. Authorization for the study was obtained from the institutional authorities.ResultsForty-one MDCT pulmonary angiograms were reviewed of which 37 were retained. Of the 4 excluded studies, 3 were repeat angiograms and 1 study was not technically adequate. Twelve of 37 patients (32.4%) had CT angiograms that were positive for PE, of which 7 were males. The mean age of these patients was 47.6±10.5 years (age range from 33 to 65 years). Twenty five patients out of 37 (67.6%) had CT angiograms that were negative for PE. Eleven PE-positive patients (91.7%) had at least 1 identifiable thromboembolic risk factor whilst 5 PE-negative patients (20%) also had at least a thromboembolic risk factor. The relative risk of the occurrence of PE in patients with at least a thromboembolic risk factor was estimated at 14.4.ConclusionAcute PE is a reality in sub-Saharan Africa, with an increased likelihood of MDCT evidence in patients with clinical suspicion of PE who have at least a thromboembolic risk factor. The increasing availability of MDCT will help provide more information on the occurrence of PE in these settings.
Cholecystosonography was undertaken in 90 patients with sickle cell disease aged 15 years and over. Gall stones were found in 26 (28.9%) patients. There was no sex difference, but the incidence increased with age from 13.2% at under 20 years to 75% at 30 years and over. The mean serum cholesterol and total and unconjugated bilirubin concentrations were not significantly different between patients with and without gall stones. As most (80.8%) stones were radiolucent they were probably of pigment type, containing little or no calcium, and further investigation into how they are produced is needed. Sickle cell patients with acute abdominal crisis should have gall bladder disease excluded before a diagnosis ofvascular crisis is made.Sickle cell disease is a major health problem in Africa, especially south of the Sahara. In Cameroon, which stretches from latitude 20 to 13°N ofthe equator, the carrier state ranges from 10-25% of the population in the southern parts of the country to 30-40% in the northern parts. 1 2 Anaemia is the commonest complication due to haemolysis of the sickled cells, but the deposition of the resulting excess pigment as a possible predisposing factor to other complications has received little attention.Sickle cell disease was formerly primarily a paediatric problem, but better management has led to more children surviving to adulthood and thus developing other complications of their disease.In view of the increase in the number of patients with sickle cell disease who survive into adulthood in our region and also the increased incidence of gall stones with age,3 we thought that a study of gall stone disease in this highly selected group of patients was indicated. The hiatus in our knowledge of gall stone disease in Cameroonian patients with sickle cell disease, the need to establish its prevalence, and the need to evaluate radiology as a diagnostic tool led us to undertake this study. Cholesterol concentrations were determined using the oxidase method, total bilirubin concentrations using the diazo reaction with diazotised sulphanilic acid in the presence of dimethylsulphoxide, and unconjugated bilirubin concentrations by the diazo reaction without dimethylsulphoxide.After an overnight fast all 90 patients were screened for gall stones using real time cholecystosonography and a 3 5 MHz transducer. The examination was conducted in both the supine and the left lateral decubitus positions. When the need arose it was carried out in an erect position. Multiple tomographic sections, parallel to and perpendicular to the long axis of the gall bladder were obtained. Gall stones were identified as the presence of intravesicular hyperechogenic structures with acoustic shadows, mobile with gravity in a pear shaped gall bladder whose expanded lower end, tapered proximal contour, and relation to the liver fossa could be seen.Patients who were found to have gall stones were further investigated by two anteroposterior plain x ray examinations of the abdomen: one centred on the right hypochondrium a...
Superior vena cava thrombosis (SVCT) is a rare pathology, though of great significance since it implies the development of a malignant process. The most common etiologies are basically bronchopulmonary and mediastinal tumors. Observations involving 2 patients presenting with superior vena cava syndrome (SVCS) are reported in this study, in which radiologic investigations (chest roentgenogram, computed tomography scan of the thorax, and superior vena cavography) revealed thrombosis of the SVC disclosing in both cases a non-Hodgkin's lymphoma. The first case was a mediastinal Burkitt's lymphoma in a thirty-eight-year-old man (exceptional form) and in the second case a lymphoblastic non-Hodgkin's lymphoma in a nine-year-old girl. In the patient with Burkitt's lymphoma healing was satisfactory twenty-four months after treatment by surgery, chemotherapy, and radiotherapy. The second patient died suddenly. In both cases the SVCT revealed the tumor. The causes of SVCT are reviewed and discussed.
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