Imaging of non-traumatic abdominal emergencies in adults at Limbe Regional Hospital: A qualitative survey of frontline physicians

Introduction: The choice of imaging modalities in non-traumatic abdominal emergencies typically manifesting as pain is informed by the clinical context, availability, cost and safety considerations. The objective of this study was to elucidate how emergency department (ED) physicians use and perceive the role of imaging in non-traumatic abdominal emergencies (NTAE) in adults. Materials and methods: A qualitative in-depth interview of consenting physicians working at the ED of Limbe Regional Hospital was conducted during the month of April 2021. Data was collected on sociodemographic variables, work experience and imaging prescription attitudes for non-traumatic abdominal emergencies. Interview data were audio-recorded, transcribed and analyzed thematically. Results: Fourteen participants were interviewed in-depth of which 9 (64.3%) were females and the median age (range) of all participants was 29 (27 to 35) years. The average duration of work experience after qualification as a physician was 2 years (range: 1 to 6 years) and all participants were general practitioners. Plain abdominal radiography and ultrasonography were reported to be the first-line imaging modalities for all NTAEs, with both often requested sequentially. The utilization of computed tomography was reserved for situations where plain films and ultrasonography were negative or indeterminate, and often upon recommendation by a specialist physician or the reporting radiologist. The perceived role of imaging was to provide a diagnosis as the clinical impression was often uncertain. Conclusion: Plain abdominal films and ultrasonography remain key imaging modalities for the assessment of non-traumatic abdominal emergencies, with computed tomography utilization being more reserved. The continuous sensitization and mentoring of frontline physicians will be useful to foster better utilization of imaging modalities.   English title: Imagerie des urgences abdominales non traumatiques chez l’adulte : Enquête qualitative auprès des médecins du service des urgences à Hôpital Régional de Limbe  Introduction: La disponibilité croissante des modalités d'imagerie dans les hôpitaux donne la possibilité aux médecins de première ligne de choisir la technique la mieux indiquée pour leurs patients. L'objectif de cette étude était d'élucider comment les médecins du service des urgences de l’Hôpital Régional de Limbe au Cameroun conçoivent l’utilité des modalités d'imagerie médicale dans la prise en charge des urgences abdominales non traumatiques chez les adultes. Matériel et méthodes: Un entretien qualitatif détaillé avec les médecins exerçant au service des urgences était réalisé pendant le mois d’avril 2021. Les données étaient recueillies sur les caractéristiques sociodémographiques et les habitudes lors des demandes d’examen d’imagerie pour investiguer les urgences abdominales non-traumatiques. Les interviews étaient enregistrées sur fichier audio, transcrit et analysé de façon thématique. Résultats: Quatorze participants ont été interrogés dont 9 (64,3%) étaient des femmes, et l'âge médian (intervalle) était de 29 (27 à 35) ans. La durée moyenne de l'expérience de travail après l’obtention du diplôme de docteur en médecine était de 2 ans (intervalle : 1 à 6 ans). Tous les participants étaient des médecins généralistes. L'échographie et la radiographie de l’abdomen sans préparation, souvent couplée, étaient citées comme les modalités d'imagerie demandées en première intention pour investiguer les urgences abdominales non traumatiques. La demande de la tomodensitométrie était réservée aux cas où l’échographie et la radiographie étaient non contributives, voire par recommandation par un médecin spécialiste ou du radiologue. Selon les répondants, le principal rôle de l'imagerie serait de fournir un diagnostic de certitude. Conclusion: L'échographie et la radiographie demeurent les principales modalités d'imagerie dans l'investigation des urgences abdominales non-traumatiques, l’utilisation du scanner étant plus restreinte. Une sensibilisation pour renforcer les connaissances et pratiques des médecins de première ligne s’avérait utile

Benign Cystic Peritoneal Mesothelioma Revealed by Small Bowel Obstruction

Benign cystic peritoneal mesothelioma is a rare tumor which frequently occurs in women of reproductive age. Abdominal pain associated with pelvic or abdominal mass is the common clinical presentation. We report the case of a 22-year-old woman with a pathological proved benign cystic mesothelioma of the peritoneum revealed by a small bowel obstruction and a painful left-sided pelvic mass with signs of psoitis. Contrast enhanced abdominal CT-scan demonstrated a large pelvic cystic mass with mass effect on rectosigmoid and pelvic organs. The patient underwent surgical removal of the tumor. Pathological examination revealed the diagnosis of benign cystic mesothelioma of the peritoneum. The outcome was excellent with a 12-month recoil

Pseudoaneurysm of the Common Carotid Artery in an Infant due to Swallowed Fish Bone

Carotid artery pseudoaneurysm is a rare condition, particularly in the paediatric population. Only about 30 cases of carotid artery aneurysms in infants have been published until now. This paper reports the case of a giant pseudoaneurysm of the left common carotid artery due to swallowed fish bone by an 8-year-old boy. This pseudoaneurysm was 5.5 cm transverse-diameter and resulted in severe respiratory distress. It was treated by resection and end-to-end anastomosis with satisfactory outcome after one-year follow-up. To the best of our knowledge, this is the largest carotid artery pseudoaneurysm ever described in children

Case Report Pseudoaneurysm of the Common Carotid Artery in an Infant due to Swallowed Fish Bone

Carotid artery pseudoaneurysm is a rare condition, particularly in the paediatric population. Only about 30 cases of carotid artery aneurysms in infants have been published until now. This paper reports the case of a giant pseudoaneurysm of the left common carotid artery due to swallowed fish bone by an 8-year-old boy. This pseudoaneurysm was 5.5 cm transverse-diameter and resulted in severe respiratory distress. It was treated by resection and end-to-end anastomosis with satisfactory outcome after one-year follow-up. To the best of our knowledge, this is the largest carotid artery pseudoaneurysm ever described in children

Urethral Duplication with a Cystic Phallic Urethra Associated with a Uterus Didelphys, Partial Agenesis of the Tibia, and an Equinovarus Foot

Urethral duplication is a rare congenital malformation, especially in females. It may be associated with complex urogenital malformations, but the association with a cystic phallic urethra and a uterus didelphys is exceptional. We report a case of a newborn with urethral duplication, with the accessory urethra exteriorized by a large cyst, associated with a uterus didelphys and bone malformations. We discuss the clinical, radiographic, and therapeutic aspects as well as a literature review

Evaluation de la pertinence des demandes d’angioscanner thoracique pour suspicion d’embolie pulmonaire à Yaoundé

Introduction : L’objectif de la présente étude était d’évaluer la pertinence des demandes d’angioscanner pour suspicion d’embolie pulmonaire (EP) à Yaoundé. Matériel et méthodes : Il s’agissait d’une étude transversale descriptive avec collecte rétrospective et prospective des données. Elle s’est déroulée sur une durée de 7 mois, dans les services de Cardiologie et d’Imagerie médicale de 4 hôpitaux de la ville de Yaoundé. Étaient inclus tous les patients ayant réalisés ou réalisant un angioscanner thoracique pour suspicion d’embolie pulmonaire (EP) durant la période de novembre 2018 à mai 2019. Les variables étudiées étaient les données sociodémographiques, la probabilité clinique de l’EP par le score de Wells, les facteurs prédisposants, ainsi que le recours aux examens paracliniques (D-dimères, échocardiographie, échodoppler des membres). La pertinence de la demande d’angioscanner thoracique a été évaluée selon les recommandations de la Société Européenne de Cardiologie. Le test de Khi carré et le test exact de Fisher ont été utilisés pour rechercher les facteurs associés au diagnostic d’embolie pulmonaire. Une valeur p<0,05 a été considéré comme statistiquement significative. Résultats : Nous avons retenu au total 71 patients dont la moyenne d’âge était de 54 ±15 ans avec des extrêmes de 18 et 89 ans. A l’évaluation du score de Wells, 25 patients (35,2%) avaient une probabilité clinique faible, 40 (56,3%) avaient une probabilité clinique intermédiaire et 6 (8,5%) avaient une probabilité clinique forte. La demande d’angioscanner thoracique était pertinente dans 76% des cas. La proportion d’embolie pulmonaire au scanner était de 39,4% (N=28). Cette fréquence était proportionnelle au degré de suspicion clinique soit 12% en cas de probabilité faible, 47,5% en cas de probabilité intermédiaire, et 100% en cas de probabilité forte. Le facteur le plus associé au diagnostic d’EP était la présence de signes de thrombose veineuse profonde (p=0,012). Conclusion: Les demandes d’angioscanner sont pertinentes dans trois quarts des cas dans notre série. L’utilisation du score de probabilité de Wells est fortement corrélée au diagnostic d’embolie pulmonaire en particulier en présence de signes cliniques de thrombose veineuse profonde. Ces résultats suggèrent de renforcer la sensibilisation des prescripteurs sur l’utilisation courante de ce score afin de limiter le risque d’irradiation et les dépenses financières des patients. English title: Relevance in the request of computed tomography pulmonary angiography for suspected pulmonary embolism in Yaoundé  Introduction: The present study aimed to evaluate the relevance in the prescription of computed tomography pulmonary angiography for pulmonary embolism suspicion in Yaoundé. Materials and methods. We conducted a cross sectional study during a period of 7 months (November 2018 to May 2019) at the cardiology and imaging units of 4 hospitals in Yaoundé. All consenting patients who underwent CTPA were included in the study. The variables studied were socio-demographic data, clinical probability (using Wells score) and paraclinical workups (D-dimers testing, echocardiography, venous ultrasonography). The relevance of prescription was evaluate using the European Society of Cardiology‘s guidelines. Chi square and Fisher tests were used to find association between clinical parameters and diagnostic of pulmonary embolism. A p value<0.05 was considered statistically significant. Results. A total number of 71 patients were recruited; the mean age was 54 ±15.4 years ranging between 18 to 89 years. In assessment of the Wells score, 25 patients (35.2%) had low clinical probability, 40 (56.3%) had intermediate clinical probability and 6 (8.5%) had high clinical probability. We have found that 76% of the request were appropriated according to the current guidelines of the European Society of Cardiology (ESC). The proportion of the pulmonary embolism in our population study was 39.4%. There was a linear relationship between level of clinical suspicion and proportion of pulmonary embolism with 12% in low probability, 47.5% in intermediate probability, and 100% in high Probability. The most associated factor of pulmonary embolism in CTPA was the presence of sign of deep venous thrombosis (p=0,012). Conclusion. The clinical request of computed tomography pulmonary angiography was relevant in three quarter of cases in our population. In case of high clinical suspicion, the diagnostic of pulmonary embolism was always positive. There is an urgent need to reinforce sensibilization of physician about adequate clinical request to reduce the risk of irradiation and high expenditure of the patients

Acute pulmonary embolism in the era of multi-detector CT: a reality in sub-Saharan Africa

<p>Abstract</p> <p>Background</p> <p>The 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.</p> <p>Methods</p> <p>Consecutive 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.</p> <p>Results</p> <p>Forty-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.</p> <p>Conclusion</p> <p>Acute 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.</p