Wandering spleen: Case report

Wandering spleens are rare clinical entities found more commonly in women aged 20-40 years. We report one such case found in a 24-year-old nulliparous woman who presented with low abdominal pains of sudden onset and splenomegaly. An emergency abdominal CT scan showed an enlarged spleen located in the right lumbar region and extending into the pelvis. There was a long splenic pedicle containing tortuous vessels. A review of literature and the postulated aetiological factors and associations are discussed

The utility of ultrasonography compared to surgical and pathology findings in evaluating suspected acute appendicitis at a tertiary institution in Kenya

Objective: To investigate the role of ultrasonography in evaluating patients with clinical suspicion of acute appendicitis.Design: A prospective descriptive study of patients clinically suspected to have acute appendicitis. The abdominal sonographic findings were correlated to the surgical and pathology results.Setting: Kenyatta National Hospital and the Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi.Subjects: Patients with a clinical suspicion of acute appendicitis referred for abdominal ultrasonography during the study period.Results: A total of 112 patients were recruited following ethical approval and informed consent. Males were 73 and females 39 giving a male to female ratio of 1.9:1. The age distribution was from 8 to 70 years with a median age of 27.1 years (IQR 11.5, Q1 = 19.6, Q3=37.1). All patients presented with abdominal pain which was localized at the right iliac fossa in 96 (86%) patients and generalized in 16 (14%). Ultrasound examination of abdomen showed that 97 (87%) patients had findings concerning for appendicitis. The rest (15) patients did not have sonographic features concerning for appendicitis. All patients underwent appendicectomy and 61(54.5%) had inflamed appendices, 32 (28.6%) perforated appendices, 27(24.1%) abscess and 5(4.5%) were gangrenous. The histology of the excised appendices resulted in accuracy, sensitivity, specificity, PPV and NPV of sonographic diagnosis of acute appendicitis to be 88.4%, 92%, 58.3%, 95% and 47% respectively. The overall negative appendicectomy rate was 10.7%.Conclusion: Abdominal ultrasonography using graded compression technique is a useful tool for evaluation of suspected acute appendicitis. However, the ultrasound findings should always be carefully correlated with clinical findings since its negative predictive value is quite low (47%)

The prevalence of abnormal chest radiograph findings among HIV infected children

Background: Human Immunodeficiency virus infected children are highly susceptible to opportunistic infections of the respiratory system which are the most common cause of morbidity and mortality. The chest radiograph is the most frequently requested examination for the evaluation of respiratory disease. Its applications include screening, diagnosis and monitoring response to medication of respiratory illnesses.Objective: To determine the prevalence of abnormal chest radiograph findings among HIV infected children. Design: Prospective cross-sectional descriptive study Setting: Kenyatta National Hospital and Mbagathi Level 5 Nairobi County hospital Subjects: The chest radiographs and clinical history of 123 HIV infected children below 15 years were studied between November 2014 and February 2015. Results: The age range of the children was 1-15 years with a median age of 24 months. The male: female ratio was 1:1.02. Normal chest radiographs were found in 54/123 (44%) while 69/123 (56%) had abnormal chest radiographic findings. Pulmonary opacities were identified in the majority of patients with abnormal chest radiographs (67%) while almost 51% showed lymphadenopathy. In the pulmonary opacities, “other infiltrate’’ (61%) was found to be more common than consolidation (39%). Pleural effusions were not common while cavitary lesions and pneumothorax were not identified. There was no significant association between the radiographic findings and the children’s age and sex. The findings of this study correlated well with similar studies in Africa. Conclusion: HIV infected children especially those below the age of 5 years, are highly susceptible to chest infections. This was seen in the high prevalence of cough and severe respiratory distress as well as the significant number of abnormal chest radiograph findings. The high prevalence of ‘other infiltrate’ in this study may indicate that the causative pathogen may not respond to standard antibiotic regimes; and further clinical studies to confirm this are required

Utility of Multidetector Computed Tomography (MDCT) scan in surgically treated acute abdomen at Kenyatta National Hospital- Kenya

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Prevalence of chest radiograph findings in neonates with respiratory distress at Kenyatta National Hospital

Background: Most of the global neonatal deaths from pulmonary infections occur in the developing nations. The main imaging used in the diagnosis and follow-up of these patients is the chest radiograph.Objective: To describe the prevalence of chest radiographic findings in neonates with signs and symptoms of respiratory distress admitted at the newborn unit of Kenyatta National Hospital.Design: Descriptive cross-sectional study.Subjects: Neonates aged 1-30 days with clinical signs of respiratory distress and available chest radiograph during the study period.Results: Using consecutive sampling, a total of 100 neonates with clinical signs of respiratory distress and available chest radiographs were recruited following ethical approval and parental informed consent. The male to female ratio was 1.04:1. The median age of neonates studied was 5.3 days (range 1 to 30 days). The mean birthweight was 2.1 kilograms (SD=0.9). Twenty-three percent (23%) of the study population were premature. The chest radiograph patterns were normal in 39% and abnormal in 61%. The abnormal chest findings were “other infiltrate” in 47% and alveolar consolidation in 14%. The most common causes of respiratory distress using radiographic features were respiratory distress syndrome (41.1%), transient tachypnoea of the newborn (16.8%) and neonatal pneumonia (15.8%). Non-pulmonary causes of respiratory distress were diagnosed in six neonates who presented with congenital heart disease (3), metabolic disorders (2) and choanal atresia (1). Conclusion: From the neonatal chest radiograph findings; most neonates present with medical causes of respiratory distress of which  the most common radiographic presentation was “other infiltrate