Pregnancy related breast diseases in a developing African country: Initial Sonographic Evaluation

Benign diseases are more common than malignant diseases in pregnant and lactating women. Fibroadenomas are the most commonly identifiedbenign breast tumour in pregnant and lactating women. Pregnancy related breast cancer is defined as breast cancer that occurs during pregnancy or within 1 year of delivery. Its incidence is estimated at 1 in 3000 to 1 in 10 000 pregnancies. Several reproductive factors like age at menarche, age at menopause, age at full-term pregnancy, parity, age at any birth and spacing of pregnancies, breast feeding, characteristics of the menstrual cycle, infertility, spontaneous and induced abortions, characteristics of the menstrual cycle and infertility are some of the factors that have been incriminated as risk factors for breast cancer. We sought to describe the predominant breast pattern, sonographic array of pregnancy related breast diseases in women referred to the breast imaging unit in the department of Radiology at the University College Hospital, Ibadan south west Nigeria. Socio-demographic characteristics in these women were also evaluated. Archived images were reviewed and documented and data was analysed with SPSS version 17 and presented with descriptives. In this descriptive study, we retrospectively retrieved the sonomammographic records of 21 women (pregnant or lactating) referred to and imaged in the department of radiology, University college hospital Ibadan, between 2006 and 2013. Diagnostic breast sonograms performed by MO and ATS; Consultant  radiologists with 7-10 years' experience utilized a 7-10 MHz transducer of the General electric GE Logiq P5 machine for the scans. Twenty-one women with ages between 22-42 years (Mean 31.4 ±5.4 SD) pregnant or lactating were referred to the radiology department for sonomammographic  evaluation. Majority of the women were in the 3rd decade. Referral was mainly (11) by family Physicians from the general outpatient clinic, 5 were self-referred, 2 from radiotherapy department, 2 from obstetrics and gynaecology department and 1 from the surgical outpatient clinic. Nineteen (89.5%) were lactating and breastfeeding while 2 (10.5%) were pregnant. Nipple discharge (89.5%) was the predominant presenting complaint in the study. They were all married with the majority attaining menarche at age 14.6±2.1 SD years. Most of the women were multi-parous 17(89.5%) and possessed higher level of Education 17 (81.0%). Twenty (96.0%) women had no previous breast disease while only 1 (4.0%) woman had a positive family history of breast cancer. They weighed between 44-102kg (mean 69.84kg±15.33SD). Their mean height was 159.8cm. Waist hip ratio was between 0.69-0.93 (Mean 0.83). The heterogeneous fibroglandular pattern was predominant in 15 (71.4%) women. Final BIRADS assessment of 2 was most frequent (11/21) 52.4% while 19.0% were assigned to BIRADS categories 0 and 1 (4/21). Histological diagnosis of Invasive ductal  carcinoma was made in the 3 women with final BIRADS of 5 breast diseases found in most pregnant and lactating women were benign. It is important to note that malignant breast lesions can also occur in this group of women who may assume that the changes noted in their breast are due to  lactation

Experience with three-dimensional computed tomographic angiography in Ibadan, Nigeria

No Abstract

Mammographic parasitic calcifications in South West Nigeria: prospective and descriptive study

Introduction: Lymphatic filariasis caused by nematode parasite Wuchereria bancrofti and Brugia Malayi is endemic in the tropics. In Nigeria, 25% of the population is infected. Lymph edema and elephantiasis are the predominant manifestations. Its infrequent manifestation is in the breast. This paper discusses the epidemiology, reviews literature, imaging options and mammographic appearances of these parasitic nematodes. Methods: This prospective descriptive study reports on 39 cases of parasitic calcifications seen during mammography in the Radiology Department, University College Hospital between 2006 and 2012 in Ibadan, South West Nigeria. Each mammogram was reported by MO and ATS: assigned a final Bi-RADs category. Parasitic calcifications were further evaluated for distribution, and types of calcification. Results: A total of 527 women had mammography done between 2006 and 2012. Thirty-nine women (7.4%) had parasitic breast calcifications. The ages of the women ranged between 38-71 years - mean of 52.36±8.72 SD. Twenty-three (59%) were post-menopausal, 16(41%) were pre-menopausal. The majority (31; 79.5%) were screeners while 8(20.5%) were follow up cases. Approximately half (51.3%) of the women had no complaints. Pain (23.1%) was the commonest presentation in the remaining half. Solitary calcifications were predominant (20) while only 3 cases had 10 calcifications. Left sided calcifications (53.8%) were the majority. Calcifications were subcutaneous in 2/3rds of the women (66.7%) while the Yoruba tribe (84.6%) was principal. Conclusion: Parasitic breast calcifications can be misdiagnosed on mammography for suspicious micro-calcification. This publication should alert radiologists in a tropical country like Nigeria to increase diagnostic vigilance thereby preventing unnecessary anxiety and invasive work-up procedures.Key words: Parasite, mammography, calcificatio

Malignant haemangiopericytoma of the left thigh with metastases to the bones and lungs: A case report

Haemangiopericytoma is an uncommon mesenchymal neoplasm. Haemangiopericytoma is believed to arise from the pericytes, contractile spindle cells that surround the capillaries and post-capillary venules. We present an unusual case of histologically confirmed malignant haemangiopericytoma of the left thigh in a 70 year old male with metastasis to the lungs and left femoral bone

Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report

<p>Abstract</p> <p>Introduction</p> <p>Intracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement.</p> <p>Case presentation</p> <p>We present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment.</p> <p>Conclusion</p> <p>The clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.</p

Case Report: Mediastinal teratomas: CT evaluation in 2 patients

This is a report of 2 males aged 48 years and 50 years respectively presenting with persistent cough. Computed tomography showed posterior and anterior mediastinal masses respectively. Needle aspiration and cytology confirmed teratoma, with sarcomatous change in the first patient. Due to advanced disease only radiotherapy was offered but the patient died after a few courses. The other patient had excision of the mass, confirmed to be a benign teratoma. Computed tomography is invaluable in the diagnosis of mediastinal teratomas. Keywords: Teratoma, Mediastinal, CT scan Nig. J. of Surgical Research 4(1-2) 2002: 62-6

Computed tomography features of head injury in Ghanaian children

Background: Injuries to the head are common in children. There are several reports in literature of head injury and evaluation with computed tomography scan (CT scan) but only a few focus on children. Method: A retrospective review of films and reports of the CT scans of 41 children with head injury. Results: Positive CT findings were noted in 19 (46.3%). Road traffic accident was found to be the commonest cause of injury with the highest incidence in the 5 – 9 year age group. Cranial fractures were the commonest (73.68%) CT findings especially in the frontal and parietal bones. Intracranial haemorrgage was outlined in 47.37%. In classifying the extent of head injury type 3 with intracranial injury alone occurred most (58.8%). Extraparenchymal haemorrages occurred more in 69.2% than the intracerebral variety (30.8%) Hydrocaphalus and cerebral oedema were also reported. Conclusion: CT scan provides accurate non-invasive diagnosis of fractures, intracranial haemorrhages and other sequale of head injury. However, it should be done only when clinically indicated to reduce cost and avoid unnecessary irradiation Key words: Head injury, computed tomography children Nig. J. of Surgical Research Vol.4(3-4) 2002: 84-8

Case Report: Unusual computed tomographic features of intracranial tuberculoma: a case report

A case report of a 57-year old woman who presented with signs and symptoms of intracranial mass. Computed tomographic (CT) and clinical features were unusual and suggestive of a parasaggital Meningioma. However an accurate diagnosis of a tuberculoma was made at surgery and histopathological examination. (Nig J Surg Res 2003; 5: 67 – 69) Key words: Intracranial tuberculoma, computed tomography, meningiom

Maternal ophthalmic artery Doppler velocimetry in pre-eclampsia in Southwestern Nigeria

Richard Busayo Olatunji,1 Ademola Joseph Adekanmi,1 Millicent Olubunmi Obajimi,1 Olumuyiwa Adebola Roberts,2 Temitope Olumuyiwa Ojo3 1Department of Radiology, 2Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, 3Department of Community Medicine,&nbsp;Obafemi Awolowo University Teaching&nbsp;Hospital Complex,&nbsp;Ile-Ife, Osun State,&nbsp;Nigeria Background: Pre-eclampsia (PE) poses a serious challenge to maternal and fetal health in Africa. It is associated with hemodynamic changes that may affect the internal carotid/ophthalmic artery circulation with consequent neuro-ophthalmic manifestations. Ophthalmic artery Doppler (OAD) ultrasound is an important tool that can be used to detect hemodynamic changes in PE and monitor its severity. In this study, we evaluated hemodynamic changes on OAD ultrasound in the ophthalmic arteries of pre-eclamptic women and compared these with values in healthy pregnant women. Methods: OAD parameters, such as, peak systolic velocity, peak diastolic velocity, end diastolic velocity, pulsatility index, and peak ratio, were measured on transorbital triplex ultrasound scan with a 7&ndash;10 MHz multifrequency linear transducer in 42 consenting pre-eclamptic patients and 41 pregnant controls matched for maternal age, gestational age, and parity at the Department of Radiology, University College Hospital, Ibadan. Univariate, bivariate, and receiver operating characteristic curve data analyses were performed. P&lt;0.05 was considered to be statistically significant. Results: Mean resistivity index, pulsatility index, and peak systolic velocity were significantly lower in pre-eclamptic patients than in the controls. Mean peak diastolic velocity, end diastolic velocity, and peak ratio were significantly higher in the pre-eclamptic group. The receiver operating characteristic curve showed that the resistivity index (sensitivity 75%, specificity 77.8%) could distinguish mild from severe PE while the peak ratio (sensitivity 90.5%, specificity 81.3%) could accurately detect PE. Conclusion: OAD ultrasound can be used to monitor patients with PE for early detection of progression to severe forms before cerebral complications develop. OAD screening of patients at high risk for PE can also detect early changes of hemodynamic derangement. Keywords: ophthalmic artery, hemodynamic changes, ultrasound, Doppler parameter