Correlation Between the Clinical Diagnosis and Sonographic Diagnosis in Women with First-Trimester Vaginal Bleeding.

BACKGROUND: Vaginal bleeding is the most common cause of presentation at the emergency department in the first trimester. Clinical presentation helps determine the likely cause of first-trimester vaginal bleeding. However, ultrasound imaging is required to reach a definitive diagnosis. OBJECTIVE: To determine the relationship between clinical diagnosis and ultrasonographic findings in women with first-trimester vaginal bleeding. METHODS: A prospective longitudinal study was conducted on 94 pregnant patients with a history of bleeding per vagina (PV) in the first trimester by using transvaginal ultrasound. RESULTS: PV spotting was noted in 64.9% and heavy bleeding in 35.1%. The most common clinically associated symptom was abdominal pain (68, 72.3%), and the least common clinically associated symptom was vesicle expulsion (2.1%). The most common predisposing factor was fever (31, 33.0%). The most frequent clinical diagnosis was threatened abortion (48, 51.1%), and the least common clinical diagnosis was gestational trophoblastic disease (GTD) and inevitable abortion (1, 1.1%). The most common ultrasound diagnosis at the initial scan was incomplete abortion (19.2%), while at follow-up scans, it was threatened abortion (48, 51.1%). The overall concordance between clinical diagnosis and ultrasound was 38.8%, with both complete abortion and GTD showing a concordance of 100%. The least concordance was seen in missed abortions (25%). CONCLUSION: Clinical assessment is insufficient in the identification of the cause of vaginal bleeding due to the overall low concordance rate. A combination of clinical assessment and ultrasonography is required for decision-making in every case.

COVID-19: Challenges and coping strategies in radiology departments in Nigeria.

Context: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. In a developing country, such as Nigeria, which already had myriad problems with funds and equipment in the health sector. Aims: This study aims to examine the challenges encountered by the staff in Radiology facilities and how they combated the challenges. Settings and Design: A descriptive cross-sectional study of radiology facilities in Nigeria. Subjects and Methods: Radiologists from nine government and four private facilities who attended to COVID-19 patients were asked to fill questionnaires on challenges faced and their coping strategies. Responses were sent through E-mail. Statistical Analysis Used: Data from the responses were analyzed using Microsoft excel for Mac 2011 and presented as figures and tables. Results: Majority of the government 7 (77.8%) and private facilities 4 (100%) had no equipment dedicated only to COVID-19 patients. Seven (77.8%) government facilities complained of inadequate staff, poor availability of personal protective equipment (PPEs) 8 (88.9%), and lack of technology for remote viewing 7 (77.8%). Fear of cross-infection was a challenge in one of the facilities 1 (11.1%). Coping strategies adopted include ensuring less traffic in the department by discouraging walk-in patients and canceling non-emergent cases, booking suspected/confirmed cases for lighter times, using old film for face shields and cloth for facemasks, staff education on COVID-19 and preventive measures, and sending reports to physicians through E-mail. Conclusions: There were a lot of challenges during the COVID-19 crisis, with government hospitals experiencing more challenges than private facilities. The challenges included among others inadequate staff strength and lack of technology for remote viewing. Some were overcome using education and by production of facemasks/shields production using recycled materials.

RésuméLe contexte: COVID-19 came suddenly, bringing to the fore the challenges inherent in the health system. Dans un pays en développement, comme Le Nigeria, qui avait déjà une myriade de problèmes de fonds et d'équipements dans le secteur de la santé. Objectifs : Cette étude vise à examiner les défis rencontrés par le personnel des établissements de radiologie et comment ils ont relevé les défis. Paramètres et conception: une section descriptive étude des installations de radiologie au Nigeria. Sujets et méthodes: Radiologues de neuf établissements publics et de quatre établissements privés qui ont participé aux patients COVID-19 ont été invités à remplir des questionnaires sur les défis rencontrés et leurs stratégies d'adaptation. Les réponses ont été envoyées par courrier électronique. Analyse statistique utilisée: Les données des réponses ont été analysées à l'aide de Microsoft Excel pour Mac 2011 et présentées sous forme de figures et de tableaux. Résultats: La majorité des établissements publics 7 (77,8 %) et privés 4 (100 %) ne disposaient d'aucun équipement dédié uniquement aux patients COVID-19. Sept (77,8 %) établissements publics se sont plaints d'un personnel inadéquat, d'une faible disponibilité des équipements de protection individuelle (EPI) 8 (88,9 %), et le manque de technologie pour la visualisation à distance 7 (77,8 %). La peur d'une infection croisée était un défi dans l'un des établissements 1 (11,1 %). Faire faceles stratégies adoptées comprennent la réduction de la circulation dans le service en décourageant les patients sans rendez-vous et en annulant les cas non urgents, en réservant les cas suspects/confirmés pour des périodes plus légères, en utilisant un vieux film pour les écrans faciaux et un tissu pour les masques faciaux, la formation du personnel sur COVID-19 et mesures préventives et l'envoi de rapports aux médecins par courrier électronique. Conclusions: Il y a eu beaucoup de défis pendant la COVID-19 crise, les hôpitaux publics étant confrontés à plus de défis que les établissements privés. Les défis comprenaient entre autres l'insuffisance la force du personnel et le manque de technologie pour la visualisation à distance. Certains ont été surmontés grâce à l'éducation et à la production de masques faciaux/boucliers utilisant des matériaux recyclés. Mots-clés: défis, les stratégies d'adaptation, COVID-19, Nigeria.

Comparative ultrasound measurement of normal thyroid gland dimensions in school aged children in our local environment.

OBJECTIVE: The objective of this study was to determine the measurement of normal range of ultrasound (US) thyroid gland dimensions in school-aged children (6-16 years) in our environment and compared with what is obtained elsewhere. SETTING AND DESIGN: A prospective ultrasound measurement study done in University of Benin Teaching Hospital Benin, Nigeria. MATERIALS AND METHODS: A prospective ultrasound (US) study of thyroid dimensions of 500 school-aged children in our environment consisting of 227 boys and 273 girls was done from 1 December 2006 to July 2007. The subjects were examined by the authors and subjects with palpable abnormal thyroid gland were excluded from the study. The thyroid dimensions (length, height, and diameter) were taken for each lobe by means of ultrasound (US). In addition volume of each thyroid lobe was calculated and the summation of volume of the lobes was taken as thyroid gland volume of each subject. Also height and weight of patients were documented from which the subject's body surface was calculated. Incidental thyroid gland lesion in US was excluded from the study. Using the Statistical program of social science (SPSS) and INSTAT (Graph Pad Inc. USA) the data were analyzed. Informed consent was obtained from all the subjects and the study was done in line with the ethical guidelines of the centers. RESULTS: The US thyroid gland volume in school-aged children in Benin City from this study ranges between 1.17 cm 3 and 7.19 cm 3 , mean volume range of 1.76-4.95 cm 3 , median volume range of 1.73-4.73 cm 3 , and range of standard deviation from 0.39 cm 3 to 1.49 cm 3 . The average mean thyroid volume is 2.32 cm 3 with the following average dimensions; anteroposterior right lobe =1.06 cm, mediolateral right lobe = 1.01 cm and craniocaudal right lobe = 2.34 cm, and anteroposterior left lobe = 1.01 cm, mediolateral left lobe = 1.04 cm and craniocaudal left lobe = 2.41 cm for both boys and girls respectively. These data are significantly lower than data obtained by European based World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) 1997. However there is significant similarity with data obtained in similar environment. CONCLUSION: Ultrasound thyroid gland dimensions in school-aged children in our environment are reproducible and the data obtained are comparable to those obtained in other environment. The values may be better used in our environment as reference data for screening purposes.

The state of occupational radiation protection and monitoring in public and private X-ray facilities in Edo state, Nigeria.

AIMS AND OBJECTIVES: To find out the state of radiation protection and monitoring practices of the public and private X-ray centres in Edo state. MATERIALS AND METHODS: Survey visits were made to all the functional X-ray facilities in Edo state and the available facilities identified, staff interviewed and collected data analyzed. RESULT: There are 18 functional X-ray facilities comprising 10 (55.56%) publicly owned and eight (44.44%) privately owned. Only two (20%) of the public and five (62.5%) of the private X-ray units have personnel and environmental monitoring. All the X-ray centers in both public and private hospitals have effective lead aprons. All the public (100%) and only four (50%) of the private centers have gonadal shield although none is using them on a routine basis. Qualified radiographers are available only in five (50%) of the public and six (75%) of the private centers. Only three (30%) of the public X-ray centers have the services of radiologists. Among the private X-ray units, five (62.5%) have radiologist while three (37.5%) have no radiologist. Only one (10%) of the public centers and one (12.5%) private X-ray centre have a purpose-built adequately designed X-ray unit with barium plasters and lead lining of walls and doors. There is also only limited lead lining of doors and walls in three (37.5%) private units while no lead lining or barium plasters are used in five (62.5%) of the private units. No X-ray unit in Edo state uses digital radiography or computerized information system. This means that lost hard copy must be repeated, leading to more radiation to patients and staff. CONCLUSIONS: There are inadequate radiation protection and monitoring practices in most of the functional X-ray facilities in Edo state with only five (62.5%) of the private and two (20%) of the public X-ray units monitored. There is poor adherence to the advice of the medical physicists due to the cost implications of the implementation.

Armillifer armillatus infection.

We report a case of human pentastomiasis in a 70-year-old retired long-distance driver/farmer whose diagnosis was made incidentally while being investigated for a 1-month history of cough and abdominal pain. The chest X-ray revealed multiple comma-shaped and rounded opacities in keeping with Armillifer infection, most likely Armillifer armillatus. The patient made an uneventful recovery after a 10-day course of mebendazole (an antihelminthic) tablet and ciprofloxacin (antibiotic) capsules and was discharged home. He is presently being followed up. This is the first case we have seen in our medical unit thus we are reporting it.

Computed tomography of patients with head trauma following road traffic accident in Benin City, Nigeria.

BACKGROUND: The outcome of head trauma as a result of road accident rests with increased use of CT scan and other radiological imaging modalities for prompt diagnosis is important. OBJECTIVE: To find out the time of presentation for CT scan, symptoms for referral for CT scan and pattern of injuries in patients with cranial CT scan following road traffic accidents. METHODS: Retrospective analysis of cranial computed tomography (CT) films, request cards, duplicate copy of radiology reports, soft copy CT images and case notes of 61 patients who underwent cranial CT scan on account of road traffic accidents. The study CT scans were performed at the radiology department of University Teaching Hospital between 1st January 2002 and 31st December 2004. RESULTS: 51 patients (83.6%) were male while 10 (16.4%) were female with male to female ratio of 5:1. Thirty - eight (62.3%) patients were aged 20-39 years. Forty two patients (68.9%) presented after one week of injury. No patient presented within the first six hours of injury. The symptoms needing referral for CT scan included head injury 30 (49.2%), seizures 10 16.4%), skull fractures 8 (13.1%) and persistent headache 6 (5.6%). A total of 113 lesions were seen as some patients presented with more than one lesion. The findings on CT scan included 10 patients with normal findings , 21 (34.4%) skull fractures , 21 (34.4%) intra-cerebral haemorrhage , 19 (31.2%) brain contusion , 18 (29.5%) paranasal sinus collection,11 (18.0%) cerebral oedema, 10 (16.4%) subdural haematoma and 5 (8.2%) epidural haematoma. Over 80% of the subdural and epidural haematomas were associated with skull fractures. The yield from plain radiography was poor being positive in only 8 (13.1%) while CT scan was positive in 51 (83.61%). Also 75 (about 66%) of the 113 lesions seen on CT scan were treatable surgically. CONCLUSION: CT scan is an effective imaging modality of patient with road traffic accident and should be promptly requested in symptomatic patients who sustain trauma to the head toward identification of lesions that are amenable to surgical treatment.

Transfontanelle ultrasonography of infant brain: analysis of findings in 114 patients in Benin City, Nigeria.

OBJECTIVES: To analyse the pattern of findings in sonographic examination of infant brains. SETTING: Radiology Department of a University Teaching Hospital. MATERIALS AND METHODS: The ultrasound request cards, reports and case notes of 114 consecutive term infants who underwent transfontanelle ultrasonography over a four-year period (between 1st May 2000 and 31st April 2004) were retrospectively analysed. The transfontanelle ultrasonographies were done using a two dimensional Sonoace 1500 (Medison Inc, South Korea 1995) ultrasound scanner fitted with 6.5 megahertz (MHz) curvilinear small head probe. The scans were done in both coronal and sagittal sections applying the standard techniques. RESULT: Atotal of 114 infants were seen in the study period with male to female ratio of 1:1. Sixty eight patients (59.65%) presented within the first 2 months of age. Hydrocephalus 34 (29.04%), seizure disorders 16 (14.04%) and suspected intracranial bleeding 19 (16.67%) constituted over half of the presenting complaints. The result showed that 54 patients (47.37%) had normal findings, 43 (37.72%) had hydrocephalus of which in 25 (21.93%) it was communicating while in 18 (15.79%) it was non-communicating 6 (5.26%) had cephalohaematoma, 5 (4.39%) had encephalcoele, 4 (3.51%) had periventricular leukomalacia, and 2 (1.75%) had subgaleal cyst. CONCLUSION: Transfontanelle ultrasonography is a useful technique for diagnosis of lesions within the infant brain. Hydrocephalus is the most frequent reason for request of transfontanelle ultrasound scan and also the most frequent abnormal finding.

Ultrasonic evaluation of orbito-ocular trauma in Benin-City, Nigeria.

AIMS AND OBJECTIVES: To find out the causes, time of presentation for ultrasound scan, pattern of eye injuries and orbital ultrasound findings in patients with orbito-ocular trauma. MATERIALS AND METHODS: Retrospective study of request cards, case notes and ultrasound reports of 67 patients who had trauma to the eye and were assessed with ultrasonography over a 3-year period (between 20th January 2000 and 19th January 2003) was done. The collected data included age, sex, presenting complaint, past medical history, duration of the injury before presentation to ultrasonographic study and ultrasound findings. RESULT: Sixty-seven patients were seen consisting of 54 males (83.58%) and 11 females (16.42%) with male to female ratio of 5:1. Age range was 4 to 91 years with mean age of 30.8 years. 44 patients (65. 67%) had blunt trauma while 23 patients (34.32%) had penetrating trauma. The causes of the ocular trauma include road traffic accidents 32 (47.76%), assaults 16 (23.88%), gunshot injuries 10 (14. 93%), sports injuries 5 (7.46%), and falls from heights 4 (5.92%) patients. 42 patients (53.73%), especially those with severe injuries presented late for ultrasonography. Those who made early presentation were cases of assault because of police involvement. Forty-five patients (67.16%) had structurally identifiable pathology in one or both eyes. Retinal detachment 18 (26.87%), vitreous haemorrhage 17 (25.37%), traumatic cataract 13 (19.40), ruptured globe 6 (8.96%) and posterior dislocation of the lens 6 (8.96) were the commonest abnormal sonographic findings. In 22 patients (32.84%) both eyes were normal. CONCLUSION: Ultrasound scan is a useful imaging modality for examination of the globe in patients with ocular trauma. Road traffic accident is the commonest cause of traumatic ocular injury affecting the globe. Retinal detachment and vitreous haemorrhage are the most frequent injuries to the globe diagnosed by ultrasound scan. Measures to reduce road traffic accidents will have far reaching positive effect in preventing blindness resulting from orbito-ocular trauma in Nigeria.

Prevalence and characteristics of aquagenic pruritus in a young African population.

BACKGROUND: Aquagenic pruritus (AP) occurs during or after contact of the skin with water such as occurs in bathing. METHODS: This study aims to describe the prevalence of aquagenic pruritus in a young adult population and describe the circumstances of bathing.A Population-based cross sectional study involving administration of Questionnaires to young adult Nigerians on the occurrence of pruritus associated with bathing. RESULTS: The prevalence of bathing pruritus among respondents in this study was 23.8%. The commonest type of water respondents itch to was rain water (23%) followed by cold water (19%). 8.33% of respondents feels like avoiding bathing because of these. CONCLUSION: Bathing pruritus is a common finding among young adult Nigerians in the general population.

An audit of ultrasonography performed and reported by trainee radiologists.

BACKGROUND: Proforma information, instructions and procedures of training in radiology are lacking in Nigeria. OBJECTIVE: To describe the errors in ultrasonography performed by unsupervised trainee radiologists. METHODS: The radiology records of all ultrasound scans (USS) carried out and all reports that came back to the unit of the authors on account of misdiagnosis, doubtful diagnosis, misinformation or error in the reports were studied. The patients with the returned reports were rescanned where available by consultants and the collected data analysed. RESULTS: A total of 4680 patients had ultrasound studies without supervision resulting in 605 (12.93%) queried reports. The USS scans of 235 (5.02%) patients were repeated with consultants in attendance resulting in significant change in reports of 95 (2.03%) patients. Analysis of the request cards of 605 queried reports showed omission of relevant clinical information 463 (76.53%), outright wrong information 65 (10.73%),and unconventional abbreviations 139 (22.98%), while 493 (81.49%) were completed by a nurse, medical student or junior resident. Typographical errors comprised 174 (28.76%) of the 605 queried reports. False negative error was the highest type of error seen in 55 (57.89%) of the 95 patients with significant change in their report after repeat scan as lesions not detected were not documented. CONCLUSION: Trainee radiologists make significant errors in carrying out and reporting ultrasonography without adequate direct supervision of the study by their training consultants. Majority of the errors originate from lack of accurate filling of the patients request cards by the requesting physicians, lack of adequate preparation for the intended study, and typographical errors in writing reports. False negative reports are by far the greatest cause of errors recorded as lesions not detected were not documented.

Isolated dextrogastria: a case report.

BACKGROUND: Isolated dextrogastria is a rare congenital anomaly in which the stomach is right-sided while the intestines, the organs in the chest, and the other organs in the abdomen are in normal situs. The importance of recognising the spectrum of situs anomalies is because the altered anatomy associated with these anomalies may result in misdiagnosis. OBJECTIVE: To report a case of isolated dextrogastria in an 18-year old woman who was seen during pre-university admission medical examination. METHODS: The routine chest X-ray of a young woman as a part of pre-admission medical examination showed the gastric air bubble under the right diaphragm rather than on the left. She was then subjected to further clinical and radiological evaluation. FINDINGS: The personal, past and family histories were uneventful as was the physical examination. Trans-abdominal ultrasonography showed a normal-sized and a normally sited liver in the right hypochondrium with normal gall bladder, and normally sited left and right lobes of the liver. The liver echo pattern was normal. The stomach was found below the lower border of the right lobe of the liver. The kidneys and the spleen were normal in number, position, size and architectural pattern. A barium meal showed a well-defined and a well developed stomach with a reverse J shape and duodenal C loop that was reversed in shape. CONCLUSION: The practice of the radiographer is always placing the marker before exposing the film instead of marking the radiograph after processing, which is the key to accurate identification of situs anomalies need emphasis.

Radiation protection practices of staff during extra-corporeal shock wave lithotripsy at Okada, Nigeria.

BACKGROUND: The study was designed to find out the radiation protection practices of radiologists and other staff involved in the first extra-corporeal shock wave lithotripsy in Nigeria, performed at Igbinedion Hospital and Medical Research Centre, Okada. METHODOLOGY: Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure in local and international journals with interest in precautions to reducing radiation exposure. RESULTS: Only lead apron and lead gloves were used by the radiologists for radiation protection and shielding during fluoroscopy procedures. The fluoroscopy was the screen type with TV monitor. Multiple sessions were used in several patients with multiple pre- and post- treatment radiographic studies including contrast studies with average of two sessions per patient. All the patients were adults aged between 26 and 65 years with mean age of 42.5 years. 627-6000 shock waves were delivered over 45-135 minutes at intensity of 143-19KV depending on patients build and the size of the stones. The sizes of the patients varied from very obese with large bulk to slim built. Radiation monitoring of the staff and patients was not done. Staff believed that radiation effect from the lithotripsy procedure was low therefore adequate radiation monitoring and radiation reducing alteration in the procedure was rarely adopted. CONCLUSION: Extended fluoroscopy time, multiple fluoroscopy examinations, multiple treatment sessions and multiple x-ray examinations which increased both the patients' and staff's radiation exposures were noted. Proper radiation protection and monitoring of patients and staff are necessary to avoid the risks from low-level exposure to radiation such as in ESWL.

Isolated dextrocardia with bilateral undescended testis and bilateral polydactyl of the hands and feet: a case report.

The incidence of dextrocardia with or without situs inversus is rare though the true incidence in Nigeria is not known. Plain films are the preliminary investigations of choice in diagnosis of situs anomalies. The aim of this case report is to emphasise the importance of recognition of the spectrum of situs anomalies, because the altered anatomy associated with these anomalies may result in confusing imaging findings, misdiagnosis and difficulties with treatment when seen in conjunction with acquired abnormalities of the chest and abdomen. This study also aim to emphasise the need for accurate placement of radiographic markers by the radiographers before exposure of the films as the key for identification of situs anomalies. The case of dextrocardia without situs inversus diagnosed in a 4-month old baby boy who also had bilateral undescended testis and bilateral polydactyl of hands and feet is presented. The imaging modalities for assessment of situs anomalies are discussed.

Computed tomography study of complicated bacterial meningitis.

OBJECTIVE: To monitor the structural intracranial complications of bacterial meningitis using computed tomography (CT) scan. DESIGN: Retrospective study of medical and radiological records of patients who underwent CT scan over a 4 year period. SETTING: A University Teaching Hospital in a developing country. SUBJECTS: Thirty-three patients with clinically and laboratory-proven cases of bacterial meningitis who had clinical features of central nervous system complication of the disease. OUTCOME MEASURES: Only patients with available complete records were studied with material obtained from the medical records and radiology departments of the hospital. RESULTS: Persistent headache (30.3%), persistent fever (18.18%), seizures (15.5%) and torticollis (12.12%) were the most common presenting features that necessitated the request for CT scan. Communicating hydrocephalus (36.36%), cerebral abscess (12.12%), multiple areas of cerebral infarction (12.12%) and subdural empyema (9.09%) were the most common CT scan findings. The complications were more common in children aged less than 15 years. CONCLUSIONS: Computed Tomography is an accurate and useful means of diagnosing intracranial complications of bacterial meningitis. Early and effective diagnosis of treatable lesions such as hydrocephalus, cerebral abscess and subdural empyema will help improve prognosis of the patients. There appears to be no alternative to prevention, adequate and early treatment of this condition to reduce its long-term neurological sequelae.

An audit of rejected repeated x-ray films as a quality assurance element in a radiology department.

OBJECTIVES: To find out the causes, number, percentage and sizes of rejected radiographic films with a view of adopting measures that will reduce the rate and number of rejected films. SETTING: Radiology Department of a University Teaching Hospital. MATERIALS AND METHODS: Over a two-year period (1st April 2002 to 31st March 2004), the total number of x-ray films utilized for radiographic examinations, rejected films and sizes of rejected films were collected retrospectively from the medical record of radiology department. All the rejected films were viewed by a radiologist and three radiographers for the causes of the rejects which was arrived at by consensus. The data was analysed. RESULT: A total of 15,095 films were used in the study period and 1,338 films (8.86%) were rejected or wasted. The rate of rejected films varied from 7.69% to 13.82% with average of 8.86%. The greatest cause of film rejects was radiographers' faults 547 (40.88%), followed by equipments faults 255 (19.06%), and patients' faults 250 (18.90%). The highest reject rate (13.82%) was for films used for examination of the spine (15 x 30) cm size. This is followed by 9.92% for skull (18 x 24) cm films and 8.83% for small sized films (24 x 30) cm used for paediatric patients. Of a total of 1,338 rejected films, 1276 (95.37%) additional exposure were done to obtain the basic desired diagnostic information involving 1151 patients; 885 (76.89%) of these patients needed at least one additional hospital visit to take the repeat exposure. CONCLUSION: Rejected films are not billable; patients receive additional radiation and may even come to hospital in another day for the repeat. Radiographer's work is increased as well as that of the support staff. The waiting room may be congested and waiting time increased. The cost of processing chemical and films are increased, thus if work is quantified in monetary terms, the cost of repeats is high. Rejected-repeated film analysis is cheap, simple, practicable, easy to interpret and an effective indictor of quality assurance of radiology departments.

Fibular hemimelia: a case report.

Fibular hemimelia is the congenital absence of the fibula and it is the most common congenital absence of long bone of the extremities. Shortening of the extremity is obvious at birth with leg-length discrepancy. On plain radiograph of the leg and foot, significant fibular deficiency (hypoplasia) or absence of the fibula can be seen. In this case report, a 6-month-old baby boy with fibular hemimelia is presented. The radiological diagnosis and differential diagnosis are discussed. The treatments which include repeated corrective osteotomies and leg-lengthening surgery are costly and associated with residual deformity.