Assessment of diaphragmatic levels on plain chest radiograph--a new approach.

BACKGROUND: The aim of this study was to provide an alternate simple linear measurement of diaphragmatic levels from a relatively fixed position, the lung apex, on chest radiographs. STUDY DESIGN: 526 consecutive posteroanterior (PA) chest radiographs of Nigerian adult subjects reported as normal were evaluated. The 'Lung apex to diaphragmatic apex' (LATDA) distances in centimeters for both hemidiaphragms were obtained from the chest radiographs. RESULTS: There were 210 males and 316 females ranging in age from 15 to 85 years. The mean ranges of LATDA values on the right were 21.2 cm to 23.8 cm and 20.8 cm to 22.7 cm, with total means of 22.9 cm and 21.5 cm in males and females respectively. On the left, the ranges were 23.1cm to 25.5 cm and 21.6 cm to 23.5 cm with total means of 24.4 cm and 22.6 cm in males and females respectively. Left LATDA was higher in 95% of subjects and higher LATDA values represent lower hemidiaphragms while low LATDA values indicate elevated hemidiaphragms. LATDA measurements were statistically higher in males for all age groups. Mean differences between right and left LATDA were 1.5 cm and 1.2 cm in males and females respectively. CONCLUSION: From this study, the lower limits of normal LATDA values in females and males are 16 cm and 18 cm while upper limits are 28 cm and 30 cm respectively. A "rule of twos" that could be applied to routine use in clinical practice is suggested thus: Left LATDA value is 2 cm higher than right LATDA value and LATDA values in males are 2 cm higher than in females.

An unusual presentation of congenital bronchoesophageal fistula.

We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features suggestive of congenital diaphragmatic hernia. Emergency limited barium swallow done was initially reported as a case of diaphragmatic hernia. Autopsy revealed pus within the right lung, and a fistulous connection between the oesophagus and an intralobar sequestrated lung. No diaphragmatic hernia or intra-abdominal organ abnormality were seen, and an occipital meningomyelocoele was also confirmed.

The Ibadan conjoined twins: a report of omphalopagus twins and a review of cases reported in Nigeria over 60 years.

An omphalopagus set of female conjoined twins, undiagnosed prenatally, who presented as obstructed labour needing operative delivery is reported. Their anatomic characteristics and clinical features, including overwhelming sepsis in twin II which forced early separation, and those which led to their demise are described. Twelve other cases reported in Nigeria over the past 60 years are reviewed with reference to the aetiology and epidemiology of conjoined twinning and the determinants of successful surgical separation.

A fatal case of paraquat poisoning in a Nigerian.

A fatal case of paraquat poisoning in an adolescent girl is reported. Death resulted from respiratory failure because of extensive interstitial and intra-alveolar fibrosis.

Sinography in chronic fistulating osteomyelitis in sickle-cell anaemia.

The sinographic appearances in 18 long bones of 14 consecutive patients with sickle-cell anaemia and chronic haematogenous osteomyelitis were studied prospectively; the observed features were compared with the plain radiographic and operative findings. Four sinographic patterns were noted: (1) infected bone cavities with or without sequestra; (2) extensive soft-tissue tracks, alone or in association with infected bone cavities; (3) narrow, wavy intramedullary tracks; (4) short sinus tracks in the soft tissue. Plain films were of no value in demonstrating the presence and extent of soft-tissue and narrow intramedullary tracks; they failed to show infected bone cavities in four instances because of very sclerotic bone. The sinographic features correlated well with the operative findings and contributed significantly to the choice of definitive treatment in 13 out of the 18 bones.

A basic X-ray service for a rural community in Southwestern Nigeria 1976-1980. A preliminary report.

The development of a basic X-ray service in a rural community in southwestern Nigeria is reviewed over a period of 5 years. Of the 3,278 examinations done during this period, chest X-rays constituted 56%. Most of the other examinations were requested on account of trauma of upper and lower extremities: 42 and 43%, respectively. Injuries to the elbow region constituted half of the X-rays for the upper extremities. There was an early upsurge of attendance for all X-rays reaching its peak at the first 2 years of the project, but a stable state was soon established within the subsequent 3 years. The non-chest examinations remained equally divided between the years under review. It is estimated that the introduction of the X-ray service has saved the community some 6,600 working days or 18 years in the 56-month period. This estimate excludes transportation for the accompanying relatives.

Radiological evaluation of anal fistulae: a prospective study of fistulograms.

A review of 33 fistulograms in a four-year study is presented. Four types of communicating tracts have emerged: single (58%), branched (18%), fistulous abscess (15%) and compound (9%). This classification has formed the basis of selection of operative treatment in all the cases. Diminished lumbo-sacral angle was also found in most of the anal fistula cases and this establishes a possible association between the pathology of anal fistula and the low back syndrome.

Studies on the prevalence of renal disease and hypertension in relation to schistosomiasis. V. Radiological findings: plain X-ray abdomen and intravenous pyelogram.

After studying two rural communities with varing endemicity of urinary schistosomiasis by total cross-sectional population survey, a stratified sample was obtained using defined criteria. Plain X-ray abdomen and intravenous pyelogram were carried out on the sample. Findings on plain X-ray of the abdomen, using the usual parameters of psoas and kidney shadows in the Nigerian, indicate that the two communities studied are similar but urinary calculi and urinary tract distortion are significantly more prominent in the community with the higher endemicity of urinary schistosomiasis.

PIP: Radiologic findings are reported from 2 communities, 1 with high and the other with low endemicity of urinary schistosomiasis, of Ibadan. After studying the 2 rural communities with varying endemicities of urinary schistosomiasis by total cross-sectional population survey, a stratified sample was obtained using defined criteria (all cases of proteinuria of 100 mg%; all cases of diastolic blood pressure of 90 mm or greater; all cases with significant bacteriuria; 20% of cases with history of nocturia; and age-selected trace and absent proteinuria for 20% of cases). Plain X-ray abdomen and intravenous pyelogram were carried out on this defined sample population. Findings on plain abdominal X-ray, using the usual parameters of psoas and kidney shadows in the Nigerian, indicated that the 2 communities studied were similar, but urinary calculi and urinary tract distortion were significantly more prominent in the community with the higher endemicity of urinary schistosomiasis. X-rays are not included in the text, instead tabular information on the morphology of renal areas is presented.

The radiologic features of fibrous dysplasia of the craniofacial bones.

The radiographs of twenty-five patients (eight males, seventeen females) with histologically proven craniofacial fibrous dysplasia were analyzed. The lesions could be classified into six radiologic types: (1) peau d'orange, (2) whorled plaquelike, (3) diffuse sclerotic, (4) cystlike (multilocular or unilocular), (5) pagetoid, and (6) chalky types. The peau d'orange type was by far the most common (40 per cent) followed by the plaquelike (20 per cent, cystlike (16 per cent), and sclerotic (12 per cent). Most of the patients were young, with 60 per cent being underthe age of 20 years and 96 per cent under the age of 40 years.

Radiology of multiloculated fibrous dysplasia of the jaws.

Three cases of multiloculated lesion of the jaw (two in the mandible and one in the maxillar) closely mimicking ameloblastoma are described. Histology showed all three to be fibrous dysplasia. Against a diagnosis of ameloblastoma were (1) the relative fuzziness of the margins of the loculi and septae; (2) the mineralization of the matrix which gave a ground-glass background instead of the distinct radiolucency seen in ameloblastoma; and (3) the non-resorption of the dental root apices within the lesion.

Tomography of petrous bone in deafness associated with Paget's disease.

Two cases of Paget's disease presenting with deafness are described. Tomography of the petrous bones showed, in both cases, an upward tilt of the long axes of the bones including their auditory canals, generalized sclerosis of the petrous pyramids and enlargement of the ossicles. In one case, there was narrowing of the internal auditory canal. Review of the literature revealed three radiological phases in Paget's disease of the temporal bone:--(i) early changes consisting mainly of demineralisation; (ii) an intermediate phase consisting of diminishing visibility of the semicircular canals and cochlea; and (iii) a late phase consisting of complete blotting out of the structures of the optic capsule and replacement of the ossicles by Pagetic bone. Our two cases fall within the last phase.

Radiological features of tuberculosis of the spine in Ibadan, Nigeria.

In Nigeria, tuberculosis of the spine remains an important medical problem in the diagnosis and management of which radiology plays an invaluable role. The present study reviewed sixty-nine cases seen in 1966-1972 at the University College Hospital, Ibadan, Nigeria. The possible radiological classification of the disease was grouped into seven different types:- (i) disc space narrowing only (ii) kissing lesions; (iii) wedge collapse of vertebra; (iv) vertebra plana; (v) lesions localised in the vertebral body and/or its appendages; (vi) para-spinal abscesses; (vii) complete destruction of vertebral body. The dorsolumbar region was the most frequently involved with D.11 vertebra being most often affected. The maximum number of vertebrae involved was eight but involvement of two was the most frequent. Some uncommonly reported radiological features encountered include bone sclerosis, intervertebral non-osteophytic bony bridge formation and skip lesions.

Albright's syndrome in a Nigerian: a case report.

A Nigerian male with typical features of Albright's syndrome will be described. Although the lesions were predominantly unilateral, his main complaint was that of severe facial deformity. He had a radical excision of the facial lesion which was followed by a rapid recurrence. The differential diagnosis of Albright's syndrome will be discussed.

Urinary tract changes in obstetric vesico-vaginal fistulae: a report of 216 cases studied by intravenous urography.

Intravenous urographies carried out routinely on 216 cases of vesico-vaginal fistulae were reviewed. All the patients had suffered from urinary incontinence following obstructed labour for periods varying from immediate post-partum period to as long as 35 years with the majority (48%) presenting in the first year of the disease. One hundred and eleven patients (51-4%) showed no urinary tract abnormality. Calyceal abnormality was graded from 1-5 in ascending order of severity. The most frequent abnormality was Grade 1 (or minimal calyceal blunting) found in 75 (71%) of 105 cases showing lesions. Ten patients had non-functioning kidneys. There was no correlation of severity of calyceal grading with duration of the disease. Other notable changes were hydroureter in 75 (34%), medial deviation of the terminal ureters in 21 (9-7%) and bladder calculi in four. The study reveals a high risk of morbidity to the kidneys in patients with vesico-vaginal fistulae and the predominant role of fibrous itssue in tis genesis is postulated.

Fibrous dysplasia of the jaws in Nigerians.

The clinicoradiologic features and surgical treatment of fibrous dysplasia of the jaws in forty-seven Nigerian patients are described. Marked facial deformity and functional disturbances were the main indications for operation. We noticed one case of malignant transformation. It is our opinion that a more-than-usual aggressive excision is indicated in Nigerian patients.