Giant pericardial cyst, an unusual cause of right heart failure in an elderly patient with tuberculosis and HIV: A case report.

Pericardial cysts are rare mediastinal masses commonly asymptomatic and incidentally found on chest radiographs. Pericardial cysts may be acquired/inflammatory in origin and may be symptomatic. We present a case of 65-year-old male who presented with symptoms of right heart failure. Diagnosis of a giant pericardial cyst was made using imaging modalities such as chest X-ray, computed tomography scan, and echocardiography. Percutaneous cyst aspiration was done under echocardiography guidance. Radiologists and cardiothoracic surgeons need to understand the pathology of inflammatory/acquired pericardial cysts to include in their differential diagnosis of mediastinal masses.

Challenges of practicing neuro-endovascular interventions in a resource-limited country; Ghana in focus.

OBJECTIVE: Now is the time to reflect on the situation of neuro-endovascular interventions (NEVT) in Africa, particularly Ghana, and to renew our commitment to provide high-quality health care to our people. This evaluation is significant because it seeks to assess progress toward our goals and identify potential obstacles for remedial action and to highlight the challenges of NEVT in Ghana. METHODS: Retrospective review of all endovascular treatments performed between January 1, 2019, and December 31, 2021, at two Ghanaian hospitals. A descriptive analysis was done having entered data in Microsoft Excel utilizing frequencies and percentages. Four experienced specialist radiologists discussed NEVT issues in Ghana. The fishbone diagram was used to depict the challenges and problems of NEVT practices in Ghana. RESULTS: From January 2019 to December 2021, 278 patients' records were analyzed at two Ghanaian hospitals. The majority of patients (71.9%) had digital subtraction angiography of the head and neck. The high cost of medical supplies, lack of vendor interest, and limited awareness of symptoms by general practitioners were noted as obstacles associated with neuro-endovascular treatment in Ghana. CONCLUSION: Although the future of NEVT is bright, Interventional Neuroradiologists and other stakeholder need to make conscious effort to improve quality, accessibility, and cost of NEVT in Ghana.

Towards the establishment of national imaging practice guidelines: A preliminary study of the basic computed tomography imaging protocols in Ghana.

BACKGROUND: There is a need to harmonize imaging practices in computed tomography (CT) imaging. This study, therefore, investigated the variability of the basic imaging protocols used for CT imaging of common indications in Ghana in order to generate recommendations for the development of national imaging practice guidelines in CT imaging. METHOD: A cross-sectional study, utilizing a structured online questionnaire, was undertaken (between December 2018 to March 2019) to collect indication-based imaging protocol data (scan coverage, scan series, image quality requirement, slice thickness, reconstruction, scan mode and orientation, required window, AEC usage, scan and breath hold techniques etc.,) across the various CT facilities in the country. Data were analysed and with experts' input, recommendations were made. RESULTS: The imaging protocols used across the CT facilities in the country were largely similar, with a few variabilities for similar examinations. These variabilities were found in scan coverages, series and slice thicknesses. In particular, for a brain tumour examination, 92% of the 25 facilities used both non-contrast and contrast phases while 8% preferred only the IV contrast phase. Seventy percent of all the facilities (n=10) performing pulmonary angiograms in the country also used a two-sequence scan, and others (30%) worked with only the angiogram phase. A majority (89%) of the 19 facilities that were engaged in CT-IVU procedures also used 3-4 scan phases, while 11% preferred a split-bolus technique. None of the facilities employed the low-dose or ultra-low dose protocol for kidney stone examination. CONCLUSIONS: The study's outcome provides an important preliminary roadmap that could lead to the development of imaging practice guidelines to ensure harmonization of imaging practices to improve the protection and safety of patients across the CT facilities.

Hydrocalyx presenting as lumbar pain. A case report and review of the literature.

Hydrocalyx is an obstructed renal calyx from infundibulo-pelvic diminution or stenosis which leads to dilatation of the calyx. It becomes clinically important when associated with flank pains, haematuria, infection, renal impairment or stone formation. On intravenous urography the finding of a cystic dilatation of a calyx that communicates with the renal pelvis supports the diagnosis. This case is A 50-year-old man with recurrent flank pains who was diagnosed with left hydrocalyx on a Computed Tomography Urography (CT Urography). He opted for conservative management. Management of hydrocalyx can be conservative for patients without significant renal damage or symptoms and surgical with nephron sparing intent for those who have severe symptoms and complications.

A review of computed tomography patterns of metastatic breast cancer patients undergoing treatment at a private oncology centre in Ghana.

INTRODUCTION: breast cancer is the commonest malignant disease in Ghanaian women and accounts for 17% of cancer-related deaths in the country. It has been classified into molecular subtypes depending on the presence or absence of hormone receptors and the human epidermal growth factor receptor 2. Computed tomography is often the preferred modality for monitoring metastatic disease due to its ability to determine the extent of local and metastatic disease. METHODS: this was a retrospective study conducted at Sweden Ghana Medical Centre (SGMC). Hospital records and chest and abdominal computed tomography (CT) scan images of breast cancer patients who had been managed at SGMC between June 2016 and August 2019 were used to document age, gender, histological group, type of surgical intervention done, molecular subtypes of the disease and imaging findings. Microsoft Excel 2016 and SPSS version 20.0 were used to summarise the data obtained into tables, charts and to test for significant associations. RESULTS: the most common site of breast cancer metastasis was lymph nodes. The three commonest sites of distant metastases were the lung seen in 44 patients (55.3%), bone in 37 patients (44.6%) and liver in 33 patients (39.8%). Chi square test for association between the molecular subtypes of the breast cancer and proportion of patients that showed a particular type of metastases revealed that, the differences noted for lung, pleural and cardiac metastases were statistically significant, that for bone and liver were not. CONCLUSION: breast cancer commonly metastasised to lymph nodes, lung, bone, liver, pleura and heart in descending order. The commonest CT patterns for metastases were multiple nodules for lung, effusion for pleura and heart and osteolytic lesions for bone.

Chest Computed Tomography findings in patients with corona virus disease 2019 (COVID-19): An initial experience in three centres in Ghana, West Africa.

BACKGROUND: Radiological examinations have a significant role in the diagnosis and management of Coronavirus disease 2019 (COVID-19), the disease caused by the novel coronavirus SARS-CoV-2. Many COVID-19 patients show typical Chest Computed Tomography (CT Scan) features which can aid in the diagnoses and triaging of such patients. This is especially so in resource-limited settings where access to molecular diagnostic techniques such as Reverse Transcription Polymerase Chain Reaction (RT-PCR) is not optimal. We report chest CT findings in 28 patients diagnosed with COVID-19 in Ghana. OBJECTIVE: To document common chest CT scan findings amongst patients with COVID-19 infection in Ghana. METHOD: Chest CT scans of twenty-eight COVID-19 patients (n = 28) were retrieved and reviewed independently by two experienced radiologists and their findings documented. Two 64 and one 32 slice spiral CT scanners were used at three centres. RESULTS: Chest CT Images from 16 males (57.1.7%) and 12 females (42.9%) patients aged between 36 and 65 years with mean age of 55.9 years (SD-8.4years) were evaluated. Of these, 21 (75.0%) of them were COVID-19 patients who were undiagnosed at the time of imaging while 7 (25.0%) were known confirmed COVID-19 patients. On the chest CT scans (n = 28), 17 (66.7%) patients showed predominantly ground glass opacities while 12 (42.9%) had evidence of consolidation predominantly. In 26 (92.9%) of the patients, the opacities were bilateral and peripheral in distribution. None of these patients had pleural effusion. CONCLUSION: COVID-19 patients tend to manifest typical imaging features on chest CT scan. The most common chest imaging finding was bilateral, peripheral and predominantly basal ground glass opacities. Importantly, these findings were frequently obtained before PCR diagnosis. Chest CT scan can help in the diagnosis and triaging of suspected or confirmed COVID-19 patients in jurisdictions with limited PCR diagnostic capacity and can improve early isolation, contact tracing and treatment thus helping to reduce community spread, morbidity and mortality.

Congenital transpositions of stomach and spleens with partial pyloric stenosis.

The occurrence of chromosomal aberrations resulting in congenital transposition of internal organs is rare. Isolated congenital stomach and spleen (multiple) transposition with partial pyloric stenosis, where the rest of the internal organs remain in their normal positions, to the best of our knowledge has not been reported before. Attention to, knowledge and records of this case should be considered vital for understanding future symptoms and occurrences and also for prevention of surgical mistakes.

Pneumatic reduction of intussusception in children at Korle Bu Teaching Hospital: an initial experience.

BACKGROUND: Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the first time the technique has been used in Ghana. MATERIALS AND METHODS: A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed. RESULTS: There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months). Twelve (67%) of the cases were reduced successfully while 6 (33%) failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7%) cases. CONCLUSION: Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.