The journey of Radiology in Ethiopia.

The practice of radiology began after the invention of X-rays in 1895 which then spread to different parts of the world. There is no documentation on how and when the x-ray was introduced to the Ethiopian medical practice. However, radiology as a profession was in place for the last four decades. Similar with the experience in other countries, the history of progress in the field of radiology in the Ethiopian setup is related directly to technological advances that occurred during the past few decades. Radiography was the main modality used in the first two decades. In the early years of the initiation of radiology training, only radiographs and ultrasounds were available for training and service. In the subsequent years, modern cross-sectional imaging equipment was introduced. This was mainly accomplished with the involvement of the private institutions which played a significant role. So far, there are more than 300 practicing radiologists as diagnosticians. Recently, also radiologic interventions were also introduced with the commencement of subspecialty training.

FIBULAR HEMIMELIA: A RARE CASE REPORT.

Fibular hemimelia is a rare congenital absence of the fibula that may occur as an isolated anomaly or as a part of a malformation syndrome. Shortening of the extremity is obvious at birth with leg-length discrepancy. On plain radiograph of the leg and foot, significant deficiency or absence of the fibula can be seen. In this case report, a 6 year old boy with fibular hemimelia is presented. Radiological diagnosis and differential diagnosis are discussed.

Parosteal lipoma with hyperostosis: case report.

Parosteal lipoma is an extremely rare benign tumor that is composed mainly of mature adipose tissue and has an intimate relationship to the underlying periosteal bone. We present a case of parosteal lipoma of humerus combined with hyperostosis. Standard radiography demonstrated a radiolucent mass surrounding an exostosis. CT showed a fat density, lobulated mass surrounding the larger osseous excrescence and cortex. The patient underwent surgery. Intraoperative examination found a well encapsulated, homogenous, yellowish, fatty tissue attached by a stalk to the underlying bone. The pathology specimen showed mature adipose tissue consistent with the intraoperative finding.

Adamantinoma of tibia in Ethiopia: the first bone transplant in Ethiopia.

UNLABELLED: Adamantinoma of long bones is an extremely rare tumor with no report, to authors' knowledge from neither Ethiopia nor Africa. We are reporting a 25 year old female college student with one and half years history of right mid leg pain and swelling with radiologically and histologically proven adamantinoma of right tibia. At CURE Hospital, she had undergone complete excision of the tumor with histologically documented clean margins. The limb was salvaged by reconstructing with a fresh frozen tibial allograft obtained from the USA and an interlocking intramedullary nail (SIGN nail). Such insertion and incorporation of huge allograft using SIGN nail and saving a limb is the first surgery in Ethiopia. The gradual incorporation of the allograft at different months during follow-up is elucidated with clinical signs of healing. CONCLUSION: At times, limb salvage surgery and technology should be offered to selected patients with a chosen type of bone tumor.

Brown tumor an uncommon and late manifestation of hyperparathyroidism: a case series done at Tikur Anbessa Specialized Hospital, Addis Ababa.

Brown tumor of hyperparathyroidism is a non-neoplastic osteoclastic process which results in cystic lesions that are often expansile. It occurs rarely and is often a late manifestation of primary hyperparathyroidism (PHPT). Multiple bone involvement is extremely rare. Because of its resemblance with benign tumors if it occurs as a solitary bone lesion and of metastatic bone lesion when it is multiple, differentiation is often difficult without biochemical analysis. Here we presented eight patients who visited Tikur Anbessa Specialized Hospital for the last 15 years with primary skeletal complaints. Out of these six were females and except one patient all had multiple brown tumors. Based on radiographic features only it is often difficult to diagnose the condition and biochemical tests and anterior neck sonography is usually crucial to reach at a definitive diagnosis. Although the occurrence of more than one separate bone lesion in the skeleton usually suggests metastasis, our cases shows that brown tumors should also be included in the differential diagnosis of such lesions, particularly in patients with hyperparathyroidism.

Entrance surface dose measurement in pediatric patients undergoing common diagnostic x-ray examinations in black lion and Yekatit 12 Hospital Addis Ababa, Ethiopia.

BACKGROUND: Early childhood exposure carries an enhanced radiation risk and estimated that the probability of induction of cancer especially leukemia is about two to three times as high as in adults. Hence, dose measurement is mandatory for optimization in radiation protection to comply with international reference levels. OBJECTIVES: To estimate pediatric patient's radiation dose arising from common diagnostic x-ray examinations by measuring Entrance Surface Dose, thereby, to compare the results from established reference values and other published studies. MATERIAL AND METHODS: A cross-sectional study was conducted on pediatric patients under 15 years of age in Black Lion and Yekatite 12 Hospitals on May and August, 2009 respectively. Exposure factors used for commonly performed x-ray examinations like, chest, skull, abdomen, pelvis and spine were obtained from each Hospital. For each examination four age groups 0-1, 1-5, 5-10 and 10-15 years were studied. Entrance Surface Dose in air was measured using dositime dx X-ray Digital Dosimeter and Exposure Time Meter. RESULT: In Black lion hospital, the lowest and the highest calculated mean Entrance Surface Doses in microGY were 104 and 2482 for chest Anteroposterior (0-1) years and lumbo-sacral lateral (10-15) years, respectively. In Yekatit 12 hospital, the lowest and the highest calculated mean Entrance Surface Doses in microGY were 200 and 3570 for chest antrioposterior (0-1) years and lumbo-sacral lateral (10-15)years, respectively. Wide variations of doses for the same type of examination and projection have been detected in each hospital. CONCLUSION: The wider dose variation suggests that there is a pressing need to seek dose optimization to children in order to reduce the detriment caused by the unnecessary high doses imparted to them.

Patterns of lumbar myelographic findings in patients with LBP a 5 years retrospective study at Yehuleshet Higher Clinic, Addis Ababa, Ethiopia.

BACKGROUND: Low back pain (LBP) is usually defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). LBP is a common health problem and the imaging of which need carful clinical diagnostic triage. Most of us will experience at least one episode of LBP during our life. Despite its burden to the health facilities, more than 90% have no identifiable organic cause so their diagnosis is based on exclusion of other specific pathologies. OBJECTIVE: The study asses level of association of LBP and lumbar Myelographic findings in a higher clinic in Addis Ababa and provide baseline information of patterns of lumbar myelographic disease. PATIENTS AND METHODS: This is a retrospective record review of patients with LBP for whom lumbar myelography was done at Yehuleshet Higher Clinic. Data were collected from the clinics record, both hard and soft copy records were used a total of 1688 patients who had lumbar myelography study done for a complaint of LBP in the years from 2002-2008 are included in the study. RESULTS: Among the study subjects 895 (53%) were males and 793 (47%) were females. Mean age was 42.41 +/- 13.22. 1073 (63.6%) had abnormal myelographic findings and the rest 615 (36.4%) had normal lumbar myelography. The commonest abnormality is disc prolapse 36.7% with L4-L5 and L5-S1 being the commonest sites. CONCLUSION: Even if lumbar myelography showed abnormal findings in 63.6% a significant number of the studies (36.4%) were normal indicating lack of optimal clinical triage. Overall in countries like ours, where the recommended primary imaging modality, i.e., MRI is inaccessible and expensive, the value of myelography is unquestionable. RECOMMENDATION: But because of the invasive nature of the examination which also uses radiation, a diagnostic clinical triage should be taken first before subjecting patients to Myelographic procedures. Further studies to assess the positive predictive value of myelography with surgical confirmation are recommended.

Osteochondroma of the coccyx: a case report.

Osteochondroma is the most common benign bone tumor. Majority of solitary osteochondromas are asymptomatic however, may give functional impairment due to pain from pressure or mass effect. Osteochondromas occur most often about the knee and picked incidentally, coccygeal osteochondroma however; is a rare occurrence. On a plain radiography, it typically appears as a bony projection with a clear cortex and medulla related to the coccyx. Here we present the case of a 7-year-old child with coccygeal osteochondroma.

Local diagnostic reference levels for adult posteroanterior (PA) chest x-ray examination in Addis Ababa, Ethiopia.

BACKGROUND: The Local Diagnostic Reference Levels (LDRLs) form an efficient, concise and powerful standard for optimizing the radiation protection of a patient. OBJECTIVES: To calculate the Entrance Surface Doses (ESDs) received by patients undergoing PA chest X-ray examinations in major public hospitals in Addis Ababa, thereby to establish the first Ethiopian LDRLs as part of ongoing dose reduction program. MATERIALS AND METHODS: The entrance dose in air per examination was measured in eight hospitals comprising nine X-ray units and a sample of 192 radiographs. The entrance dose in air was measured using dositime dx X-ray Digital Dosimeter and Exposure Time Meter. The data were analyzedstatistically, and the minimum, median, mean, maximum, and third quartile values of ESDs are reported Finally, the proposed LDRLs are compared with the international reference dose values reported by the Commission for European Community (CEC), the International Atomic Energy Agency (IAEA) and the National Radiological Protection Board (NRPB). RESULTS: The third quartile value of the distribution of mean doses at individual hospitals participating in this survey is found to be 1.08 milligray (mGy). Hospitals mean ESDs for PA chest X-ray examination is found with the range of 0.0.76 to 1.48 mGy. Most of the ESD measured doses were slightly greater than the NRPB, CEC and IAEA reference doses. CONCLUSION: The results of the present study indicate a need for Quality Assurance (QA) programs to be undertaken to avert considerable cost and high patient doses. The results are useful to national and professional organizations and can be used as a baseline upon which future dose measurements may be compared.

Spleen length in childhood with ultrasound normal based on age at Tikur Anbessa Hospital.

BACKGROUND: Spleen is a hemopoetic organ which is capable of supporting elements of different systems. Determination of pathologic changes in size of spleen necessitates knowing the normal range of dimensions in healthy neonates, infant, and children. OBJECTIVE: The study was done with the purpose of estimating normal spleen measurement in pediatric subjects. METHODS: This is a cross-sectional prospective study conducted among children from birth up to 15 yrs at Black Lion and St. Paulos Hospital from May 2005 up to November 2005. RESULT: Among 152 children 86 (56.6%) of the study subjects were males and the rest 66 (43.4%) were females. In addition 54 (35.5%) were above eight years and 98 (64.5%) were less than or equal to eight years. The average spleen size for children 0-3 and 3-6 months, 10-12 and 12-14 years were 5.6 cm, 6 cm, 11.2 cm and 11.97 cm respectively. CONCLUSION: The length of the spleen and left kidney are equivalent at birth and grow with almost equal rate with the age of the subject. The ratio of the spleen-to-left kidney is almost one at all age groups, which can be helpful in case there is doubt of splenomegally.

Incidence of normal pineal and chroids plexus calcification on brain CT (computerized tomography) at Tikur Anbessa Teaching Hospital Addis Ababa, Ethiopia.

OBJECTIVE: To determine the incidence of normal calcification of pineal gland and choroids plexus on Brain -CT (computerized Tomography) and to see its association with age and sex. METHOD: A cross-sectional descriptive study was conducted at Radiology Department, Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia from May 2001 to August 2002. A total of 518 patients; 312 males and 206 females underwent brain-CT without pineal or choroids plexus pathology. RESULTS: The over all incidence of normal pineal gland calcification was 72.0 % and that of choroid plexus 43.3 %. The incidence of normal pineal gland and choroids plexus calcification were higher in males than in females by 13.1% and 6.0% respectively. The frequency of pineal gland and choroids plexus calcification showed a steady increase with age on both sex groups. CONCLUSION: The incidence of normal pineal gland calcification in this study is similar to most of the findings of other studies while the incidence of choroids plexus calcification was lower as compared the finding of other studies.

Ultrasound assessment of common bile duct diameter in Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

BACKGROUND: The diameter of common bile duct is one of the critical issues that has to be addressed in diagnosing and treating hepatobilary diseases. Thus measurement of common bile duct diameter is an important component of the evaluation of biliary system as the size of common bile duct is a predictor of biliary obstruction. As a dilated common bile duct distinguishes obstructive from non obstructive causes of jaundice, accurate standards for normal measurements must be available. There is no study addressing the diameter of common bile duct diameter among Ethiopians. OBJECTIVE: To assess the normal common bile duct diameter among Ethiopians and to identify factors associated with common bile duct diameter. MATERIALS AND METHODS: A cross-sectional descriptive study. Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia from April, 2001 to September, 2002. A total of 293 adult patients of which 160 females and 133 males who were to undergo abdominal ultrasound were put under the study. All patients had fasted for longer than six hours. Patients with known biliary, pancreatic disease or surgery were not included in the study. The transverse and anteroposterior diameter of the common bite duct were measured just caudal to the level of portahepatis. RESULT: The mean diameter of the common bile duct diameter was found to be 3.9 mm; measured diameter ranged from 2.1 to 6mm. There was also a positive correlation between the common bile duct diameter with age and weight. No significant difference was noted between the two sexes and common bile duct diameter. No association was observed with height and common bile duct diameter. CONCLUSION: The study showed the mean common bile duct diameter to be 3.9 mm and the diameter of the common bile duct was observed to increase with increasing of age and weight. The normal common bile duct diameter in Ethiopia is not previously studied, so this study can be a base line for future widespread and extended studies.

Two cases of interathoracic pathologies presented as secondory hypertrophic osteoarthopathy.

The vast majority of cases of Hypertrophic osteoarthropathy are associated with intra thoracic neoplasms mainly broncogenic cancer and benign fibrous tumor. Less commonly extra thoracic pathologies can present with this disorder. Two cases are presented here. The first is a 50-years-old male who came with complaints of significant weight loss, chest symptoms and multiple upper extremities joint pain. The second case was a 44 years old female who presented similarly with chest symptoms, joint and bone pain limited to lower extremities bilaterally. Chest x-ray and x-ray of extremities were suggestive of secondary hypertrophic ostroarthropathy and intrathoracic masses. The first patient with bronchogenic carcinoma, bronchoscopy with biopsy conform the diagnosis. The second patient was operated and the operative biopsy result was consistent with benign pleural fibroma.

A case of primary hyperparathyrodism due to parathyroid adenoma Doppler ultrasound diagnosis.

Primary hyperparathyroidism is due to abnormal parathyroid hormone production of various causes. Bone and kidney are target organs of the disease (1). A 40 years old female patient from Dire Dawa presented with leg pain of three months duration. Serum calcium, alkaline phosphatase and creatinine were elevated X-rays show renal stone, bone resorption and brown tumor. Abdominal ultrasound showed left hydronephrosis. Color and power Doppler ultrasound of the neck showed hypo echoic retro thyroid vascular mass. The epidemiological and clinical feature, x-ray and ultrasound findings are briefly discussed.

A case of symptomatic aberrant right subclavian artery.

Aberrant right subclavian artery is one of the aortic arch anomalies which is almost always asymptomatic. A 27-year-old lady, from Asebe Teferi, presented with dysphagia of eight months duration. Physical examination revealed no abnormality. Barium swallow and post Intravenous-contrast computerized tomography (CT) scan showed aberrant right subclavian artery. She was operated via the approach of left thoracotomy. The aberrant right subclavian was legated, brought anterior to trachea and reimplanted to the left stubclavian artery. She had uneventful postoperative course and discharged symptom free.

Unusual presentation of metastatic involvement of a bone.

Metastatic involvement of a bone below the knee and elbow is rare. If it occurs it usually arises from primary tumours of the bronchus or pelvic organs, particularly the colon and the bladder. The case of a 58 years old male patient with recurrent transitional cell carcinoma of the bladder who presented with metastatic involvement of a metatarsal bone is presented. He presented with pain and swelling over the right foot. He was given antibiotic and there was no improvement, histopathological examination confirmed metastatic involvement of the metatarsal bone. To our knowledge, metastatic involvement of a bone below the knee has never been reported in Ethiopia.

Renal osteodystrophy presenting with multiple calcified periarticular swellings.

Renal osteodystrophy denotes skeletal abnormality in patients with renal disease. Although radiological and histological evidences of osseous abnormality are commonly seen in advanced renal failure, clinical symptoms of bone disease are uncommon. In this article a case of chronic renal failure presented with multiple calcified periarticular swellings measuring up to 5 cm in diameter is described. The patient also had severe osteopenia, subperiosteal erosions, bilateral shrunken echogenic kidneys as well as clinical and biochemical evidences of chronic renal failure. Renal osteodystrophy is discussed and related literature is reviewed.