The Radiographic Appearances of Bilateral Ureteroceles and Their Management in an Adult Patient Presenting With Recurrent Urinary Tract Infections.

A ureterocele is a congenital abnormality in which there is abnormal dilatation of the distalmost portion of the ureter, as it enters the urinary bladder. Patients present with frequent urinary tract infections, urinary retention, cyclical abdominal pains, failure to thrive, and hematuria. Ureteroceles are often diagnosed on antenatal ultrasound and sometimes postnatally on ultrasounds done in the setting of a urinary tract infection. This case describes a 51-year-old female who presented with recurrent urinary tract infections. Subsequent imaging with ultrasound, intravenous urogram, and computed tomography demonstrated features typical for bilateral ureteroceles.

Anatomical variations in the circle of Willis on magnetic resonance angiography in a south Trinidad population.

Objectives: This article seeks to determine the prevalence of a complete circle of Willis (CoW) and its common morphological variations in a south Trinidad population, while also investigating the influence of gender, age, and ethnicity on CoW morphology. Methods: A prospective, descriptive, cross-sectional study was done on the magnetic resonance images for consecutive patients who had a brain MRI/magnetic resonance angiography at a tertiary health institution in south Trinidad between October 2019 and September 2020. Patients with significant cerebrovascular disease and/or a history of prior neurosurgical intervention were excluded. Results: A complete CoW was seen in 24.3%, with more complete circles observed in younger participants (≤45 years) and Afro-Trinidadians. No gender predilection for a complete CoW was demonstrated. The most common variations in the anterior and posterior parts of the circle were a hypoplastic anterior communicating artery (8.6%, n = 13) and bilateral aplastic posterior communicating arteries (18.4%, n = 28), respectively. Conclusions: Significant variations exist in the CoW of a south Trinidad population with a frequency of complete in 24.3%, and more complete circles in younger patients and Afro-Trinidadians. Gender did not influence CoW morphology. Advances in knowledge: Structural abnormalities in the CoW may be linked to future incidence of cerebrovascular diseases and should therefore be communicated to the referring physician in the written radiology report. Knowledge of variant anatomy and its frequency for a particular populations is also required by neurosurgeons and neuro-interventional radiologists to help with preprocedural planning and to minimize complications.

Null-Cell Ectopic Pituitary Adenoma of the Nasal Cavity.

An ectopic pituitary adenoma (EPA) is an uncommon type of pituitary adenoma, accounting for only 2% of all pituitary adenomas. EPAs are benign tumors that can occur anywhere along the migratory embryonic path of the pituitary gland and have no relationship to intrasellar elements. They are usually hormonally active and have a minor female predominance. The clinical features of EPAs are highly dependent on its hormonal activity, anatomical location, and its local mass effect. Appropriate radiological imaging is essential for the evaluation of EPAs. Imaging investigations show a normal pituitary gland and sellar turcica, provide details on the size of the tumor, its margins, and extent, and help with surgical planning. The criteria for diagnosing an ectopic pituitary adenoma depend on detailed histopathological examination. EPA management should be individualized. We present a case of a 71-year-old male who presented with a 9-month history of left nasal obstruction, purulent nasal discharge, and intermittent anterior epistaxis. The patient was being managed by his general practitioner for chronic rhinosinusitis but failure of his symptoms to resolve prompted a visit to the otorhinolaryngologist. The patient was diagnosed with a null-cell ectopic pituitary adenoma through histological analysis of a biopsy specimen that showed adenohypophyseal cells without cell-type-specific differentiation. The patient subsequently underwent an endoscopic endonasal excision and had an uneventful hospital stay.

A No-Cost, Bedside, Self-Traction Maneuver for Relief From Chronic Cervical Radiculopathy: A Case Report.

Cervical radiculopathy secondary to spondylosis is common in the elderly. Systematic reviews suggest that no single treatment modality represents the standard of care. A no-cost, bedside, self-traction intervention can be a useful adjunct to current options. A 60-year-old South Asian male presented with severe cervical radiculopathic pain in April 2019, proven by magnetic resonance imaging to be secondary to spondylosis. Since late 2019, he has been doing a daily self-traction procedure in which he lies prone with the anterior chest and abdomen flat on a bed, shoulders just off the mattress edge, and arms to the side. The position is maintained for 60 seconds, where the weight of the head provides traction. Overhead cervical traction has not been needed for the past three years, and the pain has been bearable. His Neck Disability Index has decreased from 25 to 2. This no-cost, minute-long daily maneuver has provided relief from chronic cervical neuropathic pain due to cervical spondylosis.

The Importance of Imaging in the Detection of Intraoral Foreign Body.

Intraoral foreign bodies (IOFBs) can be seen incidentally on computed tomography (CT) imaging and may mimic pathology. It is therefore important to identify the imaging features of a comestible intraoral foreign body and differentiate them from true pathology to avoid unwarranted patient distress and further imaging or procedures that are unnecessary and costly. This case describes a 31-year-old male who presented to the emergency room following a fall from an eight-foot height, with loss of consciousness for five minutes and right periorbital edema. Subsequent CT imaging of the facial bones revealed multiple facial and orbital fractures as well as a circumscribed, ovoid, hyperdensity with internal air pockets within the inferior left buccal space, which was diagnosed as an intraoral foreign body. Here, we aim to highlight the imaging features of this particular case of comestible intraoral foreign body.

Superior Mesenteric Artery Thrombosis in a Patient With Median Arcuate Ligament Syndrome.

Median arcuate ligament syndrome (MALS) is a rare and controversial vascular compression syndrome. In this condition, the median arcuate ligament compresses the celiac artery, resulting in symptoms such as postprandial abdominal pain, vomiting, and weight loss. Its diagnosis is based on clinical findings in conjunction with supporting radiological features such as elevated flow velocities on Doppler ultrasound and focal indentation of the proximal celiac artery with the typical 'hooked' or 'J'-shaped appearance on conventional angiography or computed tomography angiography (CTA). Herein is the case of a 44-year-old female who presented with early satiety, postprandial abdominal pain, vomiting, and weight loss. A computed tomography mesenteric angiogram (CTMA) showed thickening of the median arcuate ligament with a hooked appearance of the celiac artery and thrombosis of the mid to distal superior mesenteric artery with associated ischemia of a short segment of the jejunum. Subsequent Doppler ultrasound demonstrated elevated peak systolic velocities within the celiac artery over the compressed segment, which varied with respiration (end-inspiration: 234.3 cm/s and end-expiration: 373.5 cm/s).

Paclitaxel-Induced Pneumonitis in Trinidad: A Case Report.

Paclitaxel-induced pneumonitis (PIP) is an immune-mediated disease resulting from a delayed hypersensitivity reaction (type IV) to paclitaxel, an anti-microtubule chemotherapeutic drug commonly used to treat breast cancer in both neoadjuvant and adjuvant settings. PIP is diagnosed by exclusion utilizing laboratory work-up, imaging, biopsy studies, and results of antibiotic therapy because there is no single diagnostic test. Ground-glass opacifications on CT, coupled with minimal restrictive disturbance with decreased diffusion on pulmonary function tests (PFTs), negative bronchoalveolar lavage (BAL), and bronchoscopy cultures, may assist physicians in diagnosing paclitaxel-induced pneumonitis. In this report, we describe a case of PIP present in Trinidad, West Indies, which has not been described previously in this region.

The Use of Contrast-Enhanced Multidetector Computed Tomography Imaging in Advanced Abdominal Pregnancy.

An advanced abdominal pregnancy is defined as an extrauterine pregnancy over twenty weeks gestation with a fetus living, or showing evidence of having once lived, in the mother's abdominopelvic cavity. Our case is a 35-year-old patient with a 23-week extrauterine pregnancy, with a congenital head defect (scaphocephaly and hydrocephalus), located in the left side of the maternal abdomen with a period of gestation of 23 weeks, who underwent preoperative imaging with contrast-enhanced multidetector computed tomography (CE-MDCT). CT imaging provided significant information on the placenta and its arterial supply/venous drainage and confirmed the presence of an arteriovenous malformation of the right uterine artery. CT imaging also allowed planning of preoperative uterine artery coil embolization.

Choledocholithiasis in Pregnancy: A Case Report.

Cholelithiasis during pregnancy and the postpartum period has an incidence of 12%, with pregnancy being an important risk factor for gallstones. Patients with choledocholithiasis can experience complications, such as obstructive jaundice, cholangitis, and pancreatitis, which may be detrimental to both mother and fetus. A case of cholelithiasis in a second-trimester pregnancy was complicated by choledocholithiasis and obstructive jaundice. Ultrasonography (US), magnetic resonance cholangiopancreatography (MRCP), along with serial blood tests, confirmed the diagnosis. Treatment was safely achieved using endoscopic retrograde cholangiopancreatography (ERCP). In pregnancy, complicated cholelithiasis is investigated using blood tests, ultrasonography, and cholangiography. Evidence supports the use of intraoperative or endoscopic cholangiography for the management of such complicated gallstone disease in pregnancy.

Case of a Giant Appendicolith.

Appendicoliths are calcified deposits located within the appendiceal lumen, usually measuring less than 1 cm in diameter. Appendicoliths greater than 2 cm in the largest diameter are uncommon and referred to as giant appendicoliths. Generally, patients with giant appendicoliths are asymptomatic, with these being detected incidentally on X-ray or computed tomography (CT). However, the presence of appendicoliths has been shown to be associated with an increased risk of developing appendicitis and is associated with more severe appendicitis. There is an increased incidence of appendicoliths in retrocecal appendices. This case report is of an adult male patient who presented with a three-day history of right iliac fossa pain, nausea, and decreased appetite. CT of the abdomen and pelvis showed acute appendicitis secondary to a calcified 3.1 cm giant appendicolith. Open appendicectomy was subsequently performed as the patient's financial constraints hindered a laparoscopic approach. The clinical outcome was successful with no postoperative complications, and the patient was discharged the following day. The patient was reviewed six weeks post-laparotomy with no complaints and was discharged from the surgical outpatient clinic.

Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study.

BACKGROUND: This study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago. METHODS: Patients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables. RESULTS: One hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051). CONCLUSIONS: Significantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease. TRIAL REGISTRATION NUMBER: NCT04774861.

Impact of COVID-19 pandemic on radiology education, training, and practice: A narrative review.

Radiology education and training is of paramount clinical importance given the prominence of medical imaging utilization in effective clinical practice. The incorporation of basic radiology in the medical curriculum has continued to evolve, focusing on teaching image interpretation skills, the appropriate ordering of radiological investigations, judicious use of ionizing radiation, and providing exposure to interventional radiology. Advancements in radiology have been driven by the digital revolution, which has, in turn, had a positive impact on radiology education and training. Upon the advent of the corona virus disease 2019 (COVID-19) pandemic, many training institutions and hospitals adhered to directives which advised rescheduling of non-urgent outpatient appointments. This inevitably impacted the workflow of the radiology department, which resulted in the reduction of clinical in-person case reviews and consultations, as well as in-person teaching sessions. Several medical schools and research centers completely suspended face-to-face academic activity. This led to challenges for medical teachers to complete the radiology syllabus while ensuring that teaching activities continued safely and effectively. As a result, online teaching platforms have virtually replaced didactic face-to-face lectures. Radiology educators also sought other strategies to incorporate interactive teaching sessions while adopting the e-learning approach, as they were cognizant of the limitations that this may have on students' clinical expertise. Migration to online methods to review live cases, journal clubs, simulation-based training, clinical interaction, and radiology examination protocolling are a few examples of successfully addressing the limitations in reduced clinical exposure. In this review paper, we discuss (1) The impact of the COVID-19 pandemic on radiology education, training, and practice; (2) Challenges and strategies involved in delivering online radiology education for undergraduates and postgraduates during the COVID-19 pandemic; and (3) Difference between the implementation of radiology education during the COVID-19 pandemic and pre-COVID-19 era.

Allergic Bronchopulmonary Aspergillosis in Trinidad: A Case Report.

Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated disease resulting from a hypersensitivity reaction to Aspergillus fumigatus. ABPA is identified by bronchial asthma, peripheral eosinophilia, high levels of serum immunoglobulin E, pulmonary infiltration, mucoid impaction, and central bronchiectasis. Diagnosing ABPA is important to consider since there are treatment options that are readily available and response to therapy yields positive results. We describe a case of ABPA present in Trinidad, West Indies, which was not described previously in the literature.

An Investigative Study of Hepatic Arterial Anomalies in a West Indian Population.

PURPOSE: There are many known variations in the arterial supply to the liver. We sought to document the incidence and details of anomalies of the extrahepatic arteries in an unselected population in the West Indies. METHODS: This study spanned 24 months. All 205 CT scans were evaluated at a hepatobiliary referral center in Trinidad and Tobago. We described the anomalies of the arterial supply to the liver using the conventional classification proposed by Michels. RESULTS: 205 CT scans were evaluated, and 112 persons (54.6%) had conventional Type 1 anatomy. However, compared to the incidence in the existing medical literature, we encountered a greater incidence of replaced right hepatic arteries (18.1% vs 11%; P 0.04) and a lower incidence of accessory right hepatic arteries (2.4% vs 7%; P 0.030). CONCLUSION: Although 54.6% of persons in this West Indian population have conventional hepatic arterial supply, the distribution of anatomic variants of the right hepatic artery is quite different to that seen in North American and European centers. We found a higher incidence of replaced right hepatic arteries and a lower incidence of accessory right hepatic arteries.

Uterine Lipoleiomyoma Presenting With Pelvic Pain in a Post-Menopausal Woman.

Uterine leiomyomas (fibroids) are the most common tumor of the reproductive system in women between menarche and menopause. Uterine lipoleiomyomas are a rare variant of leiomyoma, consisting of smooth muscle cells admixed with adipocytes. Herein is the case of a 70-year-old female who presented with acute pelvic pain and a palpable pelvic mass. A computed tomography scan of her abdomen and pelvis demonstrated a large, circumscribed, fat and soft tissue density, uterine mass suggestive of a lipoleiomyoma. Histopathology examination of the resected specimen after total abdominal hysterectomy confirmed a mature lipoleiomyoma.

Spontaneous Massive Intrarenal Hemorrhage in a Patient With De Novo Ureteropelvic Junction Obstruction.

This case represents an even rarer presentation of ureteropelvic junction obstruction (UPJO), that of a spontaneous life-threatening hemorrhage into the renal pelvis of a patient with previously unknown UPJO. Unique to this patient was the emergent nature of the presentation, requiring life-saving surgery. A review of the literature follows a discussion of the case.

Retroperitoneal liposarcoma mimicking pheochromocytoma.

Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas. We discuss one such case of a 56-year-old Afro-Trinidadian female who presented to her primary care physician with a 3-month history of weakness, intermittent sweating, difficulty sleeping and elevated blood pressure. After a 2 week trial of an oral antihypertensive regime her blood pressure was still elevated and she complained of new right sided abdominal pain. A subsequent Computed Tomography scan of her abdomen revealed an enhancing, heterogeneous right suprarenal mass suspicious for pheochromocytoma. Urinary catecholamines were also elevated and an MRI of her abdomen supported the diagnosis of pheochromocytoma although intralesionsal fat was noted, an uncommon feature of pheochromocytomas. She was booked for laparoscopic adrenalectomy. Histological analysis of the resected specimen confirmed a dedifferentiated retroperitoneal liposarcoma. While the imaging features of phaeochromocytomas and retroperitoneal liposarcomas can be similar, the presence of intralesional fat on CT and MRI should favour the diagnosis of a retroperitoneal liposarcoma, albeit the clinical and biochemical picture.

Jejunal Intussusception Due to Heterotopic Pancreas: A Case Report.

Intussusception in adults is rare. Even more unusual is jejunal intussusception secondary to a heterotopic pancreas. The presence of pancreatic tissue in an ectopic location and lacking contiguity with the main pancreatic gland is defined as pancreatic heterotopia. It is very rarely symptomatic and usually diagnosed incidentally during surgical intervention for other conditions. We report the case of a 78-year-old lady who presented with a history of constipation, abdominal pain, and vomiting. A CT scan revealed features of a proximal jejunojejunal intussusception secondary to a small soft tissue density lead point. After laparotomy and segmental jejunal resection, histopathology confirmed the diagnosis of ectopic pancreatic tissue as the lead point. Although uncommon, heterotopic pancreatic tissue should be included in the differential diagnosis for proximal small bowel intussusception.

Movement Disorders and Dementia in a Woman With Chronic Aluminium Toxicity: Video-MRI Imaging.

Background: Aluminium encephalopathy results from exposure to aluminium from occupational, recreational, and environmental sources. Movement disorders, cerebellar ataxia, pyramidal tract signs, dementia, microcytic anemia and bone disease are typical manifestations. Case Report: A 55-year-old woman had clinical manifestations, persistent hyperaluminemia without magnetic resonance imaging (MRI) scan changes of toxic encephalopathy following a prolonged exposure to marine grade paints containing 30% aluminium. Chelation therapy with ethylenediaminetetraacetic acid (EDTA) demonstrated decreased levels of aluminemia and significant neurological improvement over time. Discussion: This diagnosis should be entertained in patients with movement disorders, cerebellar ataxia, pyramidal signs, and dementia of unknown etiology. Highlights: Aluminium encephalopathy (AE) is a neurological syndrome caused by aluminium neurotoxicity. Manifestations include cognitive impairment, motor dysfunction, microcytic anemia and bone disease. This case illustrates AE with hyperaluminemia associated with chronic exposure to industrial paints and clinical and biochemical reversibility after chelation therapy with ethylenediaminetetraacetic acid. Movement disorders are highlighted.