Hematemesis on an esophageal foreign body revealing a double aortic arch: a case study.

A double aortic arch is a rare abnormality of the aortic arch caused by the persistence of the distal part of the right dorsal aorta. It can be manifested by respiratory and/or digestive symptoms. We report a case of double aortic arch revealed by an esophageal foreign body complicated by haematemesis in a 13-year-old boy having required multidisciplinary care.

Evaluation of Iodinated Contrast Media Use in Abdominal CT Scans in Cancer Assessments: A Cross-Sectional Study in Lomé (Togo).

Background: There is great variability between centers regarding contrast injection protocols. They should only be injected if they can provide useful information for diagnosis with the necessary and sufficient quantity of iodine. We wanted to know through this study if the use of iodinated contrast media is optimised in abdominal CT scans performed for cancer assessment in Lomé. Materials and Methods: It was a cross-sectional, descriptive, and analytical study with a prospective collection over a period of 6 months in three CT units in Lomé. It involved abdominal CT scans performed for oncological evaluation. Data were reported as the mean ± standard deviation. The Pearson correlation coefficient, ANOVA, chi-square, and the Fisher test were used. Results: A total of 218 examinations were recorded. The female sex represented 56.88% of the patients. The mean age was 50.92 ± 15.78 years. The mean weight was 70.46 ± 15.23 kg. The mean BMI was 24.91 ± 5.32 kg/m2. The examinations were performed with a voltage of 120 kV in 195 cases (89.45%). The mean dose of injected iodine was 0.42 ± 0.09 gI/kg with a dose of 0.40 gI/kg at 80 kV and 0.45 gI/kg at 130 kV. The mean injection rate was 2.90 ± 0.34 mL/s. The mean injected volume was 83.19 ± 7.29 mL. The mean duration of the injection was 30.60 ± 7.39 s. The mean iodine delivery rate was 0.98 ± 0.17 gI/s. There was no saline injection in 152 cases (69.72%). Liver contrast enhancement was satisfactory in 94.5% of cases. There was a strong negative linear correlation between the dose of injected iodine and weight. Conclusions: Optimization guidelines for the use of iodinated contrast media are not always applied. Therefore, monitoring and benchmarking programmes for iodinated contrast injection protocols that involve all radiology personnel should be implemented.

Knowledge and perception of nuclear medicine by radiologists in French-speaking sub-Saharan Africa.

OBJECTIVES: to assess the knowledge and perception of nuclear medicine by radiologists in French-speaking sub-Saharan Africa. METHODS: cross-sectional study conducted from April 8 to June 7 2020 including radiologists practicing in French-speaking sub-Saharan African countries. Data were collected electronically via a google form. RESULTS: Of the 142 radiologists surveyed, 45.8% had already completed an internship in Europe, 3.52% in a nuclear medicine department and 72.54% had a nuclear medicine department in their country of practice. Among these radiologists, 21.13% knew the three main techniques of nuclear medicine and only 9.15% knew that nuclear medicine allows functional, metabolic and molecular studies. On average, 56.8% were aware of clinical indications for the main fields of nuclear medicine. In 47.18% of cases, they thought that scintigraphic imaging was more irradiating than radiological imaging, 71.1% knew about hybrid imaging techniques, 43.66% had read a scientific article on nuclear medicine, 4.93% had attended a nuclear medicine conference and 28.9% had recommended a scintigraphic imaging examination in their report. Half of them would like to see nuclear medicine and radiology merged into a single specialty and 95.77% considered it essential to create a nuclear medicine department in their country. CONCLUSION: The level of knowledge of radiologists in French-speaking sub-Saharan Africa about nuclear medicine was, on the whole, unsatisfactory with a generally encouraging perception.

Knowledge and attitudes of ultrasonography physicians regarding the biological effects of ultrasound in French-speaking sub-Saharan Africa.

OBJECTIVE: To assess the knowledge and practical attitudes of ultrasonography physicians regarding the biological effects of ultrasound in French-speaking sub-Saharan Africa. MATERIALS AND METHODS: A descriptive cross-sectional study carried out over a period of 03 months (from 1st August to 31st October 2019) which included doctors carrying out ultrasound examinations in French-speaking sub-Saharan African countries via an electronic survey form. RESULTS: The 137 ultrasonography physicians came from 13 different countries and included 58% radiologists, 15% gynecologists, 14% cardiologists and 13% general practitioners. The majority of ultrasonography physicians had less than 10 years of professional experience (87.60%) and performed more than 25 ultrasonographies per week (65.69%). The biological effects of ultrasound were known by 69.34% of ultrasonography physicians. Only 44% were able to cite the two biological effects of ultrasounds; 59.13% were unaware of the existence of thermal and mechanical indexes and 66.42% had no idea about the normal values of these indexes. They were unaware that their devices showed mechanical or thermal index in 48.91% of cases, consulted these indexes at the beginning of ultrasound explorations in 26.92%, and had no idea about the practical attitudes to adopt in the face of an increase in these indexes in 54.74% of cases. Half of the gynecologists and general practitioners and 55% of the radiologists affirmed that they avoid using Doppler as much as possible to explore the embryo. CONCLUSION: The level of knowledge of ultrasonography physicians about the biological effects of ultrasound was unsatisfactory in French-speaking sub-Saharan Africa and good attitudes to ultrasound safety were not always adopted.

Dosimetry of pediatric chest X-Ray examinations in Togo.

OBJECTIVE: To assess the entrance surface dose (ESD) of pediatric chest X-ray examinations in order to establish a diagnostic reference levels (DRLs) in Togo. MATERIALS AND METHODS: The study was carried out in 13 radiology departments within the 6 health regions of the country. This is a descriptive cross-sectional study relating to the dosimetric assessment of the skin of children aged from 0 to 15 years during chest X-ray examinations. The assessment was made by the empirical formula calculation of the entrance surface dose (ESD = 0.15 × (U/100)2 × Q × (1/FSD)2) and with the Internet Dose Calculation Module (MICADO) software online. Statistical assessment was performed using IBM SPSS 21 software. RESULTS: Our sample numbered 390 with a sex ratio of 1.3 and predominantly male. Examinations performed with the analog radiography units were more irradiating (0.14 mGy) than ones performed with digital detectors (0.12 mGy). The mean dose calculated with MICADO was low (Avg. = 0.12 mGy) compared to that calculated with the theoretical method (Avg. = 0.16 mGy). No significant relationship was found between the professional experience of operators and the entrance surface dose (r  > -1 with p = 0.146 not significant). MICADO doses increased with age. The values of the diagnostic reference levels used for the antero-posterior or postero-anterior chest X-ray examinations for children aged 0-1 year; 1-5 years; 5-10 years and 10-15 years were respectively, 0.15 mGy; 0.14 mGy; 0.15 mGy and 0.17 mGy. CONCLUSION: The entrance surface dose varied greatly from one health facility to another for this same examination. In most of the different age groups of children, the diagnostic reference level was higher than that found in literature. Thus, effective measures must be put in place to optimize the doses delivered to children during chest X-ray examinations.

Evaluation dosimétrique des tomodensitométries adultes auTogo / Dosimetric evaluation of adult CT scans in Togo

Objectif: Evaluer les doses délivrées aux patients adultes lors des examens TDM en vue de l'établissement des niveaux de référence diagnostiques tomodensitométriques au Togo.Matériel et méthodes: Etude transversale réalisée du 6 Mars au 30 Juillet 2018 dans 5 structures sanitaires disposant d'une unité tomodensitométrique au Togo ayant inclus les TDM cranio-encéphaliques, abdomino-pelviennes, thoraciques, thoraco-abdomino-pelviennes, rachidiennes cervicales et lombaires des patients d'au moins 15 ans.Résultats: Les 1155 TDM adultes inclus étaient dominées par les TDM cranio-encéphaliques et abdomino-pelviens avec respectivement 34,2% et 15,15%. La sex-ratio était de 1,42. Les appareils de marque GE dans 80%, étaient de 6 et 16 barrettes et 60% installés 2010. L'IDSvol de la TDM cérébrale était le plus élevé par rapport à l'IDSvol des autres types d'examen. La dispersion des PDL par acquisition et pour un examen complet inter et intra structure sanitaire était significative. Les NRD (75e percentile du PDL) par acquisition était de 1199,14mGy.cm (cérébral non traumatique), 1596,45mGy.cm (cérébral-traumatique), 635,63mGy.cm (cervical), 401,98mGy.cm (thorax), 594,42mGy.cm (abdomino-pelvien), 675,73mGy.cm (thoraco-abdomino-pelvien) et 681,35mGy.cm (lombaire). Les doses efficaces moyennes associées auxdifférents types d'examens étaient comprises entre 2-3mSv pour l'exposition de la tête et le cou et de 24mSv pour la TDM abdomino-pelvienne.

Objective: To evaluate the doses delivered to adult patients during CT scans in order to establish CT-scans diagnostic reference levels (DRL) in Togo.Material and methods: Cross-sectional study carried out from 6 March to 30 July 2018 in 5 health facilities with a CT-scans unit in Togo that included cranio-encephalic, abdominal-pelvic, thoracic, thoraco-abdominal-pelvic, cervical and lumbar spines CT-scans in patients at least 15 years of age. Results: The 1155 adult CT-scans included were dominated by cranio-encephalic and abdominal-pelvic CTs with 34.2% and 15.15% respectively. The sex-ratio was 1.42. GE brand devices in 80%, were 6 and 16 bars and 60% installed 2010. The brain CT IDSvol was the highest compared to the CTDIvol of other types of exams. The dispersion of the DLP by acquisition and for a complete inter and intra-structure examination was significant. DRLs (75th percentile of DLP) per acquisition were 1199.14mGy.cm (non-traumatic cerebral), 1596.45mGy.cm (traumatic cerebral), 635.63mGy.cm (cervical), 401.98mGy.cm (thorax),594.42mGy.cm (abdominal-pelvic), 675.73mGy.cm (thoracic-abdominal-pelvic) and 681.35mGy.cm (lumbar). The average effective doses associated with the different types of exams ranged from 2-3mSv for head and neck exposure and 24mSv for abdominal-pelvic CT. Conclusion : The high dispersion of dose delivered during CT-scan in Togo requires a process of homogenization of procedures and optimization from DRLs thus determined.(abdominal-pelvic), 675.73mGy.cm (thoracic-abdominal-pelvic) and 681.35mGy.cm (lumbar). The average effective doses associated with the different types of exams ranged from 2-3mSv for head and neck exposure and 24mSv for abdominal-pelvic CT.Conclusion: The high dispersion of dose delivered during CT-scan in Togo requires a process of homogenization of procedures and optimization from DRLs thus determined.

Digestive Duplication: A rare cause of abdominal mass in an infant.

INTRODUCTION: Intestinal duplications are rare malformations and hail sites are the most common. Today, the diagnosis is made in antenatal because of the performances of antenatal ultrasound. OBSERVATION: This was a 15-month-old male infant received for constant crying, vomiting and increased abdominal volume that had been evolving for two weeks. An abdominal ultrasound was performed and objectified an intraperitoneal cyst formation of 30 x 27 mm, surrounded by a stratified wall and contiguous to a digestive loop. Surgery was performed and confirmed the existence of non-communicating ileal duplication. CONCLUSION: Intestinal duplication is a rare malformation. Ultrasound is often sufficient for diagnosis based on the presence of a characteristic double-walled cystic mass.

Primary squamous cell carcinoma of the endometrium associated with human papilloma virus in a young woman: a case report.

BACKGROUND: Primary squamous cell carcinoma of the endometrium is an extremely rare tumor with poorly understood pathogenesis. CASE PRESENTATION: We report a case of a 28-year-old Togolese woman who had consulted for vaginal bleeding and pelvic pain. Ultrasound showed thickening of the lining of the endometrium, and biopsy curettage was done. Anatomopathological examination was noteworthy for a proliferation of squamous cells often connected by union bridges arranged in tumor lobules with dyskeratotic maturation. Immunohistochemistry showed epithelial membrane antigen positivity, anti-pancytokeratin 1 markers of tumor cells positivity, chromogranin A negativity, actin negativity, S100 negativity, estrogen receptor negativity, and progesterone receptor negativity. In situ hybridization had objectified human papillomavirus genotypes 16/18. The diagnosis of primary squamous cell carcinoma of the endometrium associated with human papilloma virus was retained. A hysterectomy was performed, and the tumor was classified pT1N0M0. CONCLUSION: The pathogenesis of this endometrial cancer is complex, and its association with human papillomavirus does not explain its genesis.

Qualité des demandes d'examens radiologiques: à propos de 552 demandes évaluées par des radiologues

Objectifs : Evaluer la qualité des demandes d'examens radiologiques. Matériels et méthodes : Il s'est agi d'une étude transversale descriptive réalisée dans le service de radiologie du CHU Campus du 1er août au 15 août 2015. Résultats : Au cours de la période d'étude, nous avons colligé 144 demandes d'examens de tomodensitométrie (26,1%) et 408 demandes d'examens de radiographie (73,9%). Les demandeurs étaient des médecins spécialistes dans 25% des cas (102 examens) pour la radiographie et 19,4% des cas (28 examens) pour la tomodensitométrie. Les demandeurs d'examen de radiographie étaient des rhumatologues dans 8,8% des cas (36 examens) et aucun urologue n'avait demandé un examen de radiographie ; les demandeurs d'examen de tomodensitométrie étaient des neurologues dans 19,4% des cas (28 examens) et aucun gynécologue ni pédiatre n'avait demandé un examen de tomodensitométrie. Les demandes sans question et les demandes sans retour étaient les deux principaux types de demandes observés. L'âge et le sexe des patients n'avaient pas été précisés respectivement dans 4,4% (18 cas) et 2,9% (12 cas) des demandes d'examen de radiographie. Les résultats d'examens para-cliniques pouvant être utiles à l'interprétation et au compte-rendu radiologique manquaient sur 384 cas (94,1%) des demandes d'examens de radiographie et sur 140 cas (97,2 %) des demandes d'examens de tomodensitométrie. Sur les demandes d'examen de radiographie, le demandeur ne pouvait être identifié par son nom dans 78 cas (19,1%) et le motif de demande était précisé dans 402 cas (98,5 %) ; sur les demandes d'examen de tomodensitométrie, le demandeur ne pouvait être identifié par un numéro de téléphone dans 96 cas (66,7%). Conclusion : Les demandes d'examen radiologiques sont établies de manière incomplète. L'exercice radiologique suppose cependant une obligation de moyens, avec sérieux, prudence et réflexion

Profil radiographique de la tuberculose pulmonaire de l'adulte immunocompétent en milieu rural au Togo

Contexte et objectifs. La tuberculose pulmonaire (TP) présente un profil varié à la radiographie thoracique. Les signes présomptifs sont à déterminer, surtout en milieux peu nantis. L'objectif de la présente étude était de décrire le profil radiographique de la TP de l'adulte immunocompétent en milieu rural. Méthodes. Etude documentaire descriptive et analytique incluant des patients adultes immunocompétents, traités pour TP et référés au centre de prise en charge de la tuberculose de la région centrale, Centre Hospitalier Régional de Sokodé durant la période du 1er janvier 2016 au 30 juin 2018. Résultats. Cent-trois dossiers ont été colligés, comprenant 38 patients (36,9%) à bacilloscopie négative et 65 autres (63,1%) à bacilloscopie positive. Le sexe féminin était prédominant (59,2% avec un sexe ratio de F/H de 1,17/1). Soixante-deux patients ont été considérés dans l'analyse, 31 à bacilloscopie positive et 31 à bacilloscopie négative. La moyenne d'âge pour les patients à bacilloscopie positive était de 37,41±16,85 ans et de 41,74±15,59 ans pour ceux à bacilloscopie négative (p=0,29). On notait 9 patients âgés de plus de 60 ans (14,5%). Les syndromes alvéolaire (88,9%) et cavitaire (76,9%) étaient plus observés chez les patients à bacilloscopie positive et jeunes, alors que les opacités réticulo-nodulaires (85,7%) prédominaient dans le groupe des patients à bacilloscopie négative. Les lésions étaient bilatérales (n=34 ; 54,8%), localisées au poumon droit (n=17 ; 27,5%). Ces lésions étaient diffuses dans 53,2%; et intéressaient le tiers supérieur du poumon dans 29% des cas. Conclusion. Chez le sujet immunocompétent, le profil radiographique de la TP bacillifère est caractérisé par des lésions alvéolaires et/ou cavitaires, tandis que celui de la TP- par les opacités réticulo-nodulaires

Bilateral semilunar perihilar opacities in a patient with pulmonary hypertension.

Pulmonary arterial aneurysm is a rare entity with a high mortality if left untreated. Pulmonary arterial hypertension is an important cause of PAAs although other infective and auto-immune causes must be excluded when an aneurysm is identified.

Breast cancer cases of female patients under 35 years of age in Togo: A series of 158 cases.

Breast cancer in young female patients represents a public health problem in developing countries. The objectives of the study were to study the epidemiological and histological characteristics of breast cancer in female patients under 35 years of age. This was a retrospective analytical study of a series of 158 cases of breast cancer in female patients under 35 years of age, conducted at the University Teaching Hospital of Lomé between 2000 and 2015. A total of 158 cases were collected, representing 36.2% (436) of all breast cancer cases. The average age of the patients was 30.9 years (range, 16-35 years). A family history of breast cancer at the 1st or 2nd degree was identified in 13.9% of cases. Genetic mutation studies were carried out for 7 patients, 5 of which revealed mutations (4 BRCA1 and 1 BRCA2). According to the locus, the cancer was located preferentially in the left breast in 88 cases (55.7%). Malignant mammary lesions were epithelial tumors (n=144 cases, 91.1%), infiltrating (n=125 cases, 79.1%) and non-infiltrating (n=19 cases, 12.0%). The other histological groups consisted of 8 cases of sarcomas (5 cases of angiosarcoma, 2 cases of fibrosarcoma and 1 case of Kaposi's sarcoma), 5 cases of lymphomas and one case of melanoma. Not otherwise specified infiltrating ductal carcinomas were SBR II and III in 43.2 and 35.2% of cases, respectively. The tumors classified as T4 were the most frequent (30.4%). Regarding the lymph node status, lymph node metastasis was noted in 22.8% of cases. Studies of hormone receptors were carried out in 23 patients and were positive for 11 patients: Estrogen receptor (ER)+plus progesterone receptor (PR)+(7 patients), ER+PR-(4 patients). Of the aforementioned 8 cases of sarcoma, 5 were angiosarcoma. The lymphomas were predominantly Burkitt's type for 4 cases. Mammary ultrasonography was performed in 45.6% of the patients and 54.4% underwent the combined ultrasonography and mammography. Ultrasound identified one or more sign of malignancy in 67 patients (42.4%), and combined ultrasonography and mammography classified 51.9% of lesions in BIRADS 4 and 5. The incidence of breast cancer in young Togolese patients is high. It is a disease distinguished by a delay in diagnosis, which contributes to the high number of cases that initially diagnosed at an advanced stage, particularly the high histo-prognosis grades of infiltrating ductal carcinoma. These results indicate a genetic origin; therefore, a thorough investigation into genetic mutations should be carried. In addition, further collaborative studies are required to verify these results.

Primary Neuroendocrine Breast Carcinoma in a 13-Year-Old Girl: Ultrasonography and Pathology Findings.

Neuroendocrine carcinoma (NEC) of the breast is a rare disease and has been scarcely reported by African authors. The authors report a case of breast NEC in a 13-year-old African girl initially diagnosed as an atypical adenofibroma by ultrasonography. Ultrasound-guided biopsy and conventional histological examination indicated two potential diagnoses: primary malignant non-Hodgkin's lymphoma and undifferentiated carcinoma. According to immunohistochemistry performed on paraffin blocks in France, infiltrating ductal carcinoma with a strong neuroendocrine component was confirmed by CD56, CD57, and chromogranin A markers.

Breast Abscessed Cancer in Nonlactating Women in Tropical Environment: Radiological, Bacteriological, and Anatomopathological Features about 3 Cases.

The association of breast cancer and abscess is rare in daily practice. The authors report a short series of 3 cases of cancer of the breast in nonlactating women presented as breast abscess, reviewing aspects in radiology (ultrasound and mammography), correlating them with the histopathology findings and the bacteriological profile of the isolated germs.

Diagnostic Difficulties in Pathological Laboratories in Developing Countries: A Case Report of Differentiated Squamous Cell Carcinoma in a Young Togolese Woman.

We report a case of poorly differentiated squamous cell carcinoma of the vulva induced by human papillomavirus in a 23-year-old woman, in whom we experienced diagnostic difficulties.

Tuberculous Abscess of the Chest Wall Simulate Pyogenic Abscess.

The chest wall tuberculosis abscesses is rare. We present a case of a 27-year-old immunocompetent male who presented chest wall abscesses. Imaging (chest radiographic, ultrasound, and computed tomography) and Ziehl-Neelsen staining demonstrated chest wall tuberculosis abscesses.

Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy.

The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619, p value = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26, p value = 0.031).