Intracranial meningiomas at a tertiary hospital: Spectrum of MRI findings with histopathologic correlation.

Background: Intracranial meningiomas consist of a heterogenous group of histological subtypes, some of which are rare. Data that may play an important role in neurosurgical decision-making regarding the incidence and MRI features of these histological subtypes in the South African population groups, are lacking. Objectives: This study aimed to assess the spectrum of MRI findings and histological subtypes of meningiomas in the South African context, with the goal of improving the paucity of literature on the topic. Method: A retrospective review of the MRI features of 41 cases of histologically confirmed intracranial meningiomas was performed at a tertiary hospital level. Imaging features were audited and correlated with histological subtypes during statistical analysis. Results: Eleven different histological subtypes of meningioma were encountered. World Health Organization (WHO) Grade I meningothelial meningiomas were the most common histological subgroup. Overall, meningiomas were found to be predominantly isointense to grey matter on T1-weighted imaging, irrespective of the histological subtype, with greater signal variability on T2-weighted imaging. Morphologies of specific subtypes are in keeping with the literature. Conclusion: Analysis of this series of intracranial meningiomas did not demonstrate statistically significant differences in MRI features between histological subtypes to allow for accurate preoperative prediction of meningioma subtype or WHO grade. This highlights the importance of definitive histopathological diagnosis rather than over-reliance on presumed benign imaging features. Contribution: This original research article discusses the impact of histological subtype on the MRI appearance of intracranial meningiomas, with the aim to improve the paucity of literature on the subject in the context of the South African population.

Complicated spontaneous pneumoparotid mimicking a neck mass in a child with Down's syndrome.

Spontaneous or self-induced pneumoparotid, which usually manifests as acute unilateral gland enlargement, is caused by insufflation of air from the oral cavity via Stensen's duct. A 9-year-old patient, with known Down's syndrome, presented with a progressively enlarging, painless, spontaneous, left neck mass. Computed tomography showed features consistent with pneumoparotid, without underlying associated pathology. Identification of true cases of spontaneous pneumoparotid is crucial, as these require a holistic management approach to prevent recurrence and complications.

Hepatic mesenchymal hamartoma: An uncommon but important paediatric diagnosis.

Hepatic mesenchymal hamartoma is a rare hepatic tumour seen in the paediatric population. Although this entity has a variable imaging appearance, it has a favourable prognosis if diagnosed and managed correctly. This case presents the ultrasound and computed tomography findings of an 11-month-old patient who presented with a history of progressive abdominal distension and an elevated alfa fetoprotein level on biochemistry. The case describes how a confident perioperative diagnosis could be made on the basis of characteristic imaging features.

Incidental amniocele in a case of antepartum haemorrhage.

An amniocele, or contained uterine rupture, is a phenomenon in which there is herniation of the amniotic sac through a uterine defect, secondary to various causes. It is associated with severe morbidity and mortality. This case presents the findings in a 36-year-old female at 29 weeks gestation who was initially managed as antepartum haemorrhage secondary to placenta previa, based on ultrasound. Upon further imaging, an amniocele was diagnosed. This case report illustrates the importance of early identification of this life-threatening condition.

Page kidney: A rare cause of secondary hypertension.

Page kidney is a rare phenomenon that can present with hypertension. The presence of a subcapsular perirenal collection causes parenchymal compression leading to renal hypoperfusion. Subsequent activation of the renin-angiotensin-aldosterone system results in an increase in systemic blood pressure. The causes of renal subcapsular collections are varied, with most cases being secondary to post-traumatic haematomas. We present the case of a young hypertensive patient, treated as primary hypertension with persistently uncontrolled blood pressures. This was despite good treatment adherence. On further investigation, imaging identified the presence of bilateral subcapsular collections. This case illustrates the importance of a thorough workup in a young hypertensive patient with refractory hypertension. Given that Page kidney is curable, timeous intervention can save the patient from unnecessary medications and the morbidity of uncontrolled blood pressures.