Nepalese Journal of Radiology

Medical Education at the Crossroads

Birendra Raj Joshi — 2019-05-30

N/A

Early Experience of Percutaneous Transhepatic Biliary Stenting in Malignant Biliary Obstruction in Nepal

Ajit Thapa — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22966

Introduction: Percutaneous biliary stenting is recommended for palliation of unresectable malignant biliary obstruction with short life expectancy. Percutaneous biliary stenting is newer interventional imaging guided procedure being practiced in Nepal. Aim of this study is to share our early experience of percutaneous biliary stenting and its complications in Nepal.
Methods: Retrospective review of clinical success, complication, stent patency and survival was done in 31 patients with nonoperable malignant biliary obstruction who underwent percutaneous transhepatic metallic biliary stenting from August 2016 to July 2018
Results: We successfully stented 31 malignant biliary obstructions, following external biliary drainage via sonography and fluoroscopy guidance, one week prior to the stenting. The patients were followed up for documentation and management of any complications related to the procedure. Cent percent reduction in bilirubin levels <50% after 2 weeks were achieved. Procedure related mortality was nil. Major complications including early stent block were seen in 7 patients, which we managed accordingly. Stent patency rate for 3 months was 73% and for 6 months was 45%. Although the procedure is recommended in short life expectancy patients, average survival of the patients in our experience was 7.1 months after the procedure with 2 of the patients survived >12 months after the procedure.
Conclusion: Percutaneous biliary stenting is less invasive palliation for unresectable malignant biliary obstruction with less complication as well.

Keywords: Biliary Tract, Cholestasis, Fluoroscopy

A Study on Measurements of Different Dimensions of Maxillary Sinus by Computed Tomography in Adult Nepalese Population

Umesh Prasad Khanal — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22974

Introduction: Measurement of different dimensions of maxillary sinus and anterior wall
thickness of maxillary sinus by Computed Tomography in normal Nepalese population
Methods: Dimensions of 90 patients were measured in CT PNS using Syngovia Software. AP diameter, width and anterior wall thickness were measured in axial images and height was measured in coronal images.
Results: The mean volume of maxillary sinuses in study of male population on left and right side were 17.09 cm3±3.89, 17.19 cm3 ±4 respectively whereas in female were 15.64 cm3±3.5 and 15.21cm3±3.2 respectively as shown in Table 1. This shows the volume of male was significantly larger than female with P- Value = 0.012 (<0.05). Similarly, the thickness of Anterior Wall (AW) of maxillary sinus was also measured in this study and the mean value of left and right side in male were 0.16cm± 0.04 and 0.15cm± 0.03 respectively and in female were 0.12cm± 0.04 and 0.14cm± 0.02 respectively.
Conclusion: This study showed that CT is a reliable method for the measurement of different dimensions of the maxillary sinus. The result showed greater mean value of volume in male than female with significant differences. So this study concluded that the measurement of volume of maxillary sinus can help in the identification of gender which can be very useful for forensic sciences.

Keywords: Humans, Maxillary Sinus, Tomography, X-Ray Computed

Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis and Correlation with Histopathology

Aimandu Shrestha — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22975

Introduction: Acute appendicitis is a common surgical condition; yet its diagnosis can be elusive at times and missed diagnosis can lead to attendant complications of perforation and its sequelae. On the contrary, negative appendectomy subjects one to unnecessary surgery and its physiological and psychological consequences. Among the various available modalities of diagnosis of appendicitis, Ultrasonography(USG) is easily accessible, non invasive, less time consuming, low cost investigation no radiation hazards. So, USG is appropriate diagnostic modality in our country.
Methods: This prospective observational study was carried out from January 2011 to June 2011, in the radiology department of Bir hospital. Total of 80 cases with clinical impression of acute appendicitis were enrolled. These patients underwent surgery for suspected acute appendicitis. Details of signs and symptoms, lab findings including Total Leukocyte count (TLC), Differential Leukocyte Count (DLC) and USG findings were recorded. Intra-operative and histopathology findings were also recorded. The findings were analyzed to assess accuracy of ultrasonography in acute appendicitis. Histopathological report was considered the goal standard.
Results: A total of 93 cases clinically diagnosed as acute appendicitis were subjected for USG. Out of 93 cases, 80 cases underwent surgery. Among 80 cases, sonography showed acute appendicitis in 56 cases out of which 54 was proved by histopathology as well. However, ultrasonography was not able to detect appendicitis in 9 cases. The sensitivity and specificity of USG for acute appendicitis were 87.7% and 88.2% respectively. The positive and negative predictive values were 96.4% and 62.5% respectively. Overall negative appendectomy rate of 21.2% had been used a basis for decision making, the rate of error being 13.7%.
Conclusion: Ultrasonography is a fairly accurate and safe modality in acute appendicitis. It can be useful in reducing negative appendectomy rate.

Keywords: Appendicitis, Appendectomy, Ultrasonography

Clinical Predictors of Abnormal Computed Tomography Findings in Mild Head Injury

Nikunj Yogi — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22978

Introduction: Whether to scan a minor head injury with Glasgow Coma Scale (GCS) 15 who appears well and has a normal physical and neurological exam or not is an issue commonly faced in all emergency departments. In this study, we tried to assess the predictability of clinical parameters in predicting traumatic intracranial lesions in Computed Tomography (CT) scans of patients with minor head injuries with GCS 15.
Methods: A prospective observational study was carried out in between January to December 2016 in Manipal Teaching Hospital, Pokhara, Nepal. Various clinical predictors of 415 cases of minor head injury with GCS 15 were assessed to see if they could predict the abnormal CT scans in these cases. Clinical variables found significant in bivariate analyses were further analyzed using logistic regression to calculate the odds of each variable to detect abnormal CT scans.
Results: There were 119 (28.7%) abnormal CT scans in the study. Vomiting, LOC (Loss of Consciousness), seizure and headache were the significant predictors of abnormal CT scans with an odds of 4.254 (95% CI: 2.373-7.627), 2.396 (95% CI: 1.258-4.562), 5.803 (95% CI: 1.110-30.336) and 1.967 (95% CI: 1.008-3.839) respectively
Conclusion: Vomiting, LOC, seizure and headache are important clinical predictors of abnormal CT scan in cases of minor head injuries with GCS 15.

Keywords: Craniocerebral Trauma, Glasgow coma scale, Neurologic Examination

Ultrasound Measurement of Thyroid Isthmus Thickness in Clinically Euthyroid Subjects

Prakash Kayastha — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22979

Introduction: The purpose of this study was to establish the reference value of normal thickness of thyroid isthmus among clinically euthyroid Nepalese individuals using Ultrasonography and correlate this with thyroid volume, sex, individual’s built and geographic location.
Methods: This was a prospective cross sectional study involving 485 clinically euthyroid individuals. B -mode Ultrasonography was used to measure the thickness of thyroid isthmus in transverse plane. Mean thickness of isthmus for male and female was obtained and Pearson correlation test was used to see the relationship with various factors.
Results: Among 485 individuals between 1 to 83 years of age, 221 were males and 264 were females. Maximum individuals (72.99%) were from hilly region and minimum (3.30%) were from Himalayan region. Mean thickness of isthmus was 3.097 ± 1.009 mm (range 1.0 to 6.8 mm). It was 3.114 ± 0.9513 mm for male and 3.083 ± 1.056 mm for female. Isthmus thickness best correlated with total thyroid volume (r=0.373, p=0.0001). Isthmus thickness also positively correlated with body mass index (r=0.355, p =0.0001), body surface area (r= 0.296, p=0.0001), weight (r =0.334, p=0.0001) and height (r =0.130, p =0.004) of the individuals.
Conclusion: This study estimated the normal reference value of thyroid isthmus thickness. As isthmus thickness correlated well with total thyroid volume, it can roughly guide the thyroid volume and help assessment of thyroid size in diffuse thyroid disease.

Keywords: Body Weight, Thyroid Diseases, Ultrasonography

Implications of Ultrasonography in the Diagnosis and Management of Patients Presenting with Non-Traumatic Acute Abdominal Pain in a Tertiary Hospital of Mid-Western Region of Nepal

Prasanna Ghimire — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22980

Introduction: Acute abdomen is the most common condition for patients presenting in the emergency. Ultrasound among other imaging modalities is the most common diagnostic tool employed in the diagnosis of such cases.
Methods: A prospective study of consecutive patients presenting with acute abdomen fulfilling the inclusion and exclusion criteria were included in the study. Ultrasound was performed by single radiologist and findings were correlated to the clinical, pathological and surgical findings.
Results: A total of 248 patients fulfilled all criteria and were included in the study. The age of patients ranged from 15-62 years with mean age of 41.3 years. There was female predominance with a male to female ratio of 1:1.8. Ultrasound accurately diagnosed 233 cases (93.9 %). Urolithiasis was the most common finding (45.16%) followed by acute appendicitis (19.35%).
Conclusion: Ultrasound has pivotal role in the diagnosis and overall management of patient presenting with acute abdomen. Urolithiasis is the most common etiology for non- traumatic acute abdomen.

Keywords: Abdomen, Acute, Abdominal Cavity, Emergencies

Role of Ultrasound in Detection of Abruptio Placentae and its Clinical Correlation

Sangeeta Devi Gurung — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22982

Introduction: Abruptio placentae is one of the major complications in second half of pregnancy. It accounts for 0.4-1 % of all deliveries. With the advent of ultrasonography, though abruptio placentae has been diagnosed however the sensitivity is less. Those patients clinically suspicious of abruption placenta with negative ultrasound findings can have positive intrapartum findings suggestive of abruptio. Fetal outcome is associated with the gestational age. Preterm deliveries with abruption have higher incidence of perinatal morbidity and mortality as compared to term pregnancies.
Methods: It is a prospective study conducted in Manipal Teaching Hospital, Pokhara from July 2017 to July 2018. All the cases of more than twenty eight weeks gestation, singleton pregnancies without preexisting maternal medical diseases suspicious of abruption placentae were included in the study. Ultrasonological and intrapartum findings were recorded. Data was analyzed using SPSS (VERSION16).
Results: Out of forty patients presented with per vaginal bleeding, sixteen were diagnosed as placental abruption either clinically or ultrasonographically. Only ten patients had positive ultrasound findings of retroplacental clot or subchorionic hemorrhage. Out of six patients with negative ultrasound findings, only four had positive Intrapartum findings suggestive of abruption placenta. The specificity (100%) of ultrasound in diagnosing abruption was more than the sensitivity (71.43%) and the accuracy was 75%.
Conclusion: Ultrasound is less sensitive in diagnosing abruption placenta and the lesser the gestational age, the more in the increase in perinatal morbidity and mortality.

Keywords: Gestational Age, Hemorrhage, Uterine, Premature Birth

Biloma: An Unusual Complication in a Patient With Calculus Cholecystitis

Prakash Sharma — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22986

A biloma is an encapsulated collection of bile located in the abdomen. It usually occurs spontaneously or can be secondary to traumatic injury (hepatobiliary surgery) and in rare condition it can occur as complication of cholecystitis and cholangiocarcinoma. The diagnosis can be suggested on the basis of patient’s medical history, clinical symptoms and imaging findings but final definitive diagnosis can only be made by aspiration of the content and biochemical analysis. We here report a case of 62 years male patient admitted with acute abdominal pain in the right hypochondrium caused by a spontaneous biloma. We discuss the role of the various diagnostic imaging techniques, particularly which of ultrasound and CT. The biloma was identified on computed tomography in this case.

Keywords: Abdominal pain, Bile, Tomography

Mesenteric Hydatid Cyst

Bikash Kumar Singh — 2019-05-30

DOI: https://doi.org/10.3126/njr.v8i2.22988

The aim of this article is to make radiologists and clinicians familial with the spectrum of cystic lesions in the abdomen. Mesenteric and omental cystic lesions are uncommon. One should be familiar with them as well as with other conditions that manifest as cysts. Initial step in diagnosing a cystic abdominal mass is to localize the organ of origin. Differential diagnosis includes enteric duplication cyst, enteric cyst, mesothelial cyst, non pancreatic pseudocyst, cystic mesothelioma, cystic teratoma, and urachal cyst. There is significant overlap in imaging features of abdominal cysts, which often require histological correlation to establish a final diagnosis. The main role of imaging is to document the nature of the abdominal mass and its origin.

Keywords: Mesentery, Omentum, Radiologists