SA Journal of Radiology <p>The <em>SA Journal of Radiology</em> is the official journal of the Radiological Society of South Africa and the Professional Association of Radiologists in South Africa and Namibia. The SA Journal of Radiology is a general diagnostic radiological journal which carries original research and review articles, pictorial essays, case reports, letters, editorials, radiological practice and other radiological articles.</p><p>Other websites related to this journal: <a href="" target="_blank"></a></p> en-US SA Journal of Radiology 1027-202X <p>The author(s) retain copyright on work published by AOSIS unless specified otherwise.</p><p><strong>Licensing and publishing rights</strong></p><p>Author(s) of work published by AOSIS are required to grant AOSIS the unlimited rights to publish the definitive work in any format, language and medium, for any lawful purpose. AOSIS requires journal authors to publish their work in open access under the <span style="text-decoration: underline;">Creative Commons Attribution 4.0 International</span> (CC BY 4.0) licence. </p><p>Read more here: <a href="" target="_blank"></a>.</p><p>The authors retain the non-exclusive right to do anything they wish with the published article(s), provided attribution is given to the applicable journal with details of the original publication, as set out in the official citation of the article published in the journal. The retained right specifically includes the right to post the article on the authors’ or their institution’s websites or in institutional repositories.</p><p>Previously published work may have been published under a different licence. We advise the community that if they would like to reuse the work to consult the applicable licence at article level.</p> Outcomes of prostate artery embolisation for benign prostatic hyperplasia in 10 cases at Steve Biko Academic Hospital <p><strong>Background:</strong> Benign prostate hyperplasia (BPH) remains a common cause of lower urinary tract symptoms (LUTS) in ageing men in South Africa and can impact significantly on the quality of life (QOL) of these patients. The Urology Department at Steve Biko Academic Hospital (SBAH) can generally only offer men with LUTS the following treatment options: watchful waiting, medical treatment and surgical management. In men with symptomatic BPH, who are refractory to medical treatment, where anaesthesia is contra-indicated because of co-morbidities or transurethral resection of the prostate (TURP) is contra-indicated because of the prostate size, the Urology and Radiology departments at SBAH recently introduced prostate artery embolisation (PAE).</p><p><strong>Aim:</strong> To assess the outcome of PAE in 10 men with LUTS, secondary to BPH, by comparing their urinary symptoms, QOL and prostate volume before and 3 months after they underwent PAE in the Radiology Department at SBAH.</p><p><strong>Method:</strong> The review included the first 10 men who had undergone therapeutic PAE for symptomatic BPH from May 2016 to September 2016. The subjective symptomatic feedback was assessed according to the International Prostate Symptom Score (IPSS) and the Global Quality of Life questionnaire, created by the American Urological Association (AUA). The reduction in the size of the prostate was measured on magnetic resonance imaging (MRI).</p><p><strong>Results:</strong> Embolisation was technically achieved in all 10 patients. Bilateral embolisation was performed on nine patients. One patient received unilateral embolisation secondary to unilateral tortuous and atherosclerotic changes of the iliac arteries. Within the 3-month followup, the mean IPSS score improved by 15.7 points (<em>p</em> &lt; 0.0039), the mean QOL improved by 4.1 points (<em>p</em> &lt; 0.0039) and the mean prostate volume reduction was 21.8 mL (<em>p</em> &lt; 0.0039). Despite improvements observed, there was one clinical failure. No major complications were reported that increased hospital stay, required hospital readmission or required surgery.</p><p><strong>Conclusion:</strong> The study on the first 10 PAE performed in SBAH concludes that PAE is a safe and effective procedure with favourable short-term follow-up results. This indicates that PAE can safely be offered to patients, who are refractory to medical treatment and not suitable candidates for surgery, in urology departments such as in SBAH.</p> Hatty G. Fischer Farhana E. Suleman Samia Ahmad Copyright (c) 2019-03-05 2019-03-05 23 1 Vanishing white matter disease imaged over 3 years <p>Childhood ataxia and central nervous system hypomyelination (CACH), also known as ‘vanishing white matter disease’ (VWM), is a leukoencephalopathy with autosomal recessive inheritance. It is characterised by normal psychomotor development initially, with an onset of neurological deterioration that follows a chronic and progressive course. Stress conditions such as febrile infections, minor head trauma or even acute fright provoke major episodes of neurological deterioration. We present a case of a 2-year-old child who presented with spasticity and cerebellar ataxia. After magnetic resonance imaging (MRI) of the brain, CACH/ VWM was diagnosed on the basis of the typical clinical and MRI findings. As there is no known cure for CACH/VWM, our patient was followed up over 3 years with MRIs of the brain to assess the progressive involvement of the cerebral white matter. In those patients with suggestive or inconclusive MRI findings for CACH/VWM, particularly in the presymptomatic stage and adult onset variants, involvement of the inner rim of the corpus callosum should prompt the inclusion of CACH/VWM in the differential diagnosis. Biochemical markers such as the asialotransferrin: transferrin ratio in the cerebrospinal fluid can also potentially be used as a screening tool in this subset of patients prior to gene mutation analysis.</p> Denny Mathew Nasreen Mahomed Copyright (c) 2019-03-05 2019-03-05 23 1 Embryonal rhabdomyosarcoma of the biliary tree in a paediatric patient – A rare cause of obstructive jaundice <p>Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in the paediatric age group, ranking fourth in frequency after central nervous system tumours, neuroblastomas and nephroblastomas. Embryonal RMS of the biliary tree is considered a rare entity, with the most common clinical presentation being that of obstructive jaundice. We present the case of a 4-year-old boy who presented with hepatomegaly and obstructive jaundice. Biochemically, there was evidence of elevated ductal enzymes with conjugated hyperbilirubinaemia. The magnetic resonance imaging (MRI) features were consistent with a biliary RMS with the differential diagnosis of a choledochal cyst initially included based on the computed tomography images. The diagnosis of embryonal biliary RMS was later confirmed on histology. This case illustrates the importance of considering malignant aetiologies in paediatric cases of obstructive jaundice, as this entity is infrequently described in the literature and may mimic the appearance of a choledochal cyst. The demonstration of enhancement of intraductal material within the biliary tree on MRI and the presence of arterial waveforms within the intraductal mass on ultrasound assists in the differentiation between biliary RMS and a choledochal cyst.</p> Denny Mathew Heliodora de Lima Nasreen Mahomed Copyright (c) 2019-03-05 2019-03-05 23 1 Solid to cystic: A case report of imaging findings of atypical lung metastases <p>The imaging spectrum of pulmonary metastases varies greatly, with solid and partly cavitating nodules being the most common. When imaging the oncology patient, specifically follow-up imaging post-treatment, the radiological aim is to assess for disease regression and thus treatment response, usually with resolution of these nodules. We report an interesting case series of a patient with primary endometrial carcinoma presenting with pulmonary metastases. This imaging series eloquently depicts the temporal evolution of the metastatic solid pulmonary nodules to cavitating nodules and finally to thin-walled cysts. Baseline imaging in this scenario is vital to exclude pre-existing cystic lung disease. The progression of solid pulmonary metastases to simple cysts is an uncommon therapy-related consequence, but an important entity to recognise, not only as an indicator of good treatment response, but also to evaluate for potential life-threatening complications such as spontaneous pneumothoraces.</p> Tanusha Sewchuran Copyright (c) 2019-03-05 2019-03-05 23 1 Cost analysis of violence-related medical imaging in a Free State tertiary trauma unit <p><strong>Background:</strong> Violence is a leading public health problem worldwide. Beyond the pain and suffering, violence has a significant economic impact on a country’s health, policing and judicial services. Because of the lack of current and comprehensive data in South Africa, local violence-related economic impact studies are largely estimations. Violence-related imaging expenditure, as a component of a public hospital’s expenditure, is yet to be determined.</p><p><strong>Objectives:</strong> The goals of this study were to measure the violence-related patient burden on Pelonomi Tertiary Hospital’s (PTH) trauma and radiology services, determine the imagingcomponent cost of violence-related injuries and calculate the financial burden violence has on the hospital’s expenditures.</p><p><strong>Method:</strong> From the PTH’s trauma unit patient registry, 1380 patients with violence-related injuries were consecutively sampled for 6 months ending 31 December 2017. Imaging investigations were documented and categorised according to the South African National Department of Health’s 2017 Uniform Patient Fee Schedule (UPFS). Descriptive analysis and cost calculations were performed using the 2017 UPFS tariff schedule and hospital-specific health efficiency indicators – patient-day equivalent and expenditure per patient-day equivalent.</p><p><strong>Results:</strong> Violence-related injuries accounted for 50.64% of all trauma department visits and received a total of 5475 imaging investigations. Violence-related imaging investigations represented 14.81% of all investigations performed by the radiology department in the study period. Overall violence-related admission costs amounted to R35 410 241.85 (8.33% of the hospital’s total expenditure), of which 20.08% (R7 108 845.00) was attributed to imaging investigations.</p><p><strong>Conclusion:</strong> Violence-related admissions had a high patient and financial burden on PTH. The pinnacle of healthcare cost saving is violence prevention; however, the cost-conscious radiologist could assist with cost saving if responsible and ethical imaging practices are followed.</p> Tiaan P. Steyn Fekade A. Gebremariam Copyright (c) 2019-03-05 2019-03-05 23 1