Correlation of sonographic inferior vena cava and aorta diameter ratio with dehydration in Nigerian children

Background

Accurate assessment of the degree of dehydration is essential in the management and fluid therapy of dehydrated children. The invasiveness of central venous pressure limits its routine clinical use. Fortunately, some studies have suggested that ultrasonographic measurement of inferior vena cava (IVC) diameter: aorta diameter ratio (IADR) is an objective method of assessing intravascular volume.

Objectives

To determine the clinical usefulness of ultrasound measurement of IADR in assessment of children with dehydration.

Methodology

This was a cross-sectional study which compared dehydrated children to age- and sex-matched euvolemic healthy children as controls. The maximum anteroposterior diameter of the abdominal aorta (at peak systole) and maximum IVC diameter (in expiration) were measured.

Results

A total of 120 subjects and 120 controls were evaluated. The mean age was 21.73 ± 20.89 months for subjects and 21.19 ± 22.13 months for control. The mean IADR for children with mild, moderate, and severe dehydration was 0.75 ± 0.07, 0.55 ± 0.07, and 0.33 ± 0.05, respectively. The mean IADR for controls was 0.99 ± 0.06. IADR had an inverse relationship with the degree of dehydration in the subjects. A cut-off point of 0.86, with a sensitivity and specificity of 96.7% in predicting dehydration, was derived, with the sensitivity and specificity increasing with increasing level of dehydration.

Conclusion

IADR is sensitive and specific for assessing moderate and severe dehydration in Nigerian children.

Analysis of Presentations and Outcomes of Care of Children with Disorders of Sexual Development in a Nigerian Hospital

STUDY OBJECTIVE

To describe the presentation, diagnosis, management, and short-term outcome of children with disorders of sexual development (DSD) in the context of multidisciplinary team care.

DESIGN

Prospective descriptive study.

SETTING

University Teaching Hospital.

PARTICIPANTS

All children who presented with genital ambiguity.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Records of all patients diagnosed and managed for DSD between January 2011 and December 2016 were reviewed. The care pathway included clinical, laboratory, internal genitalia evaluation, and panel (including parents) meeting.

RESULTS

Fifteen children presented with DSD at a median age of 20 months. Only 5/15 (33.3%) presented in the neonatal period. Ten of fifteen patients (66.7%) presented with genital ambiguity. Ovotesticular DSD was the most common diagnosis (9/15; 60%). Seven of the patients were genetically female (46, XX), 1 was genetically male (46, XY) and 1 without genetic diagnosis. Six patients were assigned male gender and they underwent male genitoplasty. Five of them had excision of Müllerian structures with gonadectomy. Three of fifteen patients (20%) were diagnosed as 46, XX DSD, at a median age of 7 years. All of them were due to congenital adrenal hyperplasia and underwent female genitoplasty. Two patients were diagnosed as XY, DSD. They were both raised as female at presentation and were reassigned male sex. Both had urethroplasty done. Four patients had postoperative urethrocutaneous fistula and 1 had partial wound dehiscence. The median follow-up period was 21 months (interquartile range, 2-26 months).

CONCLUSION

The frequency of ovotesticular DSD is high in our setting. The decision of sex assignment was finally made at a median age of 7.5 months in most of our patients with satisfactory short-term surgical outcome.

Neck trauma: a red-herring to diagnosis of chemodectoma

Chemodectoma, a neuroendocrine tumour of the paraganglionic cells in the carotid body remains an uncommon tumour. We report the first case from University of Ilorin Teaching Hospital, Ilorin, Nigeria. Though with a red herring history of trauma induced swelling, clinical and radiologic features were characteristic of chemodectoma. Histologic features of the excised lesion are presented.

Posterior reversible encephalopathy syndrome in a adult female

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic diagnosis, with rapidly evolving neurologic condition, characterized by headache, confusion, altered mental status, seizures, cortical blindness, lethargy, stupor, and occasionally, focal neurological signs accompanied by a typical computed tomography or magnetic resonance imaging pattern. With early recognition and treatment, complete resolution of symptoms occurs. Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Atypical imaging finding of contrast enhancement of lesion can occur, but is less common. A 20-year-old primiparous lady presented with posterior reversible encephalopathy syndrome. To the best of our knowledge, this is the first documented case in Nigeria. This case-report highlights the importance of recognizing the salient imaging features in this lethal but reversible entity with prompt management.

Traumatic diaphragmatic hernia masquerading as left-sided hydropneumothorax: a case report

Traumatic diaphragmatic rupture (TDR) is rare in children and can be easily overlooked because of lack of awareness of late presentation and concomitant injuries. A 4-year-old girl presented with respiratory distress 2 months after a road traffic accident. The initial differential diagnosis was pneumonia or pulmonary tuberculosis with associated pleural effusion. On further assessment, a diaphragmatic hernia was suspected. The initial radiograph showed left hydropneumothorax. Fluoroscopy, follow-up chest radiographs and barium swallow confirmed the diagnosis of left TDR. Surgery was undertaken but unfortunately she did not survive. Awareness of delayed presentation of TDR is essential for prompt management.

The diagnostic value of the triple bubble sign in proximal jejunal atresia: a case report

Proximal jejunal atresia (PJA) is a common cause of intestinal obstruction in the newborn. Despite the need for an early surgical intervention to minimize morbidity and mortality, a timely identification is frequently precluded by the absence of specific clinical and investigative clues. Against the background of the limitations in making a timely diagnosis of PJA in a tropical setting, where opportunities for high-tech imaging tools are few, we report the diagnostic value of the "triple bubble" sign on the plain radiograph of a Nigerian infant. This radiologic finding led to an early diagnosis and ultimately a prompt surgical extirpation. The paper suggests that the presence of this sign should be a pointer to an early diagnosis of PJA.