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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.

Cette étude a pour objectif d’analyser la justification des examens tomodensitométriques (TDM) thoraciques et/ou abdomino-pelviens réalisés au Togo. Il s’agissait d’une étude prospective descriptive portant sur 353 TDM thoraciques et/ou abdomino-pelviennes réalisées du 1er septembre au 30 novembre 2018. L’analyse de la justification était notamment faite sur la formulation de l’indication clinique, la cohérence de l’indication clinique avec la TDM demandée et la conformité de l’indication clinique avec le Guide du bon usage (GBU) des examens d’imagerie médicale des Sociétés françaises de radiologie (SFR) et de médecine nucléaire (SFMN). Les TDM abdomino-pelviennes, thoraciques et thoraco-abdomino-pelviennes représentaient respectivement 64,87 %, 18,7 % et 16,4 % de l’échantillon. L’âge moyen des patients était de 52,4 ans avec des extrêmes de 6 et 92 ans. Les demandeurs étaient des médecins spécialistes dans 51,8 % des cas et des paramédicaux dans 1 % des cas. Et 63,46 % des TDM étaient précédées par un examen non ou moins irradiant et 0,85 % étaient réalisées sans indication clinique. La formulation de l’indication clinique était bonne dans 66,01 %, acceptable dans 32,58 %, et mauvaise dans 0,57 %. Ces indications étaient incohérentes avec la TDM demandée dans 3,4 % des cas, et non conformes au GBU dans 17,28 % des cas. Plus la formulation de l’indication clinique était bonne, cohérente avec la TDM demandée et conforme au GBU, plus les résultats étaient pathologiques. Au total, 18,7 % des TDM étaient jugéesa priorinon justifiées. En définitive, un nombre significatif de TDM réalisées au Togo n’étaient pas justifiées d’où la nécessité d’organisation régulière de formations continues en radioprotection des patients notamment pour les demandeurs.

Background: This study aimed to describe the results of mammography done during breast cancer awareness campaigns in Lome. Methods: This was a retrospective multicenter study which focused on the analysis of mammographic examinations, with or without breast ultrasound, carried out in three (3) clinics in Lome over a period of five (5) years during the breast cancer awareness month (Pink October) campaigns. We included in our study women of all ages who underwent a mammography during the study period. Additional ultrasound was performed as needed in some women to better characterize a lesion. The parameters studied were socio-demographic data, and aspects of breast lesions. We classified the lesions in order of severity according to the BI-RADS classification. Results: During the study we counted one thousand and seventy-four (1074) women who underwent mammography examinations, corresponding to an average of 214.8 women per year. The median age of the women was 46 years. The most represented age group was 40 - 49, constituting 30% of cases. Mammography was performed on all women and ultrasound was performed on 51.3% of women. Lesions suspicious for malignancy (BI-RADS IV) and lesions highly suggestive of malignancy (BI-RADS V) represented 3.5% and 1.9% of cases respectively, amounting to a prevalence of 5.4%. They occurred more frequently from the age of 30 years with a statistically significant difference (p = 0.02). These lesions could be identified on mammograms as masses with irregular shapes and spiculated margins representing 16.1% and 9.7% of masses respectively. On ultrasound, these were solid masses with irregular and ill-defined borders, representing 25.2% and 5.2% of solid masses respectively. Lesions suspicious for malignancy were most often found in the UOQ (upper outer quadrant) in 70% of cases. Conclusion: Mammography screening for breast cancer remains a necessity in our community, even if the rate of cancer detected remains low. It allows for early diagnosis of cancers, promoting better management.

Background: This study aimed to determine the level of continuing medical education (CME) of medical imaging technicians in French-speaking West Africa. Materials and methods: This opinion survey was administered to radiology technicians in French-speaking West Africa from 1st June to 31st October 2020, i.e. over a period of 5 months concerning their level of CME and their need for CME. Results: Out of 100 technicians, 69% were men. The mean age was 40 years, with extremes ranging from age 23 to age 57. The majority of technicians (64%) worked in the public sector and 78% had work experience of less than 11 years. Most technicians were holders of a Bachelor’s degree (73%). The types of CMEs they knew were congresses, seminars, and modular training in 46% of the cases. The most available CMEs were seminars (63%). All technicians agreed on the need for CME and 96% said it had an impact on the delivery of radiology services. Technicians who had received CME at least once represented 61%. For 90% of technicians, the specific CME sought was management in radiology (33.33%) and radiation protection (25.81%). Conclusion: The need for CME is increasingly indisputable to radiology technicians in French-speaking West Africa; however, it remains a luxury for them, due to its scarcity and its high cost.

Background: “Gossypiboma” or “textiloma” refers to accidental retention of textile material in an operated area of the body. Abdominal surgery is most often responsible for this complication. The purpose of our study was to describe the appearance of abdominal gossypibomas on computed tomography (CT) scan images. Materials and Methods: We conducted a retrospective study over ten years (from January 1, 2009 to December 31, 2018) at the Teaching University Hospital of Lome. We collected all surgically confirmed cases of abdominal gossypibomas with abdominal CT scans. Results: Fifteen cases were compiled, with a sex-ratio of 0.36. The average age of the patients was 34 years. The initial surgery was emergent in nine of 15 cases, 11 of which consisted of gynecological interventions. The gossypiboma symptom incubation period was between 3 days and 3 years. A radiopaque marker was observed via CT scans in three of 15 cases. The gossypiboma appeared encapsulated and spongiform in six cases and cystic in seven cases. There were two cases where the gossypiboma migrated into hollow organs. Conclusion: Abdominal gossypibomas appear polymorphic on CT scans and should be considered in patients who present with an abdominal mass and a history of abdominal surgery, even for absent radiopaque markers.

Objective(s): 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.

La panniculite mesenterique est une maladie rare et benigne caracterisee par un processus inflammatoire et fibrotique chronique qui affecte le tissu adipeux mesenterique. Elle atteint souvent le sujet adulte de sexe masculin. Son etiologie reste inconnue. L´aspect tomodensitometrique de la PM varie selon l´importance de l´inflammation et de la fibrose. Nous rapportons deux cas de panniculite mesenterique reveles par une douleur abdominale. Le diagnostic a ete pose sur la base des donnees de la tomodensitometrie. Nous rappelons a travers ces cas, les aspects cliniques et tomodensitometriques de cette affection rare.

Background: Radiology in elderly as pediatric radiology poses a number of problems. The normal radiological appearance of the elderly patient’s chest is very varied and the changes are ubiquitous. Purpose: To describe the computed tomography profile of the elderly subject’s chest. Materials and Methods: Descriptive prospective study from January 1st to June 30th, 2018 carried out at the University Campus Hospital of Lome. Results: We recorded 64 chest CT scans. The average age of the patients was 71.3. Internists (n = 21, 32.8%) and general practitioner (n = 16, 25%) were the major applicants for these tests. In most cases, thoracic CT examinations were requested as part of an extension assessment (n = 21, 32.8%), dyspnea and pneumonitis in 18.8% of cases each. All thoracic CT examinations were performed with contrast injection. CT with the TAP protocol was the most observed, accounted for more than half of the exams (56%). The main pathological lesions observed were diffuse parenchymal lesions (39.5%), pleurisy (11.1%) and PAH (11.1%). Conclusion: Computed tomography occupies an important place in the care of the elderly but the actors involved in their care must be trained to take optimal care.

The aim of this work is to evaluate the role of Ultrasound-Doppler in the hemodynamic study of hepatic vessels during the liver cirrhosis in Togo. Method: This was an analytic cross-sectional study that measured the velocimetric parameters of hepatic vessels in cirrhotic patients and in non-cirrhotic patients. Results: The velocimetric parameters of the hepatic artery, the portal vein, and the hepatic veins were measured in 50 cirrhotic patients and 50 non-cirrhotic The caliber of the portal vein was significantly increased in cirrhotic patients compared to non-cirrhotic patients with 13.11 ± 2.16 mm versus 11.45 ± 1.02 (p < 0.00006). The systolic velocity and the hepatic artery resistance index were significantly raised in the cirrhotic patients compared to the non-cirrhotic with 67.32 ± 22.77 versus 49.97 ± 17.24 (p-value < 0.00004) respectively, and 0.78 ± 0.07 against 0.72 ± 0.08 (p < 0.00006). The caliber of the hepatic veins was significantly decreased in the cirrhotic patients compared to the non-cirrhotic patients (p < 0.0003). There was no correlation between the gender of the patients and the change in the hemodynamics of the hepatic vessels. Conclusion: The hemodynamic study of the hepatic vessels can and must rightly be a diagnostic argument for liver cirrhosis.

We evaluate the level of knowledge of clinician doctors asking for echographies on the biological effects of ultrasounds and their attitudes towards ultrasounds examinations performed in Lome. Transverse study based on a survey led from August 16th till November 30th, 2013 including 105 doctors applicant of ultrasound in Lome (Togo). The middle age of the applicant doctors was of 34 years with a sex-ratio of 4/1 and more than half practiced in public facilities. Approximately ten percent applicants thought that the ultrasound is an irradiant exam and those practicing for less than 5 years were the ones who had a good level of knowledge on the not irradiant character of the ultrasounds. The existence of the thermal and mechanical effects of the ultrasounds was known only by 4.8% of the applicants and only 1.9% of the doctors had information on the thermal index (TI) and the mechanical index (MI). More than half (66.7%) analyzed the ultrasound images joined to the report but none verified the conformity with the standards of the values of the TI and at MI shown on the images. They were 43.5% to read only the conclusion. The level of knowledge of the doctors on the biological effects of the ultrasounds is unsatisfactory. The ultrasounds although not irradiant, have biological effects imposing precautionary measures which have to guide the attitude of the applicants towards the ultrasonographic explorations.

Background: Ultrasound has become the most widely practiced medical imaging examination even in developing countries because of its non-irradiating, non-invasive nature and its relatively affordable cost. Objective: The objective of this study was to review the practice of medical ultrasound in Lome city. We carried out a descriptive cross-sectional study using the pre-established fact sheets. It took place from 16 August to 30 November 2013 in the healthcare facilities of the city of Lome. Results: A total of 47 centers were surveyed, including 14 public centers and 33 private centers. The ultrasound scanners were mostly acquired in the new state (59.6%) with only 34.1% of these ultrasound scanners equipped with the Doppler mode. There were 3 ultrasound scanners (6.4%) that had a 3D probe. Radiologists were the ones who carried out most of the ultrasound examinations in public centers, while in private they accounted for half of the performers (45.5%). Physicians enrolled in a specialty in radiology played a significant role in these private structures, accounting for 24.2% of performers. Cardiac ultrasound was performed only in 2 centers (4.2%). The ultrasound report was available in all public centers using the pre-established and standardized forms. The qualification of sonographers and the status of ultrasound scanners are relatively acceptable. Conclusion: Ultrasound scanners were mostly acquired in new condition. Radiologists remained the ones who carried out the largest number of ultrasound examination in Lome.

We report the case of a 50-year-old patient, who was explored in mammography, ultrasound and CT for a large painful mass of the right breast that had been evolving for 30 years and gradually increasing in size. There was a typical “sausage slice” appearance with clear center macrocalcifications on the mammogram; an aspect of “breast in the breast” on ultrasound. The scanner had made it possible to specify the dimensions of the mass, which measured 21.4 cm in height; 18.6 cm wide and 9.5 cm thick. Histology after exeresis noted the adenolipofibromatous nature of the mass.

Background: In dental-maxillofacial imaging, 3D sectional imaging progressively replaces conventional 2D imaging in developed countries. They are based specially on Computed tomography (CT-Scan), with the Dentascan application and cone beam computed tomography (CBCT). In developing countries those technics are newly introduced. Aim: This study aimed at studying the knowledge and practices of dentist and oral and maxillofacial surgeons on sectional imaging such as Dentascan and Cone Beam Computed Tomography (CBCT). Materials and Methods: We conducted an anonymous survey among dentists and oral maxillofacial surgeons in Togo over one month. Results: The response rate was 78.79% (27/33). They were mainly male sex (sex ratio of 2.25 men for one woman). They were aged between 27 and 71 years old with an average of 49.69 years old. The majority (61.54%) had a professional experience over 20 years. The majority of respondents (65.38%) believed their level of knowledge about dental x-Ray was poor. Half of them (50%) confirmed that they had never asked for a Dentascan, and 15.38% asked from time to time for it and only two (7.69%) asked often for this test. 96.15% confirm they have no knowledge of the Dentascan. Regarding the CBCT, 84.62% didn’t ask for it because this technique did not exist in Togo before. 69.20% of respondents confessed to be interested in continuing training on sectional imaging. Conclusion: This study shows that sectional imaging is very little used by oral and dental practitioners in Togo because of the ignorance of the new techniques and the absence of the CBCT. It is therefore necessary to promote the teaching of the new technique of sectional imaging in the training syllabus of oral and dental specialists and to initiate continuing medical training.

Background: Core needle biopsy (CNB) under ultrasound guidance is an accepted standard of care for the diagnosis of breast lesions. It is safe, cost-effective and minimally invasive compared with surgical excision. Objective: The aim of this study was to evaluate the CNB’s results regarding the procedure, complications, histopathological findings and their correlation with the imaging data and surgical histopathological findings. Method: A cross-sectional prospective and descriptive study of a consecutive series of ultrasound-guided CNB of breast lesions in women conduced from January 2015 to December 2016 at the Sylvanus Olympio university hospital of Lome, in Togo. Results: There were 72 CNB performed under ultrasound guidance in women; from which 54 were retained for the study. The mean age was 44.9 years ± 9.8. 11.1% had a family history of breast cancer. Lesions were most often palpable (90.7%). They were located in the left breast in 54.7%. Lesions were categorized probably malignant or malignant (Birads 4 and 5) in 70.4% and probably benign (Birads 3) in 29.6%. Their mean size was 24.8 mm ± 7.6 at ultrasound. There were no major complications during the procedure. One CNB (1.9%) considered inconclusive was repeated. Histologically, invasive ductal carcinoma (61.1%) was the most common lesion. Fifty-three women underwent surgical procedure and histopathological confirmation. Ultrasound-guided CNB had a sensitivity of 97.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 92.8%, and an overall diagnostic accuracy of 98.1%. Breast Imaging Reporting and Data System (Birads) categorization had a sensitivity of 94.8%, specificity of 100%, positive predictive value of 100%, negative predictive value of 87.4%, and diagnostic accuracy of 96.2%. Conclusion: Ultrasound guided CNB represent accurate methods for the characterization of breast lesions, with high values of diagnostic accuracy, sensitivity, specificity and negative predictive value. It does not involve a major complication, even in tropical environments.

Studies on the canal dimensions of the cervical spinal are rare in Africa. The aim of this study is to provide normal values of the cervical spinal canal and spinal cord dimensions of adult people in Togo. It was about a twelve-year prospective study conducted in the main Hospitals of Campus Teaching Hospital. This study involved people of more than 18 years who neither presented any clinical sign nor rachis defect. The distances measured were antero-posterior 1 (APD1) and inter-pedicular (IPD) of the cervical spinal canal, the antero-posterior 2 (APD2) and the transverse (TD) diameters of the cervical spinal cord, followed with APD2/APD1 (R1) and TD/IPD (R2) research reports. The mean age was 38 +/- 9.34 years old. The average of APD1 of the cervical spinal canal stood at 15.41 ± 0.55 mm, with a minimum of 10.48 ± 0.57 mm and a maximum of 25.00 ± 2.60 mm. The IPD average stood at 23.27 ± 1.67 mm with a minimal average of 13.68 ± 1.46 mm and a maximal average of 33.68 ± 1.46 mm. The average of DAP2 was 11.66 ± 0.66 mm, with a minimum of 10.7 ± 0.66 mm and a maximum of 12.77 ± 0.66 mm. The DT average stood at 15.55 ± 1.54 mm, with a minimal average of 14.03 ± 2.43 mm and a maximal average of 17.63 ± 1.82 mm. The ratio R1 (APD2/APD1) average was 0.80 ± 0.04, with a minimum of 0.76 ± 0.06 and a maximum of 0.85 ± 0.07. The ratio R2 (TD/IPD) average stood at 0.69 ± 0.14, with a minimum of 0.5 ± 0.12 and a maximum of 0.84 ± 0.08. The cervical spinal canal and the cervical spinal cord diameters in Togo are not significantly different from those described above.

Studies of male breast cancer are rare in Africa. In Togo in particular, no work has focused on the epidemiological, mammo-echographic, pathological, therapeutic or prognostic aspects of male breast cancer. The aim of this study is to report cases of male breast cancer in Togo by describing the main epidemiological, mammo-echographic and pathological aspects. This was a retrospective, descriptive and analytical study of 10 cases of male patients presenting with breast cancer confirmed by the pathologic examination on the echo-guided samples over a period of 6 years in University Teaching Hospital in Lome. A total of ten patients were retained. The mean age of patients was 55 years with extremes of 39 years and 65 years. All patients had a palpable breast mass. The lesions were classified in 60% American College of Radiology (ACR) 5 and 40% ACR 4. The axillary lymph node invasion rate was 40%. Infiltrating ductal carcinoma was the histologic type diagnosed in all patients. Any breast mass in an elderly male subject is suspected with high predictive value. Mammography ultrasound plays an important role in the diagnosis alongside pathology.

Objective: Determine the frequency of the sinonasal mechanical anatomic variants by CT Scan. Patients and method: Six-month retrospective study concerning sinus CT scans in the registers of Teaching Hospitals’ Imaging Services of Lome and Kara (TOGO). It involves patients without distinction of sex, of over 15 years without anomaly that can lead to a modification of the normal anatomical configuration of the paranasal sinuses’ cavities. The analysis has been made by only one radiologist. Results: The frequency of mechanical sinonasal anatomic variants stood at 91.87%. The narrowing of the middle nasal turbinate was the variant mostly observed (55.03%), dominated by the deviation of the nasal septum whose frequency was 25.48%. The narrowing of the infundibulum represented 10.80% of population. They were more represented by the Haller cell which displayed a frequency of 3.60%. The variants venturing to narrow the upper nasal turbinate, represented only by extra turbinates, involved 1.02% of the population. The other variants of mechanical sinonasal anatomic variants represented 25.02%. They were dominated by the maxillary sinus septa (11.2%). Our study showed a feminine predominance which is statistically important for Haller cells (p = 0.037) and the ethmoidbulla hypertrophy (p = 0.0036). Conclusion: The anatomic variants of mechanical sinonasal are very frequent in Togo.

Background Gossypiboma or textiloma is an accidental retention of a textile in the operated area of the body. Abdominal surgery is the most responsible for these complication. The purpose of our study was to describe aspects observed in abdominal gossypibomas on CT-scan. Methods A retrospective study was conducted over 10 years (from January 1st, 2009 to December 31st, 2018) at the Teaching University Hospital of Lomé, including all the surgically confirmed cases of the abdominal gossypibomas who had abdominal CT-scan. Results Fifteen cases have been compiled, with a sex-ratio of 0.36. The average age of the patients was 34 years old. The initial surgery was an emergency intervention in 9/15 cases. It was a gynecological intervention in 11/15 cases. The incubation period of the symptoms related to textiloma was between 3 days and 3 years. On the CT-scan, a radiopaque marker was observed in 3/15 cases. An encapsulated and spongiform aspect in 6/15 cases. A cystic form was observed in 7/15 cases. We have noticed two cases of migration of the textiloma into a hollow organs.

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.

Background: In French-speaking sub-Saharan Africa, thanatological imaging is not integrated into the training of radiology technicians. Thus, this raises a question about the knowledge level of radiology

Background: Tuberculosis primarily affects lungs, but all organs may be affected. Extra-pulmonary forms of tuberculosis cause a big public health problem as it is diagnosed late. This delay in diagnosis is not only due to the delay in the examination, but also due to difficulties related to extra-pulmonary tuberculosis diagnostic. Aim: To describe the different locations of extra-pulmonary Tuberculosis and its aspects in Togo. Patients and Methods: A retrospective analysis of all extra-pulmonary tuberculosis cases diagnosed by imaging over five years (January 2010 to December 2015) was done. All the cases were confirmed either by direct examination of biological fluids or by histological analysis of biopsy and surgical samples or by culture on specific area. Data were collected from the Department of Radiology, from Microbiology Laboratory of the Pneumo-phthisiology unit and from Pathology Laboratory of Sylvanus Olympio Teaching Hospital of Lome. Results: A total of 83 cases of extra-pulmonary Tuberculosis had been taken into account: 45 men and 38 women, with a maximum number of cases (66.3%) in the age group between 20 to 40 years old. An HIV infection was known in 51 patients (61.4%). Pulmonary damage was associated in 21 patients (25.3%). A total of 116 extra-pulmonary tuberculosis locations were recorded. Damages were pleural in 37.1% (43), ganglion in 24.1% (28), osteo-articular in 15.5% (18), abdominal in 12.9% (15), military represented 8.6% (10), a case of testicular damage, and a case of mammary tuberculosis. Conclusion: The medical scanning based on conventional radiography, ultrasonography and TDM is indispensable for the diagnosis and the care taking of extra-pulmonary tuberculosis since some locations may be confused with many other diseases and lead to misdiagnosis errors and delay the treatment.

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.

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.

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 Lome 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.

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.

Key Clinical Message 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.

Introduction: Severe strokes have poor prognosis by their heavy motor and cognitive consequences. Objective: To describe the epidemiological, clinical and therapeutic aspects of these strokes. Material and Method: A retrospective and analytical study was conducted from January 2015 to December 2016 in the neurology department of our University Hospital. The diagnosis of severe stroke was based on clinical criteria (NIHSS score greater than 17, Glasgow score less than 9, and a WFNS stage greater than or equal to IV); and CT scan criteria (stroke location in the posterior fossa, carotid and Sylvian malignant infarction, cerebral hemorrhage with ventricular flood and mass effect). Results: We recorded 1964 strokes and 163 patients had severe stroke with a frequency of 8.3%. Of the 163 severe strokes, ischemic were observed in 38.7% and hemorrhagic for 61.3%. The average age was 55.8 ± 12.8. The motor deficit (76.1%) and disturbances of consciousness (62.6%) were the most admission signs. High blood pressure was the main risk factor (64.8%) and the etiology of hemorrhage in 83.5%. Atherosclerosis was the main etiology (86.4%) of ischemia. The hemorrhagic lesions location was diencephalic (67.7%) and brainstem (21.7%). Overall mortality was 44.8%, including 72.6% of early mortality due to haemorrhage. Predictive factors of mortality were the high NIHSS score, low Glasgow score, presence of ventricular flood, and high volume of hematoma. Conclusion: The high incidence of severe stroke and its early mortality rate demonstrate that many challenges remain to be done to improve the management of patients and avoid disabling sequelae.

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.

Purpose: To list pediatric ultrasound exams performed at Kara University Hospital Center in Togo and the pathologies observed. Materials and methods: This was a retrospective and descriptive study of the results of pediatric ultrasound examinations performed in the Department of Radiology and Imaging of Kara University Hospital Center. The study ran from January 1, 2013 to December 31, 2016, over a period of 3 years. Results: The frequency of pediatric ultrasounds was 5.1%. The average age of the patients was 2.16 years with extremes of 1 day to 15 years. There was a male predominance with a sex ratio of 1.4. Abdomino-pelvic ultrasound were the most represented, 92%, followed by cervical ultrasound in 2.6% of cases. Abdominal ultrasound indications were dominated by abdominal pain in 33.6% of cases, followed by palpation of abdominal mass in 15.7%. Cervical ultrasounds were motivated in 5 out of 8 cases by the cervical swelling. Abdomino-pelvic ultrasonography was pathological in 70.1% of cases. Hepatic affections were the most common abdominal abnormality in 37.8% of cases followed by splenic disorders. Hepatic lesions were dominated by European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431 444 homogeneous hepatomegaly with 63.2% of cases. Cervical ultrasound was pathological in 6 out of 8 cases. The lesions observed were mainly cervical lymphadenopathy (4 cases out of 6). Conclusion: Ultrasound is a very useful tool in the exploration of pediatric diseases. The abdominal ultrasound is the most performed and hepatic pathologies are the most common.

Objective: to make an inventory and assess the training in radiology in Togo. Methodology: Descriptive study, with opinion survey, carried out from June to August 2016 including students in Master and Residents in radiology of the academic year 2015 - 2016. Results: The response rate was 91%. All the training sites had conventional radiography and functional ultrasound. For 57% of students the quality of practical instruction was 4/5. The availability of teachers was acceptable (3/5) to good (4/5) according to 84%. Competence for examinations varies from bad (2/5) to excellent (5/5) for the Master 1 and from good to excellent in Master 2. The difference in responses was not significant regardless of the year of study or training course (p> 0.05). For the performance and interpretation of radiological examinations, the junior residents were considered mediocre (1/5) to acceptable versus acceptable to seniors. For an ultrasound, this score varied from 1/5 for the juniors residents to 4/5 for the seniors. The competence to carry out a vessels ultrasound Doppler was 1/5 for the junior residents and 2/5 for the senior. Conclusion: Learners in radiology in Togo are generally satisfied with the training they receive. Acquisitions of significant skills have been observed from one level of training to another.

Purpose: To analyze the waste factors of rejected X-rays films. Methodology: Descriptive and analytical prospective study from 1 January to 30 June 2017 carried out in the department of radiology and medical imaging of the Campus University Hospital of Lomé in Togo. Results: 4912 patients had received 5630 radiographic incidences, including 3288 (58.4%) on the analogy and 2342 (41.5%) on the digital. The reject rate was 12.5%. The vast majority of the X-rays films, 682 (96.9%) were rejected by the radiographers themselves just after development. The resumption frequency ranged from one repeat (550 X-rays films, or 78%) to 4 repeats (8 X-rays films, or 1%). Almost all of the rejected films, 702 (99.7%) came from the analogical room. Chest X-ray was the incidence with more rejection in 33.9% followed by pelvic and lower limb incidences in 21% of cases. More than 2/3 of the rejected films, 473 (67.2%), came from the students' act. The causes of the rejection were mainly centering (25.5%), underexposure (20.17%) and overexposure (12.93). The financial loss caused by the scrap of X-rays films amounted to about 418800F CFA or 638.5 €. Conclusion: Strengthening communication between radiographers and radiologists is necessary to avoid unnecessary repeats of patient’s radiographs.

Le but de notre étude était de déterminer la fréquence des fractures de membres liées à l'exercice de la fonction militaire au sein des Forces de Défense et de Sécurité en milieu africain en vue de ressortir l'impact des différentes circonstances de survenue. Nous avons entrepris une étude rétrospective descriptive allant du 1er janvier 2004 au 31 décembre 2013. Elle a concerné les agents des forces de défense et de sécurité traités pour des fractures de membres au cours de notre période d'étude. Sept cent quatre (704) cas de fractures de membres ont été dénombrées. La moyenne d'âge des patients était de 30,57 ans avec des extrêmes de 19 et 55 ans et une nette prédominance masculine (95,71%). L'Armée de Terre (51,05%) et la Gendarmerie Nationale (38,86%) étaient les plus représentées. Les hommes du rang étaient majoritaires (43,08%), suivis des sous-officiers (32,59%). La fréquence annuelle des fractures de membres en rapport avec la profession militaire était de 63 cas. Les fractures de jambe étaient les lésions les plus recensées (32,96 %). Les Formations et les stages militaires ont été les circonstances de survenue les plus rencontrées (42,60 %), suivies des accidents de la circulation (39,43%). La perte des journées de service liée à ces lésions était estimée à 14009 jours par an. Les fractures de jambes occupent le premier rang des fractures de membres en rapport avec l'exercice de la profession militaire. Les formations-stages militaires et les accidents de la voie publique en sont les deux grandes circonstances de survenue.

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,pvalue = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26,pvalue = 0.031).

Le fibromatosis colli (FC) est pseudotumeur rare du muscle sterno-cleido-mastoidien (SCM), a l'origine d'un torticolis dit congenital chez le nouveau-ne ou le nourrisson. Le mecanisme etio-pathogenique de sa survenue est sujet a controverse. Son diagnostic fait appel a l'echographie qui permet de mettre en evidence un epaississement caracteristique du muscle. Nous rapportons deux cas diagnostiques par l'echographie avec pour un cas une notion de malposition intra-uterine et pour l'autre cas une absence totale de malposition et de traumatisme obstetrical qui pourtant est evoque comme element du mecanisme de survenue du FC. Key words : Fibromatosis colli, torticolis congenital, sterno-cleido-mastoidien, echographie

Objective: To determine by radiology the different etiologies of psychomotor delays (PMD) in Lomé (Togo). Material and Method: Retrospective study of 12 months in the radiology department of CAMPUS Teaching Hospital, concerned images of CT and MRI scans of children 0-16 years of age with PMD. Results: The mean age was 4.4 years +/- 4.35. The result was pathological in 69.63% of the cases.Cerebral atrophy was the most frequent lesion (40.50%), followed by hydrocephalus (23.14%). The congenital stenosis of the Sylvius aqueduct was the most frequent malformation (37.93%). Triventricular hydrocephalus accounted for 45.61% of hydrocephalus. The most common tumor lesions were choroid plexus carcinoma and craniopharyngioma (28.57% each). Meningo-encephalitis accounted for half of infectious cases. Conclusion: PMD is most often the consequence of several cerebral pathologies. The most frequent of which is cerebral atrophy.