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Tension pneumocephalus is an unusual bad life-threatening neurosurgical emergency, this is the equivalent of tension pneumothorax. This often follows head trauma, epidural injections, complicating neurological spinal, craniofacial or sinus surgery. This is a forty-five-year-old man that was involved in a road traffic accident, was referred for a computed tomography of the brain on account of altered consciousness, irrational behavior, and restlessness. A non-contrast enhanced computed tomography of the brain was done, this demonstrated multiple areas of cortical discontinuity in the facial and skull vaults in keeping with fractures, extensive negative density (HU: -968) hypodensity in the frontal region bilaterally causing marked inferior displacement of both frontal lobes of the brain, with associated splaying of the interhemispheric fissure likened to the ‘Mount Fuji sign’ of severe/tension pneumocephalus. Pockets of negative density hypodensities are also noted in both cerebral hemispheres in keeping with pneumatoceles are also demonstrated. Generalized effacement of sulci and gyri in keeping with cerebral edema is also demonstrated. The outcome of the patient in the peripheral center was not known as at the time of this report, because all effort to get across to the patient and relations proved abortive. We present a case of tension pneumocephalus following road transport accident, to review the computed tomographic features due to its peculiar presentation.

Gallstones present as acute calculus cholecystitis in about 20% of individuals with symptomatic disease, having a wide range of symptom severity. The adult population is most often affected in about 10-15% within the developed countries. This is a 75-year-old man that was referred for a confirmatory ultrasonography from a peripheral health centre on account of an entertained ileocecal tumor following an abdominal ultrasound scan done in a local health care facility. The patient had an abdominal ultrasonography that showed an impacted calculus in the infundibulum of the gallbladder measuring about 30mm x 30mm in dimension with associated distended gall bladder; this shows thick and trabeculated wall, heterogenous content with circumferential hypoechoic halo of acute cholecystitis. The patient had percutaneous cholecystectomy in the peripheral care facility and was reported to have done considerably well for discharge. We report the ultrasonographic findings of acute calculus cholecystitis due to its peculiarity and presentations.

Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract, and responsible for less than 1% of cases of intestinal obstruction. This is a case of a 50-year-old male who was referred for computed tomography of the abdomen on account of abdominal pain, abdominal swelling and discomfort, restlessness, vomiting, constipation, easy fatigability, excess sweating and restlessness. The scout image of the computed tomography (CT) demonstrated linear streaks and foci of radiolucency beneath and around the 10th and 11th anterior ribs on the right most likely pneumobilia. Air distended bowel loops were also demonstrated. Serial axial slides demonstrated an impacted calculus measuring about 30mm in widest transverse diameter in the right iliac region most probably the ileocecal valve region extending in to the cecum with associated dilated bowel loops showing multiple air-fluid levels raising a suspicion of mechanical bowel obstruction. The gall bladder measures about 50mm x 30mm in cranio-caudal and mediolateral diameter, with turbid contents and thickened walls of about 4mm most likely from cholecystitis. A diagnosis of mechanical bowel obstruction following an impacted calculus at the ileocecal valve was entertained; Gallstone ileus in a 50-year-old man. The patient had surgical treatment, this comprised of exploratory laparotomy with entero-lithotomy, fistula repair and cholecystectomy. The patient did well post-operatively and was discharged home subsequently and advised on follow-up visits. We present a case of mechanical bowel obstruction following an impacted gall stone at the ileocecal valve in a 50-year-old male patient.

Hydrops fetalis is the abnormal accumulation of fluid in two or more different fetal compartments and most times associated with polyhydramnios and placental edema, and has an estimated incidence of about 1 in 3000 pregnancies. A 27-year-old multigravida; G8P7, was referred for the first ultrasonography in the Index pregnancy on account of not feeling/observing fetal movement for about two-weeks. The obstetric ultrasonography demonstrated a single fetus with absent fetal heartbeat, in hyper-flexed position, accumulation of fluid in the abdominal cavity; right sub-diaphragmatic region and in the right pleural cavity in keeping with fetal ascites and fetal effusion. There is overriding of fetal skull with Thickened/edematous placenta with a thickness of about 7cm, and fetal skin thickness of about 10mm. There is associated intrafetal gas. The estimated femoral length gave a gestational age approximating 41-weeks. A diagnosis of hydrops fetalis most likely non-immune form with fetal demise presenting at 41-weeks gestational age in a multiparous woman with features anemia presumably from sepsis and urinary tract infection (bilateral pyelonephritis and cystitis) in a setting of poor antenatal care was entertained. The fetus was expelled following induction of labor at the peripheral centre, the patient had transfusion done with commencement of antibiotics for correction of anemia and sepsis with plans of further clinical and laboratory evaluation. We present the ultrasonographic features of hydrops fetalis with intrauterine fetal demise due to its unique presentation

Urinary calculi are the third most common affliction of the urinary tract only exceeded by urinary tract infections and pathologies of the prostate gland. Urinary tract calculi contribute to a major concern encountered in the practice of urology, it affects about 10-12% of the population with a variable incidence with respect to sex, age, occupation, geographical area, climate, dietary fluid intake, social class and race. Urethral calculus is always found on the site of prostatic urethra, bulbar and fossa navicularis. Primary urethral calculi are usually associated with urethral strictures, posterior urethral valve and a diverticulum. Urethral calculi represent 1-2% of all calculi in the urinary tract. This is a case of a 32-year-old farmer and fisherman who had a retrograde urethrocystography (RUCG) that showed an obstructive prostatic calculus, bladder wall calcification and thickening with contrast refluxing into the seminal vesicles bilaterally.

Protrusion acetabuli is the medial protrusion of the acetabulum in to the pelvic cavity, also known as arthrokatadysis, more common in females and classified etiologically as primary (idiopathic) and secondary forms. This is a 66-year-old female patient that presented for a plain radiograph of the pelvis and hip joints from a peripheral healthcare center on account of pain and inability to stand and move her waist and hips bilaterally, reduced movement of the legs and pain in the knees for more than three-year duration of onset. The plain radiograph of the pelvis and both hip joints demonstrate reduced density of the demonstrated bones, medial protrusion of the medial wall of the acetabulum in to the pelvic cavity bilaterally (distance between the imaginary Kohler’s line and medial acetabular wall is about 22mm bilaterally; Degree: III), obliteration of the hip joints bilaterally, thickening and sclerosis of the acetabular walls and other articular margins, subarticular cysts on the femur, acetabulum and pelvic bones. The patient had no coexisting condition like rheumatoid arthritis, Marfan’s syndrome and psoriatic arthritis. A diagnosis of bilateral idiopathic protrusio acetabuli was made. The patient was advised on bilateral total hip arthroplasty to improve the symptoms. We report a case of bilateral idiopathic protrusion acetabuli in an elderly female patient in order to describe the features of this condition radiographically.

Urinary schistosomiasis (US) causes chronic ill health and caused by the blood fluke Schistosoma haematobium. This disease is endemic in Africa and eastern Mediterranean countries, and has a predilection for the male gender. This is a 64-year-old farmer (swampy farming and fishing) for more than forty years, that was referred from a peripheral health care centre for abdominal and pelvic ultrasonography on account of abdominal pain and discomfort, bilateral loin pain, dysuria, and terminal hematuria for close to a year duration of onset. The ultrasonography demonstrated bladder wall thickening, mucosal thickening and polypoid proliferation in to the bladder lumen, irregular echogenic crust in the bladder base, suspended mobile echoes in urine most likely from hematoma and/or cystitis, there is associated mild-moderate biliterate dilatation of the pelvi-calyceal systems and ureters(hydroureteronephrosis). The remaining abdominal and pelvic organs appeared normal. Urinary parasitology demonstrated the ova of Schistosoma haematobium confirming the diagnosis of urinary schistosomiasis. We report the ultrasonographic features of urinary schistosomiasis because of its peculiar presentation and to emphasize importance of ultrasound in its assessment.

Unicornuate uterus is a form of uterine anomalies which arise from failure of development and fusion of the Mullerian ducts, and accounts for about 2.4-13% of all Mullerian anomalies. This is a 30-year-old housewife referred for hysterosalpingography (HSG) on account of secondary infertility. The patient also had history of recurrent abortion in the first trimester. The HSG showed an ellipsoidal or Banana shaped uterus in the left lateral pelvic cavity with prominent left fallopian tube that showed peri-fimbrial spillage of contrast medium with non-demonstration of a communicating rudimentary horn. She also had a pelvic ultrasound that showed an empty uterus with a right hypoechoic solid area most likely the right rudimentary horn. We report the radiologic features of Unicornuate uterus due to its rare nature and peculiar presentation

Foreign bodies are uncommon and may be ingested, inserted into a body cavity or deposited in the body by traumatic or iatrogenic injury. Foreign body ingestion is more common in children with equal incidence in males and females, and has a peak incidence in the ages between six months to three years. This is a case of a seven-year-old male child with behavioral abnormality and long history of ingestion of foreign bodies who presented with abdominal pain and discomfort with passage of hard solid stone like particles in feaces. The patient had a conventional abdominal radiograph that showed multiple radiopaque structures of varying sizes, some of which are clump-like in the peripheral abdomen; the large colon and region of the rectum.

Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base to apex axis directed to the right and caudad. The malposition is intrinsic to the heart and not caused by extracardiac abnormalities. Dextrocardia is a rare condition and usually found incidentally and in association with other congenital abnormalities. It has an incidence of less than 1%. This is an 18 year old Nigerian female who was referred for computed tomography (CT) of the chest on account of prolonged and recurrent cough with a suspicion of diffuse interstitial lung disease. The chest and upper abdominal CT scan showed dextrocardia with a right placed heart, displaced spleen and stomach to the right hemi-abdomen and liver displaced to the left hemi-abdomen; confirming the diagnosis of dextrocardia with situs inversus. We present this case of dextrocardia with abdominal situs inversus due to its rarity in literature.

Syndactyly is a Greek word meaning fused digits, may involve fusion of the soft tissues with or without bony fusion. It is regarded as the most common congenital defect of the hand, detected in 1 out of every 2000 live births, twice as common in males, and more among the Caucasians. This is a 10-month-old male infant that was referred for plain radiograph of the right hand on account of completely fused 2nd to 5th digits and an incompletely fused 1st digit with medial deviation since birth. The plain radiograph showed soft tissue fusion of the 2nd to 4th web spaces completely with a partially fused 1st web space. There is associated fusion of the distal phalanges of the 4th and 5th digit, foreshortening of the 3rd and 4th metacarpals with the middle phalanges of the 2nd and 5th digits. There is flexion of the interphalangeal joint and medial deviation of the 1st digit. There is also haphazard arrangement of the metacarpals and phalanges most especially the 3rd and 4th digits. Prominence of the thenar and hypothenar eminences with mild ulnar deviation of the entire right hand were also demonstrated. The contralateral left hand appears within normal limits, a complementary ultrasound showed normal abdominal organ situs. A diagnosis of congenital syndactyly most likely the complex-complicated form in a 10-month-old infant was established. The surgical repair to establish function and achieve excellent aesthetics was deferred until the child clocks about 24-months of age. We report a case of congenital syndactyly of the right hand due to its radiographic form of presentation in this 10-month-old infant.

The spleen is the largest encapsulated lymphoid and intraperitoneal organ in the human body located in the left hypochondrium, and consisting of the white pulp for the immune system and the red pulp for phagocytoses of blood elements. Congenital anomalies of the spleen may vary, ranging from those of the shape, size and location, among which are lobulation, clefts and notches, accessory spleen, wandering spleen and polysplenia. This is a 10-year-old male child referred for an abdominal and pelvic ultrasonography on account of urinary infection (UTI), had no history of trauma and instrumentation to the abdomen or left hypochondrial region. The abdominopelvic ultrasonogram showed a normal sized spleen with a diameter of 110mm, that showed a deep and central fissure extending superior and right medially on the diaphragmatic surface of the spleen. Linear echolucent areas are also demonstrated bilaterally; fissures, multiple notches are also noted on the superior border and clefts; appearing as linear echolucent areas on the superior border dividing it in to lobules. These clefts measure about 2cm from the superior border of the spleen. No accessory or multiple splenic tissues or wandering spleen is however demonstrated. The abdominal organs show normal situs. We report the ultrasonographic appearance of congenital anomalies involving the shape of the spleen in a 10-year-old child due to its peculiar presentation.

Spinal osteochondroma are basically of two forms, these are spinal osteochondromas in patients with multiple osteochondromas and solitary osteochondromas occurring in the spine. Osteochondromas are more prevalent among the male gender and has an age of onset between 20-30 years. This is a 27-year-old lady that was referred for plain radiograph of the cervical region on account of a hard mass on the left aspect of the neck that was slowly growing for two years duration. He patient also complained of occasional left shoulder, forearm, wrist and hand pain with occasional numbness. The plain radiography was done in both anterior-posterior and lateral projection, showed a soft tissue density fullness and an expansile missed sclerotic and lucent lesion/mass involving the spinous processes of the second to sixth cervical vertebrae. The expansile, and mixed sclerotic and lucent appearance of this area proffered the differential of a solitary cervical spinal osteochondroma. The patient had surgical excision of the tumor, and histopathologic assessment of the tumor confirmed osteochondroma. We report the radiologic finding of a case of Solitary cervical spine osteochondroma in a 27-year-old lady due to its rare nature and presentation

Proximal Focal Femoral Deficiency (PFFD) is a term used to describe a condition where the femur is short and associated with an apparent loss of continuity between the shaft and neck. PFFD is reported as an uncommon but complex clinical condition. This was commonly grouped with other disorders like coxa vara and short bowel tumours. This has a female to male ratio of 2:1 and an incidence of 1 case per 50,000 population to 1 case per 200,000 population. This is a case report of a three-year-old female that was referred for plain radiograph of the lower limbs on account of limb-length discrepancy and abnormal gait. The plain pelvic and lower limb radiograph showed a markedly shortened femur with non-demonstration of the femoral head and neck. There was a vertically oriented acetabula fossa with altered acetabula and iliac angles. The patient is currently managed conservatively mainly by reassurance and use of crutches.

Dandy-Walker Malformation (DWM) is an unusual hereditary intracranial anomaly that affects the cerebellum and its components and is also characterised with an enlarged posterior fossa. DWM can appear dramatically or develop unnoticed and occurs with occipital cephalocele in about 5% of cases. This is a case report of a 10-month-old male child with DWM who had a co-existing occipital cephalocele and presented on account of hydrocephalus and poor developmental milestone. He had a Contrast Enhanced Computed Tomographic (CECT) scan of the brain; which showed a posterior fossa cysts, a hypoplastic cerebellar vermis with a dysmorphic fourth ventricle that appear continuous with the posterior fossa cyst giving the so called ‘key hole deformity’. There is also associated hydrocephalus with an occipital cephalocele.

Neonatal small left colon syndrome is a well-defined functional disease of the lower colon and it results in signs and symptoms of intestinal obstruction. It is an uncommon cause of neonatal intestinal obstruction characterised by an abrupt transition of intestinal caliber at or near the splenic flexure. More than 50% of affected patients are born to mothers with diabetes. We report a five-day-old neonate who presented with abdominal distension and vomiting diagnosed to have small left colon syndrome by contrast enema. He had surgical resection of the narrowed segment and anastomosis with subsequent resolution of symptoms.

Background: Diagnostic mammography is a radiographic examination of the breast to detect the palpable and nonpalpable lesions. More than 1.15 million women are diagnosed of breast cancer yearly worldwide. Objective: This study is aimed at evaluating the mammographic outcomes among 123 Nigerian females who had the sign and symptoms of breast diseases. Materials and Methods: This is a cross-sectional study (retrospective in nature) of 123 adult females who came for diagnostic mammography between December 2010 and November 2012 at the mammographic suite of radiology department UDUTH. MLO and CC views were done for the breast examination though compression views were occasionally employed. Results: One hundred and twenty-three females had diagnostic mammography, with a minimum age of 30 years. The prevalence of diagnostic mammography within the stated period is 61.5%. The mammographic findings were normal in 62 (50.4%) and abnormal in 61 (49.6%) of the subjects. The abnormal mammographic findings were masses in either or both breasts in 45 participants (36.6%), architectural distortion in either or both breasts in 10 participants (8.1%), isolated calcification in either or both breasts in 4 participants (3.3%), left retracted nipple in 1 (0.8%) participant while another subject (0.8%) had a retracted right nipple. Conclusion: Diagnostic mammography can detect the various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. These findings affirmed the need of routine early screening so that breast diseases can be detected early.