Browsing by Author "Said-Hartley, Qonita"

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    Open Access
    Factors influencing pneumothorax rates of transthoracic CT-guided lung biopsies in a Tertiary centre in Cape Town, South Africa
    (2020) Richards-Edwards, William H; Said-Hartley, Qonita
    Background: Histological sampling of pulmonary lesions is important in diagnosis of lung carcinoma and affects subsequent decisions on specific management. Transthoracic CT-guided lung biopsy is considered an effective option to obtain tissue with low rates of complications, with pneumothorax being the most common. Objectives: To determine the pneumothorax rate of transthoracic CT-guided lung biopsies of focal lung lesions at Groote Schuur Hospital, and assess how procedural, patient and lesion factors influence these results. Methods: A retrospective review of 237 CT-guided lung biopsies performed over a 24-month period. Patient's CT, biopsy reports and post-procedure x-rays were reviewed. The relationship between pneumothorax rates and categorical demographic and clinical variables was analysed with Cochran's trend test. Mann-Whitney U tests were used to assess differences in continuous variables. Factors influencing pneumothorax rates of transthoracic CT-guided lung biopsies in a Tertiary Centre in Cape Town, South Africa. Results: Pneumothorax occurred in 43 (18.1%) of the 237 biopsies. A chest drain was required in 7 of 43 pneumothoraces (16%; 3% overall). Risk factors that were significantly associated with pneumothorax rate include pleural-lesion distance (p<0.001), smaller lesion size (p=0.002), smaller needle gauge (p=0.012) and perilesional emphysema (p=0.011). Patient age, sex, position, lesion location and level of experience of the performing radiologist had no significant influence on the pneumothorax rate. Conclusion: Our post-procedure pneumothorax rate is within the acceptable range when compared to other institutions. Pleural-lesion distance, lesion size, smaller needle gauge and presence of perilesional emphysema were the most significant risk factors influencing pneumothorax rate. Knowledge of these findings may be applicable in pre-procedure planning to reduce complications and useful to local referring clinicians and patients.
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    Interstitial lung disease (ILD) in adult patients with autoimmune connective tissue disease (CTD) at Groote Schuur Hospital
    (2020) Palalane, Elisa Assis; Hodkinson, Bridget; Alpizar-Rodriguez, Deshire; Botha, Stella; Calligaro, Greg; Said-Hartley, Qonita
    Introduction. Interstitial lung disease (ILD) is prevalent in patients with autoimmune rheumatic diseases (ARD), leads to significant morbidity and mortality and is poorly characterized in South Africa (SA). We undertook this study to describe the clinical, serological and radiological features of ILD associated with ARD in a tertiary referral hospital. Methods. A cross-sectional study of patients with ILD attending the rheumatology and respiratory outpatient clinics of Groote Schuur Hospital between October 2018 and September 2019. Clinical, serological and radiological features were documented. We compared features of 3 groups of patients: rheumatoid arthritis (RA), systemic sclerosis (SSc) and other autoimmune connective tissue diseases (OCTD) which included idiopathic inflammatory myopathies, mixed connective tissue disease, systemic lupus erythematosus, primary Sjogren's syndrome and overlap syndromes. Factors associated with usual interstitial pneumonia (UIP) subtype were assessed. Results. Of 124 patients, 37 (29.8%) had RA, 32 (25,8%) SSc and 55 (44.4%) OCTD. Most patients were female (86.3%), of mixed racial ancestry (75.0%), and the median (IQR) age was 55 (46-66). Over one-third were smokers, emphysema was diagnosed in 22.6%, and one-third had previous pulmonary tuberculosis (PTB) infection. Smoking, emphysema, and previous PTB were higher in RA group but the difference was not statistically significant. All SSc patients and more than two-thirds of RA and OCTD patients had gastroesophageal reflux disease (GORD). Nonspecific interstitial pneumonia (NSIP) was the commonest pattern of ILD (63.7%), followed by usual interstitial pneumonia (UIP) (26.6%) and other patterns (9.7%). RA patients had similar frequencies of NSIP and UIP. Patients with RA were significantly older (median (IQR)) at ILD onset (62 (55-68) years), compared to SSc (49 (38-56)) and OCTD (42 (33-56)) (p < 0.001). Pulmonary function tests (PFTs) were significantly worse in SSc and OCTD groups. Regarding MTX exposure, 37.1% patients has MTX prescribed before ILD diagnosis, 33.9% continued, started or restarted after ILD diagnosis. No case of acute pneumonitis was documented. Pulmonary function tests and high-resolution computer tomography severity correlated poorly, with PFTs underestimating the severity. In the analysis comparing patients with and without UIP, RA diagnosis (OR 3.8, 95% CI 1.5-9.5), older age (0R 1.1, 95% CI 1.0-1.1), COPD (OR 3.2, 95% CI 1.4-8.0), longer ARD-ILD interval, and higher FVC (OR 1.0, 95% CI 1.0-1.1) were significantly associated with UIP. Conclusions: ILD was most commonly diagnosed in RA and SSc patients, with NSIP seen most frequently overall. Smoking, GORD, and PTB were frequent comorbidities. Amongst RA patients, we observed older age of onset and, interestingly, similar frequencies of NSIP and UIP patterns. The use of MTX was not associated with the development of acute pneumonitis in patients with ILD.
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    Range and frequency of AORTIC arch variants in a South African population
    (2019) Kasirye, Napo Nalunga Sayfa; Andronikou, Savvas; Said-Hartley, Qonita
    The purpose of this study was to describe the range and frequency of aortic arch (AA) branching patterns using multi-detector computed tomography (MDCT). MDCT images of 400 patients who attended Groote Schuur Hospital between January 2013 and December 2014 for CT Chest and CT Thoracic angiogram were assessed. Six different branching patterns were observed. A left-sided AA with three major branches was present in 67% of the patients. Bovine-type AA (26 %) and independent origin of the left vertebral artery (5%) were the next two most common patterns. The pattern and distribution of aortic arch branching patterns demonstrated in our study matches those found in studies conducted in other populations in South Africa, Kenya and other countries around the world. In addition, a link between gender and aortic arch branching patterns has been demonstrated in our study. Knowledge of the presence of variant aortic arch branching patterns will aid interventionists and surgeons to better plan procedures in order to avoid complications. Therefore, performing CT Angiograms of the chest in patients admitted for procedures involving the thorax would be beneficial.
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    Variation in thoracic wall thickness on multi-detector CT in adult patients and its implications in needle thoracostomy for tension pneumothorax
    (2022) Chang, Ju-Mei; Said-Hartley, Qonita
    Background: Traditional treatment guideline for chest trauma to prevent tension pneumothorax is needle thoracostomy with a large-calibre catheter needle inserted in the second intercostal space (ICS) in the midclavicular line (MCL). However, due to variations of chest wall thickness, the 50mm needle-mounted catheter is insufficient and may only reach the pleural space. Objectives: To investigate whether the recommended anatomical site and the length of the angiocatheter used for patients in Western Cape, South Africa was optimal and explore alternative locations. Methods: We performed retrospective study measuring chest wall thickness (CWT) of adult patients treated for chest injuries in the Groote Schuur Hospital (GSH) trauma unit between 2014 and 2016. These patients underwent contrasted CT chest studies and image data were obtained via GSH Picture Archiving and Communication System. Multiple levels and sites of CWT were measured, using multiplanar CT acquisition. Patients with underlying chest wall pathology that is not trauma related, congenital anatomical abnormality, foreign bodies or partially imaged chest were excluded. Result: A total of 153 patients were eligible for the study. The mean ± SD chest wall thicknesses of the left and right 2nd ICS MCL were 41,03 ± 15,24mm and 41,77 ± 15,83mm, respectively. Thus, suggesting that 20.9% of patients (n=32) would fail needle decompression at 2nd ICS MCL. The average CWT of the 3rd ICS MCL, 4th ICS MCL, 4th ICS AAL, 4th ICS MAL, 5th ICS MCL, 5th ICS AAL, 5th ICS MAL were 33.95, 27.18, 34.41, 41.31, 21.68, 28.42 and 36.31mm, respectively. The location with the highest needle decompression failure rate was the right 4th ICS MAL (26.1%), whereas the lowest failure rate was the right 5th ICS MCL (3.9%). The location with the highest rate of organ injury was the 4th ICS MCL (26%), and the safest location was at the 4th ICS MAL with no organ injury. Conclusion: Failure rate for needle decompression using the traditional 14G 50 mm angiocatheter at the 2nd ICS MCL in the South African population is high. We recommend that needle decompression should be performed at the 5th ICS AAL, due to the low failure rate and reduced risk of iatrogenic organ injury.