MORPHOLOGICAL DIAGNOSIS OF ATRIOVENTRICULAR SEPTAL DEFECT: COMPARISON BETWEEN TWO DIMENSIONAL ECHOCARDIOGRAPHY, ANGIOCARDIOGRAPHY AND SURGERY

The selection and result of operative procedure for repairing atrioventricular septal defect (AVSD) are largely dependent on completeness and accuracy of preoperative morphological diagnosis. To evaluate the value of two dimensional echocardiographic (2DE) technique devised specifically for morpholagical diagnosis, the results of 2DE,angiocardiography and surgery were examined retrospectively in 87 children with AVSD.Age ranged from 3 months to 11 years old (mean 3.9 years). 46 had partial AVSD, 12 had transitional AVSD, 29 had complete AVSD (type A in 21, type B in 4, type C in 4).2DE diagnosis is concordant with surgical diagnosis in 36/37 (97%) patients with partial AVSD, in 25/31 (84%) patients with transitional or complete AVSD. Most discordant diagnosis between 2DE and surgery occurred in patients with transitional or type A AVSD.The 2DE technique for morphological diagnosis of A VSD is superior to angiocardiography.The results indicated that morphological manifestations of AVSD could be clearly demonstrated with the use of apical and subxiphoid 2D imaging planes, reliable morphological diagnosis could be obtained.

Incidental Finding of Pyeloureteral Junction Syndrome during Extension Workup for Prostatic Adenocarcinoma

Introduction: Prostate cancer is one of the most common cancers in men. In cases of suspected locally advanced disease or lymph node or bone metastases, thoraco-abdomino-pelvic CT is still useful for detecting visceral metastases. In the course of this extension work-up, other abnormalities may be discovered by chance, which had previously remained silent, and which could be diagnosed and managed in childhood, hence the interest of presenting a case of incidental finding of pyeloureteral junction syndrome during extension workup for prostatic adenocarcinoma at Yaounde Central Hospital. Observation: A 72-year-old patient presented to the department with acute urinary retention. The clinical examination, with an empty bladder, and in particular the digital rectal exam (DRE), was in favor of malignant prostatic hypertrophy. A workup was ordered, including a total PSA returned to 61.3 ng/ml (PSA performed one week after the episode of acute urinary retention) with cytobacteriological examination of sterile urine. Renal function was slightly impaired, with creatinemia at 14 ng/ml. Renal and vesico-prostatic ultrasound revealed a 57 g prostate with regular, clean contours and a polycystic right kidney. A prostate biopsy was indicated, which revealed a histopathological aspect in favor of a prostatic adenocarcinoma ISUP 1. An extension work-up including a thoraco-abdomino-pelvic CT scan revealed no signs of local or distant secondary localization, but a pyeloureteral junction syndrome with significant hydronephrosis, parenchymal destruction and compensatory hypertrophy of the contralateral kidney was found. Conclusion: The prostate cancer extension work-up revealed a pathology that can be diagnosed early. It is therefore important to reinforce prenatal and natal screening, which will enable malformative uropathies to be identified early and corrected in time to preserve patients’ renal function. Furthermore, we must be careful in the ultrasound diagnosis of pyeloureteral junction syndrome.