,¥ BRD original articie ABDOMINAL ULTRASOUND FINDINGS IN AIDS PATIENTS IN SOKOT! Saidu SA, etal A PRELIMINARY REPORT. *SAIDUSA, **MAKUSIDI MA, “*FISYAKU K, *MA'AJISM, Introduet The abdominal manifestations in the patient with HIV infection are becoming increasingly frequent. "Africa has been the most affected, but epidemics are spreading in Asia and Russia.’ The myriad ‘causes of abdominal pain or lesions in the AIDS patient include a wide variety of opportunistic infections and neoplasms. * Some of these are tuberculosis, Kaposi's sarcoma and Non- Hodgkin's lymphoma, among others Ultrasonography has been found tobe diagnostic in most of these patients with abdominal pathology’ especially in the majority of sub-Sabaran African counties where Computed Tomography is not available of to0 costly.” Materials and Metho AA descriptive study of the abnormalities found at ultrasonography in AIDS patients was done over & ‘one-year period. The CDC 1993 classification was used 10 diagnose AIDS, All patients seen in the Medicine Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto with AIDS between May 2004 and April 2005 were included in the study. The patient's personal data including age, sex, and ovcupation among others were taken, The clinical presentation and the ultrasound findings were also noted, All abdominal organs were investigated in the search for lesions, using an Apogee 800 plus ultrasound machine with a multiple frequency probe (range between 2 and SMHz). Any abnormality or lesion was thus documented. Results: A total of 65 patients with AIDS had abdominal ultrasound. There were 38 males (58.5%) and 27 females (41.5%). The mean age was 38 years (range of 22-65 years). Table I shows that the highest number of patients (30/65 [46.2%4)) belonged to the 31-40 years age bracket, This was followed by the 21-30 years age bracket with 18 patients 27.7%). ABSTRACT Aim: To determine the diagnostic usefulness of abdominal Ultrasonography in the cline assessment of the acquired immune deficiency syndrome (AIDS) patient Methodology: A descriptive crossesectional study of the abnormalities found at ultrasonography in AIDS patients was done over a’ one-year period. all abdominal organs were investigated in search of lesions. using an Apogee 800 plus ultrasound machine -Result: Sity five (65) patients were recruited with 38 males (58.5%) and 27 females (41.59%). The mean age was 38 years (range 22-65 years). Of these, 32 patients (49.2%) had positive Findings. In some instances more than one abnormality was found in a patient. Pathological findings were most frequent i the Kidneys (n=12). Others were splenomegaly (n9), hepaiomegaly (n=7) and pelvic inflammatory disease (n=6).. Abdominal ‘bmphadenopathy, chronic liver disease, asits and urinary tract infection were less frequent. Ina some cases, the lesions were not specific 10 AIDS e.g. prostatic enlargement (n=2) und uterine fibroid (n=I) Conclusions: These findings may have implication for the radiologist, especially in developing countries, where accurate inicrobiological or pathological diagnosis of diseases inthe HIV infected patient is often not possible. Many physicians consequently sometimes rely upon ultrasound asa “diagnostic” investigation. Further and indeed larger studies are required to better appreciate the patterns and correlates of ulrasonograp to clinical and laboratory findings for the development of diagnostic algorithms in resource-poor counsries. Author Affiliations: Departments of *Radiology and **Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto and Department of *** Radiology, Aminu Kano ing Author: Dr Saidu SA. Department of Radiology, smanu Danfodiyo University Teaching Hospital, Sokoto-Nigeria Key words: AIDS, Abdominal, Ultrasonography, Sokoto Thirty two patients (49.2%) had positive findings at ultrasonography. In some instances, more than one abnormality ‘vas found ina patient. Pathological findings were most frequent in the kidneys (112) of which were 9 cases of nephropathy, 1 case of renal eyst, I ease of pyelonephritis, This was followed by splenomegaly (n=9), hepatomegaly (n=?) and pelvic inflammatory disease (1-6) 38 shown in Table I. The others were less frequent. Some lesions were also noted to be non-specific to AIDS e.g. prostatic enlargement (n=2) ectopic kidney. (2=1) and Uterine fibroid (n=1). BOMI, Vol 2, No. I, January-June 2008. 7‘Table 1: Age distribution of patients Age range (Years) 0-10 11-20 21-30 31-40 41-50 s1-60 61-70 Total No. ofpatients Percentage 1 Ls 0 0 18 27 30 462 10 134 4 62 2 3.1 6s 100 Table 2: Pathological findings at abdominal ultrasonography. Pathology Renal Pathology Splenomegaly Hepatomegaly PID Lymphadenopathy Prostate Enlargement Ascitis UTIL Uterine Fibroid Chronic Liverdisease Cholangitis ‘Numberof Patients with ‘each Pathology. 2 _NB:Some patients showed more than one pathology. it in their study was parenteral drug Systemic abdominal ultrasound addiction, The mean age of our ‘would be of value, at leasteven fonly patients was 38 years, which is not to pick the lesions when they are much different from their finding of “some times as separate 30 yea Often times, however, they combine to present the picture of a Diseases of the kidneys or present entities particular disease. abdomi associated with tuberculosis. ” For example genitourinary tract, hepatobiliary nal lymphadenopathy, system, haemopoietic system among, splenomegaly, mild to moderate others occur to a much higher degree ascitis and nephropathy tend to be in HIV/AIDS patients than in the sometimes non-specific. abdominal — general population.” These may be a "They are, however, direct consequence of HIV infection, due to an opportunistic infection or neoplasm or related todrug toxicity ‘There were more males (58.5%) in our study than females, This is in We found more lesions inthe kidneys, agreement with the work of Erdozain followed by the liver and the spleen, et al’ Howevei, they had a much — This is contrary tothe finding of N'Zi higher percentage of males, 78/34, PK eral that found most lesions inthe ‘Our higher proportion of females may lymph nodes, though followed closely rot be unconnected with the higher by the liver and kidneys.” To the polygamy rate in our environment, contrary, we found only 2 cases of since the main route of infection here abdominal or paraaortic is heterosexual. The main risk group lymphadenopathy. The high BOMS, Vol. 2, No. I, January-June 2005. Saidu SA, et al proportion of kidney diseases in our patients may not be unconnected with the high prevalence of nephropathy in the black and Hispanic population. Itis infact not only more prevalent in those populations, but also more severe.” In these cases of nephropathy ultrasound reveals enlarged hyperechoic kidneys, though in a large number of our own, patients, the kidney size was within ‘normal limits Lymphadenopathy is due to either marked follicular hyperplasia in the node in response to HIV infection or tuberculosis or lymphoma especially NHL" Veerapand P. and colleagues ina study in Thailand found abdominal lymphadenopathy to be mostly caused by TB, with non-tuberculous mycobacteria as the second most common cause.” They found only one case of lymphoma out of the 63 eases, (1.6%). Smith EI et al, however, had ‘much more splenomegaly than any other abdominal lesion in their study in Canada. In a comparative study between HIV- infected patients and the full-blown AIDS group Tsibwabwa er af found that the AIDS group had a higher proportion of splenomegaly. hepatomegaly, lymphadenopathy biliary tract abnormality and ascites, than in the HIV infected indiviudals, ‘They found no difference in the renal tract and pancreatic abnormalities between the AIDS and HIV infected groups. All the patients recruited in ‘ourstudy were AIDS patients Conclusions: ‘These findings may have implication for the radiologist, especially in developing countries, where accurate microbiological or pathological diagnosis of diseases in the HIV- infected patient is often not possible Many physicians consequently sometimes rely upon ultrasound as 3 “diagnostic” investigation. Further and indeed larger studies are required to better appreciate the pattems and correlates of ultrasonography 10 clinical and laboratory findings for the development of diagnostic algorithms in resource-poor countries. RREFERENCES 1. Erdozain IC, Gonzalez Gateia M, Pintado ¥, er al. Abdominal echography in patients. with human immunodeficiency virus (HIV) infection. Diagnostic usefulness in the evaluation of associated medica Surgical pathology. Ann Med Ingemma. 1995; 12(3): 113-121 2. Smith FJ, Mathieson JR, Cooperberg PL. Abdominal abnormalities in AIDS: dciection at US in a large population Radiology. 1994; 192 (3) 691-695, 3. Evans A, Lee R, Mammen Tobin A. Pyadigamage A, Shann S, Waugh M. HIV revisited: the global impact of the HIV/AIDS epidemic. Skinmed, 2004; 363) 149-156. 4. Slaven EM, Lopez F, Weintraub SL, Mena JC, Malion WK, The AIDS patient with abdominal pain: a new challenge for the emergency physician. Emerg Med Clin North Am. 2003;21(4),987 101s, Said S, Fig.l: Transverse abdominal ultrasound image of a man showing enlarged peripancreatic and paraaortic lymph nodes, The largest is shown centrally and measures 5.lem x 3.6em. The patient also had mild splenomegaly and bilateral Grade | nephropathy. 5. Tsibwabwa ET, Mwaba P, Bogle Taylor 1, Zumla A. Four year study of abdominal ultrasound in 900 Cental Altiean adults with AIDS referred for diagnostic imaging, Abdom imaging 200,24 (3), 290-296, 6.N7Zi PK, Coulibaly A and N' Dri K. et al. Ultasound aspects. of abdominal involvement in adults with HIV infection in Iwory Coast: apropos of 146 cases, Sante, 1990:9(2): 85-88, 7, Tarantino L, Giorgio A, de Stefano G, Farella N, Perrotta A, Esposito | Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine needle aspiration biopsy of lymph nodes and spleen. Absom Imaging. 2005; 28 (5):602-608, 8. Monill Serra JM, Martinez Noguera A, Montserrat E, Maideu J, Saba IM, Abdominal Ultrasound findings of disseminated tuberculosis in AIDS, Clin Ultrasound, 1997; 25(1): 1-6 9. Fauci AS, Lane HC. Human Immunodeficiency Virus disease: AIDS and Related disorders. in: Kasper DL Braunwald E, Fauci AS, Hauser SL, Longo DL, Jamieson JL. (eds). Harrison's Prices of Internal Medicine, Vol. 116° edition New York MoGraw Hil, 2005: 1076-1139 10. Saif MW Greenberg BR. Abdominal presentation of Burkit's lymphoma in an HIV positive patient. AIDS patient care STDS, 1998; 12(7):567-571 11, Veerapand P, Chotimanvijit R, Laohasrisakul N, Muennoach W. Percutaneous ultrisound-guided fine needle aspiration af abdominal lymphadenopathy in AIDS patients. J Med Association Thai 2004;87 (4) 400- 404, BOM, Vol. 2, No. 1, January-June 2005. B