Background: Disparities in MR access between different countries and healthcare systems are well documented. Determinants of unequal access within the same healthcare system and geographical region are poorly understood.Objective: An analysis of public sector MR utilisation in South Africa’s Western Cape province (WCP).Methods: A retrospective study of WCP MR and population data for 2013 and 2018. MR units/106 people, studies, and studies/103 people were calculated for each year, for the whole province and the ‘western’ and ‘eastern’ referral pathways, stratified by age (0–14 years, 14 years)Results: Between 2013 and 2018, the WCP population increased 8% (4.63 vs 5.08 × 106 people) while MR resources were unchanged (‘western’ = 2 units; ‘eastern’ = 1), equating to decreasing access (units/106 people) for the province (0.65 vs 0.59; –9.2%), the ‘western’ (0.97 vs 0.9; –7.2%) and ‘eastern’ (0.39 vs 0.35; -10.3%) pathways. In 2013, 40% (4005/10 090) of studies were in the ‘eastern’ pathway serving 55% (2 066 079/4 629 051) of the population. Between 2013 and 2018 ‘eastern’ population growth (n = 286 781) exceeded ‘western’ (n = 168 469) by 70% (n = 118 312). By 2018, 38% (7939/12 848) of studies were performed in the ‘eastern’ pathway, then serving 56% (2 849 753/5 084 301) of the population. Among 0–14-year-olds, ‘western’ utilisation (studies/103 people) exceeded ‘eastern’ by a factor of approximately 2.4 throughout. In patients 14 years, the utilisation differential increased from 1.78 to 1.98 in the review period.Conclusion: Ensuring equitable services on the same healthcare platform requires ongoing surveillance of resource and population distribution. MR access can serve as a proxy for equity in highly specialised services.

Bilateral acute hearing loss is rare, and the aetiology is poorly defined. Less common treatable pathologies such as otosyphilis must be part of the differential diagnosis and should be actively excluded. We present a case of a 23-year-old woman who developed acute bilateral hearing loss due to otosyphilis, confirmed on audiometry and laboratory tests. In this article, the CT, MRI and clinical findings are presented and discussed.

The SA Journal of Radiology is the official journal of the Radiological Society of South Africa and the Professional Association of Radiologists in South Africa and Namibia. The SA Journal of Radiology is a general diagnostic radiological journal which carries original research and review articles, pictorial essays, case reports, letters, editorials, radiological practice and other radiological articles.

The SA Journal of Radiology is the official journal of the Radiological Society of South Africa and the Professional Association of Radiologists in South Africa and Namibia. The SA Journal of Radiology is a general diagnostic radiological journal which carries original research and review articles, pictorial essays, case reports, letters, editorials, radiological practice and other radiological articles.

Phosphaturic mesenchymal tumours (PMT) are rare, benign lesions and the most common tumour to cause tumour-induced osteomalacia (TIO), a paraneoplastic syndrome. Patients frequently exhibit severe osteomalacia, accompanied by multiple fractures, which significantly impair their quality of life. Complete surgical resection is curative.Contribution: A rare case of sinonasal PMT is presented, with a focus on the imaging findings and role of the radiologist and nuclear physician.

This case report presents the clinical evaluation of an 11-year-old boy with a unilateral polypoid nasal mass causing nasal obstruction, facial asymmetry, and intermittent epistaxis. His clinical picture raised concerns of a juvenile nasopharyngeal angiofibroma; however, further imaging and histopathological evaluation ultimately confirmed the diagnosis of allergic fungal rhinosinusitis (AFRS). Although this patient was younger in age than those traditionally associated with AFRS, classical features present on both computed tomography (CT) and magnetic resonance imaging (MRI) aided in his diagnosis and management. This case underscores the importance of a comprehensive diagnostic approach when evaluating unilateral sinonasal masses in paediatric patients, specifically in atypical presentations where the diagnosis of AFRS may not initially be considered. It highlights the critical role of imaging as a diagnostic tool, specifically CT and MRI, which were pivotal in the work-up and management of this case. Additionally, the need for caution during biopsies of sinonasal masses in children is emphasised, as there is potential for catastrophic bleeding in vascularised masses such as juvenile nasopharyngeal angiofibroma. This case demonstrates that AFRS can occur in younger children, highlighting the need to include this in the differential diagnosis, even in patients outside of the traditionally described age group.