Cervical vertebral osteomyelitis is rare. While an early and correct diagnosis is critical to prevent catastrophic neurological injury, the diagnosis of cervical vertebral osteomyelitis is often difficult because of its rarity and variable symptoms. We present a case of C1 and C2 vertebrae osteomyelitis with a misleading presentation and its fatal outcome.
An aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptomatic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dysphagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively.
Renal arteriovenous malformation (AVM) is a rare congenital anomaly of the urinary system. We present a patient with bilateral renal AVMs who presented with back pain and microscopic hematuria. This case highlights the importance of careful diagnostic work-up in the evaluation of upper tract hematuria. Renal AVM was found to be the cause of mild back pain and persistent microscopic hematuria in a 45-year-old lady. This case highlights the importance of complete diagnostic work-up in the evaluation of microscopic hematuria in arriving at the correct diagnosis of an uncommon clinical entity.
The wide use of computed tomography (CT) scanning for patients with blunt abdominal trauma can reveal incidental findings that vary in their importance. We evaluated these findings, how it was reported by radiologists and its implication on the trauma care. In 30 out of 154 patients, 32 incidental findings were discovered (19.5%). Out of these 32 findings, only 3 cases (9.4%) were considered significant and required immediate attention from the managing team. In all these 3 cases, the findings were described in the body of the report and highlighted in the conclusion section at the end of the radiology report. However, similar reporting style was used in only 58.4% of cases with moderate clinical concern and 23.5% of cases with little clinical concern. In 41.2% of cases with little concern, the incidental findings were not mentioned in the radiology report. In conclusion, incidental findings in CT scan performed for blunt abdominal trauma were common but many were clinically insignificant. There is little consistency in radiology reporting of these findings especially those with moderate and little clinical concern.
Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.
Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).
A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.