MyMedR

A case of cough induced rib fracture with subcutaneous emphysema and pneumothorax

Shukri WNA, Ng VH, Ismail AK

Med J Malaysia, 2019 12;74(6):551-552.

PMID: 31929488

Coughing is an important reflex mechanism which enhances the clearance of secretions and particulates from the airways, however repetitive muscle strain due to prolonged coughing may cause the uncommon complication of stress fracture of the ribs. The following is an unusual case of cough induced multiple rib fractures associated with subcutaneous emphysema and pneumothorax which was missed in the emergency setting. Delayed diagnosis and treatment would have been avoided if this uncommon condition was considered as a possibility.

Matched MeSH terms: Radiography, Thoracic

A case of missed blunt traumatic aortic injury (BTAI)

Nik Azlan NM, Rossman H

Med J Malaysia, 2017 06;72(3):193-194.

PMID: 28733569 MyJurnal

We are reporting a case of missed blunt traumatic aortic injury (BTAI). A 28 year male presented with chest pain following a motor vehicle accident. He was discharged following normal clinical signs and chest radiograph. The following day he complained of lower limb weakness. Traumatic aortic dissection was revealed via computer tomography (CT) of the thorax. BTAI cannot be ruled out with normal clinical signs and chest radiograph alone. CT thorax is mandatory to rule out BTAI in high impact chest injury.

Matched MeSH terms: Radiography, Thoracic

A case of pulmonary tuberculosis masquerading as lung carcinoma

Tan KT, Kannan SK, Rajahram GS

Med J Malaysia, 2019 12;74(6):547-548.

PMID: 31929486

Tuberculosis is a nimble chameleon. It can manifest itself in various ways with atypical clinical and radiographic findings. In this report we discuss the importance of radiographic findings (nodular or mass-like forms) requiring a correlation with microbiological and histopathological results to differentiate lung cancer from TB.

Matched MeSH terms: Radiography, Thoracic

A discrimination method for the detection of pneumonia using chest radiograph

Noor NM, Rijal OM, Yunus A, Abu-Bakar SA

Comput Med Imaging Graph, 2010 Mar;34(2):160-6.

PMID: 19758785 DOI: 10.1016/j.compmedimag.2009.08.005

This paper presents a statistical method for the detection of lobar pneumonia when using digitized chest X-ray films. Each region of interest was represented by a vector of wavelet texture measures which is then multiplied by the orthogonal matrix Q(2). The first two elements of the transformed vectors were shown to have a bivariate normal distribution. Misclassification probabilities were estimated using probability ellipsoids and discriminant functions. The result of this study recommends the detection of pneumonia by constructing probability ellipsoids or discriminant function using maximum energy and maximum column sum energy texture measures where misclassification probabilities were less than 0.15.

Matched MeSH terms: Radiography, Thoracic*

Fulltext A report of the first three cases of diffuse panbronchiolitis in Malaysia

Zainudin BM, Roslina AM, Fadilah SA, Samad SA, Sufarlan AW, Isa MR

Med J Malaysia, 1996 Mar;51(1):136-40.

PMID: 10967994

Three cases of diffuse panbronchiolitis (DPB) occurring in two Malaysian Chinese patients and one Malay patient are reported. They had similar clinical, radiological and physiological features which are characteristic of DPB. The diagnosis in one of the cases was confirmed histologically by transbronchial lung biopsy. These could be the first three cases identified in Malaysia.

Matched MeSH terms: Radiography, Thoracic

Fulltext Airway stenting for tracheal stenosis

Eng JB, Hooi LN, Ng SH

Med J Malaysia, 1999 Mar;54(1):125-7.

PMID: 10972017

Patients with upper airway obstruction from malignant disease are difficult to manage. A 62 year old patient presented with stridor and was found to have an upper tracheal tumour. Bronchoscopy, dilatation and stenting were performed successfully. The techniques and indications for the use of dynamic airway stent are discussed.

Matched MeSH terms: Radiography, Thoracic

Fulltext An Overview of Deep Learning Techniques on Chest X-Ray and CT Scan Identification of COVID-19

Serena Low WC, Chuah JH, Tee CATH, Anis S, Shoaib MA, Faisal A, et al.

Comput Math Methods Med, 2021;2021:5528144.

PMID: 34194535 DOI: 10.1155/2021/5528144

Pneumonia is an infamous life-threatening lung bacterial or viral infection. The latest viral infection endangering the lives of many people worldwide is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. This paper is aimed at detecting and differentiating viral pneumonia and COVID-19 disease using digital X-ray images. The current practices include tedious conventional processes that solely rely on the radiologist or medical consultant's technical expertise that are limited, time-consuming, inefficient, and outdated. The implementation is easily prone to human errors of being misdiagnosed. The development of deep learning and technology improvement allows medical scientists and researchers to venture into various neural networks and algorithms to develop applications, tools, and instruments that can further support medical radiologists. This paper presents an overview of deep learning techniques made in the chest radiography on COVID-19 and pneumonia cases.

Matched MeSH terms: Radiography, Thoracic/statistics & numerical data

Fulltext An unusual presentation of adult onset Still's disease

Ghosal A, Pal RB, Das SK, Das T

Med J Malaysia, 2012 Oct;67(5):532-3.

PMID: 23770876

Adult onset still's disease usually presents with high grade intermittent fever, polyarthritis, salmon pink evanescent rash and hepatosplenomegaly. Pulmonary involvement in the form of pneumonitis, as a presenting feature is very rare. We report a case of a young lady who presented with fever, cough and respiratory distress. Chest X-ray revealed patchy infiltration in left upper lung zone. She was subsequently diagnosed as Adult onset Still's disease. There was no improvement in clinical condition despite five days of antibiotics. On trans-bronchial lung biopsy (TBLB) proved she had interstitial pneumonitis and responded dramatically to steroid treatment.

Matched MeSH terms: Radiography, Thoracic*

Fulltext Application of phase congruency for discriminating some lung diseases using chest radiograph

Rijal OM, Ebrahimian H, Noor NM, Hussin A, Yunus A, Mahayiddin AA

Comput Math Methods Med, 2015;2015:424970.

PMID: 25918551 DOI: 10.1155/2015/424970

A novel procedure using phase congruency is proposed for discriminating some lung disease using chest radiograph. Phase congruency provides information about transitions between adjacent pixels. Abrupt changes of phase congruency values between pixels may suggest a possible boundary or another feature that may be used for discrimination. This property of phase congruency may have potential for deciding between disease present and disease absent where the regions of infection on the images have no obvious shape, size, or configuration. Five texture measures calculated from phase congruency and Gabor were shown to be normally distributed. This gave good indicators of discrimination errors in the form of the probability of Type I Error (δ) and the probability of Type II Error (β). However, since 1 - δ is the true positive fraction (TPF) and β is the false positive fraction (FPF), an ROC analysis was used to decide on the choice of texture measures. Given that features are normally distributed, for the discrimination between disease present and disease absent, energy, contrast, and homogeneity from phase congruency gave better results compared to those using Gabor. Similarly, for the more difficult problem of discriminating lobar pneumonia and lung cancer, entropy and homogeneity from phase congruency gave better results relative to Gabor.

Matched MeSH terms: Radiography, Thoracic

Applying a statistical PTB detection procedure to complement the gold standard

Noor NM, Yunus A, Bakar SA, Hussin A, Rijal OM

Comput Med Imaging Graph, 2011 Apr;35(3):186-94.

PMID: 21036539 DOI: 10.1016/j.compmedimag.2010.10.002

This paper investigates a novel statistical discrimination procedure to detect PTB when the gold standard requirement is taken into consideration. Archived data were used to establish two groups of patients which are the control and test group. The control group was used to develop the statistical discrimination procedure using four vectors of wavelet coefficients as feature vectors for the detection of pulmonary tuberculosis (PTB), lung cancer (LC), and normal lung (NL). This discrimination procedure was investigated using the test group where the number of sputum positive and sputum negative cases that were correctly classified as PTB cases were noted. The proposed statistical discrimination method is able to detect PTB patients and LC with high true positive fraction. The method is also able to detect PTB patients that are sputum negative and therefore may be used as a complement to the gold standard.

Matched MeSH terms: Radiography, Thoracic/methods*; Radiography, Thoracic/standards*

Fulltext Asbestosis in Malaysia: report on first two cases

Lim HH, Rampal KG, Joginder S, Abu Bakar CM, Chan KH, Vivek TN

Med J Malaysia, 1999 Sep;54(3):364-7.

PMID: 11045065

The first two cases of asbestosis in Malaysia are reported. Both had considerable occupational exposure to asbestos dust in the past, with a long latency period exceeding 30 years. One case presented with distinctive clinical and radiological features, while the other case was only confirmed by histological diagnosis. The usefulness of modern investigation techniques such as CT scan in the diagnosis of asbestosis is also illustrated.

Matched MeSH terms: Radiography, Thoracic

Fulltext Bilateral tension pneumothorax after acupuncture

Mohammad N

BMJ Case Rep, 2018 Apr 19;2018.

PMID: 29674395 DOI: 10.1136/bcr-2017-221550

Acupuncture is an ancient complementary medicine which is currently used worldwide. Many serious adverse events have been reported which include a spectrum of mild-to-fatal complications. However, the level of awareness with regard to complications is still low both to physicians and patients. We report a 63-year-old who presented with acute shortness of breath 2 hours after having had acupuncture. On examination, there was absent breath sound heard on the left lung and slightly reduced breath sound on the right lung. She had type 1 respiratory failure. Urgent chest radiograph confirmed bilateral pneumothorax which was more severe on the left with tension pneumothorax and mediastinal shift. Chest tubes were inserted bilaterally after failed needle aspiration attempts. Subsequently, the pneumothoraces resolved, and she was discharged well. The bilateral pneumothoraces caused by acupuncture were curable but could have been potentially fatal if diagnosis was delayed. This case report adds to the limited current literature on the complications of acupuncture leading to bilateral pneumothoraces.

Matched MeSH terms: Radiography, Thoracic/methods*

Cardiac metastasis: a rare involvement of primitive neuroectodermal tumour of the lung

Ngow HA, Wan Khairina WM

Pathol Oncol Res, 2011 Sep;17(3):771-4.

PMID: 21213128 DOI: 10.1007/s12253-010-9328-9

A 15 year-old adolescent was referred with 2 month history of worsening of breathlessness and haemoptysis. He also reported constitutional symptoms of fever, poor appetite and weight loss. The chest roentgenogram showed a massive right pleural effusion with apparent cardiomegaly. The cardiac silhouette over the right heart border was obliterated and the mediastinum was widened. Computed tomogram of the thorax showed a bulky heterogeneous mass in the right lung with extension to the heart. Subsequent CT guided lung biopsy revealed Primitive Neuroectodermal tumour (PNET). Here, we illustrate the clinical course of an aggressive pulmonary PNET with lethal cardiac metastasis.

Matched MeSH terms: Radiography, Thoracic

Chest Radiograph (CXR) Manifestations of the Novel Coronavirus Disease 2019 (COVID-19): A Mini-review

Chan WY, Hamid MTR, Gowdh NFM, Rahmat K, Yaakup NA, Chai CS

Curr Med Imaging, 2021;17(6):677-685.

PMID: 33390122 DOI: 10.2174/1573405616666201231103312

BACKGROUND: Coronavirus disease 2019 (COVID-19) is highly contagious and has claimed more than one million lives, besides causing hardship and disruptions. The Fleischner Society has recommended chest X-ray (CXR) in detecting cases at high risk of disease progression, for triaging suspected patients with moderate-to-severe illness, and for eliminating false negatives in areas with high pre-test probability or limited resources. Although CXR is less sensitive than real-- time reverse transcription-polymerase chain reaction (RT-PCR) in detecting mild COVID-19, it is nevertheless useful because of equipment portability, low cost and practicality in serial assessments of disease progression among hospitalized patients.

OBJECTIVE: This study aims to review the typical and relatively atypical CXR manifestations of COVID-19 pneumonia in a tertiary care hospital.

METHODS: The CXRs of 136 COVID-19 patients confirmed through real-time RT-PCR from March to May 2020 were reviewed. A literature search was performed using PubMed.

RESULTS: A total of 54 patients had abnormal CXR whilst the others were normal. Typical CXR findings included pulmonary consolidation or ground-glass opacities in a multifocal, bilateral peripheral, or lower zone distribution, whereas atypical CXR features comprised cavitation and pleural effusion.

CONCLUSION: Typical findings of COVID-19 infection in chest computed tomography studies can also be seen in CXR. The presence of atypical features associated with worse disease outcome. Recognition of these features on CXR will improve the accuracy and speed of diagnosing COVID-19 patients.

Matched MeSH terms: Radiography, Thoracic*

Fulltext Chest Radiograph Findings In Novel Swine-Origin Influenza A (H1N1) Virus (S-OIV) Infection: A UKMMC Experience

Norzailin AB, Norhafizah E

Med J Malaysia, 2015 Apr;70(2):93-7.

PMID: 26162384 MyJurnal

OBJECTIVE: 1.To evaluates and recognizes findings in chest radiograph in patients with laboratory-confirmed S-OIV (H1N1) infection treated at UKMMC. 2. To evaluate whether the findings on initial chest radiographs of influenza A (H1N1) patients can help to predict the prognosis.

MATERIAL AND METHODS: Total of 109 adult patients presenting to the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with flu-like symptoms who were positive for influenza A and these patients had underwent chest radiographs (CXR). The initial CXRs were evaluated for the pattern (consolidation, ground-glass, and reticulation), distribution, and extend of abnormality. The disease is classifies by the clinical severity (mild, moderate or severe illness) and adverse outcome (ventilated, death or recovered well).

RESULTS: The initial CXRs were normal in 56% of cases. The predominant radiographic finding was consolidation, most commonly involving the middle and lower zones (35% of cases). There is no significant association between initial CXR findings with the patient clinical outcome either fully recovered or death/ ventilated.

CONCLUSION: Normal chest radiographs is the most common radiographic finding in S-OIV (H1N1) infection and the most common abnormal lung finding is consolidation. Initial chest radiographs did not determine the patient clinical outcome and a normal initial radiograph could not exclude adverse outcome.

Matched MeSH terms: Radiography, Thoracic

Fulltext Chest x-ray as an essential part of routine medical examination: is it necessary?

Izamin I, Rizal AM

Med J Malaysia, 2012 Dec;67(6):606-9.

PMID: 23770954 MyJurnal

INTRODUCTION: Various studies in primary care and hospitalized patients have discouraged routine use of chest x-ray (CXR) in medical examination.
PURPOSE: The study aims to determine the prevalence of abnormal routine CXR and cost of one CXR at a public health clinic and discuss the rationale of CXR in routine medical examination.
METHODOLOGY: Data of patients who visited Klinik Kesihatan Bandar Kota Bharu (KKBKB), a public health clinic, from 1 January until 31 December 2010 were examined. The study used cross-sectional design. All patients who came for medical examination and CXR at KKBKB were included. Cost analysis was performed from the perspective of provider.
FINDINGS: About 63.1% of 8315 CXR films in KKBKB were produced as part of routine medical examination. Prevalence of abnormal CXR was 0.25%. The cost of producing one CXR ranges from RM15.87 to RM32.34.
DISCUSSION: Low yield from CXR screening and high cost of CXR are the main concern. CXR screening would also lead to unnecessary radiation; and false-positive screening resulting in physical risk, unwarranted anxiety and more expenditure. CXR screening is appropriately reserved for high-risk patients and those with relevant clinical findings.

Matched MeSH terms: Radiography, Thoracic*

Clear cell "sugar" tumour of the lung: a case report

Shiran MS, Tan GC, Arunachalam N, Sabariah AR, Pathmanathan R

Malays J Pathol, 2006 Dec;28(2):113-6.

PMID: 18376801

We report a case of clear cell "sugar" tumour of the lung (CCTL) occurring in a 26-year-old lady. The patient was asymptomatic and the lesion was picked up in the course of a pre-employment medical examination. A well-defined 5 cm nodule in the right lower lobe was detected on routine chest X-Ray. Microscopical examination of the coin lesion showed clear cells containing abundant diastase-sensitive intracytoplasmic glycogen, as demohstrated with periodic acid-Schiff stains. Tumour immunoreactivity for HMB-45 and non-reactivity for cytokeratin support the histological diagnosis. To our knowledge, this is the first reported case of CCTL in Malaysia.

Matched MeSH terms: Radiography, Thoracic

Fulltext Coinfection of leprosy and tuberculosis

Shetty S, Umakanth S, Manandhar B, Nepali PB

BMJ Case Rep, 2018 Mar 15;2018.

PMID: 29545426 DOI: 10.1136/bcr-2017-222352

Leprosy and tuberculosis (TB) are endemic to India, however, their coinfection is not frequently encountered in clinical practice. Here, we report a 32-year-old female patient who presented with a history of high-grade intermittent fever, cough and painless skin lesions since a month, along with bilateral claw hand (on examination). The haematological profile was suggestive of anaemia of chronic disease, chest radiograph showed consolidation, sputum smears were positive for Mycobacterium tuberculosis, and skin slit smear confirmed leprosy. The patient was prescribed WHO recommended multidrug therapy for multibacillary leprosy with three drugs. Additionally, prednisolone was added to her regimen for 2 weeks to treat the type 2 lepra reaction. For treatment of TB, she was placed on the standard 6-month short course chemotherapy. She was lost to follow-up, and attempts were made to contact her. Later, it came to our notice that she had discontinued medications and passed away 3 months after diagnosis.

Matched MeSH terms: Radiography, Thoracic

Computed and conventional chest radiography: a comparison of image quality and radiation dose

Ramli K, Abdullah BJ, Ng KH, Mahmud R, Hussain AF

Australas Radiol, 2005 Dec;49(6):460-6.

PMID: 16351609

The aim of this study was to compare the image quality and entrance skin dose (ESD) for film-screen and computed chest radiography. Analysis of the image quality and dose on chest radiography was carried out on a conventional X-ray unit using film-screen, storage phosphor plates and selenium drum direct chest radiography. For each receptor, ESD was measured in 60 patients using thermoluminescent dosemeters. Images were printed on 35 x 43 cm films. Image quality was assessed subjectively by evaluation of anatomic features and estimation of the image quality, following the guidelines established by the protocols of the Commission of the European Communities. There was no statistically significant difference noted between the computed and conventional images (Wilcoxon rank sum test, P > 0.05). Imaging of the mediastinum and peripheral lung structures were better visualized with the storage phosphor and selenium drum technique than with the film-screen combination. The patients' mean ESD for chest radiography using the storage phosphor, film-screen combination and selenium drum was 0.20, 0.20 and 0.25 mGy, respectively, with no statistically significant difference with P > 0.05 (chi(2) tests).

Matched MeSH terms: Radiography, Thoracic/methods*

Fulltext Computed tomographic findings of cerebral fat embolism following multiple bone fractures

Law HL, Wong SL, Tan S

Singapore Med J, 2013 Feb;54(2):e28-30.

PMID: 23462838

Fat embolism to the lungs and brain is an uncommon complication following fractures. Few reports with descriptions of computed tomographic (CT) findings of emboli to the brain or cerebral fat embolism are available. We report a case of cerebral fat embolism following multiple skeletal fractures and present its CT findings here.

Matched MeSH terms: Radiography, Thoracic

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