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  1. Fulltext A case of primary pleural synovial sarcoma with endobronchial recurrence
    Wan JL, Lam YF, Foong KW, Abdul Ghani N, Lachmanan K
    Respirol Case Rep, 2020 Apr;8(3):e00547.
    PMID: 32166036 DOI: 10.1002/rcr2.547
    Primary pleural synovial sarcoma (PPSS) is an extremely rare malignancy without a known cause. The diagnosis is made after excluding metastasis from an extra-thoracic sarcoma. We report a case of a 67-year-old gentleman who presented with an incidental finding of a left lung mass on a routine chest X-ray. A computed tomography (CT) of the thorax and whole-body positron emission tomography (PET)-CT was done confirming a left lung mass with no other extra-thoracic involvement. A lobectomy was performed with a diagnostic and therapeutic intent. The histopathological examination and immunohistochemistry study revealed a pleural-based tumour with features suggestive of synovial sarcoma. Subsequently, he underwent post-operative radiotherapy. However, three months later, he developed an endobronchial recurrence, complicated by post-obstructive pneumonia resulting in his demise. This case highlights a rare form of malignancy with a rare site of recurrence.
    Matched MeSH terms: Thorax
  2. The Cobblestone Heart
    Tan WJ, Suz CS, Azza O, Zuki M
    Med J Malaysia, 2021 03;76(2):241-244.
    PMID: 33742636
    Sarcoidosis is a chronic, multisystem disorder. A 38 years old lady presented at Hospital Raja Perempuan Zainab II, Kota Bharu ,Malaysia with cough and breathless for 2 months and constitutional symptoms of weight loss and loss of appetite. She was initially treated as smear negative pulmonary tuberculosis for 5 months. However, her clinical condition deteriorated with worsening New York Heart Association (NYHA) class 1 to class 3. Subsequently, workout of computed tomography( CT) thorax showed multiple perilymphatic distribution of nodules and multiple mediastinal lymphadenopathy coupled with pleura biopsy showed non caseating granuloma and cardiac magnetic resonance imaging (MRI) with positive late gadolinium enhancement revised the diagnosis of pulmonary sarcoidosis with cardiac involvement. Patient's functional status and cough improved with immunosuppresant was given in tapering dose fashion.
    Matched MeSH terms: Thorax
  3. Fulltext Kashima operation: an endoscopic phonosurgery by laser for bilateral vocal cord palsy
    Alamgir Chowdhury, M., Farid Hossain Chowdhury, Khaled Bin Shahabuddin, Tofazzal Hossain, A.B.M., Shaila Kabir
    Borneo Journal of Medical Sciences, 2021;15(1):31-35.
    MyJurnal
    Complete or partial restriction of the vocal cords usually occurs due to cancer, neurologic causes or mechanical causes like huge neck mass, trauma to the neck, viral infection, and sometimes iatrogenic during surgery. Bilateral vocal cord palsy is a severe condition that can lead to significant problems in breathing, speaking, and swallowing. If any patient presents with stridor, it requires urgent surgical airway management followed by specific treatment. A case of viral bilateral abductor vocal cord palsy in a 41-year-old female is reported here. The patient presented with stridor, and immediate tracheostomy was done. The stridor developed first 3 months earlier followed by cold and fever for a week. The stridor worsened gradually and leads to a state of commencing immediate tracheostomy. There was no history of trauma to the neck or any neck surgery. All basic laboratory blood test was within the normal limit. The laryngoscopic examination showed both vocal cords were immobile and almost median position with a small gap at the posterior commissure. Chest and neck plain X-ray along with computed tomography scan of neck was normal which ruled out the other causes of bilateral vocal cord palsy. The patient subsequently underwent successful left posterior cordectomy by laser, and decannulation of tracheostomy was done, known as Kashima operation.
    Matched MeSH terms: Thorax
  4. Fulltext Spontaneous oesophageal perforation: a case report
    Shu Ann Hon, Jan Jan Chai, Lian Thai Lee, Qin Jian Low
    Malaysian Journal of Medicine and Health Sciences, 2020;16(2):326-328.
    MyJurnal

    A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesoph- agogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.
    Matched MeSH terms: Pneumothorax; Thorax
  5. Single-stage open repair of severe asymmetric pectus excavatum and mitral valve replacement in connective tissue disease
    Pau CP, Chong KS, Yakub MA, Khalil AA
    Asian Cardiovasc Thorac Ann, 2021 May 04.
    PMID: 33947231 DOI: 10.1177/02184923211014004
    We present a 14-year-old boy with Loey-Dietz syndrome with severe mitral regurgitation, pectus excavatum and scoliosis. The Haller index was 25. The heart was displaced into the left hemithorax. The right inferior pulmonary vein was very close to the sternum and vertebral body. Single-stage surgery was performed. An osseo-myo-cutaneous pedicled flap was created by sterno-manubrial junction dislocation and rib resection with bilateral internal mammary arteries supplying the flap. Cardiopulmonary bypass and mitral valve replacement was performed. The defect was bridged with three straight plates. The flap was laid on top and anchored. Early outcome at three months was good.
    Matched MeSH terms: Thorax
  6. Fulltext Aggressive scalp and sternal lesion: A presentation of rare case of metastatic eccrine carcinoma
    Rownose CS, Mohamad Saupi MS, Sharif SZ, Lah NASN
    Ann Med Surg (Lond), 2021 May;65:102322.
    PMID: 33996055 DOI: 10.1016/j.amsu.2021.102322
    Introduction: Ductal Eccrine carcinoma (DEC) is a rare primary cutaneous tumor that exhibits both squamous and adnexal ductal differentiation. Due to its rarity in clinical practice we present as case of DEC and a literature review on the latest management of this rare disease.

    Case presentation: We report a case 41 years old female presented with lesion on the scalp and sternal mass, increasing in size with itchiness and erythematous for 6 months duration. Further CECT scan of brain and neck shows features of malignant left frontal scalp lesion with poor plane with overlying skin and underlying skull bone and CECT of thorax shows a large, irregular heterogeneously enhancing mass with necrotic center noted at right hilar within superior segment of right lower lobe, encasing right middle and lower lobe bronchi. Wedge biopsy of scalp lesion showed an intradermal lesion extensively infiltrating by malignant gland accompanied by desmoplasia and the tumor cells are seen extending into the surgical margins suggestive of ductal eccrine carcinoma.Clinical Discussion:This case highlights the importance and challenges in achieving early diagnosis coupled with the scarcity of information on these leads to difficulty in managing this patient.

    Conclusion: In managing Ductal Eccrine Carcinoma tumor, standard method of treatment for has not been established. However, wide surgical excision is the treatment of choice for localized lesions. Regarding prognosis, there is conflicting data published which we describe in this article.

    Matched MeSH terms: Thorax
  7. Fulltext Anterior penetrating chest injury with left ventricular thrombus
    Ruth Sabrina, S., Nik Azlan, N.M., Adi, O.
    Medicine & Health, 2013;8(1):28-32.
    MyJurnal
    Urban cities are synonym with a high incidence of penetrating chest injuries either from accidents or interpersonal violence. The outcome of penetrating chest wound can vary from immediate death to a prolonged morbidity. We here report a case of 39-year-gentleman who presented to Emergency Department Hospital Raja Permaisuri Bainun, Ipoh, Perak after being stabbed to the chest. His anterior penetrating chest wound was located at the 5th intercostal space medial to the midclavicular line. The stab wound penetrated the myocardium, causing minimal myocardial rupture. He also suffered from left haemothorax and hemopericardium. The haemothorax was drained with insertion of 32 French chest tube. The patient was admitted under the cardiothoracic team and discharged five days later without surgical intervention. He presented again to the Emergency Department with complains of shortness of breath and pleuritic pain. A left ventricular thrombus was detected via echocardiography. Unfortunately, he took his own discharge. Five days later he came again to Emergency Department with sporadic of loss of vision. The mural thrombus dislodged and embolized to the retinal artery causing amaurosis fugax. The patient was treated with aspirin 150mg and his symptoms subsequently resolved.
    Matched MeSH terms: Hemothorax; Thorax
  8. Fulltext A Rejang river rash
    Lim JL
    Malays Fam Physician, 2014;9(1):33-34.
    PMID: 25606297 MyJurnal
    A 30-year-old Iban woman presented to a rural primary healthcare clinic located along the Batang Rejang in Sarawak. She had a 2-day history of rash, which started over her trunk and later spread to her face and limbs. What started out as individual erythematous maculopapular spots later coalesced to form larger raised blotches. The rash was extremely pruritic and affected her sleep, and hence her visit. The rash was preceded by high grade, persistent fever that was temporarily relieved by paracetamol. She also complained of malaise, arthralgia and myalgia. Her appetite had been poor since the onset of the fever. She lived in a long house at the edge of the jungle. Although she did not have a history of going into the jungle to forage, she went regularly to the river to wash clothes. Clinically, she appeared lethargic and had bilateral conjunctival injection. Her left anterior cervical lymph nodes were palpable. There were erythematous macules measuring 5 to 15 mm distributed over her whole body but predominantly over the chest and abdominal region (Figure 1). An unusual skin lesion was discovered at the right hypochondriac region. This lesion resembled a cigarette burn with a necrotic centre (Figure 2). There was no evidence of hepato-splenomegaly. Examination of the other systems was unremarkable. On further questioning, the patient admitted being bitten by a ‘kutu babi’ or mite 3 days before the onset of her fever.
    Matched MeSH terms: Thorax
  9. Fulltext Loculated transudative pleural effusion masquerading as right upper lobe consolidation in a haemodialysis patient
    Kho SS, Tay PS, Lee J, Tie ST
    AME Case Rep, 2017;1:4.
    PMID: 30263991 DOI: 10.21037/acr.2017.09.05
    Pleural effusion is a common encounter in renal failure patients and frequently possess a diagnostic challenge to clinician especially when it was exudative. Fortunately, transudative pleural effusion secondary to fluid overload remains the commonest cause of pleural effusion in haemodialysis patients. Frequent thoracocentesis enhance pleural inflammation and potentially complicate further this challenging clinical presentation. We report a middle-aged gentleman with advanced chronic kidney disease presented with dyspnea and new right upper lobe consolidation on chest roentograph. He had a history of recurrent bilateral pleural effusion secondary to fluid overload and hence multiple attempts of thoracocentesis were performed. Medical thoracoscopy performed previously yielded non-specific pleuritis. Flexible bronchoscopy demonstrates normal airway with negative microbiological studies. Computed tomography (CT) of the thorax shown a loculated hypodense pleural effusion at the apical region of the right upper lobe. Ultrasound guided thoracocentesis anteriorly yield 400 mL of clear straw color fluid which was transudative by Light's criteria. Post tapping chest X-ray shown complete resolution of right upper lobe consolidation and patient reports immediate relieve of dyspnea. Patient was started on regular effective haemodialysis and pleural effusion did not recur during follow up. Loculated pleural effusion masquerading as mediastinal tumour had been reported but pleural effusion that conformed to the contour of a lung lobe is rare. This case highlights the atypical but unique presentation of a transudative pleural effusion and demonstrates the risk of repeated thoracocentesis complicating a simple clinical presentation.
    Matched MeSH terms: Thorax
  10. Fulltext Metastatic Bone Disease Secondary to Bronchial Adenocarcinoma in a Patient with Paget's Disease of the Bone
    Lim KP, Kok WH, Kamaruddin NA
    J ASEAN Fed Endocr Soc, 2018;33(1):63-68.
    PMID: 33442113 DOI: 10.15605/jafes.033.01.11
    A 69-year-old female complained of intermittent left hip pain for the past 3 years. Biochemical tests revealed normal serum calcium and phosphorus with markedly raised alkaline phosphatase. MRI of the hip revealed extensive marrow signal abnormalities at the left pelvic bone, while CT of the thorax revealed a spiculated lung nodule at the left lower lung lobe. In order to diagnose either primary, metastatic bone tumour or Paget's disease of the bone (PDB), an open biopsy of the left iliac bone was performed. The histopathology of bone biopsy of the left iliac bone was consistent with PDB. A CT guided biopsy of the lung mass done later revealed adenocarcinoma of the lung. She had 18F-FDG PETCECT Scan for staging evaluation and result was suggestive of new bony metastases. Patient was started on IV Zoledronic acid for treatment of the PDB. In view of the stage 4 lung adenocarcinoma with bony metastases, patient was scheduled for palliative chemotherapy.
    Matched MeSH terms: Thorax
  11. Fulltext Unusual manifestation of cutaneous toxoplasmosis in a HIV-positive patient
    Fong MY, Wong KT, Rohela M, Tan LH, Adeeba K, Lee YY, et al.
    Trop Biomed, 2010 Dec;27(3):447-50.
    PMID: 21399585 MyJurnal
    We report a case of unusual cutaneous toxoplasmosis manifestation in a HIV-positive patient. He presented with hard and painful nodular lesions on the arms, hands and chest. Serology tests for anti-Toxoplasma antibody were negative. However, histopathologic examination of the lesion revealed foci of macrophages containing crescent-shaped organisms resembling the zoites of the protozoan parasite Toxoplasma gondii. Ultrastructure examination under electron microscopy and PCR confirmed the organism as T. gondii.
    Matched MeSH terms: Thorax/pathology
  12. THE CONSISTENCY OF EXPOSURE INDICATOR VALUES IN DIGITAL RADIOGRAPHY SYSTEMS
    Jamil A, Mohd MI, Zain NM
    Radiat Prot Dosimetry, 2018 Dec 01;182(4):413-418.
    PMID: 29767799 DOI: 10.1093/rpd/ncy082
    After years of establishment of computed radiography (CR) and digital radiography (DR), manufacturers have introduced exposure indicator/index (EI) as a feedback mechanism for patient dose. However, EI consistency is uncertain for CR. Most manufacturers recommended EI values in a range of numbers for all examination, instead of giving the exact range for a specific body part, raising a concern of inappropriate exposure given to the patient in clinical practice. The aims of this study were to investigate the EI consistency in DR systems produced in constant exposure parameters and clinical condition, and to determine the interaction between the anatomical part and EI. A phantom study of skull, chest, abdomen and hand was carried out and four systems were used for comparison-Fuji CR, Carestream CR, Siemens DR and Carestream DR. For each projection, the phantom positioning and exposure parameters were set according to the standard clinical practice. All exposure parameters and clinical conditions were kept constant. Twenty (20) exposures were taken for each projection and the EI was recorded. Findings showed that EI is not consistent in DR systems despite constant exposure parameters and clinical condition except in Siemens DR, through skull examination. Statistical analysis showed a significant interaction between anatomical parts and EI values (P < 0.05). EI alone was proven to be less reliable to provide technologist a correct feedback on exposure level. The interaction between anatomical parts and EI values intensifies the need for an anatomical-specific EI values set by all manufacturers for accurate feedback on the exposure parameters used and the detector entrance dose.
    Matched MeSH terms: Thorax/radiation effects
  13. Fulltext Tracheotomy: an alternative for tracheobronchial foreign body removal
    Tang CL, Lee SC, Mohamad Lal A, Thomas RA, Ngui LX, Lim LY
    Med J Malaysia, 2014 Oct;69(5):241-3.
    PMID: 25638243 MyJurnal
    A 6 years old girl accidentally aspirated a plastic whistle while playing. Computed Tomography of thorax showed foreign body at carina level. Rigid bronchoscope under general anesthesia was attempted but unable to extract the whistle through vocal cord. Tracheostomy was later performed and foreign body was removed.
    Matched MeSH terms: Thorax
  14. Fulltext Vanishing lung syndrome Masquerading as bilateral pneumothorax: A case report
    Muhamad NI, Mohd Nawi SN, Yusoff BM, Ab Halim NA, Mohammad N, Wan Ghazali WS
    Respir Med Case Rep, 2020;31:101276.
    PMID: 33209576 DOI: 10.1016/j.rmcr.2020.101276
    Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.
    Matched MeSH terms: Pneumothorax; Thorax
  15. Fulltext Single rare central lesion with triple common aerodigestive symptoms
    Mohamad I, Mohamad IS, Nik Hassan N
    Malays Fam Physician, 2018;13(1):57-58.
    PMID: 29796215 MyJurnal
    An elderly gentleman with a known history of
    well-controlled hypertension presented with
    a three-week history of hoarseness associated
    with mild breathlessness. There was no episode
    of cyanosis, no noisy breathing, and no
    reduction in effort tolerance. There was also no
    history of chest pain or orthopnea. He denied
    any feeling of food stuck in his throat or chest,
    and he had no history of choking sensations
    during meals. He, however, was unable to
    count from 1 to 10 in one breath, and lung
    auscultation revealed reduced air entry on both
    sides. A chest radiograph was then obtained. (Copied from article).
    Matched MeSH terms: Thorax
  16. Fulltext A case of lymphangioleiomyomatosis with multiple angiomyolipomas in the kidneys: a case report
    How, S.H., Azlin, S., Pang, Y.K., Liam, C.K.
    JUMMEC, 2006;9(2):35-38.
    MyJurnal
    Lymphangioleiomyomatosis (LAM) is a rare disease. The reported prevalence is around one per million in the West but the exact prevalence in Asia is unknown. It affects primarily young women of reproductive age, with a mean age of onset at 34 years. The disease is characterised by an abnormal proliferation of smooth muscle-like cells that grow over a course of time to obstruct airways, lymphatic and blood vessels. We report a case of LAM in a young woman who presented with a spontaneous pneumothorax. Computed tomography scan of the thorax and abdomen showed homogenous thin-walled cystic lesions with normal intervening lung parenchyma and multiple lesions in her kidneys with Hounsfield units similar to that of fat.
    Matched MeSH terms: Pneumothorax; Thorax
  17. Vector competence of Malaysian Aedes aegypti to Zika virus and impact of sequential arbovirus infections
    Ong NH, Chua CL, Liew JWK, Wan Sulaiman WY, Chan YF, Sam IC, et al.
    Acta Trop, 2020 Aug;208:105472.
    PMID: 32389451 DOI: 10.1016/j.actatropica.2020.105472
    Zika virus (ZIKV) is a mosquito-borne flavivirus with global impact since 2015. Although ZIKV was first isolated from Aedes aegypti in Malaysia in 1965, not much is known about the competency of Malaysian Ae. aegypti to ZIKV. To date only 9 cases of ZIKV have been reported in Malaysia despite the abundance of mosquito vectors. This study aimed to determine the susceptibility of Ae. aegypti to ZIKV, and the impact of sequential infections in Ae. aegypti mosquitoes with DENV serotype 2 (DENV-2) followed by ZIKV. Field-caught urban Ae. aegypti were orally challenged with a Martinique strain of ZIKV, and midgut, head/thorax and saliva were collected at 3, 7 and 14 days post-infection (dpi). At 14 dpi, ZIKV-exposed mosquitoes had infection and dissemination rates of 59% (n=10/17) and 90% (n=9/10), respectively. Average titres of 3.9 and 4.4 log pfu infectious ZIKV were recovered in midgut and head/thorax, respectively. In sequential infection, prior exposure of Ae. aegypti to DENV did not affect the subsequent ZIKV infection in head/thorax albeit with a low sample size. In conclusion, Malaysian urban Ae. aegypti is susceptible to the contemporary Asian lineage of ZIKV. The established and continuous DENV circulation in Ae. aegypti did not suppress ZIKV emergence in Malaysia. Other factors contributing to low level of ZIKV circulation in Malaysia remain to be explored.
    Matched MeSH terms: Thorax
  18. Contactless respiration rate measurement using optical method and empirical mode decomposition
    Gan KB, Yahyavi ES, Ismail MS
    Technol Health Care, 2016 Sep 14;24(5):761-8.
    PMID: 27163300 DOI: 10.3233/THC-161161
    BACKGROUND: At the emergency triage center, assessment of the present of the danger signs and measurement of vital signs are measured according to the guidelines. The respiration rate is still posing a challenge to the doctor as it is impractical to use conventional devices. Attaching measurement devices to the patient will induce artificial measurements (self-awareness stress effects) besides being time-consuming. Currently, the medical officers visually count the number of times the chest movement in a minute, sometimes poses cultural challenges especially for female patients.

    OBJECTIVE: The main objective of this paper is to develop a robust algorithm to extract respiration rate using the contactless displacement sensor.

    METHODS: In this study, chest movements were used as an indicative of inspiration and expiration to measure respiratory rate using the contactless displacement sensor. The contactless optical signals were recorded from 32 healthy subjects in four different controlled breathing conditions: rest, coughing, talking and hand movement to obtain the motion artifacts that the patients may have in the emergency department. The Empirical mode decomposition (EMD) algorithm was used to derive continuous RR signal from the contactless optical signal.

    RESULTS: The analysis showed that there is a good correlation (0.9702) with RMSE of 0.33 breaths per minutes between the contact respiration rate and contactless respiration rate using empirical mode decomposition method.

    CONCLUSION: It can be concluded that the empirical mode decomposition method can extract the respiration rate of the contactless optical signal from chest movement.

    Matched MeSH terms: Thorax/physiology*
  19. Studies on the Malayan forest rat filaria, Breinlia booliati (Filarioidea: Onchocercidae): transmission to laboratory rats
    Ho BC, Singh M, Yap EH, Lim BL
    Int J Parasitol, 1976 Apr;6(2):113-6.
    PMID: 1262122
    Matched MeSH terms: Thorax/parasitology
  20. Psychometric evaluation of the shortened version of the Functional Difficulties Questionnaire to assess thoracic physical function
    Katijjahbe MA, Denehy L, Granger CL, Royse A, Royse C, Logie S, et al.
    Clin Rehabil, 2020 Jan;34(1):132-140.
    PMID: 31610700 DOI: 10.1177/0269215519879476
    OBJECTIVE: The aim of this study was to investigate the psychometric properties of the shortened version of the Functional Difficulties Questionnaire (FDQ).

    DESIGN: This is a multisite observational study.

    SETTING: The study was conducted in four tertiary care hospitals in Australia.

    SUBJECTS: A total of 225 participants, following cardiac surgery, were involved in the study.

    INTERVENTION: Participants completed the original 13-item FDQ and other measures of physical function, pain and health-related quality of life.

    METHOD: Item reduction was utilized to develop the shortened version. Reliability was evaluated using intraclass correlation coefficients (ICCs), the smallest detectable change and Bland-Altman plots. The validity and responsiveness were evaluated using correlation. Anchor and distribution-based calculation was used to calculate the minimal clinical important difference (MCID).

    RESULTS: Item reduction resulted in the creation of a 10-item shortened version of the questionnaire (FDQ-s). Within the cohort of cardiac surgery patient, the mean (SD) for the FDQ-s was 38.7 (19.61) at baseline; 15.5 (14.01) at four weeks and 7.9 (12.01) at three months. Validity: excellent internal consistency (Cronbach's α > 0.90) and fair-to-excellent construct validity (>0.4). Reliability: internal consistency was excellent (Cronbach's α > 0.8). The FDQ-s had excellent test-retest reliability (ICC = 0.89-0.92). Strong responsiveness overtime was demonstrated with large effect sizes (Cohen's d > 1.0). The MCID of the FDQ-s was calculated between 4 and 10 out of 100 (in cm).

    CONCLUSION: The FDQ-s demonstrated robust psychometric properties as a measurement tool of physical function of the thoracic region following cardiac surgery.

    Matched MeSH terms: Thorax/physiopathology*
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