MyMedR

Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma

Haron H, Yusof MR, Maskon O, Ooi J, Rahman MR

Heart Surg Forum, 2012 Feb;15(1):E59-60.

PMID: 22360910 DOI: 10.1532/HSF98.20111000

Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.

Matched MeSH terms: Fibroma/ultrasonography; Heart Neoplasms/ultrasonography; Mitral Valve Insufficiency/ultrasonography; Papillary Muscles/ultrasonography*; Tricuspid Valve/ultrasonography*; Tricuspid Valve Insufficiency/ultrasonography

Relation of Doppler ultrasound synovitis versus clinical synovitis with changes in native complement component levels in rheumatoid arthritis patients treated with biologic disease-modifying anti-rheumatic drugs

Montoro Alvarez M, Chong OY, Janta I, González C, López-Longo J, Monteagudo I, et al.

Clin Exp Rheumatol, 2015 Mar-Apr;33(2):141-5.

PMID: 25665178

The complement system plays a fundamental role in mediating the activity of rheumatoid arthritis (RA). Biologic therapy can reduce native complement component levels and its activation. We aimed to study the relation of Doppler ultrasound (US) synovitis versus clinical synovitis with changes in native complement component levels in RA patients on biologic therapy.

Matched MeSH terms: Arthritis, Rheumatoid/ultrasonography; Synovial Membrane/ultrasonography; Synovitis/ultrasonography; Ultrasonography, Doppler*

Atrial septal defect coexistent with Sjögren's syndrome

Ahmad F, Sadiq MA, Chee KH, Mahmood Zuhdi AS, Wan Ahmad WA

J Coll Physicians Surg Pak, 2014 Jun;24(6):441-3.

PMID: 24953923 DOI: 06.2014/JCPSP.441443

Pulmonary hypertension is frequently associated with atrial septal defect and various connective tissue disorders. This case describes a 74-year-old woman who presented with symptoms of heart failure and concomitant involvement of salivary glands and keratoconjunctivitis. An echocardiogram demonstrated ostium secundum atrial septal defect with left to right shunt and severe pulmonary hypertension. Laboratory investigations confirmed the diagnosis of Sjögren's syndrome (SS) with positive anti-nuclear factor and centromere SS-A/Ro pattern. Anti-Ro (SS-A) was found positive. Atrial septal defect was closed through transcatheter route with significant improvement in clinical outcome. This case report suggests a possible association of atrial septal defect with primary Sjögren's syndrome in an adult patient.

Matched MeSH terms: Heart Septal Defects, Atrial/ultrasonography; Ultrasonography, Doppler

Fulltext Symptomatic presentation of carotid sinus hypersensitivity is associated with impaired cerebral autoregulation

Tan MP, Chadwick TJ, Kerr SR, Parry SW

J Am Heart Assoc, 2014 Jun;3(3):e000514.

PMID: 24947997 DOI: 10.1161/JAHA.113.000514

Carotid sinus hypersensitivity (CSH) is associated with syncope, unexplained falls, and drop attacks in older people but occurs asymptomatically in 35% of community-dwelling elders. We hypothesized that impaired cerebral autoregulation is associated with the conversion of asymptomatic CSH to symptomatic CSH. We therefore conducted a case-control study evaluating individuals with CSH with and without the symptoms of syncope or unexplained falls, as well as non-CSH controls, to determine whether the blood pressure and heart rate changes associated with CSH are associated with symptoms only when cerebral autoregulation is altered.

Matched MeSH terms: Ultrasonography, Doppler, Transcranial; Middle Cerebral Artery/ultrasonography

Fulltext Imaging findings of a primary bladder maltoma

Maninderpal KG, Amir FH, Azad HA, Mun KS

Br J Radiol, 2011 Sep;84(1005):e186-90.

PMID: 21849361 DOI: 10.1259/bjr/66130737

Secondary involvement of the urinary bladder in non-Hodgkin's lymphoma is relatively common; however, primary malignant lymphoma of this organ is extremely rare. The most common type of primary bladder lymphoma is a low-grade B-cell mucosa-associated lymphoid tissue (MALT) lymphoma. We report here on the imaging findings of a primary bladder lymphoma with bone marrow infiltration.

Matched MeSH terms: Urinary Bladder Neoplasms/ultrasonography; Lymphoma, B-Cell, Marginal Zone/ultrasonography

Fulltext The eyes have it - A diagnostic challenge

Loh KY, Kew ST

Aust Fam Physician, 2010 Sep;39(9):647-8.

PMID: 20877768

Matched MeSH terms: Hepatolenticular Degeneration/ultrasonography; Liver Cirrhosis/ultrasonography

The effects of age, physical activity level, and body anthropometry on calcaneal speed of sound value in men

Chin KY, Soelaiman IN, Mohamed IN, Ibrahim S, Wan Ngah WZ

Arch Osteoporos, 2012;7:135-45.

PMID: 23225291 DOI: 10.1007/s11657-012-0091-2

The influences of age, physical activity, and body anthropometry on calcaneal speed of sound are different among young adults, middle-aged, and elderly men.

Matched MeSH terms: Calcaneus/ultrasonography*; Osteoporosis/ultrasonography*

Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and Blalock Taussig shunt

Alwi M, Geetha K, Bilkis AA, Lim MK, Hasri S, Haifa AL, et al.

J Am Coll Cardiol, 2000 Feb;35(2):468-76.

PMID: 10676696

We compared the result of radiofrequency (RF)-assisted valvotomy and balloon dilation with closed surgical valvotomy and Blalock Taussig (BT) shunt as primary treatment in selected patients with pulmonary atresia and intact ventricular septum (PA-IVS).

Matched MeSH terms: Heart Septal Defects/ultrasonography; Pulmonary Atresia/ultrasonography

Fulltext Tumoral cystitis in children

Zulfiqar MA, Zaleha AM, Zulkifli I, Chia WY, Samad SA

Med J Malaysia, 1998 Sep;53(3):284-7.

PMID: 10968168

Three children aged 3-11 years had ultrasonography of the urinary tract for the investigation of dysuria and haematuria. A bladder mass was seen in these 3 children. One child had computed tomography scan, cystoscopy and bladder biopsy because rhabdomyosarcoma was considered. The biopsy revealed an inflammatory process. The urine culture of the other 2 children revealed E. coli. On ultrasonography, the inflammatory mass may appear homogeneously hypoechoic or may contain moderate level echoes. The mucosal surface of the mass may be smooth or lobulated. It is important to consider an infective cause for a bladder mass in children because computed tomography, cystoscopy and biopsy may be avoided.

Matched MeSH terms: Urinary Bladder Neoplasms/ultrasonography*; Cystitis/ultrasonography*

Fulltext Prevalence, clinical predictors and diagnosis of gastro-oesophageal reflux in children with persistent respiratory symptoms

Siti Mazliah K, Norzila MZ, Deng CT, Zulfiqar A, Azizi BHO

Med J Malaysia, 2000 Jun;55(2):180-7.

PMID: 19839146

Objectives: This was a cross sectional study conducted in the Paediatric Institute among infants and children with chronic respiratory symptoms with the following objectives: i) to determine the prevalence of gastro-oesophageal reflux in children with persistent respiratory symptoms, ii) to identify the clinical predictors of GOR (Gastro-oesophageal reflux) in children with persistent respiratory symptoms and iii) assess the validity of abdominal ultrasound, barium oesophagogram and chest radiograph in diagnosing GOR in these patients.
Materials and Methods: Forty-four patients were recruited over a period of six months. All the presenting symptoms were identified. The patients were subjected to chest radiograph, abdominal ultrasound, barium oesophagogram and 24-hour pH oesophageal monitoring.
The predictive validity of clinical symptoms, chest radiograph, abdominal ultrasound and barium oesophagogram were assessed. Twenty-four hours oesophageal pH was the gold standard to diagnose GOR.
Results: The mean age of patients was 9.1 months (1-58 months). Thirty-one patients (70.5%) were confirmed to have GOR by pH study. Respiratory symptoms alone were not useful to predict GOR. Cough had the highest sensitivity of 51.6%. stridor, wheeze and choking each had a specificity of 76%. Wheeze, vomiting, choking and stridor were identified to have high specificity (90-100%) in diagnosing GOR when any two symptoms were taken in combination.
Collapse/consolidation was the commonest radiological abnormality but had low sensitivity (35.5%) and specificity (53.8%). However hyperinflation on chest radiograph had a specificity of 92.3% with positive predictive value at 80% in diagnosing GOR. Barium oesophagogram has low sensitivity (37.9%) and moderate specificity (75%) in diagnosing GOR in children with respiratory symptoms.
Abdominal ultrasound was a valid mode of diagnosing GOR when there were three or more reflux episodes demonstrated during the screening period with a specificity of 90.9%. However the sensitivity was low ie 20-25%. The specificity increased to 90-100% when two positive tests were taken in combination (abdominal ultrasound and barium oesophagogram). However the sensitivity remained low (10-20%). Chest radiograph did not improve the predictive value when considered with the above tests. Combination of clinical symptoms were useful as clinical predictors of GOR. In the absence of a pH oesophageal monitoring, a combination of barium oesophagogram and ultrasound may be helpful in diagnosing GOR.

Matched MeSH terms: Gastroesophageal Reflux/ultrasonography; Respiratory Insufficiency/ultrasonography

Fulltext Absent pulmonary valve syndrome--a case report

Ram SP, Lim MK, Mazeni A

Med J Malaysia, 1994 Mar;49(1):93-5.

PMID: 8057999

A 7-year old female child was admitted for recurrent bronchopulmonary since one week of life. She was diagnosed to have ventricular septal defect and was treated conservatively. At seven years of life, repeat echocardiogram revealed a large perimembranous ventricular septal defect, absent pulmonary valve with overriding of aorta, narrow pulmonary artery annulus, and dilated main pulmonary artery and its branches. She was treated conservatively, discharged and follow-up at the National Heart Institute Kuala Lumpur, for corrective surgery.

Matched MeSH terms: Pulmonary Valve/ultrasonography; Tetralogy of Fallot/ultrasonography*

Call for Caution: Neonatal Portal Vein Thrombosis following Enbucrilate Embolization of Placental Chorioangioma

Voon HY, Amin R, Kok JL, Tan KS

Fetal Diagn Ther, 2018;43(1):77-80.

PMID: 28796996 DOI: 10.1159/000479105

We illustrate a case of giant placental chorioangioma presenting at 20 weeks of gestation. Subsequent monitoring revealed enlargement of the lesion, associated with fetal anemia and cardiac failure, prompting in utero intervention. Amnioreduction followed by percutaneous embolization of the tumour with enbucrilate:Lipiodol Ultra-Fluid™ at a dilution of 1:5 was successfully performed. No repeat intervention or additional supportive measures were required throughout pregnancy and the baby was delivered at 36 weeks of gestation, following spontaneous labour. Due to prolonged neonatal jaundice, further investigations were undertaken, demonstrating subacute right portal vein thrombosis. Other previously reported causes of neonatal portal vein thrombosis such as umbilical vein thrombosis, neonatal umbilical vein catheterization, thrombophilia and sepsis were excluded. There was resolution of the thrombus by 6 months of life. A brief discussion of measures to minimize the risk of such an event and the long-term outcomes of neonatal portal vein thrombosis was included. Whilst the simplicity and efficacy of the procedure has been demonstrated in a handful of patients, judgment on its safety is best deferred. Counselling should be comprehensive, as even rare complications can result in significant postnatal morbidity.

Matched MeSH terms: Ultrasonography, Prenatal/methods; Ultrasonography, Doppler, Color

Inverted left atrial appendage masquerading as a cardiac mass

Leong MC, Latiff HA, Hew CC, Mazlan SL, Osman H

Echocardiography, 2013 Feb;30(2):E33-5.

PMID: 23134298 DOI: 10.1111/echo.12044

An inverted left atrial appendage is a rare phenomenon post cardiac surgery. The lesion presents as an additional mass in the left atrium, which would trigger unnecessary concerns and frequently, a battery of tests. The lesion can be easily diagnosed using echocardiography. We report a case of inverted left atrial appendage in a patient post repair of common arterial trunk. Echocardiographic pictures and features which help to identify this lesion as well as to differentiate it from other possible left atrial mass are described. This article aimed to improve the awareness of sonographers toward this rare but possible post operative lesion.

Matched MeSH terms: Heart Diseases/ultrasonography*; Atrial Appendage/ultrasonography*

Anal sphincter trauma and anal incontinence in urogynecological patients

Guzmán Rojas RA, Kamisan Atan I, Shek KL, Dietz HP

Ultrasound Obstet Gynecol, 2015 Sep;46(3):363-6.

PMID: 25766889 DOI: 10.1002/uog.14845

To determine the prevalence of evidence of residual obstetric anal sphincter injury, to evaluate its association with anal incontinence (AI) and to establish minimal diagnostic criteria for significant (residual) external anal sphincter (EAS) trauma.

Matched MeSH terms: Anal Canal/ultrasonography; Fecal Incontinence/ultrasonography; Obstetric Labor Complications/ultrasonography*

Fulltext Curvelet based automatic segmentation of supraspinatus tendon from ultrasound image: a focused assistive diagnostic method

Gupta R, Elamvazuthi I, Dass SC, Faye I, Vasant P, George J, et al.

Biomed Eng Online, 2014;13:157.

PMID: 25471386 DOI: 10.1186/1475-925X-13-157

Disorders of rotator cuff tendons results in acute pain limiting the normal range of motion for shoulder. Of all the tendons in rotator cuff, supraspinatus (SSP) tendon is affected first of any pathological changes. Diagnosis of SSP tendon using ultrasound is considered to be operator dependent with its accuracy being related to operator's level of experience.

Matched MeSH terms: Tendons/ultrasonography*; Ultrasonography; Rotator Cuff/ultrasonography*

Ocular malignant melanoma - a report of two cases

Reddy SC, Darnal HK

Nepal J Ophthalmol, 2014 Jan;6(11):113-8.

PMID: 25341837 DOI: 10.3126/nepjoph.v6i1.10783

INTRODUCTION: Melanoma is a rare malignant tumour in the eye.

OBJECTIVE: To report two cases of malignant melanoma in the eye, one in the conjunctiva and the other in the choroid.

CASES: The first case was in a 49-year-old lady who presented with a swelling on the inner side of left upper eyelid. The vision was 6/6. On everting the eyelid, multiple, pigmented, nodular swellings were noted on the tarsal conjunctiva. Excision biopsy confirmed the diagnosis of malignant melanoma of the conjunctiva. A pigmented nodular swelling occurred on the lower bulbar conjunctiva in the same eye one-and-a-half years after the first presentation. There were no secondary nodules in the body. Excision biopsy confirmed malignant melanoma of the conjunctiva. The second case was in a 72-year-old lady who presented with pain and bleeding in the right eye. There was no perception of light. The cornea was hazy and the details behind it could not be seen. There was micro perforation of the cornea with oozing of blood and secondary glaucoma. B-scan ultrasonography of the right eye revealed an intraocular tumour. The histopathology of the enucleated eyeball confirmed the diagnosis of malignant melanoma of the choroid.

CONCLUSION: In the case of conjunctival melanoma, the occurrence of tumour at multiple sites and absence of recurrence at the original site suggests the possibility of de novo origin of the tumour. Secondary glaucoma and bleeding may be the presenting features of melanoma in the choroid.

Matched MeSH terms: Ultrasonography

Fulltext Successful external cephalic version: factors predicting vaginal birth

Lim PS, Ng BK, Ali A, Shafiee MN, Kampan NC, Mohamed Ismail NA, et al.

ScientificWorldJournal, 2014;2014:860107.

PMID: 24587759 DOI: 10.1155/2014/860107

To determine the maternal and fetal outcomes of successful external cephalic version (ECV) as well as factors predicting vaginal birth.

Matched MeSH terms: Ultrasonography, Prenatal

Fulltext Perinatal management of cardiac tumors: a case series

Amelia A, Mohd Nizam MB

Med J Malaysia, 2013 Aug;68(4):374-5.

PMID: 24145275 MyJurnal

Primary cardiac tumours in the foetuses and neonates are uncommon. Foetuses with cardiac tumour have risk for heart failure and hydrops fetalis. Therefore, an early decision for delivery should be made in the evidence of foetal compromise. Early neonatal care varies on tumour size, type, location and obstructive features. Antenatal detection of foetal cardiac tumours ensures better prenatal and postnatal management. We describe our 5- year experience in managing 5 cases of primary cardiac tumours from 1st January 2006 to 31st December 2010.

Matched MeSH terms: Ultrasonography, Prenatal

Fulltext Cotton-ball granuloma mimicking axillary lymphadenopathy in a breast cancer patient

Hashim H, Alli K, Faridah Y, Rahmat K

Biomed Imaging Interv J, 2011 07 01;7(3):e19.

PMID: 22279496 MyJurnal DOI: 10.2349/biij.7.3.e19

Foreign body granuloma is a reaction to either a biodegradable substance or inert material. In a breast cancer patient who had undergone an excision or mastectomy with axillary clearance, a foreign body granuloma in the axilla may be misinterpreted as an axillary lymph node. We report our experience with a case of cotton-ball granuloma of the axilla in a breast cancer patient, which mimics a lymph node radiologically from the CT scan, mammogram and ultrasonography. Following biopsy and excision, the mass was diagnosed histologically as a foreign body granuloma.

Matched MeSH terms: Ultrasonography

Fulltext Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi

Salinawati B, Hing EY, Fam XI, Zulfiqar MA

Med J Malaysia, 2015 Aug;70(4):238-42.

PMID: 26358021 MyJurnal

AIM: To determine the (i) sensitivity and specificity of ultrasound (USG) in the detection of urinary tract calculi, (ii) size of renal calculi detected on USG, and (iii) size of renal calculi not seen on USG but detected on computed tomography urogram (CTU).
METHODS: A total of 201 patients' USG and CTU were compared retrospectively for the presence of calculi. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of USG were calculated with CTU as the gold standard.
RESULTS: From the 201 sets of data collected, 59 calculi were detected on both USG and CTU. The sensitivity and specificity of renal calculi detection on USG were 53% and 85% respectively. The mean size of the renal calculus detected on USG was 7.6 mm ± 4.1 mm and the mean size of the renal calculus not visualised on USG but detected on CTU was 4 mm ± 2.4 mm. The sensitivity and specificity of ureteric calculi detection on USG were 12% and 97% respectively. The sensitivity and specificity of urinary bladder calculi detection on USG were 20% and 100% respectively.
CONCLUSION: This study showed that the accuracy of US in detecting renal, ureteric and urinary bladder calculi were 67%, 80% and 98% respectively.
Study site: Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur

Matched MeSH terms: Ultrasonography

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