MyMedR

Cephalhematoma infected by Escherichia coli presenting as an extensive scalp abscess

Wong CS, Cheah FC

J Pediatr Surg, 2012 Dec;47(12):2336-40.

PMID: 23217901 DOI: 10.1016/j.jpedsurg.2012.09.029

Cephalhematoma is normally a self-limiting condition affecting 1%-2% of live births, especially following instrumental forceps delivery. The sub-periosteal bleed is characteristically limited by the cranial sutures. Although benign in most instances, this condition may, in a small proportion of cases, be complicated by hyperbilirubinemia or scalp infection. We describe a case of cephalhematoma in a newborn infant infected with Escherichia coli resulting in an extensive deep seated scalp abscess. The infection was also systemic causing E. coli septicemia and initial assessment assumed local extension including bone and meningeal to cause skull osteomyelitis and meningitis respectively. Further investigations and multiple-modality imaging with ultrasound, CT scan and bone scintigraphy outlined the involvement as limited to the scalp, resulting in a shorter antibiotic treatment period and earlier discharge from hospital. The infant recovered well with parenteral antibiotics, saucerization of the abscess and a later skin grafting procedure.

Matched MeSH terms: Tomography, X-Ray Computed/methods; Positron-Emission Tomography/methods

Fulltext Pulmonary resection for metastatic breast cancer

Gooi BH, Premnath N, Manjit S

Med J Malaysia, 2004 Mar;59(1):112-4.

PMID: 15535346

The management of pulmonary metastasis from breast carcinoma is challenging and often consists of palliation of symptoms. Surgical resection of pulmonary metastasis is considered inappropriate in view of the disseminated nature of the disease and limited life expectancy. It can however be a worthwhile option if imaging, including bone scans rule out metastatic disease in other part of the body. We report a patient with pulmonary metastasis from breast carcinoma who was successfully treated with pulmonary wedge resection of the metastatic lesion.

Matched MeSH terms: Tomography, X-Ray Computed

Massive subcapsular air collection in the liver: a rare life-threatening complication following ERCP rendezvous procedure

Koh PS, Ho SH, Yoong BK, Abdullah BJ, Goh KL

J Dig Dis, 2013 Jun;14(6):337-9.

PMID: 23279747 DOI: 10.1111/1751-2980.12030

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Unicameral bone cyst of the calcaneum

Hazmy CHW

Med J Malaysia, 2004 Dec;59 Suppl F:63-4.

PMID: 15941167

The calcaneus is not a common site for a unicameral solitary bone cyst. Little is known about the etiology and natural history of these lesions. The author reports an adult man with a solitary bone cyst of the os calcis which was confirmed radiologically and histologically and successfully treated with curretage and bone grafting.

Matched MeSH terms: Tomography, X-Ray Computed

Application of different imaging modalities for diagnosis of Diabetic Macular Edema: A review

Mookiah MR, Acharya UR, Fujita H, Tan JH, Chua CK, Bhandary SV, et al.

Comput Biol Med, 2015 Nov 1;66:295-315.

PMID: 26453760 DOI: 10.1016/j.compbiomed.2015.09.012

Diabetic Macular Edema (DME) is caused by accumulation of extracellular fluid from hyperpermeable capillaries within the macula. DME is one of the leading causes of blindness among Diabetes Mellitus (DM) patients. Early detection followed by laser photocoagulation can save the visual loss. This review discusses various imaging modalities viz. biomicroscopy, Fluorescein Angiography (FA), Optical Coherence Tomography (OCT) and colour fundus photographs used for diagnosis of DME. Various automated DME grading systems using retinal fundus images, associated retinal image processing techniques for fovea, exudate detection and segmentation are presented. We have also compared various imaging modalities and automated screening methods used for DME grading. The reviewed literature indicates that FA and OCT identify DME related changes accurately. FA is an invasive method, which uses fluorescein dye, and OCT is an expensive imaging method compared to fundus photographs. Moreover, using fundus images DME can be identified and automated. DME grading algorithms can be implemented for telescreening. Hence, fundus imaging based DME grading is more suitable and affordable method compared to biomicroscopy, FA, and OCT modalities.

Matched MeSH terms: Tomography, Optical Coherence

Atypical Isolated Infections of the Infratemporal Fossa: A Diagnostic Challenge

Tan SH, Chong AW, Prepageran N

Iran J Otorhinolaryngol, 2015 Sep;27(82):391-4.

PMID: 26568944

INTRODUCTION: Atypical infratemporal fossa infections are rare and potentially fatal.

CASE REPORT: A case of an aspergillosis localized in the infratemporal fossa and another case of tuberculosis of the infratemporal fossa originating from the maxillary sinus, is described. The first patient was immunocompromised and showed symptoms of facial numbness; whereas the other was an immunocompetent man who complained of trigeminal neuralgia type pain. It was difficult to differentiate between infection and tumour despite the utilization of computed tomography scans and magnetic resonance imaging.

CONCLUSION: These cases illustrate the need for a high index of suspicion; in addition to endoscopic confirmation and histopathology to establish precise diagnosis and early intervention.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Improved Accuracy and Safety of Intracorporeal Transpedicular Bone Grafting - using Contrast Impregnated Bone: A Case Report

Chiu CK, Chan C, Kwan MK

Malays Orthop J, 2014 Nov;8(3):27-9.

PMID: 26401232 MyJurnal DOI: 10.5704/MOJ.1411.006

A method of transpedicular bone grafting using contrast impregnated bone to improve the visualization of bone graft on the image intensifier is reported. A - 36-year old man who had sustained traumatic burst fracture of T12 vertebra, with Load-Sharing Classification (LSC) score of 8, was treated with posterior short segment fusion from T11 to L1 with transpedicular bone graft of T12 vertebra. We were able to correct the kyphotic end plate angle (EPA) from 19º to 1.4º. Anterior bone graft augmentation was achieved with contrast enhaced transpedicular bone grafts. At six months follow up, CT scan showed good bony integration of the anterior column with EPA of 4.5º and two years later, radiographs showed EPA of 7.6 º.

Matched MeSH terms: Tomography, X-Ray Computed

Severe descending necrotizing mediastinitis: vacuum-assisted dressing did wonder

Liew YT, Lim EY, Zulkiflee AB, Prepageran N

Gen Thorac Cardiovasc Surg, 2017 Apr;65(4):225-228.

PMID: 27016203 DOI: 10.1007/s11748-016-0642-3

Descending necrotizing mediastinitis (DNM) is a rapidly progressive disease from the spread of cervical infection. Transcervical and transthoracic drainage was the recognized traditional surgical approach to achieve adequate clearance of infection. Non-invasive vacuum-assisted dressing is a new technique where applied negative pressure can help remove infective fluid and to promote wound healing. A 60-year-old man presented with odynophagia, fever and anterior neck swelling for 2 weeks. He was diagnosed to have anterior neck abscess and underwent surgical drainage. However, it did not respond well, but progressed to involve superior and inferior mediastinum. Vacuum-assisted dressing was applied for total of 2 weeks and the patient recovered without going through usual traditional transthoracic drainage. Vacuum drainage is a simple, safe and non-invasive method of managing DNM, in well selected group with small abscess cavity without airway obstruction and septicemia. This potential technique can lead to paradigm shift in treating life-threatening DNM.

Matched MeSH terms: Tomography, X-Ray Computed

Lupus pneumonitis as the initial presentation of systemic lupus erythematosus: case series from a single institution

Wan SA, Teh CL, Jobli AT

Lupus, 2016 Apr 28.

PMID: 27125293 DOI: 10.1177/0961203316646461

Objective. The aim of this study was to examine the clinical features, treatment and outcome of systemic lupus erythematosus (SLE) patients in our centre who presented with lupus pneumonitis as the initial manifestation.
Methods. We performed a retrospective review of all patients who presented with lupus pneumonitis during the initial SLE manifestation from March 2006 to March 2015.
Results. There were a total of five patients in our study who presented with fever and cough as the main clinical features. All patients had pulmonary infiltrates on chest radiographs. High-resolution computed tomography, which was performed in two patients, showed ground glass opacities with patchy consolidations bilaterally. All patients received high-dose steroids, 80% received intravenous cyclophosphamide and 60% received intravenous immunoglobulin. Two patients died from severe lupus pneumonitis within 2 weeks of admission despite treatment with ventilation, steroids, cyclophosphamide and intravenous immunoglobulin.
Conclusions. Acute lupus pneumonitis is an uncommon presentation of SLE. Mortality in this case series is 40%.
KEYWORDS: Lupus pneumonitis; systemic lupus erythematosus

Matched MeSH terms: Tomography

Fulltext Recurrent spontaneous pneumothorax during pregnancy managed conservatively: a case report

Mohamed Faisal AH, Hazwani A, Soo CI, Andrea Ban YL

Med J Malaysia, 2016 04;71(2):93-5.

PMID: 27326955 MyJurnal

A 36-year-old lady presented with four episodes of right sided pneumothorax during pregnancy requiring multiple chest drain insertion. It was complicated with persistent air leak despite low pressure high volume suction applied to the chest drainage. She delivered safely through spontaneous vaginal delivery with chest drainage. Further imaging by high resolution computed tomography (HRCT) scan of thorax done revealed bilateral scattered pulmonary cysts and sub pleural bullae and was later followed up with respiratory unit. She had no further episodes of pneumothorax postpartum. This case highlights the vital importance of prompt recognition and management of pneumothorax in pregnancy as the patient involved is at higher risk for acute respiratory failure leading to maternal and/or foetal mortality. It is essential for early involvement of obstetric team and to expedite the delivery for a better perinatal and maternal outcome.

Matched MeSH terms: Tomography, X-Ray Computed

Well-differentiated Papillary Mesothelioma of the Tunica Vaginalis

Tan WK, Tan MY, Tan HM, Pathmanathan R, Tan WP

Urology, 2016 Apr;90:e7-8.

PMID: 26773348 DOI: 10.1016/j.urology.2015.12.046

A 39-year-old man presented with painless scrotal swelling for 2 months. He denied any asbestos exposure but worked with wall and ceiling plaster. Physical exam revealed a large right scrotum which transilluminated. Scrotal ultrasonography revealed a large right hydrocele and a polypoidal mass along the anterior wall of the scrotum. Magnetic resonance imaging of the abdomen and computed tomography of the chest showed no metastases. He underwent a right inguinal scrotal exploration and wide excision of tunica vaginalis and a partial epididymectomy. Pathology revealed well-differentiated papillary mesothelioma of the tunica vaginalis. The patient had an uneventful recovery.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Dysphagia lusoria - a rare cause of prolonged Dysphagia

Lee KG, Lath N

Med J Malaysia, 2015 Feb;70(1):52-3.

PMID: 26032533

A 64-year-old man presented with prolonged history of intermittent dysphagia with sensation of food sticking at his upper chest. Physical examination was unremarkable, and an upper endoscopy did not reveal the underlying cause. On computed tomography scan of thorax, an aberrant right subclavian artery was seen coursing posterior to the esophagus resulting in external compression, which is a typical radiological feature of Dysphagia Lusoria. The pathophysiology, clinical features, imaging features and updated treatment modalities of this rare disease are discussed.

Matched MeSH terms: Tomography

Fulltext Degenerated retained product of conception misdiagnosed as invasive trophoblastic disease

Tan AP

Med J Malaysia, 2015 Apr;70(2):100-1.

PMID: 26162386

Retained products of conception (POC) complicates nearly 1% of all pregnancies, occurring with greater frequency after termination of pregnancy than after vaginal or caesarean delivery. The presenting symptoms of retained products of conception are similar to those of gestational trophoblastic disease and hence accurate differentiation is difficult based on clinical history and physical examination alone. The distinction between these two entities is extremely important as the treatment differs dramatically. These patients often need to be further evaluated with either ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis. Hence, radiologists play a vital role in clinching the diagnosis although at times it may be challenging to differentiate between these two entities. Herein, we discuss a case of degenerated retained products of conception which was initially misdiagnosed as invasive trophoblastic disease in a 41-year-old woman whom last known pregnancy was 10 years ago.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A snapshot of stroke from Miri Hospital

Grover CS, Thiagarajah S

Med J Malaysia, 2014 Dec;69(6):268-72.

PMID: 25934957 MyJurnal

Our objective was to study the profile of cerebrovascular accidents and proportion of cerebral haemorrhage (CH) among stroke patients. This project was designed after we observed higher incidence of CH in Miri hospital as compared to conventionally reported data.

METHODS: This was a prospective observational study conducted from 1st June 2008 to 31st May 2009. All patients admitted in both male and female wards of the Medical Unit with the first incidence of a stroke were recruited for analysis. CT scan brain was done in all patients.

RESULTS: Total admissions in one year in the medical department were 3204 patients, both male and female together, out of which 215 were due to a first incidence of stroke; Stroke accounted for 6.7% of admissions and 16.8% of deaths in medical unit. 139 (64.7%) were ischaemic strokes and 76 (35.3%) were cerebral haemorrhages. The incidence of CH (35.3%) was high compared to regional data. 71.7% (154) patients had preexisting hypertension. Higher incidence of hypertension, diabetes mellitus and aspirin intake was noted in the ischaemic group. Also compliance to treatment for hypertension was better in the Ischaemic group with more defaults in CH category (P<0.01). Significantly more deaths were noted in patients with higher systolic blood pressure on presentation, poor Glasgow Coma Scale (GCS) and those with dysphagia.

CONCLUSION: Every third stroke was due to cerebral hemorrhage; CH patients were largely unaware of their hypertension or were altogether treatment naïve or defaulters while compliance was far better in ischaemic stroke category.

Matched MeSH terms: Tomography, X-Ray Computed

Aggressive renal tumour: squamous cell carcinoma with sarcomatoid differentiation

Shepherd ARH, Hoh IMY, Goh EH, Cohen PA, Steele D

ANZ J Surg, 2017 Dec;87(12):1054-1056.

PMID: 25962888 DOI: 10.1111/ans.13155

Matched MeSH terms: Tomography, X-Ray Computed

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: Tomography, X-Ray Computed

Fulltext Spinal cord injury without radiological abnormality (SCIWORA)

Izma MKO, Zulkharnain I, Ramli B, Muhamad AR, Harwant S

Med J Malaysia, 2003 Mar;58(1):105-10.

PMID: 14556334

SCIWORA or Spinal Cord Injury Without Radiological Abnormality; is a pre-MRI term that includes injuries to the spinal cord in the absence of radiological (plain radiographs, tomographs and CT scans) evidence of injury to the spinal column or cord. It occurs in skeletally immature spines because of the inherent plasticity of the bony structures in this age group. The prognosis is dependent on the extent of cord damage, and the role of active management is limited. A high index of suspicion is needed to establish a diagnosis. This diagnostic accuracy can be improved with the free availability of MRI scanning for the spines. We describe three cases of SCIWORA with a minimum follow-up of three years and a review of current literature.

Matched MeSH terms: Tomography, X-Ray Computed

Emphysematous pyelonephritis: drainage or nephrectomy?

Koh KB, Lam HS, Lee SH

Br J Urol, 1993 May;71(5):609-11.

PMID: 8518872

Four cases of emphysematous pyelonephritis are reported and the pathogenesis, surgical implications and preferred mode of management are discussed. We have not found percutaneous drainage to be useful, but feel there is an important place for surgical drainage alone because of the potential for renal recovery and the risks of emergency nephrectomy.

Matched MeSH terms: Tomography, X-Ray Computed

Radiological parameters of bleeding renal angiomyolipoma

Koh KB, George J

Scand. J. Urol. Nephrol., 1996 Aug;30(4):265-8.

PMID: 8908645

Angiomyolipomas are rare tumours of the kidney which have a tendency to bleed. We studied the clinical and radiological features of 11 patients from our institution to identify features which may be predictive of a massive haemorrhage. Tumours more than 6 cm in diameter were found to bleed and the demonstration of pseudoaneurysms on contrast CT scanning was associated with massive haemorrhage. We conclude that large angiomyolipomas should be treated to avoid haemorrhage and the detection of pseudoaneurysms should prompt urgent treatment.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Gas-containing liver abscesses: assessment by ultrasound (US) and computed tomography (CT)

Samad SA, Zulfiqar MA, Maimunah A

Med J Malaysia, 1993 Mar;48(1):33-9.

PMID: 8341170

Single gas-containing pyogenic liver abscesses in 11 patients were studied by ultrasound and computed tomography (CT). On ultrasound, all abscesses were predominantly echogenic compared to the normal liver parenchyma. The gas collections appeared as hyperreflective areas arranged in clusters associated with acoustic shadowing and ring-down artifacts. Ten abscesses (90%) had ill-defined margins on ultrasound, causing underestimation of their sizes in these patients. All abscesses were shown to be multiloculated and had clearly defined borders on CT, not appreciated or mistaken for multiplicity of abscesses on ultrasound. Ultrasound may be inadequate in the evaluation of gas-containing liver abscesses, as they have complex echotexture in addition to ring-down artifacts, acoustic shadows and poorly-defined margins; leading to underestimation of abscess size, difficulty in identifying loculations and erroneous interpretation of multiplicity of abscess cavities.

Matched MeSH terms: Tomography, X-Ray Computed

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