MyMedR

Fulltext A rare case of an appendiceal mass masquerading as a pelvic tumour and causing bilateral hydronephrosis

Abdul Rashid S, Ab Hamid S, Mohamad Saini S, Muridan R

Biomed Imaging Interv J, 2012 Apr;8(2):e11.

PMID: 22970067 MyJurnal DOI: 10.2349/biij.8.2.e11

Diagnosing acute appendicitis in children can be difficult due to atypical presenting symptoms. While there are reported cases of acute appendicitis or appendiceal masses causing unilateral hydronephrosis, bilateral hydronephrosis as a complication of appendiceal mass is very rare. We report a case of a child who presented with cardinal symptomatology associated with the urogenital tract. Ultrasound (US) investigation showed a pelvic mass causing bilateral hydronephrosis. An initial diagnosis of a pelvic teratoma was made based on the US and computed tomography (CT) scan findings. The final diagnosis of an appendiceal mass causing bilateral hydronephrosis was established intraoperatively.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A rare case of chondrosarcoma of the clavicle

Amalourde A, Vinayaga P, Naveed N, Jamal A, Looi LM, Sengupta S

Med J Malaysia, 2004 Dec;59 Suppl F:60-2.

PMID: 15941166 MyJurnal

Although all types of tumour and tumour-like conditions have been described to occur in the clavicle, they only contribute to less then 0.5% of all skeletal tumours. The incidence of primary chondrosarcoma of the clavicle is extremely rare. To our knowledge it has not been reported in Malaysia. We would like to highlight the possibility of chondrosarcoma as a differential diagnosis for a clavicular lesion.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A rare case of incarcerated bochdalek diaphragmatic hernia in a pregnant lady

Islah MA, Jiffre D

Med J Malaysia, 2010 Mar;65(1):75-6.

PMID: 21265257 MyJurnal

The occurrence of congenital diaphragmatic hernia in a pregnant adult is rare. In contrast to neonatal diaphragmatic hernias, most of the adult patients present with vague gastrointestinal symptoms mimicking other diseases hence the importance of high index of suspicion. We report a case of a young pregnant lady with congenital diaphragmatic hernia presenting with symptoms and clinical signs suggestive of acute pancreatitis. The patient had a laparotomy performed to reduce the hernial content and the diaphragmatic defect was successfully repaired.

Matched MeSH terms: Tomography, X-Ray Computed

A rare case of intussusception associated with metastasized small cell carcinoma of lung

Jarmin R, Azman A, Rahim R, Kosai NR, Das S

Acta Med Iran, 2012;50(11):782-4.

PMID: 23292632

Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.

Matched MeSH terms: Tomography, X-Ray Computed

A rare case of methicillin resistant Staphylococcus aureus (MRSA) cerebral abscess secondary to conjunctivitis

Gan YK, Azmi AZ, Ghani SA, Samsudin A

Med J Malaysia, 2017 06;72(3):197-198.

PMID: 28733571 MyJurnal

This case report discusses the rare association of cerebral abscess related to conjunctivitis in an otherwise healthy child. A 6 year old boy presented with conjunctivitis was treated with topical antibiotics and resolved after a week. Conjunctival swab cultures grew MRSA. A month later he developed status epileptics and CT scans revealed a large cerebral abscess. He was treated with intravenous antibiotics which covered for MRSA, along with an incision and drainage for the cerebral abscess. Pus cultures grew MRSA. The patient recovered well with no disturbance in visual acuity or visual field. On post-operative follow ups, he had no other neurological deficit apart from a slight limp.

Matched MeSH terms: Tomography, X-Ray Computed

A rare case of paediatric meningioma masquerading as intra-axial lesion

Tan LY, Tan AP

Med J Malaysia, 2018 12;73(6):439-440.

PMID: 30647227

Meningiomas are neoplasm arising from meningoepithelial cells, most commonly in the fifth to sixth decade of life. Meningiomas are rare in paediatric population, accounting for 0.4-4.1% of all paediatric tumours and less than 3% of paediatric brain tumours. However, meningiomas represent the most common dural based tumours in children. We describe a rare case of paediatric fibroblastic meningioma within the left middle cranial fossa masquerading as an intra-axial mass lesion. Our discussion will be centred on atypical features of paediatric meningiomas and differential diagnosis of extra-axial mass lesion in the paediatric population.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A rare case of paediatric pontine glioblastoma presenting as a cerebellopontine angle otogenic abscess

Rasalingam K, Abdullah JM, Idris Z, Pal HK, Wahab N, Omar E, et al.

Malays J Med Sci, 2008 Jan;15(1):44-8.

PMID: 22589615

We describe rare case of a 9-year old boy who presented with a two-week history of right ear discharge and mild fever. Contrast enhanced CT scan of the brain showed a lesion in the right cerebellopontine angle with mild enhancement mimicking early abscess formation. Involvement of the mastoid air cells pointing towards a radiological diagnosis of mastoiditis reinforced the diagnosis of an abscess. A magnetic resonance imaging (MRI) was planned for the patient but his conscious level deteriorated and patient slipped into coma warranting immediate surgical intervention. Intraoperatively, about 90% of the tumour was removed and the appearance of the tumour resembled that of an acoustic schwannoma but histopathology confirmed the diagnosis of a glioblastoma multiforme (GBM). MRI done post operatively showed lesion in the pons confirming the diagnosis of an exophytic pontine glioblastoma multiforme.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A rare case of retropharyngeal hibernoma

Nazli Z, Norizal MN, Noor Kaslina MK, Abdul Fattah AW

Med J Malaysia, 2015 Apr;70(2):98-9.

PMID: 26162385 MyJurnal

Hibernoma is a slow growing, rare benign tumour, which derived from brown adipose tissue. This tumour is usually found in the area where foetal fat persists such as back, axilla, retro peritoneum and thorax. Hibernoma rarely occurs in the retro pharynx. We report a case of retropharyngeal hibernoma in a 44-year-old male. He presented with obstructive symptoms for six months and a retropharyngeal mass upon examination. His CT scan findings showed a mass in the prevertebral region from level of C2 until C5 causing narrowing of upper aero digestive tract. Histopathological examination reported as hibernoma.

Matched MeSH terms: Tomography, X-Ray Computed

A rare case of unilateral postaxial duplicated foot in a developmentally normal child

Sahdi H, Hoong CW, Rasit AH, Arianto F, Siong LK, Abdullah NA

J Orthop Surg (Hong Kong), 2017 01;25(1):2309499016684989.

PMID: 28166702 DOI: 10.1177/2309499016684989

Diplopodia, being a rare congenital disorder, is infrequently discussed in published texts. Most reported cases have accounted the involvement of duplicated preaxial digits with other associated organ system and physical deformities. Here, we present an unusual case of isolated diplopodia involving postaxial toes in a child with no other organ and physical abnormalities. Radiological studies revealed a set of 10-digit-duplicated foot over the lateral aspect of the native foot, complete with phalanges and its corresponding metatarsals as well as tarsals, supplied by an anomalous posterior branch of the popliteal artery. Definitive surgery was performed just before the child was learning to walk.

Matched MeSH terms: Tomography, X-Ray Computed/methods*

Fulltext A rare complication of MRSA lid abscess and orbital abscess following strabismus surgery in a child

Kenneth Teow, K. L., Nor Akmal, B., Jamalia, R., Safinaz, M. K.

Journal of Surgical Academia, 2018;8(1):32-35.

MyJurnal

Strabismus is one of the most common ocular problems affecting the preschool population and the aim of strabismus surgery is to correct abnormal alignment of the eyes. A 5-year-old girl with strabismus underwent an uneventful surgery and was discharged on the same day with topical medications. Two days later, she returned with a painful right lower eyelid swelling, eye discharge and fever which started 1 day post-surgery. She was admitted for intravenous (IV) antibiotic. Symptoms initially improved after 24 hours of treatment, but later she had worsening eyelid swelling. An urgent CT scan of the orbit showed a right lower lid abscess with orbital cellulitis. Subsequently an examination under anaesthesia (EUA) and incision and drainage (I&D) of the lower lid abscess were performed. Culture from the pus grew Community Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA), sensitive to Vancomycin. At day 2 post I&D she subsequently developed another episode of localised right lower lid swelling. Another EUA was done but showed the lower lid and wound was free of pus. She was later found to have a toxic reaction to topical Gentamicin and hence this medication was stopped. She responded well to treatment and was discharged after completing her IV antibiotics. At 14 months outpatient follow up, she was well and orthophoric in primary gaze. While treating a disease, we should be opened to all possibilities and not to treat with multiple antibiotics once susceptibility is known

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A rare presentation of gliosarcoma in a young adult

Nor Haizura Abd Rani, Fadhli Mustaffa, Chuan Wui Teoh, Flora Li Tze Chong, Nornazirah Azizan, Firdaus Hayati, et al.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):75-75.

MyJurnal

Introduction:Gliosarcoma is a rare malignant brain tumor. The clinical presentation is acute with rapid progression of symptoms. Commonly affecting the elderly, it is rare to happen in youngsters. Case description: A 28-year-old radiographer presented to us with two episodes of unprovoked seizure. He denied any medical illnesses, or trauma, fall, motor vehicle accident and fever prior to these attacks. The computed tomography (CT) of brain was normal. He was managed as epilepsy and remained symptom-free for 3 years until the unprovoked seizure recurred. Another CT of brain performed and revealed a right parietal intracranial mass. This finding was supported by magnetic reso-nance imaging scan. The histologic examination showed a biphasic pattern of glial with predominant sarcomatous component giving a diagnosis of gliosarcoma of the brain. He had completed six cycles of adjuvant chemotherapy and was asymptomatic during clinic follow up with no tumor recurrence. Conclusion: Individuals with high risk of radiation exposure particularly radiographer as in our case requires a special attention when it comes to the diagnosis of malignancy. Despite of indolent clinical presentations, a close monitoring is needed to avoid mismanagement and subsequent morbidities.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A rare presentation ofcCutaneous metastases in advanced lung adenocarcinoma

Liyana Dhamirah Aminuddin, Sabrina Ab Wahab, Suhaili Shariffudin, Tarita Tai

Journal of Clinical and Health Sciences, 2020;5(2):75-78.

MyJurnal

Patients with lung cancer may present with respiratory and systemic symptoms. However,
cutaneous metastases from primary lung cancer is a rare phenomenon, especially in women,
that signifies a poor prognosis. This paper reported a case regarding a 71-year-old woman
who was first presented with a cutaneous nodule over the year. Her condition was further
progressed to multiple lesions on the back and abdomen, dyspnoea, haemoptysis and weight
loss. The results of the skin lesion biopsy exhibited metastatic lung adenocarcinoma with
positive immunohistochemistry for thyroid transcription factor 1 (TTF1) and cytokeratin 7 (CK7). Computed tomography (CT) scan was conducted, and it revealed a left upper lobe lung
mass. The patient was subsequently scheduled for additional management, but she had
succumbed to complications of pulmonary embolism before the necessary interventions could
be provided. In this particular case presentation, the biopsy of cutaneous lesions obtained had
revealed an undiagnosed primary malignancy.

Matched MeSH terms: Tomography, X-Ray Computed

A recurrent nasopharyngeal carcinoma with lacrimal sac involvement: a case report

Tang IP, Periyannan P, Prepageran N, Shashinder S, Singh A, Bhagubhai PN

Eur J Cancer Care (Engl), 2011 Jan;20(1):93-5.

PMID: 20088917 DOI: 10.1111/j.1365-2354.2009.01147.x

We report a very rare case of recurrent nasopharyngeal carcinoma with local involvement of lacrimal sac. The patient was treated with chemotherapy and there was no recurrence noted after 1 year of follow-up.

Matched MeSH terms: Tomography, X-Ray Computed

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: Tomography, X-Ray Computed

A review of common beam hardening correction methods for industrial x-ray computed tomography

Ahmed O, Yushou Song

Sains Malaysiana, 2018;47:1883-1890.

X-ray computed tomography (XCT) became an important instrument for quality assurance in industry products as a
non-destructive testing tool for inspection, evaluation, analysis and dimensional metrology. Thus, a high-quality image
is required. Due to the polychromatic nature of X-ray energy in XCT, this leads to errors in attenuation coefficient
which is generally known as beam hardening artifact. This leads to a distortion or blurring-like cupping and streak in
the reconstruction images, where a significant decrease in imaging quality is observed. In this paper, recent research
publications regarding common practical correction methods that were adopted to improve an imaging quality have been
discussed. It was observed from the discussion and evaluation, that a problem behind beam hardening reduction for the
multi-materials object, especially in the absence of prior information about X-ray spectrum and material characterizations
would be a significant research contribution, if the correction could be achieved without the need to perform forward
projections and multiple reconstructions.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A review of parotid tumours and their management: a ten-year-experience

Shashinder S, Tang IP, Velayutham P, Prepageran N, Gopala KG, Kuljit S, et al.

Med J Malaysia, 2009 Mar;64(1):31-3.

PMID: 19852317 MyJurnal

To review the demographics, management and outcome of patients undergoing parotidectomy at a tertiary center. A total of 76 patients who underwent parotidectomies from January 1996 to December 2005 at the ORL department of our center were reviewed. All clinical, operative, postoperative, histology data were gathered and reviewed. Fine-needle aspiration cytology (FNAC) was diagnostic in 90% of patients with a sensitivity of 76% and specificity of 96%. Twenty-one patients had malignant tumours and the rest had benign or inflammatory lesions. There were a total of 48 superficial and 28 total parotidectomies performed. Facial nerve palsy occurred in 30 (39%) patients with 4% permanent palsy and 35% temporary palsy. The recurrence rate of pleomorphic adenoma was 2.6%. FNAC and CT scan were performed prior to the surgery were useful guidance in planning the operation but clinical judgment is more important. The most common surgery performed was superficial parotidectomy and the most common cause was due to pleomorphic adenoma. The incidence of complications and recurrence of tumour are comparable to other international studies. Prior knowledge of anatomy and careful planning is needed to decrease the incidence of facial nerve palsy.

Matched MeSH terms: Tomography, X-Ray Computed

A review of surgical and audiological outcomes of bonebridge at tertiary centres in Malaysia

Tang IP, Ling XN, Prepageran N

Med J Malaysia, 2018 10;73(5):276-280.

PMID: 30350804 MyJurnal

OBJECTIVES: To investigate the surgical and audiological outcome of Bonebridge (BB) at tertiary centres in Malaysia.

STUDY DESIGN: Prospective, intra-subject repeated measurements of which each subject is his/her own control, from year 2012 to 2016 at two tertiary referral centres.

METHODS: Twenty patients with hearing loss who fulfilled criteria for BB and showed good response to bone conduction hearing aid trial were included. Implantations of BB were carried out under general anaesthesia with preoperative computed tomography (CT) planning. Complications were monitored up to six months postoperatively. Subjects' audiometric thresholds for air conduction, bone conduction and sound field at frequencies of 250Hz to 8kHz were assessed preoperatively and at six months postoperatively. Subjects' satisfaction was evaluated at 6 months post operatively with Hearing Device Satisfaction Scale (HDSS) questionnaire.

RESULTS: There was no major complication reported. Mean aided sound field thresholds showed significant improvement for more than 30dB from 500 to 4000kHz (p<0.05). There was no significant change in mean unaided air conduction and bone conduction thresholds pre and post operatively from 500 to 4000kHz, with a difference of less than 5dB (p>0.05). All the patients were very satisfied (>80%) with the implant, attributing to the promising functional outcome and acceptable cosmetic appearance.

CONCLUSIONS: BB implantation surgery is safe and is effective in restoring hearing deficits among patients aged five and above with conductive or mixed hearing loss and single-sided hearing loss.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A review of the management of 107 dizzy patients at the university hospital

Krishnan G

Med J Malaysia, 1994 Mar;49(1):44-8.

PMID: 8057990

The common investigations done were pure tone audiometry, electronystagmography, X-ray of the internal auditory meatus, CT-scan of the internal auditory meatus and X-ray of the cervical spine. After the examinations and investigations only 52 patients out of the 107 could be given any diagnosis. The most common diagnosis for the vertigo was Meniere's disease.

Matched MeSH terms: Tomography, X-Ray Computed

A sinister rash in a lady with breast malignancy

Tan WF, Voo SYM

Med J Malaysia, 2021 03;76(2):275-277.

PMID: 33742647

Cutaneous metastasis may be the first presentation of an undiagnosed malignancy or a relapse of a previously treated malignancy. We describe a case of a 64-year-old lady with cutaneous metastases from breast carcinoma, who presented with two uncommon rash morphology-carcinoma erysipeloides (CE) and annular erythema. Histopathological examination showed infiltration of neoplastic cells in the dermal lymphatics and staging CT showed distant metastases. She is currently on palliative chemotherapy. A high index of suspicion and early referral to a dermatologist is crucial for early diagnosis for a patient who presents with an inflammatory skin lesion that is refractory to treatment, particularly if the patient has a previous history of malignancy.

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

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