Acute necrotizing encephalopathy of childhood: a severe case with fatal outcome

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition which is important for clinicians to recognize as it has a high mortality rate and can result in significant neurological morbidities. It presents as acute encephalopathy with radiological findings of symmetrical brain lesions in bilateral thalami, putamen, brain stem tegmentum, internal capsule, periventricular white matter and cerebellar medulla. Intravenous methylprednisolone is the mainstay of treatment. Immunoglobulin therapy and therapeutic hypothermia may be used as adjunctive therapy in cases with severe clinical and neuroradiological presentation. We present a case of severe ANEC and discuss the clinical manifestations, neuroimaging and management options

Characterization of adnexal masses using multidetector contrast-enhanced CT scan - recognising common pitfalls that masquerade as ovarian cancer

Adnexal masses are growths that form near the uterus; the majority being ovarian tumours. Although there is no established population-screening tool for detecting ovarian cancer, ultrasound and contrast-enhanced computed tomography (CECT) are useful imaging tools in the management of adnexal masses. Our study aimed to determine the characteristics of malignant adnexal masses on CECT scan and to describe common pitfalls in diagnosis of ovarian cancer when interpreting images. We also determined the sensitivity and specificity of diagnosing ovarian cancer using CECT. A retrospective study was conducted in Hospital Serdang using data from all patients who underwent CECT scan and detected with adnexal masses, and had histopathological examination correlation from January 2013 until January 2015. Out of the 64 cases analysed; the majority of malignant lesions were serous carcinoma of the ovary (40%). The CECT scan characteristics, tumour consistency of mixed type, presence of wall enhancement, septations, ascites and peritoneal nodule/omental caking were significantly associated with ovarian malignancy (p<0.05). The sensitivity, specificity, PPV and NPV of CECT scan was 95.45%, 71.43%, 63.63% and 96.77% respectively. Contrast-enhanced computed tomography scan is a good, non-invasive method to diagnose ovarian cancer. By using a pro-forma document as a guide, good results can be achieved to help differentiate between benign and malignant lesions. Nevertheless, caution needs to be exercised in interpreting cases that mimic features of malignancy

Primary mediastinal myxoid liposarcoma

In this study, we report an extremely rare case of liposarcoma which arises primarily in mediastinum. The patient appeared to have progressive dyspnoea and prolonged cough for a duration of one year. Chest radiograph and Computed Tomography (CT) of the thorax revealed a large right mediastinal mass with fatty component. It was confi rmed to be primary liposarcoma on histopathological examination

Main methods to detect Multiple Sclerosis (MS) lesions in patients with MS

The aim of the study is to investigate the main methodsto detect Multiple Sclerosis (MS) Lesions in patientswith MS. This study was a systematic review to detect main methods to detect of MS lesion in patients with MS. As a result, we found that MRI is the most accuracy and powerful tool for diagnosing a MS especially in early phase. In conclusion, the McDonald criteria is the best criteria that it has been proposed and revised in recently years to diagnose of MS based on clinical presentation and MRI

Role of predictive mortality calculator in antenatal assessment of congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) is one of the most common major congenital anomalies. In utero visceral organ herniation into the thoracic cavity can result in lung hypoplasia and pulmonary hypertension may ensue. Post-natal mortality rates in isolated CDH remain high reaching up to 80% in severe cases. Several prenatal predictors of morbidity and mortality have been proposed. Reliable predictive markers can aid clinicians in providing effective family counselling, prediction of survival, and propose therapeutic options. Decreased total fetal lung volume (TFLV) via magnetic resonance imaging (MRI) has been reported to be significantly associated with mortality. We report on 2 cases of CDH, with fetal MRI performed at third trimester, focusing on the TFLV and observed-to-expected TFLV. We would like to highlight the importance of predictive mortality calculator which provides statistical data for healthcare providers in counselling families and aids in risk-stratification

Double inversion recovery in evaluation of multiple sclerosis: a narrative review

Double Inversion Recovery (DIR) is an accurate method used to evaluate the Multiple Sclerosis (MS). There are also other techniques suggested for this purpose, but those are not as accurate as DIR. It is important because it could be helpful to diagnose the patients with MS in early stages and it makes the therapists able to start the therapy process in right time. This fact is accepted, but there is a lack of researches about it and still there is a need to other researches with clear methodology. This narrative review aimed to have a look on previous studies done about DIR

Non-alcoholic fatty liver disease in metabolic syndrome patients in Serdang Hospital: quantification by contrast-enhanced computed tomography

Introduction: Non-alcoholic Fatty Liver Disease (NAFLD) is one of the end organ damage detected in patients having metabolic syndrome X and it can lead to chronic liver failure. Therefore, it is important to be able to assess the condition in a quantifiable manner to help clinicians recognize and treat this disease. Objective: We aimed to determine the prevalence of NAFLD in patients with metabolic syndrome in Serdang Hospital, Malaysia using contrast-enhanced multidetector computed tomography (CECT) abdominal scan. The study also aimed to calculate the quantification of NAFLD using liver to spleen density CT Hounsfield Unit ratio, CTL/S or CTL/S measurement using abdominal CECT scans. Furthermore, we aimed to verify the correlation of dyslipidemia with NAFLD based on the CTL/S parameter. Materials and Method: We conducted a cross-sectional retrospective study in Hospital Serdang, Malaysia using data from January 2012 to December 2013. The sample size was 279 patients with metabolic syndrome who had undergone CECT abdominal scan. Patient demographics were descriptively analysed. Spearman’s correlation test was used to look for association among lipid profile, blood sugar level and CTL/S ratio. Results: The prevalence of NAFLD in metabolic syndrome patients in our population was 82.8%. Prevalence of NAFLD was high among the elderly population (≥ 57 years old). Additionally, Indian ethnics with metabolic syndrome had the highest risk of developing NAFLD (90.9%). There was a significant association between elevated LDL levels and CTL/S ratio (p<0.05); indicative of severity of NAFLD in metabolic syndrome patients. Conclusion: Contrast-enhanced CT scan can help to non-invasively detect and quantify the severity of non-alcoholic fatty liver disease using the CTL/S ratio in patients with metabolic syndrome who are referred for the scan for certain clinical indications. However, we do not recommend it as a stand-alone, first line investigation in the management of NAFLD in metabolic syndrome patients

New onset seizures in children less than 2 years: is emergent CT imaging necessary?

Background: Seizures being a common problem in paediatrics population especially in children less than 2 years old. Although Computed Tomography (CT) is invaluable in providing quick information for prompt clinical management, it has potential hazardous effects of an associated ionizing radiation which are concerning for frequent use. We are examining the yield of CT Brain findings in children less than 2 years old who presented with first episode of seizures without documented prior trauma. Materials and Methods: A cross sectional descriptive study based on retrospective data of children less than 2 years old who had undergone CT Brain examination in Hospital Serdang during first presentation of seizures from January 2012 till June 2015. The images were reviewed by 2 radiologists with special interest in Paediatric Radiology and any discrepancy was resolved by consensus. Comparative study between afebrile and febrile groups was made. Result: There were 377 CT Brain examinations performed in children less than 2 years old from January 2012 till June 2015, with 88 cases due to first episode of seizures without documented prior trauma. The age ranged between 1 to 23 months (mean 6.84 months, SD 5.223). A large proportion was represented by Malays (N=78; 88.6%) followed by foreigners/migrants (N=5; 5.7%), Chinese (N=3; 3.4%) and Indian (N=2; 2.3%). Male preponderance was noted with 61 cases (69.3%). 57 of cases had febrile seizures, while 31 of cases had afebrile seizures. Using a chi-square test, afebrile seizures were found to have significant association with abnormal CT Brain findings (N=25, 80.6%; p=0.005), intracranial bleed (N=16, 48%; p=0.001) and suspected non-accidental injuries (N=11, 35.5%; p=0.001). Conclusion: Afebrile seizures in children less than 2 years old without documented trauma signify ominous risk of having abnormal CT Brain findings, intracranial bleed and suspected non-accidental injuries thus necessitate emergent imaging at presentation

The superior mesenteric artery syndrome with chronic diarrhoea as presentation

Summary Superior mesenteric artery (SMA) syndrome is rare and potentially life-treatening gastro-vascular disorder which also known as Wilkie’s syndrome, cast syndrome, mesenteric root syndrome, chronic duodenal ileus and intermittent arterio-mesenteric occlusion. Signs and symptoms include nausea, vomiting, postprandial abdominal pain, diarrhoea, reflux and heartburn. We report such a case of SMA syndrome which presented as chronic diarrohea as symptom which lead to malabsorption and loss of retroperitoneal fat and causing the SMA syndrome

MRI findings of orbicularis oculi hypertrophy due to heavy resistance training on the inferior orbital rim

Increase in cross-sectional muscle area of major muscle groups associated by heavy resistance training has been well documented. However, there has been no published article of changes in the inferior orbicularis oculi muscle when heavy resistance training is applied. We present a case of inferior orbicularis hypertrophy detected on MRI in a gentleman who practised heavy resistance training using his lower eyelids