A case report of airway stenting in tracheal compression secondary to right subclavian artery pseudo-aneurysm

We report a 55-year old lady with the presentation of stridor and type II respiratory failure requiring tracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiograph revealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis. However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe tracheal compression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascular surgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopy for airway stenting is unknown due to limited evidence available. Indeed, this form of central airway obstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned. It may facilitate early weaning and allows less complicated airway control

Multiple cavitating pulmonary nodules secondary to Hodgkin's lymphoma

We report a 26-year old lady who presented with chronic cough and breathlessness associated with subtle TB symptoms for 1 year. Her CT thorax showed multiple cavitating pulmonary nodules with mediastinal and cervical lymphadenopathy. Cervical lymph node biopsy and CT-guided pulmonary biopsy at our centre confirmed the diagnosis of Hodgkin’s lymphoma with pulmonary infiltrations. She was successfully treated with ABVD regime but later developed life-threatening bleomycin-induced pulmonary fibrosis. Sadly, she succumbed to respiratory failure due to severe pneumonia with possibility of bleomycin-induced pulmonary fibrosis. Multiple cavitating pulmonary nodules secondary to lymphoma is rare and in TB endemic area, it may result in delayed diagnosis and treatment

Transbronchial needle aspiration of mediastinal lymph node

In Malaysia, transbronchial needle aspiration (TBNA) is a relatively new procedure performed only in a handful of respiratory centres. We reviewed TBNA of mediastinal lymph node performed in Hospital Tengku Ampuan Afzan (HTAA) to determine the yield and its complications. Data was retrieved from endoscopy databases and patients' records, CT thorax images and all cytological and histological slides were reviewed. Twenty-five patients had TBNA performed. TBNA was positive in 15 patients (60%). Overall, 80% had confirmed malignancy after bronchoscopy. Only four patients had documented bleeding after TBNA and in two of them, bleeding stopped spontaneously and another two patients required diluted adrenaline to stop the bleed. No mortality was reported from this procedure. Hence, TBNA is a safe procedure

Risk factors associated with development of dengue haemorrhagic fever or dengue shock syndrome in adults in Hospital Tengku Ampuan Afzan Kuantan

A retrospective study was conducted to investigate 183 serologically-confirmed cases of dengue fever (DF) admitted from October 2004 to March 2005 in a large hospital in Pahang. Clinical and laboratory features, progress and outcome of these patients were analysed in order to identify risk factors associated with development of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Individually, we found that older patients, secondary dengue infection, high baseline haematocrit levels, low platelet levels and prolonged activated partial thromboplastin time (APTT) ratio were significant associations with bleeding tendencies. Of these risk factors, haematocrit and APTT ratio were two independent significant risk factors on multivariate analysis. Older patients with primary infection and younger patients with secondary infection had significant bleeding tendencies. We also verified the validity of the haematocrit levels suggested as cut-off levels for plasma leakage for the Malaysian population by Malaysian Clinical Practice Guidelines for Dengue Infection in Adults (2003)

Epidermal growth factor receptor mutations in non- small cell lung cancers in a multiethnic Malaysian patient population

In Malaysian patients with NSCLC, the EGFR mutation rate was similar to that in other Asian populations. EGFR mutations were significantly more common in female patients and in never smokers. Never smoking status was the only independent predictor for the presence of EGFR mutations

The “crazy paving pattern” lung in a pregnant woman

Pulmonary Alveolar Proteinosis (PAP) is a rare disorder characterized by an abnormal accumulation of a PAS positive material within the alveolar spaces and distal bronchioles. A 29 year old lady in her 29th week of pregnancy presented with prolonged dry cough for two months which was associated with reduced effort tolerance and low grade fever. At presentation she is hypoxic and required oxygen supplement. She was initially treated empirically for tuberculosis but she continued to have worsening hypoxia. A high resolution CT thorax revealed a crazy paving pattern lung which was suggestive of PAP. She delivered a healthy baby at 36 weeks via an elective Caesarean section. Post operatively she underwent diagnostic bronchoalveolar lavage which showed acellular homogenous eosinophilic material which was positive for PAS/PASD and negative for mucin. Therapeutic whole lung lavage was performed and her symptoms and lung function tests improved. In this case report, we will discuss how we made the diagnosis of PAP and share our experience in managing a pregnant woman with this condition

Systemic sclerosis in Sarawak : a profile of patients trated in the Sarawak General Hospital

We performed a cross-sectional study of the demography, clinical and laboratory features of patients with systemic sclerosis patients followed up in our centre from 1984 to 2007. There were 23 cases with the majority of them (96%) being female. They have a mean age of 50.3 years and a mean disease duration of 6.02 (SD 5.82) years. Our patients comprised of multi-ethnic groups with predominantly Chinese (52%), Sarawak natives (35%) and Malays (13%). They have a mean lag time to diagnosis of 24.8 (SD 34.8) months. All the patients have sclerodermatous skin changes with 16(70%) having diffuse scleroderma and 7(30%) having limited scleroderma. The common clinical manifestations found in our patients were Raynaud’s phenomenon (91%), sclerodactyly (65%), digital ulcers (52%) and pulmonary fibrosis (52%). There was low incidence of pulmonary hypertension (13%) and renal involvement (4%). The majority of our patients (67%) have positive ANA with 33% positive Scl-70. The majority received calcium channel blockers (87%), aspirin (48%) and low-dose prednisolone (48%). One patient developed adenocarcinoma of the lung on follow-up. This study demonstrated the rarity of systemic sclerosis in our centre with considerable lag time to diagnosis in our patients. Diffuse cutaneous systemic scleroderma is more common in our centre with rare pulmonary hypertension and renal involvement

The bug and the big heart -- Melioidotic pericardial effusion

Melioidosis is an infection caused by Gram negative bacterium Burkholderia pseudomallei leading to abscesses in lungs, liver, spleen, musculoskeletal system, prostate and sepsis. We present a rare case of purulent pericardial effusion caused by melioidosis with concomitant pneumonia and splenic abscesses. The patient underwent pericardiocentesis and successfully recovered from cardiogenic and septic shock

Asthma control in Hospital Tengku Ampuan Afzan, Kuantan, Malaysia: a cross-sectional study

Various initiatives and medications have been introduced to achieve better control of bronchial asthma. However total control according to Global Initiative for Asthma (GINA) remains elusive even at tertiary referral hospitals. Our study is to determine the level of asthma control (according to GINA 2009), Asthma Control Test (ACT) scores and the types of medications used among patients with bronchial asthma in a large tertiary hospital