Dysphagia lusoria caused by an aberrant right subclavian artery

Dysphagia of vascular origin is termed dysphagia lusoria and it is relatively uncommon. Amongst the vascular causes, aberrant right subclavian artery is the most common. This case illustrates the usefulness of imaging in the investigation of dysphagic patient for an accurate diagnosis and appropriate management of the condition

Dysphagia caused by an aberrant right subclavian artery

An aberrant right subclavian artery is the commonest aortic arch anomaly. Majority of them were asymptom- atic. An aberrant subclavian artery is a rare cause of dysphagia in adults. This condition is also known as dys- phagia lusoria. We report a case of dysphagia in a 49-year-old woman from an aberrant right subclavian artery. Diagnosis of her condition was made with barium swallow and MDCT (multidetector computed tomography) scan. She was managed conservatively

The scattered-radiation doses at different positions and eye levels in the interventional angiography room.

It is important to know the distribution of harmful scattered-radiation doses that reach the eyes of interventional angiography staff. This is because those radiations are capable of causing radiation-induced cataract. Thus, a preliminary study was conducted to compare the scattered-doses in the angiography room at different positions and eye levels. An upper body phantom (Kyoto Kagaku PBU-31) that simulates a patient was exposed to radiation exposures from an angiographic system (Artis Q; Siemens Medical Solutions Inc., Erlangen, Germany). The technical factors for percutaneous transhepatic biliary drainage procedure in a posteroanterior (PA) projection were used for the exposure. Four durations of Digital Subtraction Angiography (DSA) acquisition were studied; 4s, 8s, 10s and 16s. The scattered doses at different positions and eye levels were measured using the nanodot optically stimulated luminescence (OSL) dosimeters (Landauer, Inc., Glenwood, USA). For each duration, a total of 27 nanodots were placed on nine paper tubes to simulate nine different positions of staff in the angiography room. On each paper tube, three nanodots were used to study the scattered doses at the eye levels of 135cm, 150cm and 165cm. The preliminary findings are similar for all four acquisition durations. Positions which are nearer to the phantom received higher dose except for the 165cm eye level. At this level, the flat panel detector acts as scattered-radiation absorber. Meanwhile, comparing the doses at different eye levels, 135cm eye level received higher dose as compared to others especially when nearer to the phantom. However, at farther positions, doses of three eye levels are quite similar. In conclusion, there is a pattern of increase or decrease in scattered-radiation doses with different positions and eye levels. The findings are useful for the angiography staff of different eye levels to know which position is safer for them during the procedure

Contour maps of normalised scattered radiation doses at different eye heights and positions in an angiography room based on multiple linear regression model

Background: The phantom study produced contour maps to educate angiography staff on the distributions of scattered radiation to their eyes. Methodology: The scattered radiation came from an upper-body PBU-31 phantom (Kyoto Kagaku) exposed to percutaneous transhepatic biliary drainage technical factors. A total of 48 nanoDots™ (Landauer Inc.) were placed on the paper tubes, corresponding to six positions and eight heights (from 135 cm to 170 cm, with 5 cm increments) of the angiography staff’s eyes from the scattered source. The studied projection and positions were posteroanterior (PA), 25° right anterior oblique (RAO), and 25° left anterior oblique (LAO). The measured doses (mGy) were normalised to the respective dose area product for each exposure (mGym2). The normalised doses (mGy/mGym2) were then transformed to their common logarithmic (log10) form and analysed using a multiple linear regression model. After the analysis, the back transformation was performed, and the contour maps of the results were produced. Results: Linear relationships were observed between log10 normalised scattered radiation doses with eye heights and positions for all projections [F (6,137) = 56.96, p< .001 (PA), F (6,137) = 299.94, p< .001 (25° RAO), F (6,137) = 333.953, p< .001 (25° LAO)]. An increase of 5 cm heights reduced normalised doses by 15.9%, 16.8%, and 6.7% in PA, 25° RAO, and 25° LAO, respectively. In PA projection, 155 cm and above eye heights received lower scattered radiation doses for all positions. Meanwhile, in 25° RAO, the flat panel detector (FD) shielded the position right next to the irradiated area. However, this position received higher scattered radiation doses in 25° LAO. Conclusion: The contour maps differed for each projection, and the distribution of scattered radiation in an angiography room was affected by the shielding of the FD. Manuscript classification: Original researc

Contour maps of normalised scattered radiation doses at different eye heights positions in an angiography room based on multiple linear regression model

Background: The phantom study produced contour maps to educate angiography staff on the distributions of scattered radiation to their eyes. Methodology: The scattered radiation came from an upper-body PBY-31 phantom (Kyoto Kagaku) exposed to percutaneous transhepatic biliary drainage technical factors. A total of 48 nanoDots™ (Landauer Inc.) were placed on the paper tubes, corresponding to six positions and eight heights (from 135 cm to 170 cm, with 5 cm increments) of the angiography staff’s eyes from the scattered source. The studied projection and positions were posteroanterior (PA), 25° right anterior oblique (RAO), and 25° left anterior oblique (LAO). The measured doses (mGy) were normalised to the respective dose area product for each exposure (mGym2). The normalised doses (mGy/mGym2) were then transformed to their common logarithmic (log10) form and analysed using a multiple linear regression model. After the analysis, the back transformation was performed, and the contour maps of the results were produced. Results: Linear relationships were observed between log10 normalised scattered radiation doses with eye heights and positions for all projections [F (6,137) = 56.96, p< .001 (PA), F (6,137) = 299.94, p< .001 (25° RAO), F (6,137) = 333.953, p< .001 (25° LAO)]. An increase of 5 cm heights reduced normalised doses by 15.9%, 16.8%, and 6.7% in PA, 25° RAO, and 25° LAO, respectively. In PA projection, 155 cm and above eye heights received lower scattered doses for all positions. Meanwhile, in 25° RAO, the flat panel detector (FD) shielded the position right next to the irradiated area. However, this position received higher scattered radiation doses in 25° LAO. Conclusion: The contour maps differed for each projection, and the distribution of scattered radiation in an angiography room was affected by the shielding of the FD

B Cell Lymphoma of Thoracic Vertebrae: a great mimicker

Non-Hodgkin lymphoma (NHL) is a malignant neoplasm affecting multiple systems in which extranodal NHL represents 10-20% of all NHL. This is a case of a 45-year-old female with no known medical illness who presented with progressive numbness of bilateral lower limbs since March 2016 which subsequently progress to loss of motor power since November 2016. She initially was diagnosed as tuberculous (TB) spondylitis which then turned out to be B cell lymphoma of the thoracic vertebra. The diagnosis was confirmed on histopathological examination (HPE) after the patient underwent laminectomy of T3-T7 vertebra bodies and excision biopsy with the removal of the caseous material. Due to a lack of specific findings, the diagnosis of vertebral NHL is often missed or delayed. It warrants the attention that NHL of a thoracic vertebra may be misdiagnosed as TB spondylitis due to their similarities, and sometimes the imaging features may simulate and overlap each other. The main treatment for vertebral NHL is chemotherapy, radiotherapy or both. Surgery may be necessary if the patient has a story of neurological deficits. However, the patient was treated conservatively as she refused chemotherapy

MSCT of huge abdominopelvic masses in female: a pictorial illustration

Introduction: The differential diagnoses for huge abdominopelvic masses in female are extensive. Many of these masses arise from the reproductive organs such as uterus, cervix and ovaries. Majority represents the commonly encountered entities such as uterine fibroid, dermoid tumour, ovarian cyst and ovarian cancer. However, some of the masses may arise from other organs such as the gastrointestinal system, urinary system, adjacent soft tissue, retroperitoneum or from metastasis. With large mass, it is a challenge for radiologists to determine the site of origin and to differentiate between these tumours. Case series We retrospectively reviewed MSCT performed for huge abdominopelvic masses. The CT findings were correlated with intra-operative findings and final HPE report. This pictorial illustration emphasize on differential diagnosis of huge abdominopelvic masses. Conclusion Familiarity with clinico-pathologic and imaging features is important and helpful for correct image interpretation of common and uncommon abdominopelvic masses

Pulmonary artery aneurysm: a very rare entity

Pulmonary artery aneurysm (PAA) is defined as a focal dilatation of the pulmonary artery. It is noted to be a very rare entity. From literature reviews, only 8 cases of pulmonary artery aneurysms being identified from a total of 109,571 cases within an extended period of 100 years. This gives an incidence of about 0.0073%. It is usually associated with some structural cardiac anomalies, structural vascular anomalies, pulmonary hypertension, vasculitis and infection. However idiopathic pulmonary artery aneurysm has also been identified in some cases. It can be classified as proximal or peripheral PAA depending on its location. Most of the patients are asymptomatic. The symptoms are only seen when complications occurred, such as bronchial or tracheal compression, dissection, rupture, thrombus formation causing pulmonary hypertension. It can be treated conservatively or surgically, especially in a symptomatic patient or if the size is more than 6 cm. We reported a case of left pulmonary artery aneurysm, which is an incidental finding in a patient who underwent a CT pulmonary artery in view of a suspected pulmonary artery embolism when he presented with sudden onset of shortness of breath and left lower limb swelling and pain for one week. A left pulmonary artery aneurysm is seen measuring about 4.2cm (W) x 3.9cm (CC) extending to the proximal branch of descending pulmonary artery. Unfortunately, no further treatment can be given to the patient in view of the patient succumbed from sepsis shortly after the diagnosis

Computed tomography (CT) in blunt liver injury: a pictorial essay

Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma

Endovascular treatment of cerebral aneurysm: early experience in a Malaysian tertiary centre

Universiti Kebangsaan Malaysia Medical Center (UKMMC) started neurointerventional service in August 2008. In this study, we aimed to evaluate the immediate and short term outcome of endovascular treatment (EVT) of cerebral aneurysm during early period of the services. A retrospective study for cerebral aneurysm treated by endovascular technique, from the Neurosurgical and Radiology Department from September 2008 till February 2010 was performed. Patient's demographic data, initial clinical presentation and assessment of the aneurysm were performed. The immediate results and short term assessment post EVT were evaluated based on standard criteria. Recurrence and complications during and following EVT procedures, were recorded. Twenty one patients with total of 22 aneurysms were treated. The mean age was 54.52 years with 57 being males and 43 females. The majority (81) had single aneurysm. The most common site was anterior communicating artery (28 ). Mean aneurysm sac size was 6.19 mm and 2.55 mm for aneurysm neck. At follow-up, 3 (27.2) had a small residual neck. Four patients (37.2) had residual aneurysm filling, but three of them were treated with stent aiming to achieve flow diversion effect instead of complete occlusion during initial treatment. There was no rebleed or rupture from the immediate to follow-up. Significant complications up to 30-days was observed in 4 patients (20) whereby 2 patients showed improvement and 2 patients died (10 mortality rate). Endovascular treatment of cerebral aneurysms performed in our centre had early outcome, morbidity and mortality compared to other higher volume centres. Longer term follow up is needed to evaluate the long termoutcome/occlusion rate, morbidity and mortality