Pictorial review of rectal carcinoma: A single centre MRI experience in SASMEC @IIUM

Colorectal cancer is known as the third most common cancer in men and second most common in women after breast cancer worldwide. Two advanced development in the cure of rectal cancer are total mesorectal excision (TME) and neoadjuvant chemoradiotherapy. High-spatial-resolution T2-weighted imaging has been the most important MRI sequence in the evaluation of rectal cancer. Using a 3.0T MRI scanner, 57 patients from June 2019 until November 2021 underwent MRI rectum staging at our centre resulting in 1 patient with T1 (1.7%), 2 patients with T2 (3.5%), 11 patients with T3 (19.3 %) and 43 patients with T4 (75.4%) diseases

Pictorial review of rectal carcinoma: a single centre MRI experience in SASMEC @IIUM

PICTORIAL REVIEW OF RECTAL CARCINOMA: A SINGLE CENTRE MRI EXPERIENCE IN SASMEC @IIUM Wan Ahmad Firdaus Wan Chek1, Raihanah Haroon2 1Radiology Department, Kulliyyah of Medicine, IIUM [email protected] 2Radiology Department, Kulliyyah of Medicine, IIUM [email protected] *Corresponding author: e-mail@[email protected]; Tel : +60137413649 Received date: Accepted date: Published date: Abstract: Colorectal cancer is known as the third most common cancer in men and second most common in women after breast cancer worldwide. Tumour infiltration into the mesorectum and the ability to achieve negative circumferential resection margin via surgery are directly related to its prognosis. Two advanced development in the cure of rectal cancer are total mesorectal excision (TME) and neoadjuvant chemoradiotherapy. MRI plays a crucial role as the most accurate and powerful device in evaluating rectal cancer patient to select the proper and optimal treatment. High-spatial-resolution T2-weighted imaging has been the most important MRI sequence in the evaluation of rectal cancer and its surrounding anatomic structures. Using a 3.0T MRI scanner, we use TNM staging at our center which involves 57 patients with rectal adenocarcinoma. We focused on the T and N staging as MRI readily evaluates only these two components. There were 57 patients who underwent MRI rectum staging at our center resulting in 1 patient with T1 (1.7%), 2 patients with T2 (3.5%), 11 patients with T3 (19.3 %) and 43 patients with T4 (75.4%) diseases. This poster offers a pictorial review of the anorectal anatomy of rectal carcinoma in different TNM stages based on MRI evaluation. Keywords: rectal carcinoma, mri local stagin

Where is the missing chicken bone ? a case of foreign body bronchiectasis.

INTRODUCTION: Foreign body aspiration is an uncommon cause of bronchiectasis in adults. While an obstructive foreign body is readily identified following clinical history of aspiration, there are reports in literature where the dislodged foreign body is neglected by fully conscious adults. Prolonged endobronchial retention of foreign body will eventually lead to recurrent infection and subsequent bronchiectasis. REPORT: Here we describe a patient with a retained chicken bone for 10 years who presented with worsening symptoms of bronchiectasis for 1 month. A chicken bone was discovered in the right lower lobe bronchus along with localized cystic bronchiectasis at the middle and lower lobes as well as superimposed lung infection. CONCLUSION: Patient was subsequently subjected for removal of foreign body using rigid bronchoscop

Where is the missing chicken bone ? a case of foreign body bronchiectasis.

INTRODUCTION: Foreign body aspiration is an uncommon cause of bronchiectasis in adults. While an obstructive foreign body is readily identified following clinical history of aspiration, there are reports in literature where the dislodged foreign body is neglected by fully conscious adults. Prolonged endobronchial retention of foreign body will eventually lead to recurrent infection and subsequent bronchiectasis. REPORT: Here we describe a patient with a retained chicken bone for 10 years who presented with worsening symptoms of bronchiectasis for 1 month. A chicken bone was discovered in the right lower lobe bronchus along with localized cystic bronchiectasis at the middle and lower lobes as well as superimposed lung infection. CONCLUSION: Patient was subsequently subjected for removal of foreign body using rigid bronchoscop

Differentiating features of Benign vs. Malignant Phyllodes Tumours: a case series

Introduction: Phyllodes tumours of the breast, first dubbed cystosarcoma phyllodes are rare fibroepithelial tumours, accounting for less than 1% of all breast neoplasms. The World Health Organization (WHO) classified these tumours into three categories, i.e benign, borderline and malignant based on histopathological features. Benign phyllodes tumour comprised most of the tumours (35-64%), whereas the incidence of malignant phyllodes tumour is 25%. Imaging features of benign phyllodes tumour include well-circumscribed margin and homogenous echotexture, whereas malignant phyllodes tumour often demonstrate irregular margin, intratumoral cystic spaces, heterogenous echotexture and internal vascularity. Case Series: We present 4 cases of female patients initially presented with breast lump. Histopathological examination of the first two cases is malignant phyllodes tumour with background of fibrocystic changes. The first case is a 46-year-old lady whose mammogram showed a well-defined equal-density lesion. Ultrasound showed a lobulated mass, partially circumscribed margin, heterogenous internal echo and intratumoral cystic spaces. The second case is a 36-year-old lady with a high-density lesion associated with multiple dystrophic calcifications on mammogram. Ultrasound showed a heterogenous mass with irregular margin and posterior shadowing. The third and fourth cases are histopathologically confirmed as benign phyllodes tumour. The third case is a 46-year-old lady whose mammogram showed an equal density lesion while sonography revealed a well-defined oval lesion with heterogenous echotexture but no intralesional cystic spaces. Another case is a 46-year-old lady with a high-density lesion on mammogram while sonographically showed a well-defined, lobulated lesion with heterogenous echotexture and intralesional cystic spaces. Conclusion: In conclusion, benign and malignant phyllodes tumours manifest several differentiating features sonographically though some of the features may overlap. Lesion margin, internal echoes and vascularity as well as presence of liquefaction may help to identify different pathological grades of phyllodes tumour. This is crucial due to diverse potential for recurrence and metastasis

The nomadic bug: a case report of salmonella septic arthritis of the sternoclavicular joint

Septic arthritis of the sternoclavicular joint is extremely rare in an otherwise healthy adult. It is reported to affect less than 0.5 % of all bone and joint infections. It usually affects immunocompromised patients or patients with a history of intravenous drug abuse. Septic arthritis of the sternoclavicular joint requires immediate treatment to prevent morbidity and mortality. Serious complications from this condition include osteomyelitis, chest wall abscess and mediastinitis. We present a rare case of sternoclavicular septic arthritis caused by Salmonella sp. in a healthy 49-year-old lady complicated with lung empyema and mediastinitis. With early detection, her condition improved with antibiotics and aspiration of the lung empyema. To our knowledge, only two previous cases of Salmonella septic arthritis of the sternoclavicular joint were reported in the literature

Difference between Alar ligament of male and female: MRI perspectives

Background: Road traffic accidents have caused serious public health concerns; which include whiplash-associated disorders involving cervical spine. MRI is often required to supplant diagnosis of this condition. Nevertheless, alar ligament of the cervical spine may show variability in MR appearance; most profoundly signal hyperintensity easily mistaken as injury. Purpose: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female in terms of its course, shape, orientation and signal homogeneity, despite determining the association between the heights of respondents with alar ligament dimensions. Methodology: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. Results: Male respondents were 70% more likely to exhibit alar ligament signal inhomogeneity which is statistically significant (p = 0.02). No significant difference in alar ligament shape, size and orientation was seen between both genders. However positive correlation between height and the craniocaudal diameter of the alar ligament as well as the anteroposterior diameter, regardless of gender; which were statistically significant (r = 0.25, n = 100, p = 0.01 and r = 0.201, n = 100, p = 0.045 respectively). Conclusion: Presence of gender variability of alar ligament MR signal intensity as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury. Acknowledgement: Radiology Department, Sultan Ahmad Shah Medical Centre (SASMEC

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

A Case of Rare Desmoid-Type Fibromatosis Presented as a Breast Lump

Desmoid-type fibromatosis (DF) is a benign but rare soft tissue tumour, occurring only in 2-4 persons in one million of the population . Its local invasiveness and high tendency to recur following resection contribute to its notorious reputation for being an aggressive type of fibromatosis. It may be encountered across all demographic but more commonly seen between the second and fourth decade of life with a female predilection. As it originated from the musculoaponeurotic structures throughout the body, it may affect any site, with the limbs and abdomen being the more commonly reported encountered sites. Chest wall DF only represents about 8-10% of the incidence. In this report, we describe our encounter with a case of chest wall DF and how it presents in the different radiological modalities that we have in our centre

A disastrous complication of colonephrocutaneous fistula: brain abscess

A rare case of colonephrocutaneous fistula complicated with a brain abscess is a lifethreatening clinical condition. We report a case of a 35-year-old lady with a history of partial left nephrectomy complicated with left colonic injury who presented with persistent vomiting associated with headache and blurry vision for 5 days. Clinically, she was confused and restless with Glasgow Coma Scale (GCS) of 12/15, however her pupils were equal and reactive bilaterally. Other neurological examinations were unremarkable. Abdominal examination noted functioning ileostomy with a skin opening at left lumbar with pus discharge. Diagnosis of brain abscess was made after contrasted computed tomography (CT) scan of brain. Urgent open drainage surgery was done followed by long course of antibiotic. Contrasted CT abdomen and fistulogram revealed a left colo-psoas and left nephrocutaneous fistula, hence, she was subjected for surgery. Intraoperatively, there was a fistula tract connecting the descending colon, remaining of left kidney, and the skin. Thus, left hemicolectomy, completion of left nephrectomy, and fistulectomy was done. The long-standing infective foci can lead to septic emboli and causes formation of abscess at distant site. Its management is challenging involving both medical and surgical therapy