Acute thoracic aortic dissection (Stanford B): challenges in early detection and management

Background: Diagnosis of acute thoracic dissection is crucial given its potential fatal complications in delayed treatment response. Early and appropriate intervention renders obviation of futile surgery. Case report: A 63 years old man with uncontrolled hypertension who presented to emergency department with sharp excruciating chest pain which radiated to the back. A Computed Tomography Angiography (CTA) was done which confirmed thoracic aortic dissection (Stanford type B) (Figures 1 and 2). An uneventful endovascular stent graft with Captivia system was done to contain the entry tear. The patient was doing well post procedure with well-controlled blood pressure. Conclusion: This case reports documents challenges in making immediate diagnosis of acute aortic dissection and in providing appropriate intervention to avert fatal outcomes

Acute low grade fever and atypical pneumonia in Asian’s epidemic area-melioidosis is an unequivocally important diagnostic differential

Background: High grade fever and atypical pneumonia in a susceptible Asian epidemic area could construe fatal consequences attributable to specific prevalence factitious organism: i.e Bukholderia pseudomallei. Case report: A 59 years old Indonesian man with predisposing factors of meliodosis initially presented with acute shortness of breath and severe frontal headache associated in Emergency Department of Hospital Teluk Intan, Malaysia. He had history of prolonged low grade fever and non-productive cough for 5 days. Methods/Results: Culture and sensitivity test for blood and pleural fluid were negative for pathogenic organism. The specific tests for tuberculosis were non-reactive for Tuberculos bacilli. The specific oxidase-negative culture and sensitivity for psedomonas was positive after day 3 of hospitalisation and the IGM-ELISA titre antibody level for meliodosis was positive. The patient was well responded to immediate treatment and was discharged for a regular outpatient follow-up for eradication therapy. Conclusion: This case report documents the potential symptoms associated with atypical pneumonia in recognising Meliodosis in an epidemic Asian area. Early suspicion may avert untowards fatal consequences and improved the quality of life

18F-FDG-PET CT features of colo-colic intussusceptions in patient with colonic carcinoma

Colo-colic intussusception is a rare manifestation of a primary tumour in an adult patient. This article aims to document the rarity of colo-colic intussusception features on the 18 FDG-PET-CT in a patient with primary colonic carcinoma. An 18 FDG-PET-CT was performed for the purpose of pretreatment staging of a colonic carcinoma in a 61-year-old man following a diagnostic colosnoscopic biopsy. He presented with abdominal distension and peri-rectal bleeding for a month. The fused 18 F-FDG PET-CT image revealed an FDG-avid mass in the left hemicolon showing a rim of FDG avidity denoting the head of intussusceptum. There are also multiple FDG-avid nodules seen along the anti-mesenteric colonic fat suspicious for lymph nodes metastasis. Debulking of tumour revealed a mucinous adenocarcinoma of colon with a metastatic lymph node. 18 FDG PET-CT features of intussusception in colonic carcinoma have never been described before. It can potentially become a preferred diagnostic tool in delineating a potential tumour mass within the intussusceptions that help improve prognosis in patients with malignancy

The association of FDG-PET (SUVmax) and inflammatory marker in predicting tumour aggressiveness

Chronic inflammation is associated with processes that contribute to the onset or progression of cancer. This study examined the correlation between dichotomised patients with malignant tumours and inflammatory markers based on the altered glucose metabolism measured by the FDG SUVmax that underpins the degree of tumour aggressiveness. Thirty-one patients underwent 18F-FDG PET/CT for various carcinoma along with blood inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL6), lipid profile and fasting blood glucose (FBG) levels were obtained in retrospective study. Patients were dichotomised by the cut-off SUVmax value of 6.0 dl/ml derived from curve analysis (P=-0.025). The mean age of the subjects were 53.16 ± 12.06 years and mean SUVmax of 8.80±6.27 g/ml. Significant correlation was noted between the SUVmax and CRP and IL6 (r=0.361; P 6.0 dl/ml was inversely related to IL-6 (OR: 0.049, with p<0.005). Serum inflammatory markers and endogenous glucose are associated with a potentially more aggressive malignant cancer. In particular, IL6 may be used as a useful surrogate marker for tumour aggressiveness with an important prognostic value