‘A fly in the ointment’

The small endobronchial malignancies are rare entity that can cause obstruction of the major airways, causing symptoms such as dyspnoea, cough, haemoptysis and postobstructive pneumonia. The obstruction may lead to gradual asphyxiation. Case series of four patients: primary carcinoid, mucoepidermoid carcinoma and mixed squamo-adenocarcinoma are reviewed. This paper describes each of these cases including the clinical presentation, plain film at presentation, CT abnormalities and discusses the utility of CT in their diagnosis. Treatment and progression of disease also will be discussed

Recurrent intussusception in an adult with variable appearances on CT scan and laparotomy findings

Intussusception in adult is a rare and the management of this is still controversy. We report such a case of recurrent proximal small bowel intussusception in an adult which has variable appearances on Computed Tomography and laparotomy findings. Intussusception can recur again if underlying caused was not treated or removed. Surgical intervention with treatment or removal underlying cause of intussusception in adult is suggested to prevent recurrent of intussusception

Doctor, there's a lump in my mouth!: imaging aspects of torus palatinus; a case report

This is a case report of a 36-year-old lady who presented with a swelling on the hard palate of her mouth. She had undergone computed tomography (CT) scan of the oropharynx and paranasal sinuses and the diagnosis of torus palatinus, a normal anatomical variant of the hard palate was made. The authors discuss about the appearance of torus palatinus in various imaging modalities, specifically dental radiograph, CT scan and magnetic resonance imaging (MRI)

Computed tomography and other imaging modalities in pediatric congenital heart disease

Congenital heart defects (CHD) are the most common congenital disabilities. Early and accurate diagnosis of coronary heart disease is very important for patients to get timely and effective treatment. In recent years, the accuracy of coronary heart disease diagnosis has been greatly improved with the development of medical imaging equipment and technology. At present, the clinical application of echocardiogram (echo), cardiovascular magnetic resonance (CMR) and computed tomography angiography (CTA) in coronary heart disease anatomy and function has increased significantly, which plays an important role in preoperative diagnosis, intraoperative monitoring, and postoperative recovery evaluation. However, each imaging technique has its indications. Providing the best examination plan for patients requires clinicians and radiologists’ close cooperation. Therefore, this study reviewed the imaging techniques for diagnosing coronary heart disease

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

3D reconstruction for volume of interest in computed tomography laser mammography images

Computer assisted diagnosis systems (CADs) is now commonly used as a second opinion to help radiologists in image interpretation by emphasizing on the suspicious areas. Segmentation of region of interests in 2-dimensional (2D) or volume of interests in 3-dimensional (3D) images is a critical step in CAD systems. 3D image segmentation using 2D slices has been a keen of interest for research purpose. In this paper we propose to reconstruct a 3D form of volume of interests (VOIs) from a series of 2D images in computed tomography laser mammography (CTLM). In this paper, a 3D Fuzzy C-Means clustering have been implemented to reconstruct VOIs for breast cancer detection in CTLM images. To assess the accuracy of the extracted VOIs against ground truth, percentage error factor is used and produced error value of 10.72% in our dataset of 62 CTLM breast images collected among Malaysian participants

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

The missing piece : radiological and surgical management of a body packer with a methamphetamine packet stuck in the stomach

Introduction Usually, body packers have no complications and current recommendations for such patients advise a conservative approach, waiting for a spontaneous packet’s evacuation with the bowel movement. In case of complications such a packet stuck in the stomach, a surgical approach seems to be safer than an endoscopic approach. Case report We report on a patient who was arrested by the police for suspected drug mules. A plain abdominal X-ray disclosed drug packets in the digestive tract. After spontaneous elimination of 35 drug packets, the patient had three unremarkable stools. However, a residual packet was noted in the follow-up plain abdominal X-ray. Ultrasonography (US) was done and a residual drug packet was noted in the stomach. This was later confirmed with non-enhanced computed tomography (CT) scan. As this was not eliminated during the 10 days following ingestion, oesophago-gastro-duodenoscopy(OGDS) was attempted but failed. It was finally removed through gastrostomy. Conclusion This case illustrated the different radiological features of a methamphetamine drug packet on x-ray, US and CT. It also stressed the importance of good collaboration between radiologist and clinician in the management of body packers. Furthermore, we have illustrated that gastrostomy is a safer approach that OGDS

Typical and atypical magnetic resonance imaging appearances of primary cardiac lymphoma

Primary cardiac lymphoma (PCL) accounts for 1.3% of all cardiac tumours. Diagnosis is particularly challenging owing to its rarity and non-specific presentation. Although transthoracic echocardiogram is the initial imaging modality used to detect cardiac masses, advances in cardiac magnetic resonance imaging (CMR) has allowed more detailed assessment, which enables accurate diagnosis and subsequent therapy. We would like to highlight two cases of PCL that were diagnosed in our institution, manifesting with typical and atypical CMR features

Correlation of clinical examination, magnetic resonance imaging and surgical findings in diagnosing ankle joint ligament injuries

Background: Ankle injury is one of the commonest joints injured, especially in sports, which contribute to significant morbidity and time loss from work. Early and accurate diagnosis is vital to prevent long-term uninviting sequelae. The study aimed to determine the accuracy of clinical findings and magnetic resonance imaging (MRI) concerning surgical findings in patients presenting with chronic ankle pain and/or instability. Methods: Retrospective review of MRI images and medical reports was performed for all patients who required surgical treatment for chronic ankle instability at two institutions during a four-year period. Medical reports of 22 female and 20 male patients with a mean age of 35.9 years (17–58 years) were analysed. From 42 patients who met the inclusion criteria, only 20 patients underwent surgery. Surgical findings were considered the gold standard. The time interval between MRI scans and arthroscopy/surgery was 5 months (3–10 months). Results: MRI showed 100% sensitivity for the diagnosis of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), and 66.7% sensitivity for the diagnosis of deltoid ligament tears. However, specificity was moderate to low, particularly for deltoid tears. Our study also demonstrated the high accuracy of MRI in detecting chondral injury with 100% sensitivity and specificity. Clinical tests, particularly tenderness on palpation and anterior drawer test (ADT), provided excellent sensitivity in the diagnosis of ATFL tear but poor specificity. Conclusion: We concluded that MRI is a reliable instrument in the diagnosis of ATFL, CFL, and chondralinjury at the ankle, but not specific in ruling out the disease. ADT and tenderness on palpation also accuratelydenote ATFL injury with high sensitivity and positive predictive value. The assessment of ligaments on MRI should be performed with caution. Clinical correlation based on the tenderness and ADT is critical when reporting.MRI to avoid over diagnosis, while arthroscopy remains the gold standard