A case of focal eventration of left hemidiaphragm with transthoracic left kidney confused with a traumatic diaphragmatic hernia

Focal eventration of the diaphragm with transthoracic kidney is a very rare condition. It is usually asymptomatic and often revealed as an incidental finding on imaging studies. We presented a case of previously undiagnosed focal eventration of left hemidiaphragm with transthoracic left kidney confused with traumatic diaphragmatic hernia. Differentiation of these two conditions is important as each were managed differently. A traumatic diaphragmatic hernia needs early surgical intervention whereas no treatment was required for focal diaphragmatic eventration in most cases. Diagnostic laparoscopy confirmed the findings in this case and the patient was managed conservatively

C1 and C2 vertebrae osteomyelitis: a misleading presentation leading to a fatal outcome

Cervical vertebral osteomyelitis is rare. While an early and correct diagnosis is critical to prevent catastrophic neurological injury, the diagnosis of cervical vertebral osteomyelitis is often difficult because of its rarity and variable symptoms. We present a case of C1 and C2 vertebrae osteomyelitis with a misleading presentation and its fatal outcome

Pulmonary AVM: diagnosis via spiral CT scan: a case report

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary arteries and pulmonary veins. It is a rare clinical problem.This case illustrates the use of spiral CT scan in diagnosing this condition

Retrocaval ureter: an unsual cause of hydronephrosis in an adult

Retrocaval ureter is a rare congenital anomaly. We describe a case of right upper tract collecting system dilatation caused by a retrocaval ureter in an adult patient. Conflicting initial radiological findings had misled the surgeons in managing this patient. This case illustrates the importance of an accurate radiological diagnosis of this condition prior to any surgical intervention for an appropriate and successful surgical management

Traumatic brain injury pattern on CT scan: a comparison of motorcyclist versus passenger vehicle patients involved in road traffic accidents

Introduction: Traumatic brain injury following road traffic accidents is a common cause of morbidity and mortality in Malaysia. We aim to determine the differences of traumatic brain injury patterns based on CT findings among motorcyclist versus passenger vehicle patients involved in road traffic accidents. Materials and method: This retrospective study was conducted in Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. A total of 100 CT scan brains of patients who were involved in road traffic accidents were retrieved and reviewed, 50 of them were motorcyclists and the other 50 were passenger vehicles. Results: Fifty percent of the motorcyclists had an abnormal CT brain finding while only 24% of the passenger vehicle showed abnormal finding. Among motorcyclist, skull fracture was the most common finding (30%) followed by subdural hemorrhage (28%). Among passenger vehicle, the most common finding was subdural hemorrhage (10%) followed by subarachnoid hemorrhage, intraparenchymal haemorrhage and skull fracture (8% each). The motorcyclist had significantly higher rate of subdural haemorrhage, extradural haemorrhage, intraparenchymal contusion and skull fracture compared to passenger vehicle patients with p value of 0.02, 0.03, 0.007 and 0.005 respectively. Conclusion: The occurrence of traumatic brain injury was significantly higher among the motorcyclist compared to passenger vehicle patients involved in road traffic accidents. The findings of this study highlighted the need for taking further measures to increase safety among the motorcyclists

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

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

The role of multislice computed tomography (MSCT) in the direction of traumatic intra abdominal injury : our experience in Hospital Tengku Ampuan Afzan(HTAA), Kuantan, Pahang

Introduction: Blunt abdominal trauma can cause multiple injuries and these injuries are often difficult to be accurately evaluated via clinical assessment. Currently, multislice computed tomography (MSCT) scan is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of traumatic intra abdominal injury and correlates the findings with subsequent patient’s management. Methodology This is a retrospective study approved by our institutional review board. All cases of CT scan performed to rule out traumatic intra abdominal injury from January 2008 until December 2009 was traced from the registration book. CT scan images were retrieved and reviewed. Analysis of findings was done and organ injuries were graded according to AAST (American Association of Surgery and Trauma). Case notes and surgical findings were reviewed for correlation with CT findings. Results There were 151 cases included in this study. Positive scan were seen in 130 patients (86.1%). Liver, spleen and renal injuries were seen in 40.8%, 33.8% and 26.2% of cases respectively. Laparotomies were performed in 42 patients from 130 positive scans (32.3%) and in 3 patients who had negative scan. Out of 45 patients who had undergone laparotomies, 10 patients had significant surgically injuries that were missed on CT scan findings. The injuries were bowel perforation (n=4), serosal tear of bowel (n=1), mesenteric injuries (n=2), spleen injury (n=1), liver injury (n=1) and laceration of broad ligaments with oozing of blood from ovarian artery (n=1). Conclusion CT scan is a useful tool in the evaluation of blunt abdominal injuries in haemodynamically stable patients especially in the detection of solid organ injuries and retroperitoneal haematoma. However assessment of bowel and mesenteric injury was not similarly effective in our study

Multislice computed tomography (MSCT) of blunt abdominal trauma: incidental findings related to the genitourinary tract

Background: MSCT is currently the imaging modality of choice in the assessment of hemodynamically stable patients with blunt abdominal trauma. Widespread use of this modality can reveal incidental findings that vary in their importance, from trivial lesions to findings that may alter the management of these trauma patients. Objective: To determine the frequency of incidental findings related to the genitourinary tract at MSCT of blunt abdominal trauma and the effect of these findings on subsequent patient’s management. Material and Methods: MSCT examinations of blunt abdominal trauma in 151 consecutive patients within two years (2008-2009) were retrospectively reviewed. Demographic data and incidental findings related to the genitourinary tract were recorded. The subsequent management of these findings was reviewed from patient’s case note. Results: Twenty one (13.9%) patients had incidental findings related to the genitourinary tract in 151 cases reviewed. Majority of them (n=18) do not require surgical intervention. However, in 3 of these 21 patients, surgical intervention was needed. Conclusion: Incidental findings related to the genitourinary tract in MSCT of blunt abdominal trauma were common. However, those requiring a surgical intervention are rare

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