Spontaneous thrombosis in a post-traumatic Splenic pseudo-aneurysm.

Introduction: Splenic pseudo-aneurysm is an uncommon complication following splenic injury caused by blunt abdominal trauma. Pseudo-aneurysm is usually treated with splenic arterial embolisation. Spontaneous thrombosis of a splenic pseudo-aneurysm can occur but it is rare. Method: We report a case of spontaneous thrombosis in a post-traumatic splenic pseudo-aneurysm. The patient was managed conservatively as he was haemodynamically stable with a repeat CT scan on the 7th day showing a tubular enhancing structure in the upper pole of the spleen demonstrating the same attenuation value . Conclusion: This case illustrates a spontaneous resolution of splenic pseudo-aneurysm, which is a rare outcome of the condition

Diagnostic dilemma of reactive arthritis aided by multimodality imaging using MRI, CECT and 18F-FDG PET/CT scans

Reactive arthritis can be an elusive diagnosis especially in the elderly. A 77-year-old lady, presented with recent history of hip pain. She had been treated for urinary tract infection caused by Chlamydia sp. and had associated weight loss. She was also investigated for possible tuberculosis and occult malignancy. CT scan abdomen/pelvis and MRI revealed peri-articular muscle inflammation. Biopsy of her hip joint failed to find the causative factor. Whole-body 18F-FDG PET/CT scan revealed increased FDG uptake at bilateral hip and shoulder joints. She recovered after an intensive course of antibiotics. Thus, she was diagnosed with reactive arthritis. Reactive arthritis is usually a diagnosis of exclusion made by a high index of suspicion and positive serology test. Molecular imaging can be an alternative investigation for joint pains in the elderly, which enables excellent anatomical and functional information to exclude more sinister conditions such as malignancy

Primary mediastinal myxoid liposarcoma

In this study, we report an extremely rare case of liposarcoma which arises primarily in mediastinum. The patient appeared to have progressive dyspnoea and prolonged cough for a duration of one year. Chest radiograph and Computed Tomography (CT) of the thorax revealed a large right mediastinal mass with fatty component. It was confi rmed to be primary liposarcoma on histopathological examination

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

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

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)

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

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

An uncommon vascular cause of spontaneous hydropneumothorax

This paper highlights a potentially life threatening and unsuspected case of multiple small pseudoaneurysms from the thyrocervical and costocervical branch of the left subclavian artery that was spontaneously ruptured. The cause was not suspected prior to thoracic CT angiography (CTA) because the initial pre-emptive diagnosis was only trivial spontaneous hydropneumothorax which became serious after a chest tube was inserted

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