Discovery of coarctation of the aorta following renal doppler sonography.

Coarctation of the aorta (CoA) is present in 0.4% of live births and in 7% of patients with congenital heart disease. While there may be florid presentations of congestive heart failure in the neonatal period, the diagnosis during adulthood is often delayed. We encountered a 20-year-old woman who was discovered to be hypertensive on routine check-up. Following bilateral abnormal renal doppler sonography, MR angiogram revealed a short-segment stenosis of the descending thoracic aorta. Review of her chest radiograph showed a small aortic knuckle. This case highlights an unconventional algorithm in diagnosing aortic coarctation in adulthood.

Isolated fallopian tube torsion in prepubertal females.

Isolated fallopian tube torsion is an uncommon diagnosis. It is particularly rare in the paediatric and post-menopausal age groups. It lacks pathognomonic symptoms, signs and imaging findings, yet each of these diagnostic steps plays a crucial role in early diagnosis. We describe two cases of isolated fallopian tube torsion in prepubertal females.

Gastrointestinal stromal tumors presenting as gynecological masses: usefulness of multidetector computed tomography.

Large extraluminal gastrointestinal tumors (GISTs) may present as pelvic masses and thus mimic gynecological neoplasms in female patients. On clinical examination and pelvic ultrasound, these tumors resemble pedunculated fibroids or ovarian tumors. Multidetector computed tomography (CT), with its ability to perform isotropic multiplanar reconstruction, is useful in differentiating GISTs from true gynecological masses by demonstrating the pedicle sign connecting a pelvic GIST to its organ of origin. This allows a preoperative diagnosis to be made, which may be helpful in guiding therapeutic options and management. We present two cases of GISTs presenting as pelvic masses in which ultrasound findings suggested a gynecological cause, but multidetector CT with multiplanar reconstruction was able to determine their true organ of origin.

Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation.

This study is a retrospective review of the transcervical fluoroscopy-guided fallopian tube recanalisation (FTR) procedures done in a multi-ethnic south-east Asian population, over 9 years. A total of 100 patients with infertility and documented proximal tubal obstruction (PTO) were referred for FTR. On-table hysterosalpingography under sedation demonstrated true PTO in 96 patients. At selective-salpingography, the PTO cleared in 16 patients; 78 required FTR and two had fimbrial blockage. The technical success rate of FTR was 86.8% and the post-FTR pregnancy rate was 36.84% at a mean follow-up interval of 12.2 months. There were no major, immediate procedure-related complications. There was an ectopic pregnancy in a single treated patient. Fluoroscopy-guided FTR is a safe treatment option in patients with infertility from PTO, with high technical success rate, low complication rate and increased chances of pregnancy; therefore it should be preferred before attempting more expensive and resource-intensive procedures.

Perineural (Tarlov) cysts mimicking adnexal masses: a report of three cases.

Perineural (Tarlov) cysts are usually incidental findings during magnetic resonance imaging (MRI) performed for low back pain. However, in a tertiary women's hospital, they may present as incidental findings on gynecological ultrasound imaging. Approximately 40,000 pelvic scans are performed annually in our department. Tarlov cysts were identified in three women between August 2007 and September 2008. In two patients (Cases 1 and 3), these cysts were initially misdiagnosed as hydrosalpinges on ultrasound examination, the latter having a differential diagnosis of an ovarian cyst. Two patients (Cases 1 and 2) were symptomatic, although Case 2 had symptoms that could not entirely be accounted for by the location of the cyst. Although asymptomatic, Case 3 underwent laparoscopy with a view to salpingectomy/cystectomy. In these patients, confirmation of Tarlov cysts was subsequently made on either computed tomography (CT) or MRI. All three patients were managed conservatively. Here we describe their clinical presentation, the appearance of the cysts on ultrasound imaging and on CT or MRI, and their eventual outcomes.

Clinics in diagnostic imaging (108). Tuberculous dactylitis of the thumb, mediastinal and left hilar lymphadenopathy, and probable left cervical lymphadenopathy.

A five-year-old girl presented with a history of left neck swelling for one week and right thumb swelling for three weeks. Imaging studies revealed a "collar-stud" abscess in the left side of the neck, massive mediastinal lymphadenopathy with a left anterior chest wall abscess, and right thumb dactylitis that was typical of tuberculosis (TB). Surgical drainage of the left neck swelling revealed acid-fast bacilli. Young children are more susceptible to tuberculous infection, and at greater risk of extrapulmonary spread. A child infected with TB indicates recent transmission, usually from an adult. Good contact tracing is essential. Individuals with HIV infection are also at greater risk of TB and atypical mycobacterial infection as well extrapulmonary TB. The clinical and radiological features of both pulmonary and extrapulmonary TB are discussed, with additional illustrative cases.

Cervical ectopic thymus in an infant.

Cervical ectopic thymus, a common embryological anomaly detected incidentally at autopsy, is rarely described in clinical patients. About 100 cases have been described in the literature, ten percent of which occurred in neonates. We report a case of solid cervical ectopic thymus in a three-month-old male infant presenting as a neck lump and snoring at sleep. The embryopathogenesis, clinical features, diagnostic modalities and management options are discussed, together with a review of the literature.

Omental infarction in children: imaging features with pathological correlation.

INTRODUCTION: Omental infarction is a rare occurrence in the paediatric population. It often presents as an acute abdomen that can mimic acute appendicitis and cholecystitis. METHODS: Six cases of omental infarction in children, proven on histopathology, were retrospectively reviewed for their clinical presentation and imaging findings on ultrasonography and computed tomography. RESULTS: These cases revealed clinical and imaging findings on computed tomography that were suggestive and helpful in the pre-operative diagnosis of omental infarction. Findings on ultrasonography were less specific. Histopathological specimens revealed findings of vasculitis in all cases. CONCLUSION: There are clinical and imaging features that will help in the pre-operative diagnosis of this uncommon condition. We also postulate vasculitis as a possible underlying pathology for omental infarction.

Uterine hemorrhage in a menopausal female associated with an arteriovenous malformation and myometritis.

A case is described of vaginal bleeding in a 67-year-old female as the first manifestation of a uterine arteriovenous malformation (AVM). Although bleeding is the commonest presentation of an AVM, this is the first case known to have been precipitated by florid myometritis associated with the long-standing presence of an intra-uterine contraceptive device (IUCD). Uterine imaging studies utilising ultrasound scan with color Doppler were instrumental in suggesting the source of bleeding in this case. Subsequently, the patient suffered a torrential hemorrhage which necessitated hysterectomy.

Pitfalls of gynaecological ultrasonography.

Pitfalls in gynaecological ultrasonography may arise during acquisition of images, processing and interpretation. Physical interactions between the ultrasound and body structures may produce artifacts. Physiological processes such as functional ovarian cysts may mimic lesions. Different pathological processes may produce similar ultrasonographical appearances. To minimise errors in interpretation of gynaecological ultrasonography, one needs to be aware of the limitations of ultrasonography, and the similarities in the appearances of various physiological and pathological processes.

Intramural tubal polyps--a villain in the shadows?

BACKGROUND: Intramural tubal polyps are commonly described in association with subfertility. However, there is unfamiliarity among clinicians about the investigations available for making a diagnosis of this condition. The objective of this paper was to highlight the suitable investigations for diagnosis and thus increase awareness of this condition and its relationship with subfertility. METHOD: A retrospective review of 14 patients with intramural tubal polyps was done for the period from January to December 1996. An attempt was made to correlate the radiographic findings on hysterosalpingography with transvaginal ultrasound examinations and hydrochromotubation performed under laparoscopic observation. The fertility history of these patients was also examined. RESULTS: The review demonstrated a prevalence of 3.8% of intramural tubal polyps in a selected population of predominantly subfertile women. Only hysterosalpingography was useful in making the diagnosis in-vivo. Fifty percent of the patients did not have any other obvious pathology to explain their subfertility. CONCLUSION: We conclude that meticulous hysterosalpingography is useful as a diagnostic investigation and that consistent reporting is needed for good follow-up.

Cystic hygroma in adulthood.

The majority of cystic hygromas present in childhood, usually below the age of two years. A case report of adult presentation is presented, with discussion of development, presentation, pathology and management of cystic hygroma.

Primary gastric lymphoma.

Primary gastric lymphoma is a rare gastrointestinal lymphoma. The treatment of this condition remains controversial, especially the extent of surgical resection. Ten cases were operated on over a five-year period at our institution and the outcome was reviewed. Early results suggest no difference in survival whether the margin of resection was clear or not so long as postoperative chemotherapy was given. The outcome appear to depend more on the extent of the disease at the time of surgery. Full thickness involvement of the stomach wall with lymph node involvement were bad prognostic indicators.

A case of uterine artery pseudoaneurysms.

Uterine artery pseudoaneurysms is a rare cause of haemorrhage but is potentially life-threatening and can occur after common gynaecological operations such as a Caesarean section or a hysterectomy. A 33-year-old woman who developed secondary postpartum haemorrhage after a Caesarean section was diagnosed to have uterine artery pseudoaneurysms on ultrasound scan. She was treated with bilateral uterine artery embolisation via selective catherisation of uterine arteries. Good outcome with the aneurysms remaining obliterated was obtained. Angiographic embolisation is a safe and effective method of treating postpartum haemorrhage in haemodynamically stable patients and should be an option before resorting to surgery in appropriately selected cases.

Abdominal trauma--a review.

Trauma is a leading cause of death in the 1-44 age group. In our study, the most common cause is road traffic accidents followed by stab wounds and falls from height. Blunt abdominal trauma accounted for 79% of the cases. The spleen and liver were the most common organs involved in blunt abdominal trauma. Clinical assessment of blunt abdominal trauma is unreliable. The diagnostic peritoneal lavage is a useful triage tool in the initial assessment.

The effect of enteral fibre-containing feeds on stool parameters in the post-surgical period.

BACKGROUND/AIM OF STUDY: Specialised nutritional support includes both enteral and parenteral routes. When oral intake is not an option, but gastro-intestinal function is present, enteral tube feeding should be considered. However, one of the complications of enteral feeding access is diarrhoea. The aim of this study was to test the effect of fibre on a local population, in a prospective, single-blinded trial to determine whether the presence of fibre in enteral feeds reduced the incidence of diarrhoea in Asian patients. METHODS: Sixteen post-surgical candidates were randomly assigned to receive a fibre-supplemented (FSF) enteral formula or a fibre-free formula (FFF) for 10 days post-surgery to assess the usefulness of FSF in reducing the incidence of diarrhoea in tube-fed patients. Differences in stool consistency, stool frequency, capillary blood glucose and serum albumin levels between the two groups were determined. Antibiotic usage in both groups was noted. RESULTS: Patients in the FSF group had more bowel movements throughout the 10-day period and firmer stools than the FFF group, but this difference was not statistically significant (p = 0.39). There were no significant differences in daily mean glucose levels between both groups. CONCLUSION: We conclude that there is insufficient evidence that fibre-containing enteral formulae reduce the incidence of diarrhoea in tube-fed patients in the short term. However, these products could inherently be included for patients on tube-feeds during extended periods, with the prospect of maintaining gut function integrity and flora.

Foetal intralobar lung sequestration: antenatal diagnosis and management.

OBJECTIVES: The objectives of this study are to discuss the use of ultrasonography for the diagnosis of foetal intralobar sequestration (FILS) antenatally and the management options available for these pregnancies. METHODS: This is a retrospective review of six cases of FILS diagnosed antenatally by two dimensional (2D) and colour Doppler ultrasonography out of a total of 31,508 deliveries over a two-year period at the KK Women's and Children's Hospital. RESULTS: The incidence of FILS in this hospital was 1 in 5,251 deliveries. 2D ultrasonography showed an echogenic lung in all cases. FILS was confirmed by the demonstration of a systemic vessel leading to the affected lung on colour Doppler examination. After counselling, four terminated their pregnancies during mid-trimester, while two continued their pregnancies to term. Confirmation of the terminated cases was by post-mortem. In the two pregnancies that continued, regular growth scans were done to monitor the progression of the condition. Computed tomography confirmed the diagnosis post-delivery. Both were well but one had a resection of the sequestrated lung although he was asymptomatic. Histology also confirmed the diagnosis. CONCLUSION: FILS is a rare anomaly. 2D and colour Doppler ultrasonography are used to diagnose the condition antenatally. Termination of the pregnancy is not always indicated, as there are favourable outcomes from FILS.

Necrotising fasciitis originating from a vulval abscess--a case report.

This article reports a rare case of necrotising fasciitis starting out as a vulval abscess with rapid progression to a potentially lethal condition. Elderly people with medical conditions such as diabetes are especially prone to it. A high index of suspicion and an early surgical consult are essential in improving outcome in this condition. Once diagnosed, aggressive surgical debridement with antibiotic cover is crucial. This is followed up with meticulous nursing care of the large wound till it heals. The various diagnostic points and treatment modalities are also discussed.