Pub Date : 2019-03-11DOI: 10.46475/ASEANJR.V19I2.25
P. Pusuwan, T. Ekjeen, C. Tocharoenchai, Kobkun Maungsomboon, K. Wiyaporn, C. Komoltri, A. Ruangma, Ruentip Tiparoj
Objective: To study bone scintigraphy using between F-18 NaF PET/CT and Tc-99m MDP scan for detecting bone metastases. Material and Methods: Thirteen patients (5 males, mean age 55.4 years, range 34-74 years) who were suspected bone metastases with single or two equivocal lesions on Tc-99m MDP bone scan were recruited between October 2010 and October 2012. All these patients underwent F-18 NaF PET/CT scan within one week after Tc-99m MDP bone scan. The sensitivity, specificity and accuracy of Tc-99m MDP bone scan and F-18 NaF PET/CT in differentiating metastatic bone lesion from benign lesion by patientbased and lesion-based analyses were studied. Results: F-18 NaF PET/CT could identify all seven patients with malignant bone metastases that Tc-99m MDP bone scan was interpreted as malignancy in only three patients (42.9%) and equivocal in the rest of these patients. For lesion-based analysis of the overall 75 lesions, the sensitivity, specificity and accuracy of Tc-99m MDP bone scan were 48%, 83.3% and 70.7% and F-18 NaF PET/CT were 100% for all parameters. Besides the ability of F-18 NaF PET/CT to accurately identify malignancy from benign lesion, unenhanced CT portion of PET/CT can show extra-osseous findings that may change patient management. Conclusion: F-18 NaF PET/CT provides an excellent bone image quality and higher accuracy than Tc-99m MDP bone scan. Then F-18 NaF PET/CT is a good choice for evaluating bone metastases.
{"title":"A Comparison of Bone Scan Using between F-18 NaF PET/CT and Tc-99m MDP","authors":"P. Pusuwan, T. Ekjeen, C. Tocharoenchai, Kobkun Maungsomboon, K. Wiyaporn, C. Komoltri, A. Ruangma, Ruentip Tiparoj","doi":"10.46475/ASEANJR.V19I2.25","DOIUrl":"https://doi.org/10.46475/ASEANJR.V19I2.25","url":null,"abstract":"Objective: To study bone scintigraphy using between F-18 NaF PET/CT and Tc-99m MDP scan for detecting bone metastases. \u0000Material and Methods: Thirteen patients (5 males, mean age 55.4 years, range 34-74 years) who were suspected bone metastases with single or two equivocal lesions on Tc-99m MDP bone scan were recruited between October 2010 and October 2012. All these patients underwent F-18 NaF PET/CT scan within one week after Tc-99m MDP bone scan. The sensitivity, specificity and accuracy of Tc-99m MDP bone scan and F-18 NaF PET/CT in differentiating metastatic bone lesion from benign lesion by patientbased and lesion-based analyses were studied. \u0000Results: F-18 NaF PET/CT could identify all seven patients with malignant bone metastases that Tc-99m MDP bone scan was interpreted as malignancy in only three patients (42.9%) and equivocal in the rest of these patients. For lesion-based analysis of the overall 75 lesions, the sensitivity, specificity and accuracy of Tc-99m MDP bone scan were 48%, 83.3% and 70.7% and F-18 NaF PET/CT were 100% for all parameters. Besides the ability of F-18 NaF PET/CT to accurately identify malignancy from benign lesion, unenhanced CT portion of PET/CT can show extra-osseous findings that may change patient management. \u0000Conclusion: F-18 NaF PET/CT provides an excellent bone image quality and higher accuracy than Tc-99m MDP bone scan. Then F-18 NaF PET/CT is a good choice for evaluating bone metastases.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131970084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-11DOI: 10.46475/aseanjr.v19i2.32
Siwipan Changtham
Case Report A 55-year old man visited the orthopedic OPD due to tenderness and swelling at left ankle from a motorcycle accident, 3 hours before. Left medial malleolus fracture was diagnosed. A short leg cast was performed by orthopedist. During the wait to receive his medicines, he had sudden onset of chest discomfort, pain at left lower chest and left upper abdomen. He was sent to the ER department. He had blood pressure of 110/75 mmHg, pulse rate of 64 beats/min, respiratory rate of 20 breaths/min and oxygen saturation of 97%. A physical examination found mild pale conjunctiva, tender at left chest wall, equal breath sounds. Mild tenderness at LUQ was also noted without guarding or rebound tenderness. Chest film showed air-fluid level within left hemithorax and mild shifting of mediastinum to the right. A CT chest including upper abdomen with contrast study was performed. Discontinuity of left hemidiaphargm with herniation of stomach and duodenum into left hemithorax was seen. Splenic laceration and minimal left hemothorax were also noted. He was admitted at the traumatic surgery ward for an exploratory laparotomy. Rupture of left hemidiaphragm, approximately 10 cm in diameter, with herniation of stomach, duodenum and omentum into left thorax was found. Left hemothorax and splenic contusion were also found. Repair to left diaphragm with interrupted non-absorptable sutures was performed. No evidence of complication was detected.
{"title":"Blunt Traumatic Diaphragmatic Hernia: Case Report","authors":"Siwipan Changtham","doi":"10.46475/aseanjr.v19i2.32","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.32","url":null,"abstract":"Case Report A 55-year old man visited the orthopedic OPD due to tenderness and swelling at left ankle from a motorcycle accident, 3 hours before. Left medial malleolus fracture was diagnosed. A short leg cast was performed by orthopedist. During the wait to receive his medicines, he had sudden onset of chest discomfort, pain at left lower chest and left upper abdomen. He was sent to the ER department. He had blood pressure of 110/75 mmHg, pulse rate of 64 beats/min, respiratory rate of 20 breaths/min and oxygen saturation of 97%. A physical examination found mild pale conjunctiva, tender at left chest wall, equal breath sounds. Mild tenderness at LUQ was also noted without guarding or rebound tenderness. Chest film showed air-fluid level within left hemithorax and mild shifting of mediastinum to the right. A CT chest including upper abdomen with contrast study was performed. Discontinuity of left hemidiaphargm with herniation of stomach and duodenum into left hemithorax was seen. Splenic laceration and minimal left hemothorax were also noted. He was admitted at the traumatic surgery ward for an exploratory laparotomy. Rupture of left hemidiaphragm, approximately 10 cm in diameter, with herniation of stomach, duodenum and omentum into left thorax was found. Left hemothorax and splenic contusion were also found. Repair to left diaphragm with interrupted non-absorptable sutures was performed. No evidence of complication was detected.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121929667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v19i2.26
Nontika Boontankan, Kewalee Sasiwimonphan
Objective: To test the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CT/MR imaging and adrenal vein sampling (AVS) for diagnosis of aldosterone-producing adrenal adenoma (APA). Material and method: Retrospective study of 14 patients with primary hyperaldosteronism (PAL) who underwent both CT/MR imaging and AVS between June 2007 and June 2012 were performed. The study included 7 male and 7 female patients. Review CT/MR findings of these cases and compared with AVS results were done. Results: Five of fourteen patients (35%) had unilateral adrenal nodules on CT, and one of fourteen patients (7.1%) had bilateral adrenal nodules on CT[D1]. The remaining eight patients had no significant nodules in both adrenal glands. Among 5 patients who had unilateral adrenal nodule detected from CT, 4 patients (80%) with nodule greater than 10 mm also presented with lateralization from AVS and finally pathological proven APA. The last patient with unilateral nodule showed small size less than 10 mm and had AVS results of bilateral lesion. Medical therapy was applied for this patient instead of surgical treatment. In other group (8 of 14 patients, 57.1%), there was no significant nodule from CT or MRI and AVS results indicated bilateral lesions in two patients (25%). The rest of six patients found unilateral lesion on AVS which underwent adrenalectomy and histological revealed adrenal hyperplasia of all cases. Two of six patients concluded to be primary adrenal hyperplasia (PAH) or unilateral adrenal hyperplasia (UAH), which showed clinical cure after adenalectomy. The remaining four patients who showed no improvement of hypertension after adrenalectomy concluded to be bilateral adrenal hyperplasia (BAH). The sensitivity, specificity, accuracy, PPV and NPV for detected adrenal adenoma by CT/MRI of our study were 66.67%, 87.50%, 78.57%, 80.00%, and 77.78%, respectively. The sensitivity, specificity, accuracy, PPV and NPV for detected adrenal adenoma by AVS at cut point AVS ratio at 2 were 100%, 50%, 71.43%, 60% and 100%, respectively. Conclusion: In patient with suspected PAL who presented with unilateral adrenal nodule at least 10 mm in size detected by CT, these patient should be referred for adrenalectomy without need to performing AVS. The differentiation of subtype in patients with PAL is most reliably achieved with AVS which may reserve for patient who had no significant adrenal nodule from CT/MRI.
{"title":"Diagnostic Efficacy of CT/MR Imaging and Adrenal Vein Sampling for Localization of Aldosterone-producing Adrenal Adenomas in Primary Aldosteronism","authors":"Nontika Boontankan, Kewalee Sasiwimonphan","doi":"10.46475/aseanjr.v19i2.26","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.26","url":null,"abstract":"Objective: To test the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CT/MR imaging and adrenal vein sampling (AVS) for diagnosis of aldosterone-producing adrenal adenoma (APA). \u0000Material and method: Retrospective study of 14 patients with primary hyperaldosteronism (PAL) who underwent both CT/MR imaging and AVS between June 2007 and June 2012 were performed. The study included 7 male and 7 female patients. Review CT/MR findings of these cases and compared with AVS results were done. \u0000Results: Five of fourteen patients (35%) had unilateral adrenal nodules on CT, and one of fourteen patients (7.1%) had bilateral adrenal nodules on CT[D1]. The remaining eight patients had no significant nodules in both adrenal glands. Among 5 patients who had unilateral adrenal nodule detected from CT, 4 patients (80%) with nodule greater than 10 mm also presented with lateralization from AVS and finally pathological proven APA. The last patient with unilateral nodule showed small size less than 10 mm and had AVS results of bilateral lesion. Medical therapy was applied for this patient instead of surgical treatment. In other group (8 of 14 patients, 57.1%), there was no significant nodule from CT or MRI and AVS results indicated bilateral lesions in two patients (25%). The rest of six patients found unilateral lesion on AVS which underwent adrenalectomy and histological revealed adrenal hyperplasia of all cases. Two of six patients concluded to be primary adrenal hyperplasia (PAH) or unilateral adrenal hyperplasia (UAH), which showed clinical cure after adenalectomy. The remaining four patients who showed no improvement of hypertension after adrenalectomy concluded to be bilateral adrenal hyperplasia (BAH). The sensitivity, specificity, accuracy, PPV and NPV for detected adrenal adenoma by CT/MRI of our study were 66.67%, 87.50%, 78.57%, 80.00%, and 77.78%, respectively. The sensitivity, specificity, accuracy, PPV and NPV for detected adrenal adenoma by AVS at cut point AVS ratio at 2 were 100%, 50%, 71.43%, 60% and 100%, respectively. \u0000Conclusion: In patient with suspected PAL who presented with unilateral adrenal nodule at least 10 mm in size detected by CT, these patient should be referred for adrenalectomy without need to performing AVS. The differentiation of subtype in patients with PAL is most reliably achieved with AVS which may reserve for patient who had no significant adrenal nodule from CT/MRI.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121268822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v19i2.34
S. Hirunpat, N. Sanghan, Adchara Wanai, N. Ina, Pornrujee Hirunpat
Summary: In spite of the recent acceptance to be a common cause of acute severe headaches, reversible cerebral vasoconstriction syndrome (RCVS) is still commonly missed. The syndrome is characterized by acute severe headaches due to the vasoconstriction of the cerebral arteries, which eventually resolve spontaneously. We present a reported case of RCVS with a typical magnetic resonance angiography (MRA) appearance and a review of the literature.
{"title":"Reversible Cerebral Vasoconstriction Syndrome: A Commonly Missed Diagnosis in Acute Severe Headaches","authors":"S. Hirunpat, N. Sanghan, Adchara Wanai, N. Ina, Pornrujee Hirunpat","doi":"10.46475/aseanjr.v19i2.34","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.34","url":null,"abstract":"Summary: In spite of the recent acceptance to be a common cause of acute severe headaches, reversible cerebral vasoconstriction syndrome (RCVS) is still commonly missed. The syndrome is characterized by acute severe headaches due to the vasoconstriction of the cerebral arteries, which eventually resolve spontaneously. We present a reported case of RCVS with a typical magnetic resonance angiography (MRA) appearance and a review of the literature.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127592044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v19i2.27
P. Poonotoke
Objective: The purpose of this study is to focus on which factors affect or limit fine-needle aspirationcytology (FNAC) results of thyroid nodule, in order to increase the satisfactory cytologic results and to avoid unnecessary FNAC in patients with asymptomatic benign nodules and highly possible unsatisfactory results. Materials and Methods: The records of 217 thyroid nodules in 179 patients referred to the radiology department at Lerdsin Hospital for US-guided FNAC between January 2010 and December 2013 were retrospectively reviewed. Cytologic specimens of the FNAC were classified as unsatisfactory (non-diagnostic) and satisfactory (diagnostic) results and analyzed by mean of Logistic regression analysis, based on patientûs age, gender, nodule size, number and solid-cystic composition of nodule. Results: The cytologic result was satisfactory for diagnosis in 154 specimens (71%) and unsatisfactory in 63 specimens (29%). Patientûs age, gender, number and size of nodule of the unsatisfactory result group were not different from the satisfactory result group but the nodule composition was different. Percentage of the unsatisfactory aspiration increased as the cystic component increased, ranging from 15.3% in solid nodules to 59.3% in predominant cystic nodules (cystic >75%). Upon the binary logistic regression analysis, the predominant cystic nodule was the only significant predictor of unsatisfactory result (p-value < 0.001) while solid nodules, predominant solid nodules and solid-cystic nodules are not significant. Unsatisfactory FNAC result of the predominant cystic nodules was about 8 times higher than the solid nodule (crude odds ratio = 8.087, p-value < 0.001). Conclusion: To optimize the usefulness of FNAC,we should realize that solid-cystic composition of the thyroid nodules influence the non-diagnostic and diagnostic cytology.
{"title":"Unsatisfactory Ultrasound-Guided Fine Needle Aspiration of Thyroid Nodule: Which Factors Limit Cytology Result?","authors":"P. Poonotoke","doi":"10.46475/aseanjr.v19i2.27","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.27","url":null,"abstract":"Objective: The purpose of this study is to focus on which factors affect or limit fine-needle aspirationcytology (FNAC) results of thyroid nodule, in order to increase the satisfactory cytologic results and to avoid unnecessary FNAC in patients with asymptomatic benign nodules and highly possible unsatisfactory results. \u0000Materials and Methods: The records of 217 thyroid nodules in 179 patients referred to the radiology department at Lerdsin Hospital for US-guided FNAC between January 2010 and December 2013 were retrospectively reviewed. Cytologic specimens of the FNAC were classified as unsatisfactory (non-diagnostic) and satisfactory (diagnostic) results and analyzed by mean of Logistic regression analysis, based on patientûs age, gender, nodule size, number and solid-cystic composition of nodule. \u0000Results: The cytologic result was satisfactory for diagnosis in 154 specimens (71%) and unsatisfactory in 63 specimens (29%). Patientûs age, gender, number and size of nodule of the unsatisfactory result group were not different from the satisfactory result group but the nodule composition was different. Percentage of the unsatisfactory aspiration increased as the cystic component increased, ranging from 15.3% in solid nodules to 59.3% in predominant cystic nodules (cystic >75%). Upon the binary logistic regression analysis, the predominant cystic nodule was the only significant predictor of unsatisfactory result (p-value < 0.001) while solid nodules, predominant solid nodules and solid-cystic nodules are not significant. Unsatisfactory FNAC result of the predominant cystic nodules was about 8 times higher than the solid nodule (crude odds ratio = 8.087, p-value < 0.001). \u0000Conclusion: To optimize the usefulness of FNAC,we should realize that solid-cystic composition of the thyroid nodules influence the non-diagnostic and diagnostic cytology.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124197753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v19i2.28
Pra Urusopone
Objective: To determine the olfactory fossa depth according to the Keros classification and determine the incidence of asymmetry in height and configuration of the ethmoid roof. Materials and Methods: Retrospective analysis of 75 coronal computed tomography studies of paranasal sinuses and facial bones were performed. Measurement of the depth of the lateral lamella, classification of the depth according to Keros type and determination of the asymmetries in the ethmoid roof depth and configuration were done. Results: The mean height of the lateral lamella cribiform plate (LLCP) was 2.15+1.29 mm. The cases were classified as 87.33% Keros type1 and 12.67 % as Keros type 2. No Keros type 3 was found .There was asymmetry in the LLCP height of 33.33% of cases and a configuration asymmetry in 8% of the cases. No significant difference between the mean height and distribution of Keros type between gender and laterality were also found. Conclusion: As regards the olfactory fossa depth, the Keros type 1 was most frequently found. Asymmetry in the depth and configuration were detected in 33.33 and 8% respectively. Risk of inadvertent intracranial entry through the lateral lamella among Thai may be lower than other studies with majority of cases classified as Keros type 2 or 3.
{"title":"Computed Tomography Analysis of the Ethmoid Roof: A Region at Risk in Endoscopic Sinus Injury","authors":"Pra Urusopone","doi":"10.46475/aseanjr.v19i2.28","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.28","url":null,"abstract":"Objective: To determine the olfactory fossa depth according to the Keros classification and determine the incidence of asymmetry in height and configuration of the ethmoid roof. \u0000Materials and Methods: Retrospective analysis of 75 coronal computed tomography studies of paranasal sinuses and facial bones were performed. Measurement of the depth of the lateral lamella, classification of the depth according to Keros type and determination of the asymmetries in the ethmoid roof depth and configuration were done. \u0000Results: The mean height of the lateral lamella cribiform plate (LLCP) was 2.15+1.29 mm. The cases were classified as 87.33% Keros type1 and 12.67 % as Keros type 2. No Keros type 3 was found .There was asymmetry in the LLCP height of 33.33% of cases and a configuration asymmetry in 8% of the cases. No significant difference between the mean height and distribution of Keros type between gender and laterality were also found. \u0000Conclusion: As regards the olfactory fossa depth, the Keros type 1 was most frequently found. Asymmetry in the depth and configuration were detected in 33.33 and 8% respectively. Risk of inadvertent intracranial entry through the lateral lamella among Thai may be lower than other studies with majority of cases classified as Keros type 2 or 3.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126392278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v19i2.33
O. Tritanon, Arunee Singhsnaeh, Jiraporn Laothamatus, A. Boongird, D. Ratanakorn, P. Nitiyanant
Tumefactive multiple sclerosis is a form of demyelinating disease which patient can present with acute stroke. We reported a case of a 49-year-old woman with well controlled hypertension, who presented with right hemiplegia 15 hours prior to admission. The initial diagnosis of acute stroke was made. Emergency computed tomography showed hypodense lesion at the left lentiform nucleus and posterior limb of the left internal capsule. The magnetic resonance imaging (MRI) study showed hyperintense FLAIR lesion in the left lentiform nucleus, left internal capsule, left thalamus, and periventricular area of the left frontoparietal region, some areas of restricted diffusion and inhomogeneous enhancement. The MR spectroscopy (MRS) of the lesion showed increased choline peak, decreased creatine and NAA peaks, and maximal choline to creatine ratio 2.25. Her symptoms deteriorated with progressive headache and motor aphasia. The follow up MRI showed extension of the inhomogeneous enhancing lesion along the biopsy tract at the left frontal lobe with the enhancing and MR spectra pattern similar to the lesion. The craniotomy with left frontal lesion excision included the mass and the biopsy tract was done. The lesion showed acute and chronic inflammatory cell infiltration with macrophages, necrotic tissue and reactive gliosis. The further pathological worked up demonstrated foci of demyelination with relative axonal preservation, numerous CD68+ macrophages with intracyto-plasmic Luxol fast blue(+) myelin debris. Perivascular and parenchymal CD3+ T-cells were identified, especially in demyelinating foci. These findings supported the diagnosis of tumefactive multiple sclerosis. Her conditions were improved after treating with pulse methylprednisolone and intravenous immunoglobulin (IVIG). Follow up MRI study 4 months after treatment revealed almost resolution of the preexisting inhomogeneous enhancing lesion.
{"title":"Tumefactive Multiple Sclerosis Clinically Mimicking Acute Stroke and Lesional Migration Along the Biopsy Tract: A Case Report","authors":"O. Tritanon, Arunee Singhsnaeh, Jiraporn Laothamatus, A. Boongird, D. Ratanakorn, P. Nitiyanant","doi":"10.46475/aseanjr.v19i2.33","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.33","url":null,"abstract":"Tumefactive multiple sclerosis is a form of demyelinating disease which patient can present with acute stroke. We reported a case of a 49-year-old woman with well controlled hypertension, who presented with right hemiplegia 15 hours prior to admission. The initial diagnosis of acute stroke was made. Emergency computed tomography showed hypodense lesion at the left lentiform nucleus and posterior limb of the left internal capsule. The magnetic resonance imaging (MRI) study showed hyperintense FLAIR lesion in the left lentiform nucleus, left internal capsule, left thalamus, and periventricular area of the left frontoparietal region, some areas of restricted diffusion and inhomogeneous enhancement. The MR spectroscopy (MRS) of the lesion showed increased choline peak, decreased creatine and NAA peaks, and maximal choline to creatine ratio 2.25. Her symptoms deteriorated with progressive headache and motor aphasia. The follow up MRI showed extension of the inhomogeneous enhancing lesion along the biopsy tract at the left frontal lobe with the enhancing and MR spectra pattern similar to the lesion. The craniotomy with left frontal lesion excision included the mass and the biopsy tract was done. The lesion showed acute and chronic inflammatory cell infiltration with macrophages, necrotic tissue and reactive gliosis. The further pathological worked up demonstrated foci of demyelination with relative axonal preservation, numerous CD68+ macrophages with intracyto-plasmic Luxol fast blue(+) myelin debris. Perivascular and parenchymal CD3+ T-cells were identified, especially in demyelinating foci. These findings supported the diagnosis of tumefactive multiple sclerosis. Her conditions were improved after treating with pulse methylprednisolone and intravenous immunoglobulin (IVIG). Follow up MRI study 4 months after treatment revealed almost resolution of the preexisting inhomogeneous enhancing lesion.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124708891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v22i2.118
K. Rathore, M. Teh, M. Newman
A 73-year-old female patient presented with cardiac tamponade following Stanford type A aortic dissection required immediate pericardiocentesis and followed by root replacement with coronary artery bypass grafting. The patient's postoperative course was eventful and coronary graft kinking contributed to myocardial ischemia, but the presentation was confused with cardiac tamponade.
{"title":"Kinked coronary saphenous vein graft after aortic dissection surgery: An unusual differential diagnosis of cardiac tamponade","authors":"K. Rathore, M. Teh, M. Newman","doi":"10.46475/aseanjr.v22i2.118","DOIUrl":"https://doi.org/10.46475/aseanjr.v22i2.118","url":null,"abstract":"A 73-year-old female patient presented with cardiac tamponade following Stanford type A aortic dissection required immediate pericardiocentesis and followed by root replacement with coronary artery bypass grafting. The patient's postoperative course was eventful and coronary graft kinking contributed to myocardial ischemia, but the presentation was confused with cardiac tamponade.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122988929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In a new episode of the COVID -19 pandemic in Thailand during the beginning of 2021, cases in Samut Sakhon Province mainly occurred in foreign workers and were mostly asymptomatic or had mild disease. To prevent overwhelming the local hospital, a field hospital was established which used chest radiography as one of screening tools for triaging patients. Objective: To determine the clinical utility of chest radiographs as a screening tool for COVID-19 patients who were asymptomatic or mildly symptomatic. Materials and Methods: Six hundred nineteen patients with COVID -19 (confirmed by reverse transcriptase-polymerase chain reaction) were registered at the field hospital at Samut Sakhon provincial sport stadium during 5-8 January 2021 and had chest radiographs taken. The image readings were based on the consensus of two radiologists and a final decision was made by a third radiologist if the first two did not agree. Findings on chest radiographs and clinical outcomes were evaluated. Results: The study included 619 radiographs; 328/619 (53%) men and 291/619 (47%) women had a mean age of 33.3+/- 9.7 (range, 5-64) years. There was mild disease in 13/619, and asymptomatic infections in 606/619. Chest radiographs were normal in 568 (91.7%) and abnormal in 51 (8.3%) patients; typical findings of COVID-19 were seen in 3 (0.5%) patients. Other abnormal findings were found in 23 (3.8%) patients such as active tuberculosis in 6 (1.0%). Four patients were transferred to the hospital, one of whom required supplemental oxygen. Conclusion: Combined chest radiographic and clinical information allows better decisions regarding hospital transfers of asymptomatic and mildly symptomatic COVID-19 patients at a field hospital.
{"title":"Utility of screening chest radiographs in patients with asymptomatic and mildly symptomatic COVID-19 at a field hospital in Samut Sakhon, Thailand","authors":"Pilawan Trimankha, Lakkana Lakkana Jirapong, Runnaya Rungsin, Orawan Autravisittikul, P. Deesuwan, Yasinee Mekavuthikul, Anocha Chodpanich","doi":"10.46475/aseanjr.v22i2.119","DOIUrl":"https://doi.org/10.46475/aseanjr.v22i2.119","url":null,"abstract":"Background: In a new episode of the COVID -19 pandemic in Thailand during the beginning of 2021, cases in Samut Sakhon Province mainly occurred in foreign workers and were mostly asymptomatic or had mild disease. To prevent overwhelming the local hospital, a field hospital was established which used chest radiography as one of screening tools for triaging patients.\u0000Objective: To determine the clinical utility of chest radiographs as a screening tool for COVID-19 patients who were asymptomatic or mildly symptomatic.\u0000Materials and Methods: Six hundred nineteen patients with COVID -19 (confirmed by reverse transcriptase-polymerase chain reaction) were registered at the field hospital at Samut Sakhon provincial sport stadium during 5-8 January 2021 and had chest radiographs taken. The image readings were based on the consensus of two radiologists and a final decision was made by a third radiologist if the first two did not agree. Findings on chest radiographs and clinical outcomes were evaluated.\u0000Results: The study included 619 radiographs; 328/619 (53%) men and 291/619 (47%) women had a mean age of 33.3+/- 9.7 (range, 5-64) years. There was mild disease in 13/619, and asymptomatic infections in 606/619. Chest radiographs were normal in 568 (91.7%) and abnormal in 51 (8.3%) patients; typical findings of COVID-19 were seen in 3 (0.5%) patients. Other abnormal findings were found in 23 (3.8%) patients such as active tuberculosis in 6 (1.0%). Four patients were transferred to the hospital, one of whom required supplemental oxygen. \u0000Conclusion: Combined chest radiographic and clinical information allows better decisions regarding hospital transfers of asymptomatic and mildly symptomatic COVID-19 patients at a field hospital.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"149 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124160728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.46475/aseanjr.v19i2.29
Chanpen Buranachokpaisan
Madelungûs disease or Benign symmetric lipomatosis is the rare disease that is the one of differential diagnosis of palpable neck mass that easily diagnosis by CT imaging. We report two cases of this condition and review the radiological findings.
{"title":"Two Case Reports of Madelungûs Disease: CT Finding.","authors":"Chanpen Buranachokpaisan","doi":"10.46475/aseanjr.v19i2.29","DOIUrl":"https://doi.org/10.46475/aseanjr.v19i2.29","url":null,"abstract":"Madelungûs disease or Benign symmetric lipomatosis is the rare disease that is the one of differential diagnosis of palpable neck mass that easily diagnosis by CT imaging. We report two cases of this condition and review the radiological findings.","PeriodicalId":180936,"journal":{"name":"The ASEAN Journal of Radiology","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126884643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：