2009

Chattopadhyay P, Bandyopadhyay A, Das S, Kundu AJ
Correspondence: Dr Partha Chattopadhyay, drpartha73@hotmail.com

ABSTRACT
Gorham’s disease is a rare benign cause of progressive massive idiopathic osteolysis. The clinician’s acute awareness and high degree of suspicion are required for diagnosis because of its rarity and variable clinical presentation. Distinctive radiological and histopathological features may help in this regard. Though eventual stabilisation of the affected bone is the most common sequel, spontaneous recovery is very rarely reported in peer-reviewed literature. We report such a rare occurrence in a 17-year-old boy.

Keywords: disappearing bone disease, Gorham’s disease, Gorham-Stout syndrome, idiopathic osteolysis, massive osteolysis
Singapore Med J 2009; 50(7): e259-e263

Lim YC
Correspondence: Dr Lim Yen Chian, linyanqian@gmail.com

ABSTRACT
A 42-year-old woman with a history of depression and epilepsy ingested two types of household detergent and developed gastrointestinal symptoms, and subsequently acute renal failure. Coingestants included nontoxic quantities of paracetamol and therapeutic doses of sodium valproate and fluoxetine. The patient developed acute renal failure, and also had fever and unilateral ear inflammation. The acute renal failure resolved four days later. Patients presenting with detergent poisoning are typically screened and treated for gastrointestinal and respiratory toxicity. We discuss the mechanism of development of acute renal failure in our patient, review the literature linking detergent poisoning and nephrotoxicity, and propose a direct relationship between detergent poisoning and acute renal failure.

Keywords: acute tubular necrosis, detergent ingestion, poisoning, renal failure
Singapore Med J 2009; 50(7): e256-e258

Vasanwala FF, Puvanendran R, Ng JM, Suhail SM
Correspondence: Dr Farhad Fakhrudin Vasanwala, farhad.fakhrudin.vasanwala@singhealth.com.sg

ABSTRACT
We report two cases of dengue haemorrhagic fever which developed self-limiting gross nephrotic-range proteinuria. One patient was a 32-year-old Bangladeshi and the other a 42-year-old Chinese national. Both patients did not have manifestations of renal damage, such as increase in serum creatinine, haematuria or urinary casts. Gross nephrotic-range proteinuria, which was self-limiting due to dengue haemorrhagic fever, has not been previously reported in Singapore. We postulate that this nephrotic-range proteinuria is a manifestation of increased glomerular leakage of protein, due to glomerulonephritis associated with dengue haemorrhagic fever.

Keywords: dengue haemorrhagic fever, immune complexes, nephrotic-range proteinuria, plasma leakage, self-limiting glomerulonephritis
Singapore Med J 2009; 50(7): e253-e255

Esfe ARG, Bozorg SMV, Yazdi HR
Correspondence: Dr Hadi Rokni Yazdi, rokniyaz@sina.tums.ac.ir

ABSTRACT
A high origin of the radial artery from the brachial artery is the most frequently encountered arterial anomaly in an upper extremity, and is reported in seven percent of individuals. This variant is vulnerable to injury because of its more superficial location. A 59-year-old man developed a pseudoaneurysm following the inadvertent cannulation of a high origin radial artery. We report the successful treatment of the pseudoaneurysm by ultrasound-guided compression. Ultrasound-guided compression is an available and simple method for the repair of arterial pseudoaneurysms, and delayed complete thrombosis can be expected even if a residual flow remains after the initial compression.

Keywords: pseudoaneurysm, radial artery, radial arterial pseudoaneurysm, ultrasonography, ultrasound-guided compression
Singapore Med J 2009; 50(7): e250-e252

Yap KH, Sulaiman S
Correspondence: Dr Yap Kim Hoong, yapkimhoong@hotmail.com

ABSTRACT
Pulmonary atelectasis may be caused by endobronchial lesions or by extrinsic compression of the bronchus. However, lung collapse due to compression from a thoracic aneurysm is uncommon. We report a 76-year-old hypertensive female patient who has pulmonary atelectasis due to an extrinsic compression from a descending thoracic aortic aneurysm, and discuss possible treatment options.

Keywords: aneurysm, pulmonary atelectasis, thoracic aorta aneurysm
Singapore Med J 2009; 50(7): e247-e249

George RA, Debnath J, Singh K, Satija L, Bhargava S, Vaidya A
Correspondence: Lt Col (Dr) Jyotindu Debnath, jyotindu_debnath@rediffmail.com

ABSTRACT
Anatomical variations of the extrahepatic biliary system are common. Adequate knowledge of such variations and an appropriate roadmap before any surgical, endoscopic or percutaneous procedure/intervention help in preventing associated complications. Multiple imaging modalities can depict the anatomy of the extrahepatic biliary tree. High resolution magnetic resonance imaging and magnetic resonance cholangiopancreatography are increasingly used to delineate the hepatobiliary system. Multidetector computed tomography allows for high-speed volume scanning with an excellent spatial and temporal resolution. It also allows for multiplanar reconstructions in virtually any plane, with isotropic resolution. We describe an unusual complication of biliary stenting in a 62-year-old man with low insertion of a cystic duct, resulting in the inadvertent placement of the common bile duct stent into the cystic duct. This was demonstrated well by multidetector computed tomography and confirmed thereafter, during surgery.

Keywords: biliary anatomical variants, cystic duct lesions, low insertion of cystic duct, malpositioned biliary stent, multidetector computed tomography
Singapore Med J 2009; 50(7): e243-e246

Pattamapaspong N, Khunamornpong S, Phongnarisorn C, Pojchamarnwiputh S
Correspondence: Dr Nuttaya Pattamapaspong, nuttaya@gmail.com

ABSTRACT
We report a case of a 45-year-old woman who had a palpable mass in the left lower quadrant of the abdomen. Computed tomography (CT) showed a circumscribed mass in the left round ligament of the uterus. The mass had heterogeneous density and enhancement accompanied by mottled calcification, which was initially identified as a leiomyoma. A histopathological examination revealed a malignant perivascular epithelioid cell tumour (PEComa), which is a rare soft tissue tumour. This case demonstrates that the appearance of malignant PEComa on the CT can mimic leiomyoma, which is the most common tumour of the round ligament. To the best of our knowledge, this is the first report of a CT appearance of this round ligament tumour. The radiological features and differential diagnosis are discussed.

Keywords: leiomyoma, PEComa, perivascular epithelioid cell neoplasms, round ligament tumour, uterus lesion
Singapore Med J 2009; 50(7): e239-e242

Madhusudhan KS, Seith A, Khadgawat R, Das P, Mathur S
Correspondence: Dr Ashu Seith, ashubhalla1@yahoo.com

ABSTRACT
Tuberculosis involving the thyroid gland is a rare occurrence. We report a case of cytologically-diagnosed thyroid gland tuberculosis in a 21-year-old man who presented with thyroid swelling of short duration, and describe the magnetic resonance (MR) imaging appearances of the lesion, which to our knowledge, has not been previously described. We also report a rare complication of abscess formation in the track of the fine needle aspiration. The intermediate signal intensity of the lesions on both T1-and T2 weighted MR images may provide a clue about tuberculosis, as clinical suspicion is low due to the rarity of the disease.

Keywords: fine needle aspiration, magnetic resonance imaging, thyroid abscess, thyroid tuberculosis, tuberculosis
Singapore Med J 2009; 50(7): e235-e238

Che Mahiran CD, Alagaratnam J, Liza-Sharmini AT
Correspondence: Dr Liza-Sharmini Ahmad Tajudin, liza@kb.usm.my

ABSTRACT
Retinoblastoma, the most common primary intraocular malignancy of childhood, usually presents in the first three years of life. Atypical presentation of retinoblastoma can masquerade as virtually any ocular or orbital pathology, which may lead to diagnostic dilemmas especially in the presence of other systemic diseases. We report a 20-month-old boy who was diagnosed with coronary aneurysm as a complication of Kawasaki disease, and presented with sudden left eye redness. His mother noticed the presence of white pupillary reflex three months earlier. Atypical acute ocular presentation secondary to Kawasaki disease was initially suspected, but the presence of multiple calcification and mild proptosis on imaging suggested characteristics of advanced retinoblastoma. Histopathological examination of the enucleated eye, which revealed a classical rosette pattern appearance, confirmed the diagnosis. Atypical presentations of retinoblastoma are usually associated with advanced disease. The presence of other systemic conditions further complicates the diagnosis. Early diagnosis is important to reduce the mortality and morbidity.

Keywords: enucleation, extraocular extension, leucocoria, Kawasaki disease, retinoblastoma
Singapore Med J 2009; 50(7): e232-e234

Pang CE, Teoh SCB
Correspondence: Dr Claudine Elizabeth Pang, claudine28@gmail.com

ABSTRACT
We report an unusual case of orbital inflammatory disease presenting as anterior uveitis in an adult. A 35-year-old Chinese man presented with acute anterior uveitis unresponsive to topical steroids, and progressed to manifest optic disc swelling and posterior scleritis. Computed tomography showed a mass-like soft tissue swelling within the intraconal fat indenting the posterior medial aspect of the globe. The diagnosis of orbital inflammatory disease was made, and the patient was treated with systemic corticosteroids with prompt resolution of symptoms and signs. Anterior uveitis can be considered an unusual ophthalmic manifestation of orbital inflammatory disease in adults.

Keywords: anterior uveitis, orbital inflammatory disease, orbital pseudotumour
Singapore Med J 2009; 50(7): e229-e231