2009

Lapeña JF Jr
Correspondence: Dr José Florencio F Lapeña Jr., lapenajf@upm.edu.ph

ABSTRACT
A one-year-old boy with two months’ chronic cough and dysphonia, unresponsive to therapy for pneumonia, had a radiopaque, wedge-shaped tracheal foreign body noted on anteroposterior, but not lateral radiographs, and he eventually became aphonic. Laryngoscopy yielded a subglottic embryonated duck eggshell. Foreign body aspiration should be considered in the presence of chronic cough. Radiopaque airway foreign bodies may be metallic or calcific. The patient was fond of sucking soup from a partially-shelled embryonated duck egg. The last occasion occurred immediately before the onset of cough. The hard egg white of the same delicacy is a commonly-ingested oesophageal foreign body in the Philippines, but the preceding slurping of the amniotic fluid predisposes one to unusual eggshell aspiration. With the continuing global migration of overseas workers and their families, healthcare providers with Asian and Southeast Asian clients should consider such cultural practices in assessing symptoms suggestive of aerodigestive foreign bodies.

Keywords: “balut”, embryonated duck egg, eggshell, foreign body aspiration, laryngotracheal foreign body
Singapore Med J 2009; 50(5): e170-e171

Hussain A, Mahmood H, Ansari T, El-Hasani S
Correspondence: Mr Abdulzahra Hussain, azahrahussian@yahoo.com

ABSTRACT
The combination of pneumomediastinum, gastric wall gas and hepatic portal vein gas is a challenging clinical problem. Although different causes of the individual gas sign have been reported in the literature, the cause of a triad of these signs in a single patient is less clear, and represents an extremely rare condition. A 65-year-old man presented with severe lower chest and epigastric pain of a few hours’ duration. Initial assessment confirmed epigastric tenderness. Computed tomography showed pneumomediastinum, air in the stomach wall, hepatic portal vein gas and bowel dilatation. Small bowel and right colon dilatation was confirmed at laparotomy. The patient was treated subsequently with antibiotics to cover Gram-positive and Gram-negative bacteria, and anaerobes. The patient was discharged in good general condition on the 12th postoperative day. In conclusion, the triad of pneumomediastinum, gastric wall gas and hepatic portal vein gas is an extremely rare condition and associated with gastric necrosis.

Keywords: gastric wall gas, hepatic portal vein gas, pneumomediastinum, stomach wall necrosis
Singapore Med J 2009; 50(5): e166-e169

Khan SA, Chawla T, Azami R
Correspondence: Dr Tabish Chawla, tabish.chawla@aku.edu

ABSTRACT
A cystic dilatation of the terminal portion of the minor pancreatic duct (duct of Santorini) is referred to as a santorinicele. It is usually associated with pancreas divisum and has been suggested to be a cause of relative stenosis of the minor papilla, often leading to recurrent pancreatitis. While this anomaly has been reported in the paediatric population, it is more commonly found in the elderly. We present a 27-year-old woman with recurrent acute pancreatitis attributed to a santorinicele with a dorsal duct-exclusive pancreatic drainage.

Keywords: cystic dilatation of dorsal pancreatic duct, minor pancreatic duct, pancreas divisum, recurrent acute pancreatitis, santorinicele
Singapore Med J 2009; 50(5): e163-e165

Yap FBB
Correspondence: Dr Felix BB Yap, woodzlamp@yahoo.com

ABSTRACT
Nevus lipomatosus superficialis is a rare benign skin malformation characterised by ectopic adipocytes in the upper dermis. It is classified into two types: a classical Hoffman-Zurhelle type and the solitary type. A case of the classical type with multiple soft, non-tender, pedunculated, cerebriform, skin-coloured papules and nodules over the right lower back is presented in a 21-year-old Malay woman. She had a rare occurrence of ulceration and necrosis of the lesions.

Keywords: benign skin malformation, dermal lesion, ectopic adipose tissue, nevus lipomatosus superficialis, skin papule
Singapore Med J 2009; 50(5): e161-e162

Ho SLM, Tang BYM, Chai J, Tan SH
Correspondence: Dr Madeline Ho Sheun Ling, sheunling@yahoo.com

ABSTRACT
We report a rare case of primary B-cell lymphoma of the leg presenting with mononeuropathy multiplex. A 79-year-old Chinese woman who was being investigated for mononeuritis multiplex had an incidental finding of indurated erythematous plaques on the breast and left leg. A skin biopsy from the nodular area on the right breast showed a dense and diffuse infiltrate of atypical cells with large, round, hyperchromatic nuclei with prominent nucleoli. These atypical lymphocytes were CD20+, Bcl-2+ and Mum-1+. A diagnosis of diffuse large B-cell lymphoma, leg type involving the breast and leg with extracutaneous involvement, was made. This case highlights the importance of a full systemic and cutaneous examination in patients presenting with progressive, painful peripheral neuropathy.

Keywords: B-cell lymphoma, lymphoma, mononeuritis multiplex, peripheral neuropathy
Singapore Med J 2009; 50(5): e158-e160

Low KB, Huang J, Lim CH
Correspondence: Dr Low Kah Boon, lowkahboon@yahoo.com

ABSTRACT
A 47-year-old woman presented with dyspnoea on exertion for several weeks. Echocardiogram and multidetector computed tomography of the heart showed a right atrial mass typical of an atrial myxoma. This was confirmed on histology. The imaging features of atrial myxoma and other conditions presenting as a right-sided cardiac mass are discussed.

Keywords: atrial myxoma, cardiac tumour, heart neoplasms, myxoma, right atrial mass
Singapore Med J 2009; 50(5): 546-550

Chiam PTL, Koh TH, Chao VTT, Lee CY, See Tho VY, Tan SY, Lim ST, Hwang NC, Sin YK, Chua YL
Correspondence: Dr Paul TL Chiam, paul.chiam.t.l@nhc.com.sg

ABSTRACT
Surgical aortic valve replacement (AVR) is the standard of care for patients with symptomatic severe aortic stenosis (AS), providing relief of symptoms and prolonging survival. However, many patients are either denied or not offered surgery due to high surgical risk or non-operability for open AVR. The technology of percutaneous aortic valve implantation emerged in 2002, and has since evolved rapidly with satisfactory results. Currently, almost all the procedures are performed predominantly in Europe and North America. The first-in-Asia percutaneous transcatheter aortic valve implantation via the transfemoral route is described. A 77-year-old man with symptomatic severe AS and at high surgical risk was successfully treated, with sustained clinical improvement and satisfactory haemodynamic results at 30-day follow-up.

Keywords: aortic valve stenosis, bioprosthesis, cardiothoracic surgery, heart valve prosthesis implantation, percutaneous prosthesis implantation, percutaneous transcatheter aortic valve implantation
Singapore Med J 2009; 50(5): 534-537