2009

Rashid F, Riccio SA, Munk PL, Malfair D, Heran MKS
Correspondence: Prof Peter Loren Munk, peter.munk@vch.ca

ABSTRACT
Adrenocorticotropic hormone (ACTH) producing bronchial carcinoid tumours are a rare cause of Cushing’s syndrome. Cushing’s syndrome is frequently complicated by osteoporosis, which results in an increased tendency for the development of vertebral compression fractures. Percutaneous vertebroplasty has been shown to be an effective treatment option in the setting of painful osteoporotic compression fractures refractory to conservative therapies. We report a case where vertebroplasty was performed on a 36-year-old woman with osteoporosis and compression fractures secondary to hypercorticolism. A bronchial carcinoid tumour was found to be the source of excess ACTH production. Three-level percutaneous vertebroplasty resulted in a marked improvement in pain.

Keywords: adrenocorticotropic hormone, bronchial carcinoid tumour, carcinoid tumour, Cushing’s syndrome, osteoporotic vertebral fracture, vertebral compression fracture, vertebroplasty
Singapore Med J 2009; 50(4): e147-e150

Mohd J, Tan J, Yeo GSH
Correspondence: Dr Jasmine Mohd, jasmine.mohd@singhealth.com.sg

ABSTRACT
We describe a male neonate with foetal hydrops due to foetal anaemia caused by Kell isoimmunisation. The severity of anaemia was monitored by Doppler ultrasonography of the middle cerebral artery peak systolic velocity, and this was used to time the foetal blood transfusions. The 33-year-old Indian mother received a total of five foetal blood transfusions from 21 weeks to 31 weeks of gestation, resulting in resolution of the anaemia and hydrops.

Keywords: foetal anaemia, foetal blood transfusion, foetal hydrops, Kell isoimmunisation, middle cerebral artery peak systolic velocity
Singapore Med J 2009; 50(4): e143-e146

Leong SC, Karkos PD
Correspondence: Mr Samuel Leong, samuelleong@tiscali.co.uk

ABSTRACT
We discuss a case of an asymptomatic cervical rib presenting as a hard neck lump in a 56-year-old woman. Cervical rib is a common condition associated with thoracic outlet syndrome. The diagnosis, investigation and management of this condition is an important differential diagnosis that an ENT surgeon should know in a patient presenting with a neck mass.

Keywords: cervical rib, neck lump, thoracic outlet syndrome
Singapore Med J 2009; 50(4): e141-e142

Wan WK, Sng TY, Goh HK, Hwang SG
Correspondence: Dr Wan Wei Keat, ctach21@hotmail.com

ABSTRACT
A case of intermediate form of foetal rhabdomyoma with cytological correlation is reported in a ten-year-old girl who presented with a lump in the right neck region. Fine-needle aspirate of the lump was performed. Cytological findings were that of spindled cells and rhabdomyoblasts with abundant eosinophilic cytoplasm. The lesion was subsequently excised. Histology showed a well-circumscribed cellular lesion composed of oval- to spindle-shaped cells. There were interspersed immature skeletal muscle cells with uniform nuclei and eosinophilic tapered cytoplasm and ganglion-like rhabdomyoblasts. No marked cellular atypia or prominent mitoses was noted. Immunohistochemically, the tumour cells showed positivity for muscle specific actin, myoglobin and myogenin. There was focal positivity for desmin. The patient showed no evidence of local recurrence or metastasis after a 32-month follow-up. This is believed to be the first case report of cytological findings in an intermediate form of foetal rhabdomyoma.

Keywords: foetal rhabdomyoma, fine-needle aspiration cytology, intermediate foetal rhabdomyoma, neck mass, rhabdomyoma
Singapore Med J 2009; 50(4): e138-e140

Patro SN, Kesavadas C, Thomas B, Kapilamoorthy TR, Gupta AK
Correspondence: Dr Kesavadas Chandrasekharan, chandkesav@yahoo.com

ABSTRACT
Cryptococcal infection of the brain is commonly seen in immunocompromised patients but rarely considered as the differential diagnosis in immunocompetent patients. We present two cases of cryptococcosis involving the brain in immunocompetent patients, which strongly mimicked tuberculous infection in both conventional as well as advanced magnetic resonance (MR) imaging, and the disease was only confirmed after histopathological /cerebrospinal fluid serological study. One patient was a 52-year-old woman, and the second patient was a 23-year-old man. These two cases highlight the need for workup of fungal infections in immunocompetent patients from the tuberculous endemic regions, even when the imaging is highly suspicious of tuberculous lesions. The imaging findings in advanced MR imaging techniques such as diffusion, perfusion, susceptibility-weighted imaging and MR spectroscopy are discussed.

Keywords: brain infections, central nervous system infection, cryptococcosis, fungal infection, tuberculosis
Singapore Med J 2009; 50(4): e133-e137

Horoz OO, Yildizdas D, Yilmaz HL
Correspondence: Dr Dincer Yildizdas, dyildizdas@cu.edu.tr

ABSTRACT
Hydrocarbon aspiration causes acute lung injury, which may lead to acute respiratory distress syndrome. Surfactant has been shown to be beneficial in experimentally-induced hydrocarbon-associated acute respiratory distress syndrome. However, there has not been a clinical study evaluating the effect of surfactant application on hydrocarbon aspiration in humans. We report a 17-month-old boy with acute respiratory distress syndrome due to hydrocarbon aspiration and was successfully treated with surfactant application.

Keywords: acute respiratory distress syndrome, hydrocarbon aspiration, surfactant therapy
Singapore Med J 2009; 50(4): e130-e132

Sharifah AIM, Jasvinder K, Rus AA
Correspondence: Dr Sharifah AI Mokhtar, sharifah.mokhtar@gmail.com

ABSTRACT
Pulmonary arteriovenous malformations are rare vascular anomalies. We report a 12-year-old girl who presented with exertional dyspnoea, cyanosis and clubbing since the age of five years, and multiple pulmonary arteriovenous malformations. Computed tomography pulmonary angiogram showed a large pulmonary arteriovenous malformation at the lower lobe of the right lung. Pulmonary angiogram showed a large right lung arteriovenous malformation and two small left lung arteriovenous malformations. The multiple arteriovenous malformations were occluded with Gianturco coils. She is now asymptomatic and on regular follow-up.

Keywords: arteriovenous malformation, cyanosis, pulmonary arteriovenous malformation, pulmonary vascular anomaly
Singapore Med J 2009; 50(4): e127-e129

Lee LC, Wong R, Raju GC, Khor C, Yip J
Correspondence: Dr Lee Li Ching, leeliching@yahoo.com

ABSTRACT
We report a 25-year-old Malay man with Subutex-related endocarditis, complicated by protein-losing enteropathy from severe tricuspid regurgitation and congestive heart failure. The intestinal protein loss was reversed with surgical valvular intervention. This case highlights the importance of recognising the rare association between protein-losing enteropathy and congestive heart failure in the setting of endocarditis.

Keywords: congestive heart failure, drug abuse, endocarditis, protein-losing enteropathy, Subutex
Singapore Med J 2009; 50(4): e124-e126