2009

Colak MC, Kocaturk H, Bayram E, Karaca L
Correspondence: Dr Hasan Kocaturk, haskturk@hotmail.com

ABSTRACT
We report a 57-year-old man who presented with a two-month history of persistent epigastric pain associated with indigestion, weight loss and jaundice. Contrast-enhanced computed tomography revealed a large pseudoaneurysm 87 mm × 68 mm in diameter, with its origin from the inferior pancreaticoduodenal artery of the superior mesenteric artery and in continuity with an ectatic gastroduodenal artery. The aneurysmal mass exerted direct pressure over the head of the pancreas, common bile duct and duodenum, causing obstruction. Non-selective abdominal angiography confirmed the aneurysm stemming from the inferior pancreaticoduodenal artery. Because of the obstructive symptoms and the size of the aneurysm, surgery was planned, but the patient refused and died from massive gastrointestinal bleeding one month later.

Keywords: computed tomography, gastrointesti-nal haemorrhage, inferior pancreaticoduodenal artery, pancreaticoduodenal artery rupture,  pseudoaneurysm
Singapore Med J 2009; 50(10): e346-e349

Zhang J, Chong E, Chai P, Poh KK
Correspondence: Dr Poh Kian Keong, mdcpkk@nus.edu.sg

ABSTRACT
We report two rare cases of right ventricular lipomatous involvement, and discuss their contrasting diagnostic images and clinical manifestations. Case 1 is a 21-year-old Malay man who presented with recurrent syncope. Transthoracic echocardiography showed a homogeneous discrete mass attached to the right ventricular septum, occupying the right ventricular outflow tract. Cardiac magnetic resonance (MR) imaging showed features consistent with intracardiac lipoma, which was confirmed on histology, upon surgical resection. Case 2, a 73-year-old Caucasian woman, was found to have incidental lipomatous infiltration of the right ventricle on echocardiography and MR imaging. In contrast to the well-defined right ventricular lipoma seen in the first case, lipomatous involvement was manifested as a diffuse homogeneous thickening of the right ventricular free wall. Multimodality imaging allows for a complementary and detailed characterisation of lipomatous masses involving the ventricular septum.

Keywords: cardiac magnetic resonance imaging, echocardiography, intracardiac mass, lipoma, lipomatous hypertrophy, right ventricular fat
Singapore Med J 2009; 50(10): e342-e345

Chia EMY, Teo L, Venkatesh SK
Correspondence: Dr Lynette Teo, lynette_ls_teo@nuhs.edu.sg

ABSTRACT
A 66-year-old man presented with epigastric pain. Computed tomography (CT) of the abdomen showed portal venous gas with partial thrombosis of the portal veins, consistent with portal pyaemia. CT also showed nonspecific peripancreatic fat stranding. The patient was treated conservatively but did not improve, necessitating a laparotomy that revealed ischaemic colitis and bowel necrosis. He underwent a right hemicolectomy and showed clinical improvement. Portal pyaemia is a combination of infection and thrombosis within the portal veins. The presence of gas in the portal vein is a known feature in portal pyaemia. We showed radiological examples of hepatic and portal venous gas in several patients who presented to our institution, with a brief discussion of their radiological findings, causes, management and outcome. The mortality rate of patients with portal venous gas depends on the underlying cause. The high mortality rate of patients with portal venous gas due to bowel necrosis or ischaemia may necessitate emergent surgical intervention.

Keywords: bowel ischaemia, hepatic portal venous gas, portal pyaemia, portal pylephlebitis
Singapore Med J 2009; 50(10): 1023-1029