2.Methacholine Challenge Test as an Adjunctive Investigative Tool in Patients with Asthma-Like Symptoms: The Sabah Experience
Siew Teck Tie ; J L Wong ; A Beniyamin ; A HO ; S K K Kannan ; A R Jamalul Azizi
The Medical Journal of Malaysia 2012;67(2):204-206
Introduction: Patients with asthma-like symptoms pose a
diagnostic dilemma when physical examination is normal.
The usual practice in Malaysia would be to give empirical
asthma treatment. Bronchial challenge test (BCT) is widely
used in many countries to diagnose asthma objectively but it is not widely available in Malaysia.
Objective: To describe our experience with BCT using
methacholine at Queen Elizabeth Hospital as a supporting
tool in the investigation of patients with asthma-like
symptoms.
Methodology: Review of case notes of patients who
underwent BCT from July 2008 till April 2009. BCT was
performed via dosimeter technique. Results were classified
as high hyper responsiveness if the provocative dose of
methacholine required to achieve 20% fall in FEV1 (PD20) was less than or equal to 0.125 μmol, moderate hyper
responsiveness if PD20 was between 0.125 to 1.99 μmol or
mild hyper responsiveness if PD20 was between 2.00 to 6.6
μmol. PD20 of more than 6.6 μmol constitutes a negative MCT.
Results: 29 patients had BCT during the study period. 19
cases were included in this review. The age ranged from 13
to 70 years old. There were 12 males and 7 females. Duration of symptoms ranged from 2 weeks to 23 years. BCT was positive (mild or moderate hyper responsiveness) in 10 out of 19 patients. No patient had high bronchial hyper
responsiveness.
Conclusions: BCT is a useful adjunctive tool in the
investigation of patients presenting with asthma-like
symptoms. This test obviates empirical asthma treatment.
BCT should be made available in all major hospitals in
Malaysia.
3.Drainage of multiloculated tuberculous pleural effusion by medical thoracoscopy: When and why should it be considered?
Sze Shyang KHO ; Swee Kim CHAN ; Mei Ching YONG ; Siew Teck TIE
The Medical Journal of Malaysia 2018;73(1):49-50
Tuberculous pleural effusion (TBE) is a common encounterin our region. Up to 50% of patients with TBE will developresidual pleural thickening (RPT) which can lead tofunctional impairment. However, the need of drainageremains controversial. We report a case of end-stage renalfailure patient who presented with right multiloculatedtuberculous pleural effusion which was drained via amedical thoracoscope. Patient reports immediate relief ofbreathlessness post procedure and one month follow upshown significant improvement of RPT. We also discussedthe current perspective on the rationale of TBE drainage andthe role of medical thoracoscope in TBE management.
4.The great masquerade: Empyema thoracis as an unusual presentation of primary lung malignancy
Larry Nyanti ; Kho Sze Shyang ; Tie Siew Teck
The Medical Journal of Malaysia 2019;74(1):79-81
Primary lung malignancy presenting as empyema is rare,
with a reported incidence of 0.3%. We report a case of a 60-
year-old man presenting with unilateral pleural effusion;
diagnostic thoracocentesis confirmed Salmonella
empyema. Post-drainage, chest radiograph showed
persisting right hemithorax opacity; subsequent computed
tomography revealed a right lung mass with right upper lobe
bronchus obliteration. Percutaneous biopsy confirmed
advanced stage lung adenocarcinoma. We discuss the
mechanism of post-obstructive pneumonia in lung cancerassociated
empyema and the utility of bedside ultrasound in
diagnosis of lung masses. Clinicians are alerted to the
possibility of lung malignancy in elderly patients presenting
with empyema.
5.Radial probe endobronchial ultrasound (R-EBUS) guided transbronchial cryobiopsy in the diagnosis of peripheral solitary pulmonary nodule
Kho Sze Shyang ; Tie Siew Teck
The Medical Journal of Malaysia 2019;74(4):349-351
Solitary pulmonary nodule (SPN) always raises suspicion for
early lung cancer, in which accurate and less invasive
biopsy is needed. We report a case of transbronchial
cryobiopsy of right upper lobe SPN under radial
endobronchial ultrasound (R-EBUS) guidance after an
inconclusive computed tomography guided transthoracic
needle aspiration. A diagnosis of Stage 1B adenocarcinoma
of the lung was made. Patient subsequently underwent
curative right upper lobectomy after ruling out mediastinal
lymph node involvement. To the best of our knowledge, this
is the first report of R-EBUS guided transbronchial
cryobiopsy case reported from Malaysia.
6.Diagnostic yield of medical thoracoscopy in exudative pleural effusions in a region with high tuberculosis burden
Sze Shyang KHO ; Swee Kim CHAN ; Mei Ching YONG ; Siew Teck TIE
The Medical Journal of Malaysia 2020;75(3):254-259
Introduction: Pleural effusion is frequently encountered in
respiratory medicine. However, despite thorough
assessment including closed pleural biopsy, the cause of
around 20% of pleural effusions remains undetermined.
Medical thoracoscopy (MT) is the investigation of choice in
these circumstances especially if malignancy is suspected.
The aim of this study is to evaluate the diagnostic yield of
MT in exudative pleural effusions in a single center from
East Malaysia.
Methods: Retrospective chart review of all adult patients
who underwent MT for undiagnosed exudative pleural
effusion in a 24-month duration.
Results: Our cohort comprised of 209 patients with a median
age of 61 years old (IQR 48.5-69.5). There were 92 (44%)
patients with malignant pleural effusion (MPE) and 117 (56%)
benign effusions; which included 85 tuberculous pleural
effusion (TBE) and 32 cases of non-tuberculous exudative
pleural effusion. Conclusive pathological diagnosis was
made in 79.4% of the cases. For diagnosis of MPE, MT had a
sensitivity of 89.1% (95% CI 80.4-94.3), specificity of 100%
(95% CI 96.0-100.0), and positive predictive value (PPV) of
100% (95% CI 94.4-100) and negative predictive value (NPV)
of 92.1% (95% CI 85.6-95.9). For TBE, MT had a sensitivity of
90.5% (95% CI 81.8-95.6), specificity of 100% (95% CI 96.3-
100.0) PPV of 100% (95% CI 94.1-100) and NPV of 93.9% (95%
CI 88.0-97.2). Overall complication rate was 3.3%.
Conclusions: MT showed excellent sensitivity and
specificity in the diagnosis of exudative pleural effusion in
this region. It reduces empirical therapy by providing
histological evidence of disease when initial non-invasive
investigations were inconclusive.