1.Wandering humeral head mimicking a breast mass.
Gerald J S Tan ; Andrew G S Tan ; Wilfred C G Peh
The Medical journal of Malaysia 2008;63(2):164-5
A 74-year-old woman was incidentally found to have a left breast mass. The mass could not be adequately compressed to be visualized on mammography. Ultrasonography showed a heavily-calcified rounded mass in the left axillary tail of the left breast. Chest radiograph confirmed that the mass was a migrated humeral head. Remotely-displaced fracture-dislocations of the humeral head are very rare and to our knowledge, displacement into the breast, clinically mimicking a breast mass, has not been previously described.
Mass in breast
;
Head
;
Mass, NOS
;
Wandering
;
Breast
2.Clinics in diagnostic imaging (142). Cervical oesophagus impacted partial denture.
Sumeet KUMAR ; Sivasubramanian SRINIVASAN ; Wilfred C G PEH
Singapore medical journal 2012;53(10):690-quiz 693
A 58-year-old man presented to the emergency department with sudden pain and odynophagia after drinking water. The patient thought that part of his lower denture may have fallen into his throat. There was moderate tenderness over the lower anterior neck. Radiographs of the neck were normal. Computed tomography showed an impacted partial denture in the upper oesophagus, which was removed by rigid endoscopy. Recheck endoscopy showed a superficial mucosal laceration at 18 cm. Ingestion of dental prostheses is common among the elderly population. The role of imaging in the early detection of ingested foreign bodies, particularly nonradio-opaque ones, is discussed.
Denture, Partial
;
adverse effects
;
Esophagoscopy
;
Esophagus
;
diagnostic imaging
;
Foreign Bodies
;
diagnostic imaging
;
therapy
;
Humans
;
Male
;
Middle Aged
;
Tomography, X-Ray Computed
5.Clinics in diagnostic imaging. 141. Complete anterior cruciate ligament tear.
Hollie M Y LIM ; Wilfred C G PEH
Singapore medical journal 2012;53(9):625-quiz 632
A 38-year-old man presented with right knee pain and swelling following a football injury. Magnetic resonance (MR) imaging showed a complete anterior cruciate ligament (ACL) tear and lateral meniscal tears. The torn ACL was repaired with a graft obtained from the semitendinosus muscle, and the menisci were debrided. The mechanisms of injury to the ACL are varied and may be due to direct or indirect contact with the knee as well as with twisting injuries. Knowledge of the ACL's normal anatomy, together with MR imaging technique and understanding of the appearance of the lesion on MR examination, is crucial to aid in the identification of an ACL tear. Diagnosis of an ACL tear should be based on direct MR imaging signs, although indirect signs may be helpful, particularly in chronic tears. Other associated injuries to be aware of include meniscal and other ligamentous injuries. Normal ACL graft and post-ACL graft reconstruction complications are also briefly discussed.
Adult
;
Anterior Cruciate Ligament
;
pathology
;
surgery
;
Anterior Cruciate Ligament Injuries
;
Anterior Cruciate Ligament Reconstruction
;
adverse effects
;
rehabilitation
;
Bone-Patellar Tendon-Bone Grafting
;
adverse effects
;
rehabilitation
;
Football
;
injuries
;
Humans
;
Knee Injuries
;
pathology
;
rehabilitation
;
surgery
;
Magnetic Resonance Imaging
;
Male
;
Postoperative Complications
;
diagnosis
;
Soccer
;
injuries
;
Tendons
;
transplantation
7.Magnetic resonance imaging of diabetic foot complications.
Keynes T A LOW ; Wilfred C G PEH
Singapore medical journal 2015;56(1):23-quiz 34
This pictorial review aims to illustrate the various manifestations of the diabetic foot on magnetic resonance (MR) imaging. The utility of MR imaging and its imaging features in the diagnosis of pedal osteomyelitis are illustrated. There is often difficulty encountered in distinguishing osteomyelitis from neuroarthropathy, both clinically and on imaging. By providing an accurate diagnosis based on imaging, the radiologist plays a significant role in the management of patients with complications of diabetic foot.
Aged
;
Aged, 80 and over
;
Cellulitis
;
diagnosis
;
Diabetic Foot
;
complications
;
diagnosis
;
Female
;
Gangrene
;
diagnosis
;
Humans
;
Inflammation
;
Magnetic Resonance Imaging
;
Male
;
Middle Aged
;
Osteomyelitis
;
diagnosis
;
physiopathology
;
Risk Factors
;
Skin Diseases
;
diagnosis
;
Ulcer
;
diagnosis
8.Clinics in diagnostic imaging. 158. Duodenal ectopic pancreas.
Manickam SUBRAMANIAN ; Eric WEE ; Vijayadwaja DESAI ; Wilfred C G PEH
Singapore medical journal 2014;55(12):629-quiz 633
A 46-year-old man presented with right loin tenderness following a road traffic accident. Computed tomography and magnetic resonance imaging showed a well-defined, smooth, enhancing oval lesion in the wall of the first part of the duodenum. The lesion was seen separately from the normal pancreas. It showed attenuation, intensity and enhancement similar to that of normal pancreas. Based on the imaging appearance, a diagnosis of ectopic pancreas was made. The patient underwent oesophagogastroduodenoscopy, endoscopic ultrasonography and fine-needle aspiration cytology of the lesion, which confirmed ectopic pancreatic tissue. Since the patient was asymptomatic, surgical resection was deferred. The embryologic origin, various locations, imaging appearance and clinical significance of ectopic pancreas are discussed.
Accidents, Traffic
;
Choristoma
;
congenital
;
diagnosis
;
surgery
;
Contrast Media
;
Duodenal Diseases
;
congenital
;
diagnosis
;
surgery
;
Endoscopic Ultrasound-Guided Fine Needle Aspiration
;
Humans
;
Male
;
Middle Aged
;
Pancreas
;
Tomography, X-Ray Computed
;
methods
9.Clinics in diagnostic imaging (154). Carbon monoxide (CO) poisoning.
Puay Joo LIM ; Sumer Nrupendra SHIKHARE ; Wilfred C G PEH
Singapore medical journal 2014;55(8):405-quiz 410
A 59-year-old man with a history of major depression was found by his wife to be unconscious and foaming at the mouth. On arrival at the emergency department, the patient was noted to be unresponsive. Computed tomography of the brain showed symmetrical ill-defined areas of hypoattenuation involving the medial aspects of both lentiform nuclei, while magnetic resonance images of the brain showed symmetrical increased signal in the bilateral globi pallidi on diffusion weighted, T2-weighted and fluid attenuated inversion recovery sequences. These findings were those of acute carbon monoxide poisoning. Despite aggressive treatment, the patient's condition continued to deteriorate and he eventually passed away. The various imaging findings of carbon monoxide poisoning in the brain and the differential diagnoses are discussed.
Brain
;
diagnostic imaging
;
Carbon Monoxide Poisoning
;
diagnosis
;
diagnostic imaging
;
Depressive Disorder, Major
;
complications
;
Diagnostic Imaging
;
Fatal Outcome
;
Humans
;
Magnetic Resonance Imaging
;
Male
;
Middle Aged
;
Pulmonary Edema
;
pathology
;
Radiography, Thoracic
;
Suicide, Attempted
;
Tomography, X-Ray Computed
10.Clinics in diagnostic imaging (152). Right lower lobe segmental pulmonary embolus.
Jerome Irai Ezhil BOSCO ; Ree Nee KHOO ; Wilfred C G PEH
Singapore medical journal 2014;55(5):281-286
A 56-year-old man presented to the Accident and Emergency Department with pleuritic chest pain of sudden onset. He gave a history of short-distance air travel ten days earlier. Chest radiograph showed a peripheral-based opacity in the right lower zone, which was not seen in a previous study done three months ago, suggestive of Hampton's hump. The D-dimer level was raised. Computed tomography pulmonary angiography confirmed the diagnosis of pulmonary embolism in a right lower lobe segmental branch, with adjacent collapsed lung, consistent with lung infarction. The patient was started on heparin injection with significant relief of his symptoms. The clinical and imaging features of pulmonary embolism are described, with emphasis on the historical radiographic signs and the current dual-energy computed tomography innovations.
Adult
;
Aged
;
Angiography
;
Chest Pain
;
Female
;
Fibrin Fibrinogen Degradation Products
;
metabolism
;
Humans
;
Lung
;
diagnostic imaging
;
Male
;
Middle Aged
;
Pulmonary Embolism
;
diagnosis
;
diagnostic imaging
;
Radiography, Thoracic
;
Tomography, X-Ray Computed