1.An active boy with bilateral knee pain
Siti Suhaila Mohd Yusoff ; Nur Suhaila Idris ; Wan Aireene bt Wan Ahmed
Malaysian Family Physician 2019;14(1):26-28
A 14-year-old boy presented to an outpatient
clinic with intermittent bilateral anterior knee
pain for the past year that was relieved by
rest. He was actively involved in sports and
frequently played football in between the pain
episodes but had no history of trauma or falls.
He described the pain as throbbing in nature,
especially upon applying pressure (kneeling
during prayer). The pain was aggravated by
exercise, particularly playing football, and was
temporarily relieved by taking paracetamol.
He reported that the bone just below both
anterior knees appeared to have become
more prominent since 2 months ago. There
was no knee joint swelling, and no systemic
symptoms, such as fever, loss of appetite,
weight changes or fatigue, were present.
A physical examination revealed prominent
swelling of the bilateral tibial tuberosity, with
tenderness on pressure. However, there was no
overlying erythema or limited range of motion
with tenderness over the joint line of either
knee and no knee joint effusion. Figures 1 and
2 show the findings of a left and right knee
radiograph
2.A child with elbow pain
Zainab Mat Yudin@Badrin ; Wan Aireene Wan Ahmed ; Siti Balqis Chanmekun
Malaysian Family Physician 2019;14(2):44-45
Elbow injuries are common in children. Supracondylar fractures occurred in 16% of all pediatric
fractures. Supracondylar fractures can be classified into 4 types according to the Gartland
classification, depending on the degree of the fracture present in the lateral radiograph. This case
highlights the case of a child with a Gartland Type I fracture. A misdiagnosis of this fracture will
compromise the management of the injury with regards to immobilization and subsequent care. As
this injury can be managed on an outpatient basis, primary care frontliners need to be aware of the
condition.
3.Correlation between the maximum standard uptake value and mean Hounsfield unit on single-photon emission computed tomography-computed tomography to discriminate benign and metastatic lesions among patients with breast cancer
S. Thadchaiani SAMINATHAN ; Wan Aireene Wan AHMED ; Norazlina Mat NAWI ; Nashrulhaq TAGILING ; Ilyana AZIZ ; Yusri UDIN ; Mohd Fazrin Mohd ROHANI ; Wan Mohd Nazlee Wan ZAINON ; Mohammad Khairul Azhar Abdul RAZAB
Asian Spine Journal 2024;18(3):398-406
Methods:
In total, 185 lesions were identified on bone and SPECT-CT scans from 32 patients. Lesions were classified as metastatic (109 sclerotic lesions) and benign (76 lesions) morphologically on low-dose CT. Semiquantitative analysis using SUVmax and mean HU was performed on the lesions and compared. To discriminate benign and metastatic lesions, the correlation between SUVmax and mean HU was determined using the intraclass correlation coefficients.
Results:
The SUVmax was higher in metastatic lesions (20.66±14.36) but lower in benign lesions (10.18±12.79) (p<0.001). The mean HU was lower in metastatic lesions (166.62±202.02) but higher in benign lesions (517.65±192.8) (p<0.001). A weak negative correlation was found between the SUVmax and the mean HU for benign lesions, and a weak positive correlation was noted between the SUVmax and the mean HU on malignant lesions with no statistical significance (p=0.394 and 0.312, respectively). The cutoff values obtained were 10.8 for SUVmax (82.6% sensitivity and 84.2% specificity) and 240.86 for the mean HU (98.7% sensitivity and 88.1% specificity) in differentiating benign from malignant bone lesions.
Conclusions
Semiquantitative assessment using SUVmax and HU can complement qualitative analysis. Metastatic lesions had higher SUVmax but lower mean HU than benign lesions, whereas benign lesions demonstrated higher mean HU but lower SUVmax. A weak correlation was found between the SUVmax and the mean HU on malignant and benign lesions. Cutoff values of 10.8 for the SUVmax and 240.86 for the mean HU may differentiate bone metastases from benign lesions.
4.Severe Pulmonary Tuberculosis With Organizing Pneumonia: A Diagnostic Ambiguity
Nurashikin Mohammad ; Mohd Jazman Che Rahim ; Wan Aireene Wan Ahmed ; Wan Syamimee Wan Ghazali
Malaysian Journal of Medicine and Health Sciences 2021;17(No.2):311-313
Pulmonary TB may present insidiously and ambiguously, leaving clinicians with a diagnostic dilemma. A 30-year-old
lady with underlying spinocerebellar ataxia presented with progressive shortness of breath, prolonged cough with
whitish sputum, loss of appetite and weight loss of 1-year duration. Physical examination showed a cachectic, tachypnoeic female with finger clubbing and coarse crepitations on lung auscultation. Chest radiograph showed bilateral
air space opacities relatively sparing the upper zone. Contrast-enhanced CT thorax revealed bilateral cavitary necrotising consolidations, multiple scattered lung nodules with surrounding ground-glass opacities. After exclusion of
alternative diagnoses, cryptogenic organizing pneumonia diagnosis was made. She had a rapid clinic improvement
once steroid was started. TB polymerase chain reaction (PCR) from bronchoscopic bronchial washing eventually
was positive. Anti-TB treatment was started, and oral steroid was slowly tapered down. Organizing pneumonia (OP)
may complicate pulmonary TB. Diagnosing OP without lung biopsy requires a multi-disciplinary approach, taking
into consideration all available evidences. Early steroid therapy is lifesaving and should be considered after thorough
exclusion of alternative diseases.