Stringent criteria have traditionally guided cervical clearance in trauma patients, particularly those who exhibit mid -line cervical pain or cannot undergo a reliable examination. This can sometimes result in extended periods of cervical immobilisation or necessitate the use of further imaging scans. In the absence of fractures, dislocation, or pathological subluxation on cervical computed tomography (CT) scan, cervical collar can be safely removed. We report a polytrauma case with altered consciousness, where bilateral facet fracture dislocation at the C5/C6 level was initially overlooked. CT scan of the spine revealed traumatic brain injury and lumbar vertebral fracture, and the collar was removed and proceeded with surgical stabilisation. The progress was complicated a pulmonary embolism and CT scan also identified the overlooked cervical injuries. A retrospective review of the initial scan revealed the presence of subtle signs of a small unilateral facet avulsion fragment. Our patient succumbed to his injuries. This discovery underscores the potential for pathologies to be missed with dire consequences. Our case illustrates the severe outcomes that can arise from overlooking a cervical spine injury, underscoring the importance of keeping cervical collars in place for high-risk patients until comprehensive imaging can be performed.

Teratoma is a type of germ cell tumor that derived from all the three embryonic layers which are endoderm, mesoderm and ectoderm. The commonest site of extragonadal germ cell tumor is at the mediastinum, which accounts for 50-70% of all mediastinal tumor. Intrapleural teratoma is exteremely rare, with only one previously reported case to date. Teratoma is usually a slow growing tumor, and symptoms typically presented late as a result of compression or obstruction to the surrounding structures. Due to its rare occurrence, intrapleural teratoma can pose a diagnostic challenge for clinicians. Familiarity with the presentation and imaging findings is therefore of great values which can guide the diagnosis and later the specific management plans. This case report highlights the rare case of intrapleural teratoma and summarizes the presentations and imaging findings of intrapleural teratoma which was initially misdiagnosed as empyema thoracis. Several learning points from this case were outlined.

Contrast Enhanced CT Abdomen is usually used to investigate the source of the small bowel obstruction. A 13-year old girl presented with signs of small bowel obstruction and was complicated with acute renal injury. Non-contrast CT Abdomen showed findings consistent with bezoar, and the findings are similar to the features seen in a contrast study. This case shows that both the plain and the contrast CT abdomen give similar findings of bezoar, one not inferior to the other.

Malignant pleural mesothelioma (MPM) is a rare malignant tumor affecting the mesothelium. It commonly manifests as pleural thickening on contrast enhanced CT (CECT) thorax. We reported a case of a young lady who presented with respiratory symptoms and was initially treated as pneumonia. However, she had recurrent episodes of chylothorax with progressive internal jugular vein (IJV), brachiocephalic vein and superior vena cava (SVC) thrombosis leading to pulmonary embolism, associated with extensive mediastinal and supracalvicular lymphadenopathies. There are no evidence of pleural thickening in the initial investigations. Our case highlighted that MPM must remain in the differential diagnosis for these presentations, albeit rare.

Sternal cleft is a rare congenital anomaly that is known to be associated with other congenital abnormalities in particular coarctation of aorta and vascular anomalies. We present a case of a young teacher who presented with recurrent episodes of ischemic stroke. During the workup to look for the cause of stroke, it was discovered that this patient had complete midline sternal cleft with underlying coarctation of aorta and left subclavian artery aneurysm. We wish to highlight the relation between the presence of sternal cleft and coarctation of aorta as well as vascular anomalies as one of the rare cause of young stroke.