Faizah Mohd Zaki

Infected and ruptured retroperitoneal teratoma.

We present images of an infected and ruptured retroperitoneal teratoma in an 8-month-old baby girl, who presented with a 2-week history of low-grade intermittent fever and failure to thrive. On arrival at the hospital, she was lethargic, febrile and mildly dehydrated. The abdomen was distended with a palpable mass occupying the central abdomen and the left lumbar region. The white cell count and C reactive protein were elevated with measurement of 20.9 mg/dL and 6.27 mg/dL, respectively, indicating an underlying infection. Both tumour markers, α-fetoprotein (7.56 ng/mL) and β-human chorionic gonadotropin (<1.2 mlU/mL), were within normal limits. A sonographic study of the abdomen showed multiple intra-abdominal collections. The subsequent urgent abdominal CT revealed a relatively large left retroperitoneal cystic lesion with …

Computed Tomography Dose in Paediatric Care: Simple Dose Estimation Using Dose Length Product Conversion Coefficients

Background The use of multislice computed tomography (MSCT) is increasing worldwide; at the same time, there is a growing awareness of the future risk of cancer associated with greater exposure to radiation. Therefore, there is a need for an accessible method of effective dose estimation. This study aims to estimate the effective doses (EDs) of a variety of paediatric computed tomography (CT) examinations in five age groups using recently published age- and region-specific dose length products (DLPs) as effective dose conversion coefficients. Methods A retrospective review was performed over a 12-month period. Patients were assigned to one of five age groups: neonatal, 1-, 5-, 10- and 15-years-old. Age- and region-specific conversion coefficients were applied to the DLP data displayed on the CT console in order to estimate the ED. Results Over the 12-month period, there were a total of 283 CT scans, 211 of which were selected for study. The ED estimates for plain CT brain scans in neonatal, 1-, 5-, 10- and 15-yearolds were 2.5, 1.5, 1.4, 1.3 and 0.8 mSv, respectively. For the corresponding CT abdominal scans, the results were 18.8, 12.9, 7.8, 8.6 and 7.5 mSv; these were the highest values recorded. High-resolution CT (HRCT) temporal scans showed EDs of 2.9, 1.8, 1.5 and 1.1 mSv in 1-, 5-, 10- and 15-years-old, respectively. CT scans of the helical thorax had an estimated ED of 4.8, 4.2 and 7.0 mSv in 5-, 10- and 15-years-old, respectively. Conclusion An inverse relationship between age and effective dose was demonstrated in CT scans of the brain and abdomen/pelvis. In general, our study showed lower overall EDs compared to other centres.

Synovial haemangioma of the elbow: A rare paediatric case and imaging dilemma

Synovial haemangiomas are rare benign vascular proliferations arising in synovium-lined surfaces. While the knee is by far the joint most commonly involved, this condition can also occur in the elbow. We report an eight-year-old boy who presented to the National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia, in 2016 with a left elbow swelling of one years duration. Magnetic resonance imaging showed a lobulated intra-articular mass with intermediate signal intensity on T1-weighted imaging and low signal punctate and linear structures within the hyperintense mass on T2-weighted imaging. In addition, there was heterogeneous yet avid contrast enhancement on post-gadolinium contrast images. The mass had juxta-articular extension and bony erosion to the coronoid process and the head of the radius. Synovial haemangiomas present a diagnostic dilemma. This report highlights certain imaging characteristics to distinguish this entity from other differential diagnoses.

The role of delayed laparoscopic suction for intra-abdominal collection or abscess post appendectomy in paediatric patients: case series and review of literature

1Paediatric Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia. 2Department of Anaesthesia, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia. 3Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia. 4Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Cheras, Kuala Lumpur 56000, Malaysia.

Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid nodules? A Systematic Review and Meta-Analysis

RATIONALE AND OBJECTIVE This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. METHODS PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. CONCLUSION Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

Neonatal intestinal obstruction secondary to a floppy meckel's diverticulum successfully treated by minimal access surgery

Meckels diverticulum has several known complications including diverticulitis and perforation. The presence of mesodiverticular band or a band from the diverticulum to the anterior abdominal wall is also described and can cause obstruction or rotation of the small bowel leading to volvulus. Meckels diverticulum is also well known as the lead point for intussusception. It may be lined by ectopic gastric mucosa and can cause life-threatening gastrointestinal bleeding. We report a neonate who presented with acute intestinal obstruction secondary to a large, mobile Meckels diverticulum which due to a direct compression effect on the adjacent small bowel caused mechanical intestinal obstruction. Diagnosis was confirmed at laparoscopy, and treated by curative surgical resection. This is the first report of a large mobile Meckels diverticulum causing small bowel obstruction due to direct compression that was managed by minimally invasive surgical resection.

Bleeding small bowel cavernous haemangioma following blunt trauma to the abdomen presenting as subacute intestinal obstruction in a child.

The authors report a case of a 6-year-old girl who developed subacute intestinal obstruction after a trivial blunt trauma to her abdomen. Her normal vital signs masked the presence of intestinal bleeding. An incidental finding at surgery of a haematomatous polypoid vascular growth of the ileum was subsequently confirmed to be cavernous haemangioma of the small bowel. Surgical resection was curative in this patient.

Total pleurectomy as the surgical treatment for recurrent secondary spontaneous pneumothorax in a child with severe pulmonary Langerhans cells histiocytosis

Pulmonary Langerhans cell histiocytosis (LCH) in children is more extensive and is a rare cause of spontaneous secondary pneumothorax (SSP) which tends to be recurrent and refractory to conventional treatment. Its occurrence in paediatric patients posed great challenge to the choice of surgical management. Surgery in the form of pleurodesis is only considered if SSP does not improve after chemotherapy and after considering all relevant risk and benefits of surgery to patients. Chemical pleurodesis will not give the expected effect to eradicate SSP in this patient. Therefore mechanical pleurodesis is the treatment of choice. There are various techniques to perform mechanical pleurodesis; from pleural abrasion to pleurectomy. In the authors’ experience, bilateral total pleurectomy provided the best outcome for this 9-year-old patient with persistent respiratory distress from SSP due to extensive pulmonary LCH.