Foong Koon Cheah

Use of magnetic resonance imaging in evaluation of placental invasion

AIM To review and describe the magnetic resonance imaging (MRI) features in patients with suspected placental invasion and correlate the findings with surgery and pathology findings. MATERIALS AND METHODS A retrospective review was undertaken of the MRI images of seven consecutive patients with ultrasound findings suspicious for placental invasion. Two experienced MRI radiologists, blinded to the pathology and surgery findings, reviewed the MRI. The pathology or surgical findings were used as the reference standard to establish accuracy and concordance with the MRI findings. RESULTS Three MRI features described in an earlier series were consistently present in the patients with placental invasion: lower uterine bulging, heterogeneous placenta, and dark intraplacental linear bands on T2-weighted images. CONCLUSION MRI features, which were described in patients with placental invasion in an earlier series, were useful in establishing the presence and depth of placental invasion.

Underlying liver disease influences volumetric changes in the spared hemiliver after selective internal radiation therapy with 90Y in patients with hepatocellular carcinoma

Hypertrophy of the contralateral liver lobe after treatment with yttrium‐90 (90Y) microspheres has recently been reported. This study aimed to quantify left hepatic lobe hypertrophy after right‐sided radioembolization for hepatocellular carcinoma (HCC) and to identify pretreatment predictive factors of hypertrophy in an Asian population.

Enterolith formation in the roux limb hepaticojejunostomy

Enterolith in the Roux limb of Roux-en-Y hepaticojejunostomy is rare. We report a case of a Roux loop enterolith presenting with recurrent cholangitis. Cholescintigraphy and magnetic resonance imaging aided in the preoperative diagnosis. Intraoperatively, a large enterolith was extracted distal to the biliodigestive anastomosis. A kink of the small bowel was also noted distal to the stone. The mechanism for enterolith formation in the Roux loop is discussed.

Pictorial essay: Uncommon causes of coronary artery encasement

This pictorial essay presents cases of non-atherosclerotic coronary artery encasement which were encountered in our institution, including malignant lymphoma, Erdheim-Chester disease, immunoglobulin G4 (IgG4)-related disease and Polyarteritis Nodosa. These conditions usually have multisystemic involvement which aid in the diagnosis. Awareness of these uncommon disorders and their ancillary findings can facilitate early, accurate diagnosis and appropriate management.

Castleman's disease of the kidney: Sonographic findings

We report a case of rare Castlemans disease of the kidney that mimicked a renal neoplasm with emphasis on the imaging and histologic findings. A 47-year-old man presented with dyspeptic symptoms. Ultrasound revealed a vascular, heterogeneous mass in the left kidney. Multiphasic CT scan confirmed an enhancing lesion with enlarged left para-aortic lymph nodes suspicious for nodal metastases. The provisional diagnosis was renal cell carcinoma. Percutaneous biopsy yielded a diagnosis of Castlemans disease of the hyaline-vascular type. Despite advancement in imaging modalities, differentiation of hyaline-vascular variant of Castlemans disease from hypervascular renal neoplasm remains difficult and the final diagnosis requires histopathological confirmation.

Is subdural hemorrhage after pulmonary endarterectomy underrecognized

From the Departments of Cardiology and Cardiothoracic Surgery, National Heart Centre Singapore, Singapore; Departments of Anesthesiology, Diagnostic Radiology, Hematology, and Respiratory Medicine, Singapore General Hospital, Singapore; and Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom. Drs Yap and Ruan contributed equally to this article. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Jan 30, 2018; revisions received May 31, 2018; accepted for publication June 5, 2018; available ahead of print July 26, 2018. Address for reprints: Jonathan Yap, MBBS, MRCP, MPH, National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609 (E-mail: jonyap@yahoo.com). J Thorac Cardiovasc Surg 2018;156:2039-42 0022-5223/

Prospective study to determine early hypertrophy of the contra-lateral liver lobe after unilobar, Yttrium-90, selective internal radiation therapy in patients with hepatocellular carcinoma

36.00 Copyright 2018 by The American Association for Thoracic Surgery https://doi.org/10.1016/j.jtcvs.2018.06.029 Computed tomography scan of the brain showing an acute hyperintense subdural hemorrhage (red arrow) after pulmonary endarterectomy. T H O R

An uncommon cause of abdominal pain in a young man

Background: Liver resection is a major curative option in patients presenting with hepatocellular carcinoma. An inadequate functional liver remnant is a major limiting factor precluding liver resection. In recent years, hypertrophy of the functional liver remnant after selective internal radiation therapy hypertrophy has been observed, but the degree of hypertrophy in the early postselective internal radiation therapy period has not been well studied. Methods: We conducted a prospective study on patients undergoing unilobar, Yttrium‐90 selective internal radiation therapy for hepatocellular carcinoma to evaluate early hypertrophy at 4–6 weeks and 8–12 weeks after selective internal radiation therapy. Results: In the study, 24 eligible patients were recruited and had serial volumetric measurements performed. The median age was 66 years (38–75 years). All patients were either Child‐Pugh Class A or B, and 6/24 patients had documented, clinically relevant portal hypertension; 15 of the 24 patients were hepatitis B positive. At 4–6 weeks, modest hypertrophy was seen (median 3%; range −12 to 42%) and this increased at 8–12 weeks (median 9%; range −12 to 179%). No preprocedural factors predictive of hypertrophy were identified. Conclusion: Hypertrophy of the functional liver remnant after selective internal radiation therapy with Yttrium‐90 occurred in a subset of patients but was modest and unpredictable in the early stages. Selective internal radiation therapy cannot be recommended as a standard treatment modality to induce early hypertrophy for patients with hepatocellular carcinoma. (Surgery 2017;160:XXX‐XXX.)

Galactomannan-guided preemptive vs. empirical antifungals in the persistently febrile neutropenic patient: a prospective randomized study

A 38 year old man with a known testicular germ cell tumour presented with acute right sided abdominal pain but no other symptoms. Clinical examination showed positive Murphy’s sign. Laboratory investigations showed leucocytosis of 10.6×109 (reference range 4.0-9.0×109)/L and serum C reactive protein of 59 (0.2-9.1) mg/L. Serum liver enzymes were unremarkable. A computed tomography scan of his abdomen and pelvis was performed (fig 1). What abnormality does this scan show? Fig 1 (a) Axial and (b) coronal sections of contrast enhanced computed tomography scan of the abdomen and pelvis at the mid-ascending colon A tubular hypodense lesion surrounding a central linear hyperdensity adjacent to the ascending colon with surrounding inflammatory changes, suggestive of epiploic appendagitis …