A Rare Case of Cystic Biliary Atresia

@#Biliary atresia is one of the commonest causes of prolonged jaundice in neonate, whereas cystic biliary atresia is a rare form of biliary atresia with similar presentation, but a slightly different sonographic finding. Being able to differentiate them radiologically is important as the surgical management is different for these two diagnoses. An ultrasound examination was done for a 2-month-old baby girl with prolonged jaundice with the finding of a cyst along the portal triad, which raised the suspicion for cystic biliary atresia. The diagnosis was confirmed with intraoperative cholangiography (IOC) and Kasai procedure was done. The patient was well after the surgery with resolution of jaundice.

Pre-operative Non-Invasive Imaging for Neonatal Cholestasis in a Child with Extrahepatic Biliary Atresia

@#Hepatobiliary iminodiacetic acid (HIDA) scintigraphy is a non-invasive, functional imaging of the hepatobiliary system that serves as an adjunct imaging modality for neonatal cholestasis work-up. In view of the urgency to diagnose biliary atresia and restore bile flow through surgery, HIDA scintigraphy could help to distinguish between neonatal cholestasis due to biliary atresia and neonatal hepatitis of various causes. We describe a full-term male infant with jaundice beyond the physiological period in which HIDA scintigraphy showed absent tracer excretion from the biliary system into the intestines up to 5 hours on follow-up imaging. The intraoperative diagnosis confirmed the diagnosis of biliary atresia. The prognosis of the patient with biliary atresia depends on early surgical planning and intervention. Therefore, non-invasive diagnostic tools play an important role in the evaluation of a child with neonatal cholestasis.

Primary Pulmonary Primitive Neuroectodermal Tumour: Potential Role of F18-FDG PET/CT as an Imaging Biomarker

@#Primitive neuroectodermal tumours (PNETs) occurring directly from the lung parenchyma without involvement of the chest wall or pleura are particularly unusual. We describe a 16-year-old male who presented with severe chest and back pain following a fall during high jump competition. Incidental finding of an opacity at the right lung upper lobe was seen on his chest radiograph. Computed tomography of the thorax demonstrated a lobulated hypodense lesion in the anterior segment of right upper lobe and subsequent biopsy confirmed the diagnosis of Ewing Sarcoma/ PNET following histologic and immunohistochemical examination. Whole-body positron emission computed tomography/computed tomography (PET/CT) revealed mild, homogenous F18-fluorodeoxyglucose (FDG) uptake in the lung lesion with no evidence of metastasis. He eventually underwent right thoracotomy and right upper lobectomy. Indeed, F18-FDG PET/CT is a valuable imaging method in demonstrating active focus of glucose metabolism in lung parenchymal lesion, for preoperative evaluation and as baseline scan for patient’s monitoring.

Factors Associated with Breast-self Examination Practice and Mammogram Breast Density among Malaysian Women

@# Breast cancer is globally known to be the commonest cause of cancer-related deaths among women. Screening tools which include breast-self examination (BSE), clinical breast examination and mammography are well-recognised to aid the detection of breast cancer among high risk women. Thus, our study was aimed to evaluate breast cancer and BSE awareness and practice, and to perform mammography screening among women who attended community breast cancer awareness and screening programme. Methods: Data was collected cross-sectionally from 2,021 women during community services from September 2013 until December 2015. Results: Majority of the women had previously attended health education on breast cancer (56.3%) and had been taught BSE techniques (61.4%), but only 38.6% performed BSE monthly. Factors associated with regular BSE practice were older age, higher education level, being married, higher monthly income, had attended health education on breast cancer, and had been taught BSE techniques. A subset of 130 high-risk women had underwent mammography screening and majority had heterogenously dense and normal mammogram findings. Conclusion: These findings suggested that regular breast cancer awareness campaigns is needed to strengthen breast cancer knowledge and to emphasise BSE techniques. Such campaigns should target younger women and those with low socioeconomic status.

Lumbosacral osteosarcoma with dural spread, skip lesions and intravascular extension: A case report

Primary osteosarcoma of the spine is indeed rare and onlyseveral sporadic cases have been reported. It tends to occurin a slightly older age group than those with appendicularskeleton tumours. We present here an unusual case ofaggressive lumbosacral osteosarcoma in a young teenagercomplicated by extensive dural spread, skip lesions andintravascular extension. Although a histopathologicalexamination is mandatory to establish the diagnosis, thiscase emphasises the need of imaging to ascertain the fullextent of disease spread especially in deciding the type oftreatment to be instituted and to evaluate the response tothe treatment.

An Incidental Finding of Internal Jugular Vein Ectasia on Cervical Spine Magnetic Resonance Imaging

@#Ectasia or abnormal dilatation of a vessel may affect any vein within the body including the neck region. Internal jugular vein (IJV) ectasia commonly presents as a painless, soft swelling on the neck which appears to be prominent with increased intrapleural pressure such as during Valsalva manoeuvre. To the best of our knowledge, the occurrence of venous ectasia is infrequent with limited number of reports on this anomaly available. However with the advancement of technology especially in imaging modalities, there is improvement in detecting this condition. We describe here an incidental finding of focal IJV ectasia in an elderly lady following a cervical spine magnetic resonance imaging (MRI) for bilateral hand numbness, and discuss the management of this rare presentation.

Malignant obstruction of superior vena cava: Endovascular stenting using Y-configuration stent in stent technique

@#Malignant intrathoracic disease is the commonest cause of superior vena cava (SVC) obstruction. Life threatening SVC obstruction with intense dyspnoea requires urgent treatment. SVC stenting has been developed in recent years which results in rapid relief of the obstruction. The Yconfiguration technique has been reported to provide support for all three limbs of the bifurcation to prevent restenosis. At present, there are limited reports on the use of Y-configuration stent in stent techniques for endovascular stenting in malignant SVC obstruction. We share our clinical experience of two patients who received balloon-mounted stents using this technique