Variation in celiac trunk is common and has importance in preoperative planning to reduce the risk of accidental vascular injuries during surgical and radiological intervention. Our aim was to measure the prevalence of coeliac trunk types and describe its different variations using MDCT angiography among patients in Hospital Tengku Ampuan Afzan (HTAA), Kuantan. Materials and method: A retrospective cross sectional study was conducted. Computed Tomographic Angiography (CTA) images were retrieved from July till December 2017. Images were reconstructed in 3D Volume Rendering (VR) format using workstation and reviewed for the normal and anatomical variations of the celiac trunk. The variations were classified using Uflacker’s classification. The results were calculated using IBM SPSS statistic version 22. Results: A total of 140 cases were found, from which 23 were excluded. Mean age was 57.3 years and male/female percentage was 65.8/34.2. Anatomical variation of the CT was found in 54 (46.2%) cases. The most common variation was the origin of inferior phrenic artery (IPA) from the CT in 21 (17.9%) cases followed by celiac-colic trunk in 15 (12.8%) cases. However, 31 (26.5%) cases displayed variations not described in Uflacker’s classification. They include celiaco-phrenic trunk, coexistence of IPA with other Uflacker’s variations, Buhler arc, accessory hepatic artery from the CT and coexistence of celiac-colic trunk with gastro-splenic and hepato-splenic trunk in one case each. Conclusion: Accurate knowledge and identification of anatomical variations in CT is crucial before undergoing any surgical or invasive imaging procedure. This can help surgeons and interventional radiologists to prevent accidental vascular injuries and perform a safe procedure.
The brain is the most complex organ in the human body. Robust and vigorous daily activities may cause changes to the brain structure. Huffaz, individuals who memorise the Quran undergo intensive memorization training which may lead to structural changes in specific regions of the brain.
Radiological manifestation of pulmonary tuberculosis in HIV positive
patients is different with HIV negative patients. We aim to determine the differences in
chest radiological findings of Pulmonary Tuberculosis among HIV and non-HIV infected
patients in HTAA. (Copied from article).
Traumatic brain injury following road traffic accidents is a common cause
of morbidity and mortality in Malaysia. We aim to determine the differences of traumatic
brain injury patterns based on CT findings among motorcyclist versus passenger vehicle
patients involved in road traffic accidents. (Copied from article).
Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol.
Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 – 146.3), 211.0 minutes (165.5 – 273.5) and 85.0 minutes (48.0 – 144.8) respectively. Eight patients (2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 – 405.0) and 225.0 minutes (172.5 – 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure.
Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se.
Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).
A 35-year-old multiparous woman was found unresponsive, tachypnoeic, hypoxic and in shock 4 h postpartum. The ECG revealed S1 Q3 T3, a right bundle branch block pattern and right-axis deviation. The computed tomography of her pulmonary arteries revealed bilateral pulmonary artery thrombosis with dilated right ventricle. She was fibrinolyzed with intravenous Tenecteplase 30 mg bolus. Her saturation and tachypnoea improved and her ECG reverted to sinus rhythm subsequently. We discuss our use of off-label Tenecteplase in postpartum pulmonary embolism and review the literature.