Diffuse large B-cell lymphoma masquerading as orbital cellulitis

ABSTRACT

Hong Kong Med J 2010;16:484-6 | Number 6, December 2010
CASE REPORT
Diffuse large B-cell lymphoma masquerading as orbital cellulitis
ST Mak, Albert CM Wong, Raymond KK Tse
Department of Ophthalmology, Caritas Medical Centre, Shamshuipo, Hong Kong
 
 
Proptosis is commonly encountered in clinical practice. We report on a patient with acute proptosis, eyelid swelling, and chemosis, which was initially treated as cellulitis. After radiological and pathological assessments, a diagnosis of large B-cell lymphoma was made. The patient died within 2 months of presentation. Not all patients with proptosis have cellulitis. Proptosis, especially unilateral proptosis, should always lead to a radiological scan in case of malignancy.
 
Key words: Cellulitis; Exophthalmos; Lymphoma, B-cell; Paranasal sinus neoplasms
 
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Recurrent and consecutive non-arteritic optic neuropathy in a patient with protein S deficiency

ABSTRACT

Hong Kong Med J 2010;16:480-3 | Number 6, December 2010
CASE REPORT
Recurrent and consecutive non-arteritic optic neuropathy in a patient with protein S deficiency
Ian YH Wong, Simon CY Koo, Clement WN Chan
Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
 
 
A 50-year-old man with a history of protein S deficiency treated by long-term warfarin presented with right non-arteritic optic neuropathy. Following successful augmentation of warfarin to minimise the effect of thrombophilia, he had a recurrence in the right eye and involvement of the left eye 11 days after the initial onset. Further investigation showed a marginal blood lipid profile, which was treated with lipid-lowering agents. A combination of aetiologies was seen in this patient. Other unique factors, such as the short duration to recurrence and involvement of the fellow eye, are discussed.
 
Key words: Arteritis; Blood protein; Optic neuropathy, ischemic; Thrombophilia; Vision disorders
 
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Successful management of cholecystocolic fistula by endoscopic retrograde cholangiopancreatography: a report of two cases

ABSTRACT

Hong Kong Med J 2010;16:406-8 | Number 5, October 2010
CASE REPORT
Successful management of cholecystocolic fistula by endoscopic retrograde cholangiopancreatography: a report of two cases
Edward C Toll, Michael D Kelly
Department of Upper Gastrointestinal Surgery, Frenchay Hospital, Bristol, United Kingdom
 
 
Cholecystocolic fistula is a rare cause of diarrhoea, and the diagnosis may be significantly delayed. Air in the biliary tree on imaging should raise suspicion, and barium enema or endoscopic retrograde cholangiopancreatography will be diagnostic. Cholestyramine should provide effective symptomatic relief until definitive treatment is arranged. We report on two patients with cholecystocolic fistula presenting with severe diarrhoea. They were treated successfully by endoscopic retrograde cholangiopancreatography.
 
Key words: Biliary fistula; Contrast media; Diarrhea; Enema
 
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A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator

ABSTRACT

Hong Kong Med J 2010;16:403-5 | Number 5, October 2010
CASE REPORT
A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator
KY Ngai, HY Chan, F Ng
Department of Accident and Emergency Medicine, Caritas Medical Centre, Shamshuipo, Hong Kong
 
 
Sudden deaths of children and adolescents during competitive sports are usually due to congenital heart diseases. Ventricular fibrillation, however, may also occur in individuals with no underlying cardiac disease who have sustained a low-impact chest wall blow. This phenomenon is described as commotio cordis, and the overall survival rate is poor. Successful resuscitation can be achieved by prompt cardiopulmonary resuscitation and early defibrillation. We report a teenager who sustained a chest wall blow that resulted in a cardiac arrest during a rugby competition. Cardiopulmonary resuscitation was given by bystanders. The ambulance crew arrived with an automated external defibrillator. Ventricular fibrillation was detected and responded to defibrillation. Subsequent investigations including imaging and electrophysiological studies did not reveal any cardiac or brain abnormality, and the patient recovered well neurologically. Accessible cardiopulmonary resuscitation-trained personnel and automated external defibrillators should be present at all organised sporting events.
 
Key words: Arrhythmias, cardiac; Athletic injuries; Death, sudden, cardiac; Thoracic injuries; Ventricular fibrillation
 
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Adult hepatic cavernous haemangioma with highly elevated alpha-fetoprotein

ABSTRACT

Hong Kong Med J 2010;16:400-2 | Number 5, October 2010
CASE REPORT
Adult hepatic cavernous haemangioma with highly elevated alpha-fetoprotein
SL Han, XL Wu, ZR Jia, PF Wang
Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou City 325000, Zhejiang Province, PR China
 
 
A 35-year-old Chinese man presented with dull pain in the right hypochondrial region for the previous 2 months. Laboratory examination revealed that his serum alpha-fetoprotein level was 1890 ug/L (reference range, 0-20 ug/L), and computed tomographic scan showed a hypodense lesion in the left liver lobe. At laparotomy, a dark reddish soft tumour (3.0 x 3.5 cm in diameter) was found in the medial segment of the liver (segment III). The tumour became markedly smaller than that before resection, and a vessel-like structure was found on the cut surface. Intra-operative pathology and postoperative histopathology examinations revealed that the tumour was a cavernous haemangioma of the liver. The serum alpha-fetoprotein level decreased to 3.5 ug/L by the fourth postoperative week. Clinicians should be aware that some rare tumours besides hepatocellular carcinoma and endodermal sinus tumours (yolk sac tumour), for example, hepatic haemangioma, can produce alpha-fetoprotein.
 
Key words: alpha-Fetoproteins; Carcinoma, hepatocellular; Hemangioma; Liver neoplasms
 
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Infantile cortical hyperostosis (Caffey disease): a possible misdiagnosis as physical abuse

ABSTRACT

Hong Kong Med J 2010;16:397-9 | Number 5, October 2010
CASE REPORT
Infantile cortical hyperostosis (Caffey disease): a possible misdiagnosis as physical abuse
Henny PW Lo, HY Lau, CH Li, KT So
Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong
 
 
Infantile cortical hyperostosis (Caffey disease) is a rare self-limiting inflammatory bony disease of early infancy. We report a 1-month-old Chinese boy with Caffey disease who presented with painful swelling over his shins bilaterally. Physical abuse was initially suspected, but the radiological findings of periosteal thickening over multiple bones (particularly the mandible), symmetrical involvement, diaphyseal involvement with sparing of the epiphysis, made Caffey disease a likely diagnosis. This report highlights that infantile cortical hyperostosis is an important differential diagnosis for children suspected of being abused, and clinicians should have a high index of suspicion to avoid misdiagnosis.
 
Key words: Bone diseases; Child abuse; Diagnosis, differential; Hyperostosis, cortical, congenital; Tibia
 
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Anti-N-methyl-D-aspartate receptor encephalitis in a young woman with an ovarian tumour

ABSTRACT

Hong Kong Med J 2010;16:313-6 | Number 4, August 2010
CASE REPORT
Anti-N-methyl-D-aspartate receptor encephalitis in a young woman with an ovarian tumour
Joyce WT Lo, Eric YC Leung, Betty LH Ng, MH Fu, KK Yip, Raymond TM Chan, CM Chang
Department of Medicine, Ruttonjee Hospital, Wanchai, Hong Kong
 
 
Anti-N-methyl-D-aspartate receptor encephalitis is characterised by psychiatric and neurological abnormalities and occurs in frequent association with ovarian teratoma. We report the first confirmed case of teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis in Hong Kong in a young woman presenting with confusion and prominent dyskinesia, followed by a review of the current literature.
 
Key words: Encephalitis; Ovarian neoplasms; Paraneoplastic syndromes; Receptors, N-methyl-D-aspartate; Teratoma
 
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Clostridium perfringens liver abscess with massive haemolysis

ABSTRACT

Hong Kong Med J 2010;16:310-2 | Number 4, August 2010
CASE REPORT
Clostridium perfringens liver abscess with massive haemolysis
H Ng, SM Lam, HP Shum, WW Yan
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
Liver abscesses are commonly caused by Enterobacteriaceae and anaerobes. This report is of a patient with liver abscess with massive haemolysis and multiorgan failure caused by Clostridium perfringens. Despite the reportedly high mortality rate and poor prognostic factors, the patient eventually recovered with prompt treatment.
 
Key words: Anemia, hemolytic; Clostridium infections; Clostridium perfringens; Liver abscess; Treatment outcome
 
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Reversal of pale-to-dark nasopharyngeal follicle ratio on narrow-band imaging

ABSTRACT

Hong Kong Med J 2010;16:307-9 | Number 4, August 2010
CASE REPORT
Reversal of pale-to-dark nasopharyngeal follicle ratio on narrow-band imaging
Alexander C Vlantis, Amy BW Chan, HS Chan, John KS Woo, Michael CF Tong, C Andrew van Hasselt
Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Normal nasopharyngeal mucosa contains varying amounts of lymphoid tissue, which in adults may be minimal or absent. Nasopharyngeal mucosa with minimal lymphoid tissue has a regular follicular pattern on narrow-band imaging; pale follicles have thin, dark borders and the ratio of the pale follicle to the dark border (pale-to-dark ratio) is roughly 90%. In some patients undergoing routine nasopharyngeal endoscopy, the pale-to-dark ratio is reversed on narrow-band imaging, with dark centres surrounded by pale borders and a pale-to-dark ratio of roughly 50%. These dark follicles may represent abnormal capillary loops, as they have the same appearance as microvascular changes seen on narrow-band imaging of the oesophageal mucosa which indicate dysplasia or malignancy. While this observed change in the follicular pattern may be an early event in the evolution of nasopharyngeal carcinoma, the significance of this finding remains to be confirmed by a larger-scale study.
 
Key words: Biopsy; Carcinoma; Diagnostic imaging; Endoscopy; Nasopharynx
 
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Torsion of a nongravid myomatous uterus: radiological features and literature review

ABSTRACT

Hong Kong Med J 2010;16:304-6 | Number 4, August 2010
CASE REPORT
Torsion of a nongravid myomatous uterus: radiological features and literature review
Shiobhon Y Luk, John LY Leung, ML Cheung, S So, SH Fung, Sunny CS Cheng
Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
 
 
Torsion of the nongravid uterus is a rare but potentially fatal acute abdominal condition. The non-specific clinical presentation of this condition makes preoperative diagnosis difficult. We describe a patient with uterine torsion in whom the diagnosis was made using contrast-enhanced computed tomography with multiplanar reconstruction. Features of uterine torsion and its complications can be demonstrated by computed tomography, which is an important means of making a preoperative diagnosis.
 
Key words: Myoma; Tomography, X-ray computed; Torsion abnormality; Uterine neoplasms
 
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