Needle aspiration with ultrasound guidance is an effective treatment for breast abscess irrespective of abscess volume and size.

Renal artery stenosis (RAS) is one of the main correctable causes of secondary systemic arterial hypertension. Color Doppler ultrasound (DUS), a non-invasive imaging modality, has been used to diagnose RAS in hypertensive patients. This study was conducted in the period between June 2008 and March 2010 to compare the sensitivity, specificity, accuracy and predictive values of DUS using contrast-enhanced magnetic resonance angiography (CEMRA) as the gold standard for the diagnosis of RAS. Fifty-seven consecutive patients with clinical findings suggestive of RAS (32 males and 25 females) with a mean age of 56 years (±7.92 years) were referred to the University Kebangsaan Medical Center to be screened for RAS using DUS and CEMRA. RAS was considered significant if the reduction in diameter was >60%. A total of 114 arteries were assessed, 65 in males (57%) and 49 in females (43%). On DUS, the parameters measured were the peak systolic velocity at the proximal main renal artery (PSV-P), distal main renal artery (PSV-D) and the suprarenal aorta (PSV-A) at the level of the renal hila and the acceleration time (AT) at the main renal artery. The renal-renal ratio (RRR), which is the value of PSV-P/PSV-D, and the renal-aortic ratio (RAR), which is the value of PSV-P/PSV-A, were then calculated. The accuracy, sensitivity, specificity and positive and negative predictive values of DUS in the detection of significant RAS were determined. All measured DUS parameters were positive for the detection of RAS, with an accuracy of 98.3%. On retrospective review, all the arteries that showed significant stenosis on CEMRA demonstrated an irregular outline on DUS. We conclude that DUS is accurate in the diagnosis of significant RAS but is not very sensitive as a screening tool.

Neonatal onset multisystem inflammatory disease (NOMID) is a rare autoinflammatory disorder, which manifests early in infancy. We describe a case of a 10-year-old boy who has been unwell since infancy. He presented with urticarial rash, intermittent fever and hepatosplenomegaly followed by progressive arthropathy. His joint symptoms started at two years of age, which progressively involved multiple joints, resulting in bone and joint deformities. A series of joint radiographs demonstrated bizarre enlarging physeal mass with heterogenous calcification. Magnetic resonance imaging (MRI) of the involved right ankle and knee showed characteristic thickened and calcified physeal lesions, which enhanced post-gadolinium. This debilitating disease is also known to involve the central nervous system and eyes. This case report aims to highlight the conventional radiographic and magnetic resonance imaging (MRI) findings of this physeal abnormality in NOMID syndrome.

This case report is to enlighten the awareness on spinal epidural haematoma due to warfarin. A 58-year-old man who had been on prophylactic anticoagulant therapy after aortic valve replacement since 1998, had presented with acute onset of reduced sensation and weakness in both lower extremities 3 days prior to the admission to our centre. His prothrombin time (PT) was 46.8 seconds, international normalized ratio (INR) was 5.11, and activated partial thromboplastin time (APTT) was 167.6 seconds (control, 31.3-46.1 seconds). Magnetic resonant imaging scan revealed haematoma in post epidural space at the level of Lumbar 2 and 3. He underwent evacuation and posterior instrumentation on the 6th day. Spinal epidural haematoma should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients whom are receiving anticoagulant therapy. Prompt diagnosis and early surgical decompression would positively lead to a good outcome.