Showing 2 Abstracts.
Horseshoe lung is a rare congenital anomaly and is mostly accompanied by scimitar syndrome. We reported a 3 months old baby girl was initially referred from the district hospital for ventilator support for severe congenital pneumonia and dextrocardia with features suggestive of elevated pulmonary artery pressure. She was born via emergency caesar for fetal distress with moderate meconium-stained liquor. Apgar's score was 5 in 1 minute and 9 in 5 minutes. She initially required non-invasive ventilation support and was able to wean to nasal prong on day 2 of life subsequently was intubated for worsening respiratory distress on day 8 of life and was transferred to our hospital. In our hospital, she was treated for nosocomial pneumonia and ventilated for 2 days and subsequently able to extubate to nasal prong. She completed a total of 2 courses of antibiotics within 2 weeks of life. Clinically patient is not dysmorphic but in respiratory distress with sub and intercostal recession. No chest deformity. Auscultation reduced air entry over the right lung, and no murmur was heard. Echo showed situs solitus with mesocardia, dominant RA/RV, AV/VA concordant, small PFO with intact IVS, tricuspid regurgitation 3 mmHg, dilated pulmonary artery and PDA 1.2 mm bidirectional predominantly right to left. Chest radiograph showed opacified right chest, dextrocardia and enlarged left hemithorax. CT Thorax showed a tiny right pulmonary artery, the right pulmonary vein is not clear, probably draining into the IVC- RA junction and a hypoplastic right lung suggestive of scimitar syndrome with horseshoe lung complicated with pulmonary hypertension. She was kept on nasal prong oxygen since extubated because of elevated pulmonary artery pressure and respiratory distress and was given sildenafil. Horseshoe lung is rare, and most of the reported cases share the same spectrum of cardiovascular anomalies identified in scimitar syndrome, and it can be confirmed by CT and angiography. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: W Mustapha Wan Irfan
Keywords: Scimitar syndrome, horsehoe lung, pulmonary hypertension
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct CNS inflammatory disease with symptoms and imaging findings that overlap with other neuroinflammatory disorders. We reported a 12-year-old girl with no known medical illness presented with gradually worsening blurring vision, and nearly blindness, associated with headache with a pain score of 2-5/10. The blurring vision started 1 week ago, initially over the right eye, then the left eye 3 days later, and subsequently, visual loss bilaterally. On examination, the pupil is 6 mm but has no perception of light. On fundoscopy, noted in both eyes: swelling, elevated, blurred margin, pink, dilated tortuous blood vessels, normal fovea reflex, no macula star, also no vitiritis or retinitis. The CNS examination is unremarkable. The patient then underwent a CT scan of the brain showed apart from right mastoiditis, no significant abnormality was detected in the brain parenchyma. Noted C3/C4 levels were normal; T4/TSH levels were normal, and ESR was 62 (raised). Since the CT brain finding was normal, we proceeded with an MRI of the brain, which showed leptomeningeal enhancement. Both retrobulbar intra-orbital segments of optic nerves appear symmetrical and swollen until the intracranial compartment just before the optic chiasm with enhancement is observed post-gadolinium. Both optic discs are also bulging in keeping with papilloedema. Both intra-orbital fats were streaky. The patient then had a lumbar puncture, and the result was normal. Serum aquaporin 4 is negative; however, the MOG antibody is detected. The patient was diagnosed with Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and was given intravenous immunoglobulin (IVIg) for 5 days and steroids. Upon discharge, the patient's vision improves by up to 80%. Other differentials could be neuromyelitis optica spectrum disorder (NMOSD) or multiple sclerosis (MS). It is important to get a correct and early diagnosis of MOGAD because the prognosis and treatment for MOGAD are different from those for NMOSD and MS. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: W Mustapha Wan Irfan