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  1. Article: A unique presentation of acute tophaceous gout in the lumbar spine causing cauda equina syndrome.

    Xian, Esther Tan Wan / Xian, Shawn Kok Shi / Ming, Yeap Phey

    Radiology case reports

    2023  Volume 18, Issue 9, Page(s) 3341–3345

    Abstract: Gout is a common metabolic disease characterized by the deposition of monosodium urate (MSU) crystals and typically affects the peripheral joint, rarely involving the axial skeleton. We present a rare case of acute tophaceous gout in the lumbar spine ... ...

    Abstract Gout is a common metabolic disease characterized by the deposition of monosodium urate (MSU) crystals and typically affects the peripheral joint, rarely involving the axial skeleton. We present a rare case of acute tophaceous gout in the lumbar spine causing cauda equina syndrome. A 60-year-old man with a history of gout and prior admissions for polyarticular gout flare presented with acute onset of bilateral lower limb numbness and weakness. He underwent surgical decompression with drainage of the epidural collection, with histology consistent with tophaceous gout. The patient made a full recovery postoperatively and was discharged uneventfully. Due to the high initial suspicion for gout, early spinal decompression surgery was performed, and the patient was started on medical therapy. Spinal tophaceous should be considered in the list of different diagnoses of spinal epidural masses especially in the context of a history of gouty arthritis.
    Language English
    Publishing date 2023-07-14
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2406300-9
    ISSN 1930-0433
    ISSN 1930-0433
    DOI 10.1016/j.radcr.2023.06.070
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A unique presentation of acute tophaceous gout in the lumbar spine causing cauda equina syndrome

    Esther Tan Wan Xian, MBBS, MPhil, MRCSEd / Shawn Kok Shi Xian, MBBS, FRCR / Yeap Phey Ming, MBChB, FRCR

    Radiology Case Reports, Vol 18, Iss 9, Pp 3341-

    2023  Volume 3345

    Abstract: Gout is a common metabolic disease characterized by the deposition of monosodium urate (MSU) crystals and typically affects the peripheral joint, rarely involving the axial skeleton. We present a rare case of acute tophaceous gout in the lumbar spine ... ...

    Abstract Gout is a common metabolic disease characterized by the deposition of monosodium urate (MSU) crystals and typically affects the peripheral joint, rarely involving the axial skeleton. We present a rare case of acute tophaceous gout in the lumbar spine causing cauda equina syndrome. A 60-year-old man with a history of gout and prior admissions for polyarticular gout flare presented with acute onset of bilateral lower limb numbness and weakness. He underwent surgical decompression with drainage of the epidural collection, with histology consistent with tophaceous gout. The patient made a full recovery postoperatively and was discharged uneventfully. Due to the high initial suspicion for gout, early spinal decompression surgery was performed, and the patient was started on medical therapy. Spinal tophaceous should be considered in the list of different diagnoses of spinal epidural masses especially in the context of a history of gouty arthritis.
    Keywords Tophaceous gout ; Cauda equina syndrome ; Lumbar spine ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
    Language English
    Publishing date 2023-09-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: When crystals gave the culprit away: a rare complication of a commonly used medication.

    Wu, Jingting / Koh, Frederick H / Kok, Shawn Shi-Xian / Iqbal, Jabed / Sivarajah, Sharmini S

    ANZ journal of surgery

    2020  Volume 91, Issue 4, Page(s) 746–747

    MeSH term(s) Coronary Angiography ; Humans
    Language English
    Publishing date 2020-08-10
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.16240
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Clinics in diagnostic imaging (199). Pyometra.

    Tay, Wei Ming Ian / Subramanian, Manickam / Chinchure, Dinesh / Kok, Shi Xian Shawn

    Singapore medical journal

    2019  Volume 60, Issue 9, Page(s) 487–490

    Abstract: A 92-year-old woman presented to the emergency department with urinary symptoms, fever and suprapubic tenderness. Her inflammatory markers were raised. Urine and blood cultures were negative. Computed tomography performed to look for a source of sepsis ... ...

    Abstract A 92-year-old woman presented to the emergency department with urinary symptoms, fever and suprapubic tenderness. Her inflammatory markers were raised. Urine and blood cultures were negative. Computed tomography performed to look for a source of sepsis showed distension of the uterine cavity with high-attenuation fluid, an air-fluid level and gas locules along the uterine wall. The causes, clinical presentation and imaging features of pyometra are discussed.
    MeSH term(s) Aged, 80 and over ; China ; Diabetes Complications/diagnostic imaging ; Emergency Service, Hospital ; Female ; Fever/complications ; Humans ; Hypertension/complications ; Inflammation ; Leiomyoma/diagnostic imaging ; Middle Aged ; Myocardial Ischemia/diagnostic imaging ; Necrosis ; Peritonitis/diagnostic imaging ; Pyometra/diagnostic imaging ; Sepsis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography ; Uterus/diagnostic imaging
    Language English
    Publishing date 2019-09-25
    Publishing country Singapore
    Document type Case Reports ; Journal Article
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2019113
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Appendicitis mimicking the CT appearance of an appendiceal mucinous neoplasm.

    Soon, Jia Qi Jeremy / Aftab, Syed / Ling, Lianne Lee Ai / Uppaluri, Srinivas Anand Swaroop / Kok, Shi Xian Shawn

    Journal of radiology case reports

    2020  Volume 14, Issue 11, Page(s) 26–38

    Abstract: Occasionally, radiologically diagnosed acute appendicitis is found to harbour underlying appendiceal neoplasm on post-surgical histopathology. Conversely, a situation in which radiologically, the appendix demonstrates features consistent with an ... ...

    Abstract Occasionally, radiologically diagnosed acute appendicitis is found to harbour underlying appendiceal neoplasm on post-surgical histopathology. Conversely, a situation in which radiologically, the appendix demonstrates features consistent with an underlying tumour but post-operative pathology finds no evidence of neoplastic change is rare. We describe a case of a 50-year-old man who presented with a markedly dilated "mass-like" appendix with minimal inflammatory changes on a computed tomography scan. Radiological findings were suspicious for an appendiceal neoplasm/mucocele (i.e. low-grade mucinous neoplasm). However, the post-surgical histopathological diagnosis did not concur with the radiological diagnosis and instead demonstrated findings compatible with acute appendicitis without neoplastic change. In this case report we provide a histopathological correlation and an explanation as to how this may have happened with the hope of helping radiologists avoid this pitfall in the future.
    MeSH term(s) Adenocarcinoma, Mucinous/diagnostic imaging ; Appendiceal Neoplasms/diagnostic imaging ; Appendicitis/diagnostic imaging ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed
    Language English
    Publishing date 2020-11-30
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2586384-8
    ISSN 1943-0922 ; 1943-0922
    ISSN (online) 1943-0922
    ISSN 1943-0922
    DOI 10.3941/jrcr.v14i11.4081
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Clinics in diagnostic imaging (179). Severe rhabdomyolysis complicated by myonecrosis.

    Kok, Shi Xian Shawn / Tan, Tien Jin

    Singapore medical journal

    2017  Volume 58, Issue 8, Page(s) 467–472

    Abstract: A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels ... ...

    Abstract A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels and urine myoglobinuria were consistent with a diagnosis of rhabdomyolysis. Initial magnetic resonance imaging of the right lower limb revealed diffuse muscle oedema and features of myositis in the gluteal muscles and the adductor, anterior and posterior compartments of the thigh. Follow-up magnetic resonance imaging performed 11 days later showed interval development of areas of myonecrosis and haemorrhage. The causes, clinical presentation and imaging features of rhabdomyolysis are discussed.
    Language English
    Publishing date 2017-08
    Publishing country Singapore
    Document type Journal Article
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2017081
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Spectrum of lung perfusion changes on dual-energy CT in COVID-19: incremental benefit to conventional CT.

    Ganti, Srujana / Kok, Shawn Shi Xian / Aftab, Syed / Halagatti, Sandeep Venkatesh / Wong, Steven Bak Siew / Uppaluri, Anandswaroop Srinivas

    Emergency radiology

    2021  Volume 28, Issue 3, Page(s) 527–531

    Abstract: The purpose of this case report is to demonstrate lung perfusion changes on dual-energy CT (DECT) in patients with Coronavirus disease 2019 (COVID-19). Since the first case of COVID-19 was reported in Wuhan, Hubei province in China, the spectrum of lung ... ...

    Abstract The purpose of this case report is to demonstrate lung perfusion changes on dual-energy CT (DECT) in patients with Coronavirus disease 2019 (COVID-19). Since the first case of COVID-19 was reported in Wuhan, Hubei province in China, the spectrum of lung parenchymal findings has been well described but the underlying pathophysiology is less well understood. DECT imaging contributes to the growing evidence that vascular dysregulation has an important role in the underlying pathophysiology of the disease. Three patients with reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 underwent DECT scans. One patient had a DECT for persistent spikes in temperature while the other two patients underwent dual-energy CT pulmonary angiograms (CTPA) for worsening shortness of breath, elevated D dimers and suspected pulmonary embolism. The perfusion abnormalities include focal areas of both hyperperfusion, hypoperfusion, and areas of hypoperfusion surrounded by hyperemia. In addition, dilatation of segmental and subsegmental pulmonary arteries was seen in relation to the lung parenchymal change. DECT has proven useful in supporting the hypothesis that vascular dysregulation plays a significant role in the pulmonary pathophysiology of COVID-19. Early identification and a high index of suspicion  is required in the emergency department setting to identify and isolate cases even prior to the results of RT-PCR test being available. Vascular changes on DECT may be an additional radiological feature in detecting the presence of and predicting the severity of disease in the emergency department or acute care setting.
    MeSH term(s) Adult ; Aged ; COVID-19/diagnostic imaging ; Computed Tomography Angiography ; Contrast Media ; Early Diagnosis ; Humans ; Lung/blood supply ; Male ; Pneumonia, Viral/diagnostic imaging ; Pneumonia, Viral/virology ; Radiography, Dual-Energy Scanned Projection ; SARS-CoV-2
    Chemical Substances Contrast Media
    Language English
    Publishing date 2021-01-08
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1425144-9
    ISSN 1438-1435 ; 1070-3004
    ISSN (online) 1438-1435
    ISSN 1070-3004
    DOI 10.1007/s10140-020-01877-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Clinics in diagnostic imaging (200). Intra-articular chronic tophaceous gout of the knee.

    Lee, Yee Wah Margaret / Kok, Shi Xian Shawn / Wong, Li Weng / Wong, Bak Siew Steven

    Singapore medical journal

    2019  Volume 60, Issue 10, Page(s) 502–507

    Abstract: A 39-year-old man presented with acute left knee pain and swelling. There was limitation of movement of the knee joint. His past medical history was significant for gout. Computed radiography showed bony erosions that were not typical of chronic ... ...

    Abstract A 39-year-old man presented with acute left knee pain and swelling. There was limitation of movement of the knee joint. His past medical history was significant for gout. Computed radiography showed bony erosions that were not typical of chronic tophaceous gout. Magnetic resonance (MR) imaging showed focal deposits within the knee joint, which demonstrated isointense signal to muscle on T1-weighted sequence and intermediate signal on proton density (PD) and PD fat-saturated sequences. There was extensive, similar signal abnormality in the cruciate ligaments, popliteus tendon and lateral meniscus. These findings were in keeping with an intra-articular manifestation of chronic tophaceous gout. The clinical presentation and imaging features are herein discussed, with an emphasis on MR imaging.
    MeSH term(s) Adult ; Gout/diagnostic imaging ; Gout/surgery ; Humans ; Knee Joint/diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Pain/diagnostic imaging ; Treatment Outcome
    Language English
    Publishing date 2019-10-29
    Publishing country Singapore
    Document type Case Reports ; Journal Article
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2019129
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Dealing with COVID-19: initial perspectives of a small radiology department.

    Kok, Shawn Shi Xian / Mohamed Shah, Mohammad Taufik Bin / Cheong, Wei Kiong / Cheng, Arthur Kim Chai / Sng, Li Hoon / Salkade, Parag Ratnakar / Wong, Steven Bak Siew

    Singapore medical journal

    2020  Volume 61, Issue 7, Page(s) 375–377

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Diagnostic Imaging/methods ; Humans ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Radiology Department, Hospital/organization & administration ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-03-31
    Publishing country Singapore
    Document type Journal Article ; Review
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2020043
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Dealing with COVID-19: initial perspectives of a small radiology department

    Kok, Shawn Shi Xian / Mohamed Shah, Mohammad Taufik Bin / Cheong, Wei Kiong / Cheng, Arthur Kim Chai / Sng, Li Hoon / Salkade, Parag Ratnakar / Wong, Steven Bak Siew

    Singapore Med J

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #20736
    Database COVID19

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