The rising demand of chest imaging during the COVID-19 pandemic has necessitated adaptations to be made to the workflow in radiology departments, particularly in regard to personal protective equipment (PPE) guidelines and operations protocol. The guidelines were implemented to reduce the risk of disease transmission to frontline radiology personnel. With the rising number of COVID cases in the community, suspected COVID patients may present to our hospital’s Emergency Department (ED) even though it is not a COVID-designated hospital. Patients who present to ED are stratified as Severe Acute Respiratory Infection (SARI) cases if they exhibit respiratory symptoms, and non-SARI for those without respiratory symptoms. Imaging examinations performed for SARI patients must adhere to the new workflow. Radiographers and doctors performing Computed Tomography (CT), ultrasound and mobile radiography who come in contact with SARI patients must don full PPE. Prior to mobilization of patients, the routes must be cleared, and the cleaning team will standby for terminal cleaning. For portable examinations, donning and doffing of PPE is done in the department. All appliances must be covered prior to examination and sanitized after. Guidelines for usage of common areas such as pantry and prayer room are also employed to avoid crowding and to maintain adequate physical distancing. Adherence to the new workflow and guidelines is imperative to prevent workplace transmission from patients or other healthcare workers.

Introduction: We aimed to compare the degree of bowel distension and image quality between pineapple juice and different mannitol concentrations, as well as patients’ acceptance and side effects of these different magnetic resonant enterography (MRE) oral contrast agents. Materials and Methods: Seventy-five participants underwent MRE as an initial investigation or follow-up for inflammatory bowel disease. A systematic sampling method was used to divide the participants into three different groups: group 1 received 6.7% mannitol concentration, group 2 received 3.3% mannitol concentration and group 3 received pineapple juice as an oral contrast agent during their MRE examination. The degree of bowel distension on MRE images was assessed by a radiologist by measuring the bowel diameter from inner wall to inner wall at specified levels, while qualitative analysis was evaluated based on the presence of artefacts. All patients were asked to score their acceptance of the oral contrast and were asked about side effects such as diarrhoea, abdominal discomfort and vomiting. Results: All patients were able to completely ingest 1.5L of oral contrast. The mean diameter of bowel distension was 2.1cm in patients who received 6.7% mannitol concentration, 2.0cm in patients who received 3.3% mannitol concentration and 1.6 cm in patients who received pineapple juice. Two thirds of patients who received 6.7% mannitol and 3.3% mannitol solutions had good-quality MRE images, but 68% of patients who received pineapple juice had poor-quality MRE images. Twenty-four patients (96%) who received pineapple juice rated it as slightly acceptable and acceptable but only 12 patients (48%) who received 6.7% mannitol solution rated it as slightly acceptable and acceptable. Eighty-eight percent of patients who received 6.7% mannitol solution experienced at least one form of side effect as compared to 44% of patients who received 3.3% mannitol solution and 18% of patients who received pineapple juice. Conclusion: Optimum small bowel distension and good image quality can be achieved using 3.3% mannitol concentration as an oral contrast agent. Increase in mannitol concentration does not result in significant improvement of small bowel distension or image quality but is instead related to poorer patient acceptance and increased side effects. Pineapple juice is more palatable than mannitol and produces satisfactory small bowel distension. However, the small bowel distension is less uniform when using pineapple juice with a considerable presence of artefacts. Mannitol, 3.3% concentration, is therefore recommended as an endoluminal contrast agent for bowel in MRE.

Cases of mid-shaft humerus fracture are often managed conservatively. However, poor fracture healing is not uncommon and often require surgical intervention with equivocal prognosis and may result in complications such as radial nerve injury and nonunion. We report a case of successful healing of mid-shaft humerus fracture using traditional Chinese medicine (TCM). The principles of fracture management in TCM is very different from conventional orthopaedics utilizing light immobilization, active joint exercise and herbal agents that promote bone healing. This case report illustrates the potential role of traditional Chinese medicine in humerus fracture management.

Spontaneous pneumomediastinum (SPM) is defined as presence of free air or gas in the mediastinum. It may occur in young healthy individuals without serious underlying lung disease. SPM is a rare presentation at the Emergency Department; it typically occurs among tall and thin individuals. We report a case of spontaneous pneumomediastinum in a gentleman who presented with a short history of chest and neck pain after coming back from work. Neck radiograph showed neck subcutaneous emphysema and chest radiograph showed pneumomediastinum with no evidence of pneumothorax or rib fracture.

Dengue is endemic in over 100 countries worldwide, predominantly in the subtropical and tropical regions and the incidence has been increasing globally. Patients with severe dengue may develop massive bleeding, disseminated intravascular coagulopathy and multi-organ failure. Bleeding may occur in various body cavities and muscles; however, bleeding in the retroperitoneal space is uncommon. We report a case of a 37-year-old gentleman who presented with a 4-day history of fever associated with chills and rigours. On Day 6 of illness, he complained of left lumbar and left iliac fossa pain which was aggravated by movement. A computed tomography angiography scan of the abdomen showed the presence of a retroperitoneal haematoma, left iliopsoas and quadratus lumbarum intramuscular haematoma with active bleeding and left abdominal wall muscles haematoma. His condition gradually improved after multiple blood transfusions and he gained full recovery. Spontaneous retroperitoneal haematoma is an uncommon complication of severe dengue infection. Early diagnosis based on high index of clinical suspicion using appropriate imaging will aid in prompt management of these cases and may prevent deaths.

Neoplasm of the salivary glands is rare and accounts for 3% to 6 % of all head and neck tumors, and about 85% occurs in the parotid glands. Metastatic disease to the salivary gland, in particular the parotid gland, is noted to be uncommon among solid tumors and has not been well described before. We report a patient who presented with an initial parotid swelling, only to ascertain, it was a metastatic lesion arising from an adenocarcinoma of the pancreas.