More Skin Lesions

Lesion 1

This is a 70 year old male, presented with a 2 month history of skin lesion on his anterior shin. He has a past medical history of COPD and still a smoker with a 40 pack year history. The lesion initially started as a small itchy lesion which developed into the size you see now on the picture above over 2 mths.

What is your diagnosis of this skin lesion? How would you confirm your diagnosis and what is your treatment plan?

Lesion 2

This is a 45 year old diabetic female with lesions on her lower limb. She was referred to a specialist clinic with a non-healing ulcer on the medial gaiter area. What is the diagnosis of her skin lesion?


Answers: Posted on 27th December 2008

Lesion 1: Squamous Cell Carcinoma

Lesion 2: Diabetic Dermatopathy

A persistent Wrist sprain

A 35 year old male attended casualty after falling onto his dominant outstretched hand. He was tender all over the wrist joint but more so medial to the scaphoid area with an obvious deformity. There was no neurovascular deficit. The above xray was done and patient was sent home with a diagnoses of soft tissue injury and follow up appt in clinic.

4 days later in clinic his pain is no better so he was given more analgesia and a high arm sling. There was no neurovascular deficit noted.

2 weeks later patient requested to be seen again after complaining of un-abating pain on his wrist and swelling which has not subsided since his initial injury. He also complains of numbness over the medial 3 and half fingers.

What is the diagnoses based on the x-ray?
What is the cause of the neurological findings?
What is the preferred option for treatment?


Answer: (posted on the 20/12/2008)

It is a Perilunate dislocation, with scapho-lunate dissociation.
The Neurology is a median nerve compression
The treatment is immediate MUA (closed reduction), however with a 2 week old injury it can be difficult (almost impossible)

Well done to those who got it right!
In this case we attempted initially closed reduction but was unsuccessful. So we went for open reduction. After open reduction, under image intensifier the scapho-lunate dissociation was very obvious so k-wire fixation was necessary to maintain reduction. These are the post-operative xrays.

Good Luck Dr Lim Kian Soon

The Head of Diagnostic Division and also our only practising local Radiologist Dr Lim Kian Soon has recently left RIPAS Hospital to join his wife who was also a practising Breast Surgeon Miss Hani Trasil to work in Singapore.

Dr Lim was well known to all the doctors working at RIPAS for his work in improving the services at department of radiology, and of of his many achievements was to obtain the 64 slice CT scanner for RIPAS Hospital which had tremendously improve our imaging capability. We are now able to diagnose diseases with better precision, do 3-D CT Reconstruction, Cardiac CT Imaging and perform interventional radiology procedures with better precision and outcome. We are definitely going to miss having somebody of his calibre around, but nonetheless wish him all the very best in his future career abroad.

Send us a postcard Dr Lim!