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A 22-year-old uncircumcised male patient had a thin stream of urine and had to exert pressure while voiding. He had a history of some instrumentation in his penis during childhood, but no records were available. He was first seen by a primary care physician, who made a provisional diagnosis of stricture urethra and advised for a retrograde urethrogram (RUG). His RUG had a contrast shadow, which was thought to be possible dilated distal urethra due to proximal obstruction (stricture), and the patient was referred to us for further management (figure 1). When we examined the patient, he was found to have phimosis. A dorsal slit was done and the meatus was examined, which was normal. A gentle …

A 38-year-old man presented with bilateral breast swelling, along with pain and redness for 7 days. Bilateral axillary nodes were also palpable; which were multiple and discrete. A provisional diagnosis of bilateral breast abscess was made with suspicion of underlying malignancy. Incision and drainage through subareolar incision was performed and the adjoining tissue was excised and sent for histopathological examination.

A 78-year-old man with a 30-year history of chronic obstructive pulmonary disease (COPD) presented to the accident and emergency department with shortness of breath and a cough productive of white sputum. A provisional diagnosis of an infective exacerbation of COPD was made. He had a 60-pack-year history of smoking but had stopped a year ago. He was sent for a routine chest x-ray (CXR) and a right …

A 34+4 weeks neonate was born by spontaneous vaginal delivery with normal antenatal scans. Routine neonatal examination revealed the absence of a vaginal opening with bulging of vaginal introitus (figure 1). Urethral and anal openings were patent. A provisional diagnosis of an imperforate hymen with hydrocolpos was considered. Figure 1 Imperforate hymen noted at birth. Subsequent investigations revealed a deranged renal function at 22 hours of life (creatinine 99 µmol/L, urea 10.2 mmol/L, K 6.6 mmol/L and …

A 60-year-old man was presented with colicky upper left abdominal pain and vomiting. Haematology and biochemistry were unremarkable and there had been no recent change in bowel habits. An initial non-contrast abdominal CT, performed due to the provisional diagnosis of left renal colic, revealed a midline caecum (figure 1) and an absence of small bowel in the left abdomen (figure 2). The superior mesenteric vein was located anterior to the superior mesenteric artery (figure 3) and the duodenal–jejunal junction was present on the right side, failing to cross the midline (figure 4). The findings were consistent with partial malrotation …