CASE 392: PERFORATED SEAL-OFF DUODENUM, Dr LÊ TỰ PHÚC-Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

"A 37-year-old male presented in our hospital with moderate epigastric pain for three months. Around one week before examination, the pain became more severe, but he didn’t recognize a suddenly pain. Clinical examination revealed no muscle guarding and rebound tenderness.

Abdominal ultrasound images showed unconcentric wall thickening of the gallbladder. Beside the more thickening wall of gallbladder, a hyperechoic of air collection was found. This air collection was continuous with small hyperechoic air spots inside duodenum. A perforated duodenal ulcer with air leakage was suspected.

CT-Scan confirmed air collection beside a thickening gallbladder wall.

Blood test indicated and raised of white blood cells (10,350 / mL) with low level of CRP (0.9 mg/L) and possitive Helicobacter Pylori test.

Without surgery, the patient pain released and the air collection was disappear in ultrasound and CT-Scan images for one month follow-up. Gastroduodenal endoscopy showed a healing ulcer in the anterial wall of duodenum. White blood cell count returned to normal."

This is a case of perforated seal-off duodenum revealed by ultrasound and confirmed by CT-scan later and successfully management without surgery.

CASE 391: DOUBLE BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 53 yo, for one month  detected  her breast distention both 2 sites and  pain. In clinical examination 2 breast are hot and hard.

Ultrasound  (US 1), right breast had some echo poor focal lesions, 2-3 cm, non compressible.

US 2: same  structure at the left  breast.

US 3=

US 4: color Doppler  hypovascular.

Mammo Xray  =  very dense breast (MM1, 2).

MRI with gado=  breast are filling by  hyperintense mass  with gado enhancement.

Bood tests= WBC  normal, beta microglobuline raised 2,200 UI (n=2,100 UI)

Biopsy was done  by core biopsy  and  IHC staining  report is  lymphoma large B cell.

Conclusion= Lymphoma is most common appearance of  2 breast simultaneous infiltration.

REFERENCE

DOWNLOAD PRIMARY BREAST LYMPHOMA

CASE 390: PEDUNCULATED HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 56 YO REPORTED  HIS RUQ  SWOLLEN  SLOWLY FOR  6 MONTHS , NO DISTURB GI TRACK IN DIGESTION.

ULTRASOUND ABDOMEN:

US 1:ECHOGENEICITY OF LIVER  AND TUMOR  NEARBY  ARE DIFFERENT.

US 2:LONGITUDINAL SCAN,TUMOR AND LIVER BORDER ARE NOT CLEAR.

US 3: STRUCTURE OF THIS TUMOR IS SOLID, HYPOVASCULAR.

US 4: CROSS SECTION, TUMOR IS INTRA ABDOMEN, AT RIGHT  SITE OF AORTA.

MSCT WITH CE:

CT 1( 4 PICTURES): SAGITTAL VIEW, FRONTAL VIEW ,  CROSS-SECTION SHOWED VASCULAR SUPPLY OF THIS TUMOR IS FROM LIVER.

CT1:TUMOR IS  RELATED WITH  R/LIVER,   PEDUNCULATED, VASCULAR SUPPLY FROM LIVER.

CT2:MULTINODULAR, CONTRAST ENHANCE IS  IN BORDER OF TUMOR.

LAB BLOOD TESTS  =  HBV POSITIVE, AFP=651.8 ng/mL.

Operation  laparotomy  detected huge tumor connected with right liver border by
small area.

Microscopic report  is  undiffentiated  HCC 

( P-HCC; PEDUNCULATED HCC or  HANGING HCC..)

SUMMARY=   PRE OP IS SUSPECTED HCC, BUT IT  HAD PEDUNCLE  COME FROM RIGHT LIVER. LAPAROTOMY REMOVED BIG TUMOR  FROM THE RIGHT  LIVER.

REFERENCE:

PEDUNCULATED HCC

CASE 389: ECTOPIC APPENDICITIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 35yo, onset  epigastric pain  treated  as gastritis for one week, fever.

Ultrasound of   abdomen= pain  at  upper  left  abdomen quadrant (US 1  probe put over  pain point).

US  2= mass  rounding as  an abscess, CDI: no  more vascular  supply.

US 3 (with linear probe)  intra abscess the linear structure  look like  appendix).

US 4 =  cross section.

Emergency CT with CE=   mass  wall-off  by  small intestine and  great omentum  as an abscess  ( CT1, CT2).

Blood test  WBS = high 14k , with neutro 9.9,  CRP  38.3ng/dl.

Preoperative diagnostic is  intra abdomen abscess  due to ectopic appendicitis.

Laparoscopic view = the pus goes out  from this mass  and open operation removed appendiceal partial necrosis and  mobile coecum.

Conclusion=  appendiceal abscess in ectopic position at left abdomen site.

CASE 388: TESTIS TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Boy 11 yo with left  scrotum is bigger than right one, he went through an  operation for  left inguinal hernia  2 years before, now  no pain, no fever.

US of scrotum detected hydrovaginalis and a small focal intratestis, size  of 0,8 cm, cystic calcification  in septation ( US 1, 2, 3),  hypovascular 

and very hard  in elastography ( US 4).

MRI  reported  a cystic tumor with calcification with  size of 1 cm.

All  AFP, HCG, testosterone  or  corticoid of blood tests  are negative.

Operation  for biopsy: macroscopic tumor is intra testis,  not  invasion to tunica vaginalis; tumor is white structure  like caseum.

Microscopic report is mature teratoma.

REFERENCE

Epidermoid Cyst and Teratoma of the Testis - Journal of Ultrasound in Medicine

www.jultrasoundmed.org/content/24/10/1403.full.pdf