Two cases of right adrenal tumors in women detected spontanously by abdominal ultrasound and confirmed later by MRI [case 1] and MSCT (case 2).
Based on ADRENAL-RADS the two adrenal tumor were classified.
CASE 1: A 30 year-old HTA woman for 7 years; going to Medic in an hypertensive crisis # HTA=212/90mmHg, with a right adrenal tumor # 25x16mm on emergency ultrasound.
CASE 2: A 50 year-old woman in check-up, with adrenal tumor # 21x23mm.
A 55 year-old man with abdominal pain for 3 days in right flank.
Ultrasound noted a #46x12mm fluid-filled appendix.
But MSCT detected a wall-off transverse colon abscess with a # 14mm transwalled colonic fishbone.
Open surgery was done for removed partial colon with a fishbone.
A 55 year-old woman with epigastric pain, flatulence for 2 months that failed in gastric management. Two days before she vomited out the old gastric contents.
Ultrasound detected a dilated stomach and obstruction of extra and intrahepatic biliary ducts which may due to pancreatic head tumor #30x35 mm. CBD dilated # 15-17mm in diameter.
Lab data showed increased CA 19.9.
MSCT confirmed head of pancreas tumor which made obstruction of biliary ducts and the stomach in dilatation.
Open surgery was done for removing the pancreatic tumor and performing the gastroenterology anastomosis and common bile duct- ileum anastomosis.
Result of pathology was adenocarcinoma metastasized duodenum, transverse colon and lymph node.
Reference:
Two cases of acute appendicitis diagnosed by ultrasound at 12th and 14 th hour from onset.
CASE 1
A 37 year-old woman with epigastric pain from 2:00am and going to the umbilical region which was not released with Phosphalugel; then she went to Medic Center at 5:00am. WBC:15x10^9/L CRP:2.0mg/L
Ultrasound detected an #60x15 mm inflamed appendix which appeared as finger sign, and uterine fibroma.
MSCT confirmed an acute appendicitis.
CASE 2:
A 47 year-old man with a sudden epigastric pain at 9:00am. WBC 10.9x10^9/L, CRP 4.91mg/L.
Endoscopy noted an acute gastritis.
But ultrasound detected an 62mm long acute appendicitis [thick wall:2.7mm].
He entered the hospital at 01:00 pm and the inflamed appendix removed by endoscopic surgEru at 5 :00 pm in the same day.
A 60 year-old diabetic man with cough and LUQ pain for 10 days. He denied any trauma in history.
Going to Medic Center in pain and anemia; POCUS in emergency detected free fluid in abdomen and hyperechogenic mass around the spleen, and left pleural effusion.
Lab data noted anemia and infectious syndrome of a diabetic patient.
MSCT confirmed a splenic rupture and free fluid in abdomen and pleural effusion both two sides.
A splenectomy was done and the patient remains well.
Coughing is a rare cause induced a non-traumatic splenic rupture besides jogging, squash, cycling and electroconvulsive therapy.
References:
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COMMENTS
Background NSR is a rare condition in emergency surgery. NSR may be seen along with different diseases, such as malaria, infections, malignancies, metabolic disorders, as well as vascular and hematological diseases. Also, spontaneous rupture of the spleen may be observed. Absence history of a trauma may not remind a rupture needs a high index of suspicion for diagnosis in spleen.
Research frontiers The criteria for NSR were first described by Orloff et al in 1958 and our patients with NSR were in accordance with these criteria.
Innovations and breakthroughs Our study emphasized that rapid diagnosis, aggressive resuscitation, and surgical intervention are important for successful outcome in patients with NSR. If the patient with intra-abdominal hemorrhage has no associated trauma, splenic rupture should be considered.
Applications NSR may be shown in particular in endemic regions of malaria, hematological malignancies, and spontaneous and chronic renal failure.
Peer review In this study, NSR was presented with different diseases. Diagnosis of NSR, using ultrasonography or CT, and paracentesis, is difficult. Splenectomy may lead to a successful outcome in patients with NSR.
A 35 year-old woman in an annual check-up.
Ultrasound detected a left kidney mass without any sign or symptom.
MSCT confirmed the left kidney tumor which may belong a RCC or oncocytoma.
Histopathological result was an RCC, clear cell carcinoma.
Renal cell carcinoma (RCC) accounts for the majority (80% to 90%) of kidney cancers. Most RCCs have a clear cell histology. Often asymptomatic and diagnosed incidentally.
Most cases are sporadic, although several hereditary
clinical kidney cancer syndromes have been identified.
