CASE 849: SOLITARY MESENTERIC THROMBOSIS, Dr PHAN THANH HAI, Dr LE VAN TAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 49 year-old man with 14 day fever and epigastric pain and vomiting. Two times of ultrasound examination in another hospitals were nothing but failed in gastritis management.

Ultrasound in Medic Center detected an enlarged echogenic mesenteric vein diameter # 11mm and no flow in its lower part.

MSCT confirmed a thrombosis of a part of the mesenteric vein.

Lab data showed increased the platelets #544 H, WBC = 10,400 and positive Dengue fever Ig G.

As it exists no sign of bowel infarction a medical management was made. The pain was reduced for some days with a new generic of anticoagulant.

CASE 848: AAA GRAFT LEAKING, Dr PHAN THANH HẢI, Dr DANH ANH, BÌNH AN HOSPITAL, MEDIC MEDICAL CENTER, KIÊN GIANG - HCMC, VIETNAM.

A 81 year-old diabetic woman with abdominal aortic stent graft came into emergency as epigastric pain. TA:160/100 mmHg; HR: 100p/min. The woman was in uneasiness and throwing.

Ultrasound B-mode detected stent leak into the  repaired AAA.  Doppler technic showed aliasing in the stent graft and in the AAA which means that any rupture of the repaired AAA may appear soon [endoleak type II].

No free  fluid outside the repaired  AAA and in the abdominal cavity.

 

MSCT confirmed the endoleak AAA.

Lab data was stable.

As the risk of  AAA rupture  a scenario of  repaired AAA rupture was planned.

CASE 847: ANOTHER CASE of FHC, Dr PHAN THANH HẢi, Dr TRẦN CHÍ ĐỦ, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 18 year-old woman with PID  and RUQ pain from HV hospital asked for a pelvic MRI at Medic Center.

MRI with CE  detected PID both two sides and  thickening of hepatic capsule as perihepatic inflammation  that supposed a case of Fitz-Hugh- Curtis syndrome.

MRI and MSCT with CE could detect FHC but  ultrasound  determined the perihepatic inflammation while it exists the fluid enough around the liver.

Violon-strings [pseudo septa] adhesions between liver surface and abdominal wall and fluid may be seen in two cases of  Van Dongen.

 FHC was described since 1930 as PID and painful perihepatic area inflammation  which had been managed with antibiotics for some days. The hepatic pain may due to infected from  Chlamydia, Gonococcus,  Trichomonas  or TB genital peritoneum in pelvic region that were going up to the hepatic peritoneum but the hepatic tissue and bile ducts being intact.

   

REFERENCE 

1. https://www.sciencedirect.com/science/article/abs/pii/002822439390181B

2. CASE 351: A Case of FHC syndrome.

https://www.ultrasoundmedicvn.com/2015/12/case-351acute-abdomen-post-partum-dr.html

CASE 845-846: LUNG TB and EXTRAPULMONARY [EP]TB, Dr PHAN THANH HẢI, Dr NGUYỄN TẤN DŨNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Case 01:

A 50 year-old  diabetic woman with chest pain and cough for one week.

TB lung was revealed on chest XRay film.

Breast ultrasound detected a right breast tumor, BI-RADS 4B. And a right axillary lymph node.

Lung MSCT confirmed TB lungs. BK sputum positive.

But the mammary biopsy result was a TB mastitis.

Case 02: 

A 58 year-old man with epigastric pain.

Chest XRay revealed TB lung.

Abdominal ultrasound noted nothing. BK sputum negative.

But colonoscopy detected a colonic mass at the splenic angle of the left colon.

Result of left colonic mass biopsy was a TB of the left colon.

We learnt that the need of combination of some modalities together to diagnose an infectious syndrome.

Starting from a pulmonary localisation (primary infection), M. tuberculosis can spread to other organs during a silent phase, usually soon after primary infection. Active TB can develop in many other parts of the body, particularly in lymph nodes, meninges, bones and joints, kidneys, genital organs and the abdominal cavity.

Approximately 16% of global TB cases are classified as EPTB, although this figure varies according the local epidemiology [1]Citation 1.World Health Organization. Global Tuberculosis Report 2020. Geneva: World Health Organization; 2020.

REFERENCE:

https://medicalguidelines.msf.org/en/viewport/TUB/english/2-2-extrapulmonary-tuberculosis-20320217.html

CASE 844: MAMMARY PAGET'S DISEASE, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, MEDIC MEDICAL CENTER, HCMC VIETNAM

 A 60 year-old woman with an erosive inflamed right nipple and bad feelings of searing, prutitus, hemorrhagia for one year which was failed in treatment. 

 

Ultrasound revealed the right nipple swollen and edema of the tissue underneath but no tumor of the right breast. A right axillary lymph node was noted.

Mammography detected no tumor.

Results of biopsy in the second time were Paget disease of the right breast nipple and a ductal breast carcinoma in situ grade 3.

Surgery was done for the right mastectomy.

REFERENCE:

From Wiki 

Paget's disease of the breast is difficult to diagnose by physical exam alone due to its resemblance to dermatitis and eczema. One helpful differentiator is that eczema tends to affect the areola first, and then the nipple, whereas Paget's disease of the breast typically begins at the nipple and spreads outwards. In addition, nipple eczema is typically responsive to topical steroid application, while Paget's disease of the breast will not improve with topical steroid use.^[4]

Mammogram and biopsy with cytopathology are common confirmatory tests.^[11] In biopsy, a tissue sample removed from the affected area is then examined under the microscope by a pathologist, who distinguishes Paget cells from other cell types by staining tissues to identify specific cells (immunohistochemistry).^[5]

CASE 842-843: CASTLEMAN DISEASE, Dr PHAN THANH HAI, Dr NGUYEN THI CAM VAN, Dr ĐAO QUOC TOAN, Dr TRAN LE DUNG, MEDIC MEDICAL CENTER , HCMC, VIETNAM.

  CASE 1 :A 20 year-old girl in a check-up.

Ultrasound detected many vascularized lymph nodes into  her abdomen.

Abdomen MSCT confirmed a case of Castleman disease with vascularized lymph node which CE captured strongly.

Anapath result of the specimen was the Castleman disease of the lymph node.

Some years later there is not any recurrent sign into her abdomen and neck.

CASE 2:

A 40 year-old man in annual check-up.

Ultrasound detected vascularized lymph node close by the pancreas head.

But MSCT noted a retroperitoneal tumor.

Surgery was done and the latest result post op  also a case of the Castleman disease.

CASE 841: LIVER TUMOR or RENAL TUMOR RCC, Dr PHAN THANH HẢI, Dr PHAN HỮU BỘI HOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 69 year-old hypertensive woman underwent flatulence without anorexia in 2 weeks. Her past history noted GI hemorrhagia 2 years before. BP: 122/88 mmHg, HR: 88b/min.

Ultrasound represented a #13x11cm solid tumor maybe a liver tumor.

Lab data noted positive HCC risk and HCV infected.

But MSCT detected a tumor which suspected a GIST  tumor or mesenteric tumor.

A surgical investigation for biopsy was performed. And the results of biopsy and immunologic staining  were a chromophobe RCC.

We learn that try to having all proves may get an appropriate diagnosis.