CASE 216: MULTIPLE INTRAABDOMINAL NODULES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 32 yo,abdominal pain, no fever. Emergency ultrasound of abdomen ruled out acute appendicitis, but there are ascites, and many small round nodules of  average of 2cm in diameter at great curvature of stomach, intra great epiploon, and at hilus of liver . All of them were  very poor echo like cyst (SEE 4 IMAGES= H.1: black nodule in hilus liver, H.2: cross section of abdomen and nodule intra great omentum, H.3:  echo poor nodule at great curvature of stomach, H4 : ascites at pelvis).

Blood test are normal. Punction of ascites fluid for analyse. PCR of tuberculosis is negative.

THIS CASE  UNDERWENT BIOPSY VIA LAPAROTOMY SHOWING  MULTIPLE WHITE SPOTS OVER PERITONEUM, LIKED CARCINOMATOSIS.

REMOVING ONE BIG MASS.AT GREAT CURVATURE OF STOMACH. CUTTING SURFACE SHOWED FLUID LIKED CASEUM.

SUGGESTION OF TUBERCULOSIS. WAIT FOR MICROSCOPY REPORT.

Microsopic  report  is  tuberculosis lymphadenitis (photo).

Discussions:

Why the result  of analysis of ascites fluid is negative  from TB PCR, ADA?
WHY TUBERCULOSIS LYMPH NODE  are VERY  BLACK in echogeneicity?
HOW to DIFFERENTIATE it WITH LYMPHOMA ?
 
REF

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CASE 215: PELVIS TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 50 yo amenorrhea 3 years ago, and hypogastric area distention like being of pregnancy for 6 months.

Ultrasound at the pelvis had a masss of 20 cm in diameter, cystic septation structure which cannot separate with cervis uterus by TVS ultrasound.

MRI of pelvis showed  that mass was cystic septation with very thick border (see MRI images).

DIFFICULTY FOR DIAGNOSING THIS CASE AS THIS MASS WAS TOO BIG, ULTRASOUND WAS LIMITED OF ANGLE OF FIELD OF VIEW.

MRI CANNOT STUDY THE MOTION OF THIS MASS, STRUCTURE WAS LOOKED LIKE OVARIAN CYSTIC TUMOR, BUT MRI  SHOWED  THE BORDER VERY THICK.

OPEN OPERATION FOR REMOVING THE UTERUS AS A SAME MASS.

SECTION OF THIS MASS WAS UTERINE FIBROMA IN NECROSIS, AND MICROSCOPY CONFIRMED.

IT IS A HUGE UTERINE FIBROMA NECROSIS LOOKED LIKE OVARIAN CYST.

Reference

DEGENERATED UTERINE FIBROID MIMICKING HYDROMETRA

CASE 214: ADRENAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 50 yo, hypertension on medical treatment, well controlled, one week ago she was getting very weak and  falling down to brain trauma. CT scan the head has nothing, but  blood test  showed hypokalemia  K = 1.7 mEq /ml, abnormal EKG  with  wave T= U deformation. Ultrasound scan of abdomen detected one  2cm small tumor at right adrenal area (2 pictures).

MSCT with CE showed  this tumor in high enhancement (HU= 8.2  rising to 59.9) (see 2 CT pictures).

Blood tests from adrenal gland hormones were normal, aldosterone dynamic test was=84 pg/mL, after test 115pg/mL.

This case was operated by endoscopy for removing this tumor. See macro and microscopic specimen and report is adenoma of cortical adrenal (photo).

CASE 213: BILOBED GALLBLADDER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 29 yo,  recurrent pain at subhepatic area.

Ultrasound detected stone in gallblader with thickening wall and one cystic mass with size of 2 cm  nearby. Sonologist reported that was CBD cyst and chronic cholecystitis due to stone [3 images].

MSCT  also had same report as ultrasound report (see  image CT).

Surgeon ordered  MRCP. The MRI report was different which thought about  bilobar gallbladder that had 2 parts: one part had stone and  thickening of the wall, and another part was connected to the neck of gall bladder which had  normal wall and normal CBD.

Endoscopic surgery for removing gall bladder with stone in its fundus.

Macroscopic specimen of this gallbladder was correlated with 3 modalities of  imaging: ultrasound, CT and MRI.

 

 REFERENCE

 



CASE 212: APPENDICEAL ABSCESS, Dr NGUYỄN ĐỨC DUY LINH, Dr NGUYỄN NGỌC XUÂN GIANG, Dr PHÙ VĂN TUỐT, BÌNH AN HOSPITAL, VIETNAM

Man 38 yo with chief complaints: fever and lower abdominal pain for 10 days. Pain not releasing but getting worse with colicky pain and having dysenteric syndrome. Endoscopy  ruled out a  colonic tumor and noted  that sigmoid colon may pushed by an uncertain mass from outside.

Ultrasound of abdomen detected an abcess  in  minor pelvis which was thought to be an appendiceal abscess. 

Later  abdominal CT confirmed a right pelvic abscess with fecolith and a diagnosis of appendiceal  abscess was made.\

WBC= 14.76 K with 78.3% of neutrophile and CRP=87.24mg/L.

 Endoscopic surgery was performed. 

A wall-off abscess at pelvic region was detected which was due to perforated inflammed appendix at liberal tip . The pelvic abscess was removed and patient getting well.

CASE 211: PRESACRAL EPIDERMOID CYST, Dr PHAN THANH HẢI, Prof VÕ VĂN THÀNH, Prof NGUYỄN SÀO TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MALE 30 yo IN ROUTINE SCREENING CHECK-UP BY ULTRASOUND WHICH DETECTED ONE RETRO- URINARY BLADDER  MASS  WITH CYSTIC  SEPTATION.
 

MSCT  WITH  CE  SHOWED THAT MASS WITH SIZE OF 10CM,  BILOBAR, DENSITIES OF 2 LOBES  WERE  DIFFERENT. SACRUM  WAS  ERODED BY TUMOR, CONTRAST ENHANCED  PHASE  WAS VERY LOW (SEE 4  CT  IMAGES).  

 

OPERATION  WAS DONE FOR  REMOVING  CAPSULATED TUMOR WITH  SEBUM CONTENT LEAKING OUT [SEE  FOTO].

Pathology report is epidermoid cyst.

 

 

References  2 files pdf