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 ?
 
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