CASE 326: INTUSSUSCEPTION of COLON INDUCED by POLYP, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-326-intussusception-of-colon-induced-by-polyp-dr-l-t-phc

A 4 years-old boy presented to Medic Center with one year history of weakness, fatigue, lethargy, pale skin and less active. No recognition of other symptoms such as vomiting, abdominal pain or bloody stools. Patient was done blood test and abdominal ultrasound. 

Abdominal ultrasound detected colo-colonic intussusception in the right upper quadrant with concentric rings sign in transverse scan and "hay fork" sign in long axis scan. Located adjacent the intussusception show an isoechoic to hypoechoic solid mass, well defined oval, 30 mm in diameter, hypervascular in the hilus of the mass. Those blood vessels were continuing with the blood vessels from central portion of the intussusception. Sonologist suspected a intussusception of the ascending colon secondary to a  polyp. 

Laboratory investigations showed the reduction of Hemoglobin: 6.5 g / dl.

The patient was transferred to the hospital Nhi Dong 2. He had positive fecal occult blood test. Colonoscopy showed a polyp of ascending colon. 

A surgery was then obtained 2 weeks later.

 Surgical results confirmed polyp of the ascending colon which pathology result is tubular polyp.

CASE 325: STRETCH MARKS SKIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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Boy 15 yo, history of  treated  high dosage  corticoid  due to uveitis;  2 years later  detected  many  scars  over  skin  at abdomen, leg, arm, back ( foto).

Ultrasound  of skin abdomen  shows  that  skin thin  and  hyperechoic, soft elasoscan ( see  US pictures 1,2,3,4).

Conclusion: It is  stretch marks skin due to  overuse  corticoid  which  destructed elastic fibers  in  derma layer of the skin.

REFERENCE:

Cases  of  skin stretch marks.

CASE 324: BREAST PSEUDOTUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-324-breast-pseudotumor-

Woman 52 yo, history of hypertrophy of bilateral mammar gland. She had been in operation  for reduction of breast  size   10 years before. After operation she  detected  the  mass at the  site operation,  6- hour  position  at  2 breasts more and  more hard and no painful.

Ultrasound  check-up detected  at 2 breast,  masses  size  arround 5cm under  the skin incision at 6-hr position  of the breast,  hypoechoic  with  lateral shadowing.  At the left  breat mass  had  calcification,  soft elasto Q-score (see 5 ultrasound scan).

Mammography  cannot detected this mass.

MRI of breast without  gado, T1 ,T2 and fat subtraction, showed  fat  tissue with fibrosis  around and no axillary  lymph node.

Core biopsy of  this mass  and  reported  that  fatty tissue with  fibrosis, the border

was  fibrosis of scar  after operation  looked like a tumor. 

CASE 323: ELEPHANTIASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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BOY 16 YO, HISTORY OF    ABNORMAL DETECTION OF HAND AND LEG IN THE CHILDHOOD, SLOW GROWTH ( FOTO).

2 HANDS  AND RIGHT LEG ARE ABNORMAL. PALPATION OF THE SKIN FEELS  EDEMA AND COMPRESSIBLE, NO PAINFUL.

ULTRASOUND  of  RIGHT LEG  REVEALED  SKIN AND SUBCUTANEOUS  LAYER THICKENING  TO 1,9CM, NO RAISED  VASCULAR STRUCTURE.

MSCT  NON CE SHOWS  SKIN AND  SUBCUTANOUS   FATTY EDEMA, LOCATED THE  2 HANDS AND  FOREARM, RIGHT  HALF BODY, AND RIGHT LEG WHILE   BONES AND MUSCLES ARE NORMAL.

WHAT IS  YOUR  DIAGNOSIS?.

CASE 322: OVARY TWISTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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WOMAN 36 YO, 3 DAYS  AGO PAIN AT  SUPRAPUBIS, AND POLYKYURIA.

ULTRASOUND  OF  PELVIS WAS NORMAL.

PAIN CONTINUING  AND  RISING  AND SHE  WAS IN ADMISSION  OF ONE  EMERGENCY HOSPITAL,   IN CLINICAL SUSPECTED  RENAL COLICKY PAIN.

ULTRASOUND  AGAIN   DETECTED  ONE SUPRAPUBIS MASS,  SIZE OF10CM,  CYSTIC WITH  CLOUDY  FLUID INSIDE (US 1).

CDI  REPORT  WAS SMALL UTERUS, CANNOT  DETECT VASCULAR  AT  RIGHT UTERUS CORNER (US 2).

THIS CYSTIC MASS  WITH  MASS INTRA CYST  LIKED  SEBUM THAT  SUSGESTED  RIGHT OVARY TERATOMA  IN TORSION.

NO STONE  INTRA URINARY SYSTEM.

MSCT  NON CE   PRESENTED  OVARY MASS  LOOK LIKED TORSION OF TERATOMA.

EMERGENT OPERATION BY LAPAROTOMY DETECTED THIS MASS BEING AN OVARIAN CYST   BLACK IN  COLOR DUE TO TORSION ( SEE FOTO)

OPEN  SURGERY  REMOVED  RIGHT  OVARY MASS  ISCHEMIA AND BLEEDING INSIDE OF A  TERATOMA TUMOR.

Discussion : Why the first ultrasound examination was  normal?  Looking  the first picture ultrasound of the uterus that was  clear view and  the fluid  over  look liked urinary bladder.

But  you can see the small urinary bladder  in the lower corner of the first ultrasound picture.

The mistake  was due to ultrasound  scanning  with  the urinary bladder  not full filling , the ovary cyst  was not  septation because scanning view in small window.

The ultrasound examination is better  view  with  lateral decubitus position, but in some cases cannot see well in decubitus position.

Pathology report was an ovarian teratoma.