CASE 264: ASCITES, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 31yo  with epigastric pain 3 days ago.

She came to MEDIC  for  gastroscopy and result was  gastritis, but ultrasound of abdomen  detected free  fluid of ascites around border of liver  and  small stone in gallbladder (see  ultrasound  images).

Liver was normal,  and ultrasound  at pelvis detected  one mass  on the left side of uterus, round,  5cm diameter, solid mass  with  small vessel  inside  and  RI low ( see  ultrasound images). Sonologist  susgested  an ovary tumor  in rupture.

MSCT with CE of this mass on  left lateral of uterus...with  CE enhance  like a  nidus of  pregnancy in rupture with  a lot of blood  clots  in abdomen ( see 3 CT pictures).

Blood tests  :  CA-125  rising 125 UI/mL  and  betaHCG  rising 134UI/mL

WBC 15K  with neutro 75%, Hct  29%.

Emergency  operation  in  BINH DAN hospital  detected  hemoperitoneum due to rupture of  tubal pregnancy (photo).

DISCUSSION: 

Epigastric pain is a common indication to gastroscopy that was not available for this case.

ULTRASOUND of  ABDOMEN  MUST BE  FIRST CHOICE for CASE.

BLOOD TEST  CA-125 RISING  NO  MEANING TO  OVARY  CANCER.

Beta HCG was  most  sensitive  for  diagnosis of this case.

CASE 263: BUFFALO'S NECK, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27 yo, dental  pain  on right mandibular  for one week, he detected  the right side of neck along  SCM muscle getting hot and swelling, pain and fever (see photo).

He was treated  with antibiotics and went to ultrasound scanning. Sonologist detected this neck mass beeing   like abscess by fluid collection on right and left neck (see 3 photo and video).

MSCT found out the right mass along SCM muscle and one other mass on left side nearby thyroid gland.

Puncture this mass  removed the pus but  direct examination  with gram stain no bacteria. 

Operation for drainage. 

DISCUSSION: IT IS  A CYST of  INFECTION at LATERAL SITE  OF THE NECK. THE MOST COMMON IS  BRANCHIAL CYST.

CT  ALSO SUPPORTED THIS  DIAGNOSIS.

REF..ANATOMY OF  BRANCHIAL CYSTS.

CASE 262: BIG ABDOMEN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Man 50 yo, one week ago, onset periumbilical pain and abdominal distension, no defecation nor fever.

Chest Xray, and  abdomen standing  plain film showed  the  water-air level in  intestine, suggesting  bowel obstruction.

Ultrasound  found out colon dilatation, filling water and moving circular around with hyperperistalsis (see video).

MSCT of  abdomen in  emergency detected dilated right colon and  small intestine, retroperitoneum edema  arround the pancreas and radiologist  suggested  that pancreatitis.

Blood test: WBC  rising 12k, amylasemia normal.
Operation  laparotomy detected  all  bowel in dilatation but  no  necrosis, no tumor obstruction. 
Many white spots like candle   intra peritoneum.
Retroperitoneal space edema. Surgeon said chronic pancreatitis.

Discussion of this case:  clinical findings were abdominal pain and distension for one week. XRay  and  ultrasound found out  bowel obstruction and CT  detected  pancreatitis, but  blood test amylasemia was 17 unit.

Surgeon decided operation by bowel obstruction.
Now  report  is  chronic pancreatitis, it is  a rare  case with normal amylasemia in acute  pancreatitis.

REFERENCE:  case report

CASE 261: HARD BREAST TUMOR like AMBARELLA FRUIT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 47 yo, she herself detected at the right breast one mass, slow growth, painless like one AMBARELLA fruit.

Ultrasound  first detected  this mass in size of 4 cm, at 10 am clock at  the right breast, with  many  white spots  as  calcification. Color Doppler finding also was a hypovascular mass.

Using elastoultrasound, the mass was  very hard,  scale  blue green color on elastogram, no detected  axillary  lymph nodes.

Mammography also detected  mass and microcalcification.

Core biopsy with ultrasound guided reports microscopic  INTRADUCTAL CARCINOMA, STAGING T2N0MX.

SUMMARY: BREAST CANCER IS  EASY DIAGNOSED BY ULTRASOUND   ELASTOGRAPHY of  THIS VERY HARD  TUMOR  LIKE  GREEN AMBARELLA FRUIT.

CASE 260: ODDI TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 40 yo  pain at  RUQ  with  dark urine.

Ultrasound  first   detected  big gallbladder  with  very think wall, no stone, CBD in dilatation just to   end  of CBD, no tumor of  pancreas (2 ultrasound images).

MSCT CE detected  dilated biliary system intra and extrahepatic ( 3 CT images).

Gastro-duodenal  endoscopy  found out a round tumor at Oddi  area (see photo),  biopsy was done.

Blood tests, CEA, CA-19-9 were normal.

What is  your suggestion for   diagnosis and your next step ? 

ERCP not successful.

Biopsy of the tumor but the microscopic result was negative.

Ooen operation for exploration, surgeon detected a hard massat the head of pancreas.

Whipple operation was performed  (specimen of tumor of Oddi).

Microscopic report was  adenocarcinoma ( patho images)

REFERENCE  from Meditoons

CASE 259: PLEURAL EFFUSION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  23 yo  for one  month cough  and  dyspnea, no  fever.

Ultrasound of the thorax detected left  pleural  effusion with collapsed lung and  one mass covered  anterior mediastinum to external pericardium (see 3 ultrasound pictures of the left lung).

 

MSCT  with CE of   the  chest confirmed a  big  mediastinal  tumor   with  pleural effusion  which displaced  the heart to the right side (see 3 CT pictures).

Blood test and all  cancer markers  were normal. 

Transthoracic biopsy of this tumor with  ultrasound guided for immuno-histochemitry staining . Pathology report is  B CELL  LYMPHOMA.

This  patient is  going to treat with chemotherapy.

REFERENCE:   Mediastinal Tumor

CASE 258: MALIGNANT G I S T RECURRENCE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 54 yo,  2 years after operation for  acute obstruction of small  bowel by  tumor of  intestine, unknown microscopic  report.

Now he had  pain in the pelvis. (photo of  the skin scar operation).

Ultrasound  report   was  multiple  nodules  in  pelvis  looked like  grappe fruit

adherence  over  urinary bladder wall (2 ultrasound pictures).

MSCT CE of abdomen  detected   multiple  intramesenteric round tumors looked like  lymph nodes.

All blood test  and cancer markers were  normal.

Open laparotomy removed the mass which were  multiple  round tumors  adherent  to  great omentum and pedunculated (see  macro1, 2).

Microscopic report this tumor is  malignant  GIST recurrence.