CASE 787:TUBERCULOSIS of RIGHT AXILARY LYMPH NODE and RIGHT 3rd Digital Flexor Tendon, Dr PHAN THANH HAI, Dr NGUYEN THI TRINH, MEDIC MEDICAL CENTER,HCMC, VIETNAM

A 22 year-old girl with inflammation of her right axillary lymph node for 2 days  and the right elbow and the 3rd flexor digitorium for 5 months. But it failed in management in 2 hospitals.

Ultrasound  and  axillary lymph node biopsy at Medic Center detected  TB inflamation of the right axillary  lymph node and the right 3rd flexor digitorium.

 After the TB management for 6 months the TB inflammation of the lymph node and the right flexor digitorium were controlled successfully.

CASE 786: ACCESSORY BREAST TUBERCULOSIS, Dr PHAN THANH HAI, Dr NGUYEN THI THAO HIEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 31 year-old woman with her left axillary swollen for one week.

Ultrasound detected an 54x51 mm axillary abscess on left side with microcalcification that maybe an accessory breast abscess.

 

Result of biopsy was a soft tissue abscess.

An antibiotic regimen was done for one month.

Biopsy at that time was TB inflammation of the left accessory breast.

CASE 785: COLONOURINARY BLADDER FISTULA, Dr PHAN THANH HAI, Dr NGUYEN NGHIEP VAN. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 71 year-old man with dysuria for one month but failed in management of infectious urinary system. The patient noted foaming at his penis after urination.

Ultrasound detected gas in urinary bladder and thickening of sigmoid colon. May it exists a fistula of colon and urinary bladder as appearance ò foaming at the penis.

Endoscopy revealed colonic diverticula.

 

Cystoscopy showed acute cystitis but not ruling out a colonobladder fistula.

MSCT confirmed the tract between the sigmoid colon and urinary bladder and colonic diverticula.

Surgery detected an abscess between sigmoid colon and bladder. But there was not any fistula of the urinary bladder. A left colonoectomy was performed.

Result of histopathology of the specimen was fibrotic inflammation of colonic wall and diverticulum.

CASE 784: SKIN ULTRASOUND for PACHYDERMOPERIOSTOSIS [PDP], Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 26 year-old man with lion- like face [dermatological face]  and drumstick- like fingers [digital clubbing](hypertrophic osteoarthropathy) for 6 years.

X-rays films show thickening of the periosteum of ribs, upper and lower limb bones.

  

Skin ultrasound with 23 MHz probe reveales thickening of subcutanous layer and skin of forehead # 5mm, neck #1mm, cheek #3 mm. It exists  distorted structures as hyperechoic and hypoechoic layers in appearance without vascularisation.

             Cheek (L) and  neck (R) skin.
 

      

        Forehead skin # 5 mm of the patient (L) and                evidence # 2mm (R).

Skin biopsy result is related to Tourain-Solente-Gole syndrome (pachydermoperiostosis) which is a rare hereditary disorder affecting to bone and skin.

Pachydermoperiostosis (PDP) is a form of primary hypertrophic osteoarthropathy (see this term), a rare hereditary disorder, and is characterized by digital clubbing, pachydermia and subperiosteal new bone formation associated with pain, polyarthritis, cutis verticis gyrata, seborrhea and hyperhidrosis (from Orphanet).

REFERENCES:

CASE 783: CECUM CANCER in a Young Woman, Dr PHAN THANH HẢI, Dr TRƯƠNG CÔNG THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 31 year-old woman with loose stool but no blood nor glue secretion 1-2 times/day for two months. She lost of her weight # 1 kilogram and has some cramps at her right flank. Her past history noted a gastritis management and her familial history denies any tumoral diseases.

Abdominal ultrasound at Medic Center detected a thickening wall of the terminal ileum, the cecum and the ascending colon which were thought maybe due to an GI inflammation.

But CEA elevated # 5.04 ng/mL. FOBT positive and calprotectin raised# 240 microgram/gr.

Colonoscopy revealed an ulcer with hard border of the cecal tumor; and MSCT confirmed a tumor of the cecum and metastase lymph nodes and a  metastase node in the right lobe of the liver, T3 N2 M1.

Result of microscopic biopsy was a  well differentiated adenocarcinoma of the colon.

She went through a chemotherapy before the right colonoectomy.

CEA came back normally: 2.73 ng/mL post of therapy. 

5 months later the treated liver node shows no a relapse on abdominal MSCT.

Cancer of the colon is taken the 5th place of tumor diseases in Vietnam, and seems to be appeared more early in the young patient without any symptome.

REFERENCE:

CASE 782: TOOTHPICK PENETRATING TO ABDOMINAL WALL, Dr PHAN THANH HẢI, Dr NGUYỄN NGỌC XUÂN GIANG, BÌNH AN HOSPITAL KIÊN GIANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 49 year-old man with an abscess at the left flank of the abdomen for one week and WBC = 14,000.

Ultrasound detected a # 6cm foreign body in the wall of the abdomen lead to the descending colon wall.

MSCT confirmed a toothpick penetrating the abdominal wall from the left colon, and stone of pancreatic duct.

Operation removed the # 6cm toothpick and drained out the chocolate pus from the abdominal wall abscess.