CASE 150: PERIUMBILICAL MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 53 YO ONE WEEK AGO PERI-UMBILICAL PAIN AND FEVER

HE WAS TREATED WITH ANTIBIOTIC, AND GOING WELL AFTER.

ULTRASOUND ABDOMEN DETECTED ONE MASS CYSTIC OF 7 CM,  OVOID, NO SEPTATION , LOCATED AT THE MIDDLE LINE FROM UMBILICUS TO PELVIS. PRESSING IT OVER HAD LITTLE PAIN, ONE SONOLOGIST SUSGESTED THAT PELVI-ABDOMINAL TUMOR, WITH  RAISING OF WBC.

PICTURE 01 US LONG SCAN, 02 and 03 CROSS-SECTION SCAN WITH CDI.

 

 

MSCT IS DONE WITH CE SHOWED THAT MASS IS SUSPECTED ABSCESS BUT DON’T KNOW ORIGIN.

PICTURE 04 CT AXIAL WITH CE, 05 FRONTAL, AND 06 SAGITTAL .

 

Blood test with WBC neutrophil raising suggested abscess, but its origin still unknown.
 

Operation laparo-endoscopy detected a big abscess from the tip of appendix, then removing abscess and drainage out.

A walled off abscess intraabdomen is quite often from appendicitis.

 

 

CASE 149: LIVER and ABDOMINAL WALL ABSCESSES, Dr PHAN THANH HẢI-Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

    
Female patient 59yo has got epigastric pain for 5 months.

Ultrasound detected an abscess of left lobe of liver and expanding to abdominal wall.

FNAC and abdominal wall biopsy proved non malignant cells.

Abscess treatment was done but clinical nothing changing.
MSCT and MRI confirmed liver abscess and abdominal wall lesion.

PCR of fluid of abdominal wall showed TB positive.

Conclusion: A case of abdominal wall and left hepatic abscesses due to TB without history of TB infection. Ultrasound, MSCT and MRI findings, and with FNAC and biopsy results  were of the same opinion of liver and abdominal abscesses, but only PCR proved the final clue of TB infection.

CASE 148: GALLBLADDER CANCER POST TRAUMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

ARTER TRAUMA, WOMAN 59 YO PAIN IN RIGHT COSTAL AREA .

ULTRASOUND ABDOMEN DETECTED ABNORMAL GALL BLADDER, BIGGER THAN NORMAL, AND NO BILE FLUID INSIDE.

( Fig 01 GB in  BLACK AND WHITE, Fig 02 in CDI, Fig 03 in DOPPLER SW, Fig 04 CROSS- SECTIONAL GB).

CDI SHOWED THE LUMEN OF GALLBLADDER MORE HYPERVACULAR LOOK LIKE
A-V MALFORMATION.

MSCT with CE,  hypervascular gallbladder is supplied by cystic artery, and the central portion of gallbladder is very high enhancement.

The GB returned vein is drained to hepatic vein.

Radiologist proposes a hemangioma for her gallbladder.

Gallbladder being removed, and microscopy says it cancer.

Discussion: Why the gallbladder cancer enhances like that (more central than peripheral part)?. 

CASE 147: LIVER TUMOR MIMICKING HEPATIC ABSCESS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 35 YO, PAIN AT RIGHT SUBCOSTAL AREA, CLINICAL POSITIVE MURPHY'S SIGN.

ULTRASOUND DETECTED  A FOCAL LESION NEARBY GALLBLADDER, SIZE OF 4,9 CM, HYPOECHOIC  WITH CENTRAL WHITE SPOT, THEN SUSPECTED LIVER ABSCESS.

MSCT OF LIVER WITH CE ALSO SUGGESTED A LIVER ABSCESS.

Blood tests  showed that patient infected HBV with AFP L3  high risk.

Laparotomy was done for resection the liver tumor and gallbladder.

In macroscopy, it is an invasion to gallbladder of a very hard liver tumor.



MICROSCOPIC REPORT IS  LIVER CANCER .

 

 

 

BUT SOME QUESTIONS: IN THIS CASE, WHY   THE CENTRAL PART OF TUMOR  IS VERY HYPODENSE ON  CT  SCAN WHILE ITS  VERY  HYPERECHOIC ON  ULTRASOUND, AND IN COMPARISON TO THE MACROSCOPIC SPECIMEN,   AND WHAT IS THE REASON ?

CASE 146: JACK-FRUIT LIVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN, EPIGASTRIC PAIN FOR 6 MONTHS.

ULTRASOUND DETECTED MANY HYPERECHOIC NODULES IN LIVER, SIZE OF 1-2 CM.  THE LIVER LOOKS LIKE JACK-FRUIT ON ULTRASOUND IMAGE.

MSCT LIVER WITH 3 PHASES, ARTERIAL, VENOUS, AND LATE.

DO YOU THING LIVER METASTASIS WHICH COMES FROM...

ON CT SCANNING THE GASTRIC WALL WAS THICKENED.

GASTROSCOPY WAS DONE WITH BIOPSY SHOWING A TUMOR OF ANTRUM BLEEDING.

MICROSCOPIC REPORT OF BIOPSY AT ANTRUM GASTRIC TUMOR IS DIFFERENTIATED  MODERATELY  ADENOCARCINOMA.

CASE 145: MALIGNANT OVARIAN TUMOR ?, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 26YO, SINGLE, HYPOGASTRIC DISTENTION.

ABDOMEN ULTRASOUND SCAN OVER HER PELVIS DETECTED ONE 20CM MASS FROM PUBIS TO UMBILICAL REGION, BIG, CYSTIC, MULTILOCULATED WITH SEPTATION. IT DEPLACED UTERUS TO LEFT SIDE.

IMAGE 1: LONGITUDINAL SCAN OVER PELVIS FROM UMBILICUS TO PUBIS, THE MASS WAS MULTILOCULATED CYSTIC PATTERN.

 

 

 

IMAGE 002: COLOR DOPPLER SHOWED LOW VASCULAR SUPPLY, AND NO VEGETATION ON THE SEPTATION .

 

 

IMAGE 003:  STRUCTURE OF CENTRAL PART OF THIS MASS WAS  SOLID, HYPERECHOIC,  LIKE FATTY TISSUE.
 

 

 

 

THE MASS WAS SUSPECTED OVARY TUMOR ...

BLOOD TESTS=  AFP, BETA HCG WERE NORMAL, CA125=175UI [ N<35]UI. ROMA TEST WAS IN HIGHT RISK VALUE.

FOR MORE INFORMATION, MRI  WAS DONE WITH GADO CE. IT SHOWED THIS TUMOR CYSTIC MULTILOCATED CONTAINING  HYPERPROTEIN FLUID  AND FATTY TISSUE WITHOUT CALCIFICATION.

WITH MRI RADIOLOGIST SUSPECTED  TERATOMA OF OVARY.

LAPAROTOMY OPERATION WAS DONE AT HUNG VUONG HOSPITAL TO REMOVE  HUGE OVARIAN TUMOR, WITH  HAIR AND POLYMORPHIC TISSUES .

 

MICROSCOPIC REPORT IS MATURE TERATOMA.