CASE 181: APPENDICULAR MUCINEOUS CARCINOMA and INTUSSUSCEPTION, Dr PHAN THANH HẢI - Dr VÕ NGUYỄN THÀNH NHÂN , MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 73 yo has  pain at  right pelvis for 6 days, crisis, hyperperistalsis. Ultrasound  shows  one cystic mass  nearby  urinary bladder, with size of 4 cm, round  border with the neck connecting to lumen of  intestine.

See 3  ultrasound pictures with 3.5 MHz curve probe, and with  linear probes 12 MHz; this cystic mass has multilayer wall, calcification of the border, the fluid is cloudy. This cystic mass  is  moving  with  hyperperistalsis due to intussusception (3 images).

On MDCT this  mass is cystic,  intra  intestine lumen,  portion of  terminal ilium.

This case has emergent onset. Ultrasound first says that intussusception, but don't know what  the cyst is; MDCT  suggests an appendicular mucocele. Do you agree with the idea ?

Operation is laparotomy which detects  right colon very mobile with one mass at appendix site.

Procedure is right hemicolectomy. In macroscopic dissection, specimen is an appendicular mucocele.  Wait for confirmation of microscopy.

The  clinical  case  of  intussusceptions  in  old  woman  has  the cause. Ultrasound   detects  cystic  mass  close to urinary bladder  which  is  not common cause  for  ileo-colic  intussusception.

 MCDT  reveals   cyctic mass  intra intestinal  lumen with  mural calcification is  the key point  for   diagnosing  this case.

Microscopic report  is mucinous carcinoma of appendix.

REF  : Appendicular Mucocele as Cause of Intestinal Intussusception

CASE 180: AV FISTULA POST OP MIDDLE EAR SURGERY for 10 YEARS, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 30 yo underwent a middle ear surgery for  10 years. After  surgery about  2 years, a posterior ear mass appeared and getting its size bigger .

 There are thrills in the mass, and it is collapsed with palpation.

 Ultrasound detects tortuous dilatation of subcutaneous vasculature at temporoparietal area on right side and around right auricular area, Doppler shows continuous  flow pattern which is thought to be an AV fistula post op.

  MDCT confirms an AV fistula on 1/2 right head which is supplied by superficial temporal artery and drains away by facial and right jugular veins.

CASE 179: CHRONIC DIARRHEA and CAPSULE ENDOSCOPY, Dr PHẠM CHÍ TOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Clinical history=

Female, 91 years old, Nha be district. For 3 months: watery diarrhea without blood (over 10 times/day), no abdominal pain. Treated by many doctors and medical centers, but diarrhea did not stop.

Tropical disease hospital admission: failed treatment after a month and transmitted to Binh dan hospital.

v  Lab test: normal, Abdominal US,  CT scan: normal, UGE : normal, Rectosigmoid endoscopy: normal. Stool test: negative, suggestion : capsule endoscopy.

v  Capsule Endoscopy= Many worms with the appearance of Ankylostoma in jejunum and ileum and inflammed mucosa of small bowel.

Diagnosis=Enteritis due to parasite (maybe Ankylostoma duodenale).  Internet : some case reports like this.

Treatment=

Suggestion : stop using all kinds of drugs including antibiotics, start with Zentel 2 tablets a day/ 3 days. Diarrhea improves in getting down : 10 times and 6 times and 4 times and 2 times. Discharge. Suggestion: repeated Zentel after a week, now normal stool.

Conclusion=

Few case reports, besides anemia, acute or chronic diarrhea sometimes happens. Easy and simple treatment.

But the worm name should be proved by ELISA test for Ankylostoma.

CASE 178: CHORDOMA, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

56-year-old female patient from Tra Vinh province. She's undergoing  low back pain  more than 1 year, recently appeared constipation. Spinal x-ray shows destruction of the sacrococcygeal bone. 

 

Ultrasound shows lesion that is a  heterogeneous hypoechoic solid tumor, size 72 x42 x 62 mm, inner tumor to be calcified.

 

 

MRI shows tumor from sacrococcygeal bone, dimension = 5 x 6.5 x 7cm, high density on T2W1 and low on T1W1.

 

Patient underwent surgery at Cho Ray hospital. Histopathologic report is  chordoma.

 

CASE 177: MEDIC RADIOLOGY CASE 01= Massive Pulmonary Embolism, Dr NGUYỄN VĂN CÔNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 47 yo, admitting to the clinic because of chest pain.

Chest Xray shows no significant finding  beside slightly bulging of L pulmonary artery.

Chest CT scan with contrast at Medic Center shows R pulmonary 90% occluded with thrombus and L upper lobe artery also occluded 30%.

The patient is transferred to Singapore and conservative treated because the clot is too old and well organized.

CASE 176: PARATHYROID TUMOR, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC VIETNAM

Female patient 49 yo from Phu yen province. Slight edema, 2 leg weakness for 2 years, using wheelchair to many HCM hospitals.

She went to Medic Center in hope to make clear her illness. 

Chest X-Ray: deformation of chest bones and osteoporosis. 

Column vertebra : biconcave of vertebral bodies due to osteoporosis.

Ultrasound at Medic revealed a hypoechoic mass in the lower pole of left lobe of thyroid, and hypervascularization which was thought to be a parathyroid tumor.

PTH highly raising up of 1,048 picog/ml [16-65 picog/ml] and bone scan proved osteoporosis.

In 2 hours post op, PTH dropped down of 47.21picog/ml.

 And microscopic result= Parathyroid Adenoma.

So it is an severe osteoporosis case due to parathyroid adenoma that is unveiled successfully at Medic Center in some days while it lasted for the female patient in 2 years in her wheelchair.

CASE 175: A CARCINOMA of THYMUS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27 yo, one month ago, got cough and dyspnea at night. Chest X-ray showed one mass of 10cm near the apex of the heart.

Chest ultrasound, in sitting position, revealed pleural effusion, like bloody and this mass on chest X-ray was solid and covered the heart.

MDCT  of the lungs  with CE,  this mass belongs to anterior mediastinum and in extention around the pericardium and pleural effusion. Radiologist suggested a teratoma.

Do you agree with the CT diagnosis ?

Thoracotomy  the  case  removed  1.7  liter of  yellowish  fluid, and  tumor looked like  brain tissue.

Microscopic result  is  suggestive of  undiffentiated  thymocarcinoma. 

REFERENCE: