CASE 271: BOCHDALECK HERNIA, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 43 yo,  after a great meal, his comments were vomitting  and epigastric pain.
Emergency  abdomen ultrasound  was nothing abnormal detected (NAD).
Standing  chest abdomen X-rays showed that  left lung pneumonia in suspicion (see  chest X-ray film).

MSCT of chest-abdomen detected left  diaphragm in rupture and the  great omentum  going up to the  lung (see CT foto).

For  make sure  the colon was still  in abdomen,  Xray colon enema was done (see foto).

It was an emergency  case  with no  history of trauma.
Laparo and  thoracoendoscopy detected  a big defected wound  of posterior left  diaphragm;  great omentum  going up to the lung.
It is  BOCHDALEK HERNIA, need to suture for repairing left diaphragm (see foto).

REFERENCE:   anatomy of diaphragm.

History about Bochdalek.

CASE 270: MASS nearby STOMACH, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  44 yo,  epigastric pain for one  month. Ultrasound first  of abdomen detected one round hypechoic mass,  size of 2-3 cm at the border of antrum ( see 2 pictures of ultrasound) .and  sonologist suggested it a  GIST of stomach.

Gastroscopy  detected nothing.
MSCT with CE of this mass:  Mass was not far from the wall of antrum, enhancement with
contrast,  but  in position of  rotation,  so CT cannot  make sure that  from the wall of antrum (see CT pictures with CE) or not.

Radiologist suggested that a lymph node, size of  2,4 cm  near antrum.
Blood  test  nothing abnormal.

CLINICAL AND  RADIOLOGY CANNOT  MAKE SURE DIAGNOSIS FOR THE MASS.

IN LAPAROSCOPY FOR BIOPSY THIS MASS,  IT  IS NOT  FROM THE WALL OF ANTRUM.  (SEE OPERATION FOTO 1,2,3)  

REMOVING COMPLETLY THIS ROUND SOFT  MASS. 
SEE  MACRO  PHOTO. 

Pathologic microscopic report with IHC is  neurilemnoma.

REFERENCE case report.

CASE 269: IUD PENETRATION, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN  53 YO WHO HAD  AN IUD INSERTED FOR 16 YEARS , IN ROUTINE CHECK- UP BY  ABDOMEN ULTRASOUND (US) DETECTED  ONE MASS  OF URINARY BLADDER WHICH WAS LIKE  T SHAPE IUD  IN  PENETRATION  FROM  UTERUS  LUMEN TO URINARY BLADDER  WALL(SEE 4 US IMAGES). 

FOR  MAKE SURE THIS IUD IN PENETRATION TO URINARY BLADDER, ABDOMINAL MSCT  WAS DONE.(SEE 3  CT PICTURES).

For evaluation intra urinary bladder tip of  IUD or not, cystoscopy  detected one mass edema  of mucosa near  right  ureteral meatus (see photo).

This patient refused   treatment, returning home.

REFERENCE:

CASE 268: HEMATURIA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male 18yo  pain at  right  renal fossa  and  hematuria.

Ultrasound first  detected  one mass at upper pole  right  renal, size of 4 cm  multilobulated,   ruptured  the  capsule and    structure  was  inhomogenous, cystic and solid  with calcification.

Doppler  showed  hypovascular supplying  to this tumor ( see  3 pictures -video).

One sonologist  suggested  TCC( transitional cell carcinoma ).

MSCT with  CE of  urography of the renal mass which composes  fatty tissue, calcification, expanding  outsite of  the renal capsule, look liked  AML (see 3 CT images-3D).

Do you thing  biopsy this mass is  necessary and risk ? This case  had been in  open operation for  partial nephrectomy.

See specimen and microscopic report  with IHS is renal cancer type clear cell.

REFERENCE:

CASE 267:PELVIC MASS and MELENA, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH TÍN, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  37 yo in urgency by melena and  hypotension.

Ultrasound of  abdomen first detected  one 6cm mass  at  the pelvis, well bordered  (US image 1: mass  near  the  urinary  bladder  wall, US 2: very hypoechoic with linear probe 12MHz, US 3 elasto: this mas soft and inhomogeneous, and video hypervascular mass).

MSCT with CE of this mass showed rapid and high CE enhancement (see 3 CT images).

There were no relation between the mass with GI tract lumen.
 Blood test  Hct  20%  post blood transfusion.  And gastroscopy and colonoscopy: NAD (nothing abnormal detected).
Today, laparotomy found out the mass in the small bowel wall, with vascular congestion. And there was one site eroding the mucosa layer of intestine. Maybe bleeding from this site (see operation images).

Discussion:

Ultrasound first  presented best application for this emergency case. First, sonologist detected one cystic mass at the right pelvis, with linear probe 12 MHz;  but in using of curve  probe 3.5MHz showing a solid  mass in appearance and hypervascular mass on Doppler. Elastoscan also said this mass being a  soft mass. MSCT with CE reported this mass in fast and high contrast enhancement. At the mesenteric border no  bleeding site detected at this time, suggesting a GIST tumor in case of GI tract bleeding. Endoscopy of GI tract was complementary tool for negative detection.
Operation was set on time.

Microscopy  report with IHS is small bowel GIST.

CASE 266: COLO-COLIC INTUSSUSCEPTION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 38 yo, epigastric pain crisis on  periodic treatment  like gastritis but not response.

Ultrasound first in emergency  at MEDIC detected one mass  near  gallbladder with  multilayer cover as  OINION SIGN, and a central cyst.

This mass was  in transverse colon.  Sonologist  suggested a colocolic intussusception  (see 04  ultrasound  images and video clip).

Do you have any idea about the cyst in an intussusception mass?.

MSCT   with CE showed this  mass in transverse colon with cystic mass  looked like   appendicular mucocele.

Emergency laparotomy performed right hemicolectomy,   macroscopic specimen was appendicular mucocele [see photo]..

Microscopic report was  mucocele  appendicular  due to  fibrosis of appendix.

REFERENCE:  Case 181 Medic case.