CASE 272: EOSINOPHILIC GASTROENTERITIS and ASCITIS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Patient 42 yo, labor of the load of bread, one  month ago  complaint by  periumbilical pain crisis.durring 1-2  minutes, no  fever  no  diarrhea,   more and  more frequent.
Ultrasound  abdomen  first time detected  free fluid ascitis in  large amount of volume  but unknown origine (see  ultrasound  images).

Gastroendoscopy showed gastritis with  negative HP test,

MSCT no CE also made sure this  liver  no cirrhosis and ascitis unknown origine.

Blood test report = WBC  rising.

What is your  diagnosis for the case and what do you do next ? 

Ultrasound guided punction of ascitis which was removed the yellowish  clear fluid  and biochemistry and cytology analysis.

RECENTLY LAB  REPORT of  BLOOD TEST from THIS PATIENT.

DISCUSSION:

 This case  was represented unknown  ascitis  at first  time by  ultrasound and CT scan, and blood test  report was  eosinophil  rising  too much,  43%, that many doctors were looking for a  parasite infected cause.

But, ascitis  analysis was  transudate fluid  and hypoalbumine,   while  CA125  was very high, of 1380 UI/mL  in the male patient. So it was  difficult to explain that.

Cytology of  ascitis fluid  showed  that  many  white blood cells  of eosinophil  in  one staining microscopic champ.

Second report  of blood test today  ruled out parasite infection, but IgE very high,  of  1168 UI/mL, that  suggested an  eosinophylic gastroenteritis.

For  review and  make sure  this  diagnosis, an other  ultrasound scanning of  abdomen perfomed  to  detect   thickening of  intestine wall.  And  cytology  smear of ascitis  fluid  was more eosinophil cells. 

A course of  corticotherapy was started today. Wait for  clinical response.

After 2 days treatment with 50mg prednisolone, the blood test spectacularly responsed.

Today 9/9/2014

Update case 272:  After one week treated with corticoid,  clinical status of the patient remains well in recovery.
Ultrasound of abdomen  shows  completetly  dissapearing ascitis  ans blood test returns  nearly to  normal values ( see 2 ultrasound images, and blood test report).

REFERENCE:

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: