CASE 351:A CASE of FITZ-HUGH-CURTIS SYNDROME , Dr PHAN THANH HAI - Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 24 yo post partum,  pain at right pelvis and fever. But one day after, pain  at  liver region, palpation is very painful  at Murphy point liked  cholecystitis.

Ultrasound of abdomen  cannot  detect   cause of pain, no stone in gallbladder , no thickening of the wall of gallbladder, no free air or free fluid at  Morrison space (see US pictures 1,  2).

Ultrasound at pelvis  revealed  thickening  of pelvic  peritoneum and hypervacular  at right  uterine tube ( US 3).

MSCT of  abdomen without  CE cannot detect  abnormal ( CT 1);  with CE  injection, in delay  phase  radiologist  reported  abnormal perihepatic contrast  enhanced.

Blood tests :  high CRP of 104.89ng/ml, WBC normal.

Suggestion for this case : perihepatitis and PID [pelvic inflammatory disease] means   FITZ-HUGH-CURTIS SYNDROME.

THIS PATIENT HAD BEEN TREATED BY ANTIBIOTICS,  CLINICAL STATUS RESPONSED VERY WELL, NO MORE PAIN AND  NO FEVER, AND  DISCHARGED  HOSPITAL AFTER  3 DAYS.

REFERENCE: FHC SYNDROME.

CASE 350: SKIN TUMOR, Dr PHAN THANH HAI - Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 78 yo, presented small nodule of upper lip, slow growing for 1 year, no pain, no itching. Palpation of this tumor was hard,  size around 2 cm ( see  foto).

Ultrasound examination of this tumor from the skin of upper lip; no invasion to fatty layer but  hypervascular.

OPERATION REMOVED THIS TUMOR EASILY WITH WELL BORDERED ( SEE FOTO MACRO)

MICROSCOPIC IS BASAL CELL CARCINOMA [BCC]  WITH  IMMUNO HISTO STAINNING.

CASE 349: TESTIS TUMOR, Dr PHAN THANH HAI- Dr LE THONG NHAT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 42 YO, ONE MONTH AGO, PAIN IN ORAL SINUS, DIFFICULT EATING AND 2 DAYS  PAIN AT LEFT TESTIS [FOTO IN ORAL TUMOR AT PALATINE].

ULTRASOUND OF LEFT TESTIS PRESENTED   BIG  AND  HOT  (US 1, B MODE B&W,  CROSS SECTION OF  LEFT TESTIS HYPOECHOIC  INFILTRATION; US2, COLOR DOPPLER  IS  HYPERVASCULAR OF ONE PORTION OF TESTIS; US3, LONGITUDINAL  SECTION OF LEFT TESTIS; 

US4 ELASTOSCAN   THIS  HYPOECHOIC IS 10,5 kPA).

FNAC OF THIS MASS OF  LEFT TESTIS  HAVING   ABNORMAL CELLS.

  

BIOPSY  OF THIS TUMOR IN ORAL IS  B CELL LYMPHOMA.

MY DIAGNOSIS IS LARGE B CELL LYMPHOMA  STAGE 4.

CASE 348: STRUMA OVARII, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  57yo, in general check-up  ultrasound detected  right  ovarian  tumor [image US 1( B mode), size of  5 cm,  round border and  central necrosis with  vascular  covered  around ( US 2).   US 3  elastoscan of this tumor  is  hard= 53 kPa and inhomogeneous.

MSCT  non CE:  Right ovarian tumor  was  round  border, central necrosis, no  ascites   and uterus is in normal structure (CT 1, CT 2, CT3).

Blood test =  ROMA test  is normal.

OPERATION  FOR REMOVING THIS TUMOR.

IT IS RIGHT OVARIAN TUMOR, WELL BORDERED, HARD, NO  INVASION TO AROUND PELVIS ( PHOTO MACRO).

MICROSCOPIC  REPORT  IS  STRUMA OVARII.

REFERENCE:

CASE 347: APPENDICOLITH, Dr PHAN THANH HAI, Dr LY VAN PHAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 60 yo,  pain  at  RLAQ for one month and was treated with medicine but not  resolving her problem.

Ultrasound  scanning of  abdomen  detected  at  RLAQ  one mass with thickening of the wall  and  hypervascular ( see US images 1, 2,3,4)

WBC  is normal, CRP is raised of  16.55ng/mL.

MSCT with CE  detected one  mass  near  coecum area with   stone  ( CT images 1, 2).q

Operation for  removing of this mass.

It is  a retrocoecal  appendicitis with abssess  and stone in appendiceal lumen [ appendicolith].

REFERENCE

CASE 346: THYROID NODULE or PTC, Dr LE THANH LIEM-Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

CASE 345: LEFT RENAL VENOUS ANEURYSM, Dr NGUYỄN NGHIỆP VĂN-Dr VÕ NGUYỄN THÀNH NHÂN,MEDIC MEDICAL CENTER, HCMC, VIETNAM

FOR PICTURES PLS  CONNECT TO 3G/DOWNLOAD THE LINK

case-345-left-renal-venous-aneurysm-

Female 27yo from Baclieu province, suffered from left side lumbago, which was getting worse in effort

No history of trauma. Entered 121 hospital,  Cantho hospital but status not changing then went to Medic

Center

Sonologist said left kidney AVM which caused left renal vein dilatation of 48mm in diameter.

MSCT with CE was done that IVC appeared early with taken CE of aorta and presented a huge renal vein on left side.

DISCUSSIONS

•      Left renal vein aneurysm presented commonly on left side, and true renal vein aneurysm ( absence of media tunica) which was rare, from now on about 10 cases in literature.

•      Etiology of aneurysm of left renal vein : hypertrophy of the tunica media with fibrotic thickening) : AVM ( post trauma, RCC ), intrarenal AVM, AVM of aorta and renal vein (in case of renal vein behind AAA).

For prevention of lung venous embolism, rupture of aneuysm... patient was repaired in Cho Ray left renal AVM by coiling and getting well .

Left venous aneurysm disappeared totally post op.