CASE 499: RETINOBLASTOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

BOY 3 YO  WITH RIGHT EYE  HAVING WHITE SPOT.

ULTRASOUND   B MODE OF  RIGHT EYE  DETECTED RETINE DETACHEMENT ( US1).

US B MODE   DETECTED  THE MASS TUMOR   INSIDE OCULUS [EYEBALL]  WITH CALCIFICATION (US 2, US 4).

MRI OF  THE TUMOR IN RIGHT OCULUS WITH  CALCIFICATION  NO  INVASION OUTSIDE.

CLINICAL ULTRASOUND AND MRI  SUSPECTED  RETINOBLASTOMA.

OPERATION  REPORT  IS  TUMOR LIMITED IN RIGHT OCULUS.  MICROSCOPIC RESULT IS  RETINOBLASTOMA.

CASE 498: GALLBLADDER ABSCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN ONE MONTH  AGO WITH  EPIGASTRIC PAIN AND  LOCATED AT MURPHY POINT AND FEVER.

  

ULTRASOUND  DETECTED ONE MASS  IN HEPATIC BORDER ,  SIZE 5CM  ( US 1).

US  OBLIQUE SCANNING OF THIS MASS  IS THICKENING BORDER LIKE  AVOCADOS FRUID ( US 2).

US 3 : LIVER SCANNING OF THIS TUMOR  MADE BENDING   HILUS OF LIVER.

US 4 : ELASTOSCANNING OF THE WALL CODED  HARD PATTERN.

THERE WAS NO BLOOD INSIDE MASS AND ONE STONE  IN THE WALL OF THIS MASS  MADE THOUGHT IT GALLBLADDER.

CT SCAN WITH CE= CT1 : CROSSED SECTION  OF THIS
HYPODENSE MASS.

CT2 , CT3 :   FRONTAL VIEWS.

MRI OF ABDOMEN SHOWED THIS CYSTIC MASS, WITH ITS

VERY THICKENING WALL.

BLOOD TESTS = WBC:  1,9 K  WITH  8.9% NEUTRO,  CRP  96.8 ng/mL.

PRE OPERATIVE  DIAGNOSIS IS GALLBLADDER  ABSCESS WALLED OFF DUE TO STONE.

PHOTO OF MACROSCOPIC SPECIMEN IN   OPERATION FOR REMOVING GB ABSCESS.

  

CONCLUSION =  INFLAMMED GALLBLADDER NECROSIS BY STONE CAUSED OBSTRUCTION OF THE NECK OF GALL BLADDER.

CASE 497: MULTIPLE SKIN LESIONS AND SUBCUTANEOUS TUBERCULOSIS ABSCESS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  47 yo  with pain at RLAQ at palpation   looked  like   appendicitis  and  skin of right leg  inflammed red and bulleous  growth  with multiple nodules.( see photo of abdomen and  leg skin).

Ultrasound  of abdominal wall and the leg skin  lesions detected many small hypoechoic nodules with  size 1-3 cm,  well bordered  no vascular inside lesion.  Elastoscan is cystic lesion  (US 1, US 2, US 3, US 4, US 5, US 6 skin).

Ultrasound guided puncture showed pus   and operation removed this mass  looked like caseum. 

Pus analysis  no bacteria. ADA very high 691.1. But PCR of BK negative.

BIOPSY  OF SKIN LESION   REPORTED  TUBERCULOSIS.

SUMMARY:  IT IS CASE OF MULTIPLE SKIN LESIONS  AND SUBCUTANEOUS ABCESS DUE TO TUBERCULOSIS.

CASE 496: POST-PARTUM PELVIS ABSCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 29yo experienced  a cesarean operation  for 9 days  with normal primigest  terminal.

And she had got fever and pain at pelvis  and diarrhea (see photo).

US 1 scan at  pelvis :  longitudinal scan  shows that  fluid in abdominal walll as an abscess and a big uterus.

US 2  scan at pelvis :  air in abdominal wall and inside uterus.

US 3: reverberation by the air in abdominal wall.

MSCT with CE   =  CT 1: CROSSED SECTION : AIR  IN ABDOMEN WALL.

CT2 : AIR IN UTERUS.

CT3 : AIR AROUND UTERUS AND  PUS AROUND  PELVIS.

BLOOD TESTS=  WBC  30K  NEUTRO 23.7%  hsCRP 120.5( n 5mg/l).

EMERGENCY  DIAGNOSIS IS PELVIS ABSCESS PULL OUT THE ABDOMEN WALL.

OPERATION  LAPAROTOMY  FOR  REMOVING OF PUS   AND  HYSTERECTOMY.

CASE 495: LUNG in MILIARY TUBERCULOSIS, Dr HỒ CHÍ TRUNG, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 45 yo  with  cough  and  back pain. Chest X-rays 1:  diffuse micronodular  at right/left lungs;   X-rays 2:  spinal bone  shows compression of lumbar spine L1 and L 2. Lung US  shows  thickening of   pleural  spaces and  many B- line signs  ( US 1, US 2) US 3:  hypoechoic mass on the left site of  paravertebral L1, and US 4: cystic mass of scrotum. MSCT  of lung and  body with CE: CT1, CT 2: micronodular  lungs CT 3 , CT 4:   spine with  osteolytic appearance CT 5, CT 6:  mass in left psoas muscle. Radiology report is  miliary tuberculosis of the lung and Pott ‘s abscess  and scrotum abscess Puncture  of scrotum abscess   removed the pus like caseum. Analysis of  this pus  =ADA very high  63.64 ng (n<30 in pus). Summary=  It is the case of diffuse tuberculosis.

After 2 months of TB treatment, clinical status processes well. X-Ray film, ultrasound cannot reveal psoas muscle and testis lesions.