CASE 776: RUPTURED LEFT LIVER ABSCESS, Dr PHAN THANH HAI, Dr LE VAN TAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 52 year-old man with LUQ pain for 4 days in body bending walking. History noted he got liver abscess in one year before which was successfully in medical management.

Ultrasound detected a left liver abscess with fluid collection close by the inferior border of the left lobe of liver.

Chest Xray film was normal and the heart was nothing abnormal detected.

MSCT confirmed a 104× 56 mm left liver abscess in rupture with abdominal fluid collection close by the left lobe, the stomach and the spleen.

The left liver abscess was drained out  4 hours

 later by via endoscopic surgery.

CASE 775: ECTOPIC TESTICULAR SEMINOMA, Dr PHAN THANH HAI, Dr TRAN THI BAO CHAU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 52 year-old monk with LUQ pain for days.

Ultrasound revealed 2 left kidney stones # 6 mm. And a RLQ mass#40x37 maybe GIST beside the cecum. His scrotum were empty both 2 sides.

MSCT detected right testicle at RLQ and left one inside the left inguinal canal. And a left renal stone.

Surgery removed the right testicular tumor and reconstructed the left inguinal canal in bringing back the left undescended testicle to the left scrotum.

Result of histoanapathogy of the right testicular tumor was seminoma.

So the monk got a testicular tumor that maybe due to be misplaced into the abdominal cavity; and an undescended testicle in the left inguinal canal which is called a cryptochism.

CASE 774: THORACIC AORTIC PENETRATION DUE TO A FISH BONE, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH , and FELLOW DOCTORS from BINH DAN HOSPITAL, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 35 year-old woman with chest pain for 5 days who failed in gastritis management.

Abdominal ultrasound was nothing, but GI endoscopy detected 1/3 midle of esophagus in edema and narrowing of the lumen that may be perforated by a foreign body. The endoscopic examination must be stopped in waiting for a MSCT.

MSCT revealed a #34×2 mm fish bone which penetrated the esophageal wall to the thoracic aorta that made a critical pseudoaneurysm of the thoracic aorta.

The female patient was transmitted rapidly to Binh dan hospital. A planed management was conducted in emergency for reconstructing the thoracic aorta, sewing the hole of  the thoracic esophageal perforation and removing the fish bone.

Thoracic surgery was done successfully for reconstructing the thoracic pseudoaneurysm,

sewing the penetrated esophageal wall

and removed the fish bone with 2 sharp ends.

The woman remains well post op.

REFERENCE:

CASE 773: PCC MIMICKING RENAL CYSTIC TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 61 year-old diabetic man in  annual check-up with a #15-17mm left renal cyst known by non CE MSCT for years.

MSCT of full body detected a #21x16mm left adenal tumor, a thyroid cyst, some renal cysts and a #17mm renal  tùm or  which moderately captured CE that cannot rule out a renal tumor.

He has got a thyroid tumor#19mm and a colon polyp.

Coronary arteries were slightly stenosis.

Lab data were not interested except an endocrinal adrenal tumor.

Endoscopic surgery removed the left papillary cell carcinoma PCC and a hafl of the left kidney.

and the left adrenal tumor.

Histopathological results were the PCC of the left kidney and the left endocrine cortical adrenal tumor.

CASE 772: THYROID CANCER METASTATIC to ESOPHAGUS ?, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  47 year-old diabetic man, hoarsening, with thyroid tumor on the left lobe.

Ultrasound represented a # 49x34 mm solid mass, blurred contour, strong posterior shadowing, close to cervical esophagus with thickening wall.

He had got the lefl vocal paralysis.

MSCT and endoscopy detected  an esophageal tumor at 1/3 middle part, invading the left lobe of thyroid.

Histopathogical results were an esophageal cancer, poor differentiazed squamous cell carcinoma.

Patient died some weeks later in chemotherapy management.

 

CASE 771: BOWEL G.I.S.T, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

A 38 year-old woman with a # 47x58 mm GIST of her small bowel at LUQ, and later MSCT confirmed it.

The author would like to describe the sonographic appearances of a bowel GIST: echo mixed, with hypoechoic or cystic areas in case of large tumor. The adhered GIST from one side developes out of the lumen, exophytic, while the other side is intact. Endoscopic ultrasound could represent the layers of the wall of the tumor and help to guide the tumor biopsy.

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Merriam- Webster

exo​phyt​ic  : tending to grow outward beyond the surface epithelium from which it originates. used of tumors compare endophytic.tending to grow outward beyond the surface epithelium from which it originates.

CASE 770: INSULINOMA (PNET, PANCREATIC NEUROENDOCRINE TUMOR), Dr PHAN THANH HẢI, Dr TRẦN THỊ TRÚC PHƯƠNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 66 year-old diabetic man with hypoglicemic crisis after meal 3-4 hours, Whipple's triad positive.

Lab data: FPG low, C-peptid (fasting) elevated

Ultrasound detected a  # 20#6.5mm mass at the pancreatic tail and some hepatic cyts.

.

Cystic lesion of the pancreas tail # 2.6x2.2 mm with Doppler sign.

MSCT confirmed a 32x20mm PNET at the tail of pancreas: tissue density, highly captured contrast media.

Histoimmunopathologic stainning was a pancreatic neuroendocrine tumor [insulinoma].

References: