CASE 501: BLADDER HERNIA to SCROTUM, Dr LÊ TỰ PHÚC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 51-year-old man with pubic pain for 2 weeks with left scrotum swelling and

 increasing in size for 6 months. He has to  compress the scrotum by hand in order to empty the bladder everytime normal ending of micturition= two-stage micturition: the patient after a first spontaneous voiding, presses the mass and voids again. No other urinary symptoms. There was no history of nausea or vomiting.

Ultrasound scanning detected one sac containing of fluid on the left side of scrotum. This sac with thick wall continued upwards left pubic tubercle and getting smaller like a bird beak. This sac appears bigger when the patient did holding his breath (Valsalva maneuver) and disappered after being compression by hand to voiding.

Retrograde cystography CT revealed a left scrotal hernia with fluid density lesion continuous with left lateral bladder wall.

Diagnosis of left scrotal hernia with bladder as content was made.
Operation for repairing urinary bladder was done. A part of bladder adheres at deep orifice of inguinal canal and overcomes to scrotum by upper branch of pubis.

Have you' d ever seen a case like that before and what do you think?

CASE 500: BIG GIST TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 65 yo  check -up  for hypertension.
US SCANNING of ABDOMEN   DETECTED   ONE MASS  SIZE OF 20CM X15 CM  AT THE  LEFT UPPER ABDOMEN QUADRAN,   SOLID STRUCTURE  AND MULTICYSTIC  HYPOVASCULAR (US1, US2).

X-RAYS of ABDOMEN WITH SP :THE MASS  DEPLACED AIR  GASTRIC  FUNDUS  AND LEFT COLON  ( X-RAY PICTURE).

ON MSCT CE   THIS MASS  CAUGHT VERY QUICK CE . IN CT 1( CROSSED SECTION),  CT 2:   THIS MASS IS  NEAR THE BORDER OF  GASTRIC GREAT CURVATURE , CT3 : FRONTAL VIEW,   CT4  SAGITAL VIEW .

  

GASTRO COLONOENDOSCOPY DID NOT DETECT ANY ABNORMALITIES  INTRALUMEN. 

BLOOD TEST IS NORMAL .

FOR THIS CASE  RADIOLOGIST  SUGGESTED GIST OF  GREAT OMENTUM.

Operation removed big tumor from the gastric wall .

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.