CASE 765: MESENTERIC ABSCESS due to FISHBONE, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A male patient with his right flank pain for 3 days.

Abdominal ultrasound detected a # 12mm fluid-filled appendix with thin wall that was not enough to  diagnosing an acute appendicitis.

Lab data with hs CRP =56.91 represented an infectious syndrome of the abdomen.

To confirm the source of abdominal infection and ruling out an inflamed appendix, an abdomen MSCT was done.

MSCT detected a #14 mm fishbone in an  abscess at the left flank which was wall-off by the mesentery.

Surgery removed the abscess with fishbone succcessfuly which adhesived critically the transverse colon but no clue of coming from the bowel or colon.

MSCT is more sensitive in case of foreign body with high density like fishbone in the abdomen.

CASE 764: SCHWANNOMA of FACIAL NERVE SHEATH in PAROTID GLAND, Dr PHAN THANH HẢI, Dr NGUYỄN XUÂN HOÀNG, MEDIC MEDICAL CENTER, VIETNAM.

 

A 37 year-old  with swelling of his left face.

Parotid gland on left side existed a cluster of lymph node-like, solid, echo poor, # 5-4-4mm in parotid gland and in subcutaneous layer.

MRI confirmed a Kikuchi - Fujimoto disease,  necrotizing histiocytic lymphadenitis.

But biopsy result was a Schwannoma of the left facial nerve sheath.

CASE 763: PHYLLODES TUMOR in a Young Girl, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 14 year-old with a palpable cystic tumor in the right breast.

Two months later the cystic tumor rapidly grew up, may be a hemorrhagic cyst, but it was hardly differentizied from a phyllodes tumor.

Histopathological result was a phyllodes tumor, and chemohistoimmunologic staining result was a BI-RADS 4 B malignant phyllodes tumor in a young girl.

CASE 762: UNCONTROLLED ARTERIAL HYPERTENSION due to RENAL ARTERY STENOSIS, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 48 year-old female diabetic with uncontrollable arterial hypertension for years. TA max 200mmHg.

Ultrasound detected  stenosis of the left renal artery over 70% and, on the right one 30%.

AngioMSCT confirmed the left renal artery stenosis than the right one.

The  left renal artery  successfully stenting for the  stenosis then the arterial hypertension was solved.

Before stenting of the left renal artery

After stenting.

CASE 761: GASTRIC SLIDING HERNIA, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, Dr NGUYỄN PHÚ HỮU ( BÌNH DÂN HOSPITAL), Dr NINH NGUYEN (USA), HCMC, VIETNAM.

 

A 71 year-old woman with cardiovascular disorders: extrasystolic, ischemic heart, aortic valve regurgitation.

Lab data: Troponin T elevated.

MSCT for 30% coronary  branches obstruction but incidentally detected gastric sliding hernia through esophageal split of the diaphragm.

Chest X-ray and barium esophage: diaphragmatic hernia.

Endoscopy confirmed  diaphragmatic sliding hernia of the stomach.

Normal Respiratory function.

Operation for gastric hernia was done and the woman remains well. 

Barium esophageal films confirmed the gastric sliding hernia being solved post-op.

Coronary symptoms may mimick gastric signs especially in women, and in this case, coronary MSCT could also detect a gastric sliding hernia beside  the 30% stenosis of branches of coronary arteries.

CASE 759-760: GI GIST, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Case 1: Jejunum GIST in a 69 year-old woman.

Case 2: Stomach GIST in a 83 year-old woman.

References:

CASE 758: PULMONARY LEIOMYOMA, Dr PHAN THANH HẢI, Dr TRẦN THỊ BÍCH THÙY, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 58 year-old woman with a #53x35 mm mass at the base of the right lung was detected incidentally by ultrasound in annual check-up. The mass rubbed out the liver mirror artifact, and was proved a lung tumor in differentization from a consolidation lesion.

MSCT confirmed the right lung tumor.

Operation removed the right lung tumor.

Histopathological result was a pulmonary leiomyoma.