CASE 792: FISHBONE PENETRATED the ESOPHAGUS GOING to the MEDIASTINUM and REENTERING the ESOPHAGUS , Dr PHAN THANH HẢI, Dr LÊ HỮU LINH, Dr HỒ KHÁNH ĐỨC, BINH DAN HOSPITAL and MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  41 year-old woman misswallowed a fishbone for 5 days.

In Medic Center, MSCT and upper GI endoscopy detected a fishbone penetrating her esophagus which was going to the mediastinum and may enter the descending thoracic aorta.

 

At the emergency department of Binh Dan hospital, an open surgery for thorax was done. The result showed not any thoracic aorta lesion nor fishbone inside the mediastinum.

But the C-arm on the operation table revealed the fishbone changing its direction from transversal to longitudinal position.

An endoscopy was performed in the operation detected the fishbone coming back to the esophagus. And it was removed successfully by via endoscopy.

Fishbone came back to the esophagus is an incredible event. Patient and doctors were stunned by the fact that may have to go through an operation for reconstruction the thoracic aorta in finding the fishbone somewhere, but fortunately not have to do.

CASE 791: OVARIAN CANCER with MULTIORGAN METASTASIS, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr NGUYỄN THỊ KIM THÚY, MEDIC MEDICAL CENTER, HCMC.

 A  67 year-old woman  PARA 2002 with lower abdominal pain for 2 days and irritable bowel syndrome. She is diabetic, arterial hypertension and asthma. Her past history denied any pelvic tumor before 2021.

Ultrasound detected abdominal ascites, a liver small nodule and pelvic tumor which invaded the pelvic organes, maybe an ovarian cancer.

MRI confirmed the ovarian cancer metastasized to liver, pleural membranes, lymph noded, epiploon and peritoneum.

Blood tests data.

But abdominal fluid were negative results in two times.

Endoscopic surgery  was done  for removing the ovarian tumors, uterus and the pelvic peritoneum.

Histoanapathological results were poorly differentiazed ovarian carcinoma  stage IV, metastase.

Post-op and chemotherapy, the woman  remains  stable status.

CASES 788, 789, 790: ACHALASIA in WOMEN, Dr PHAN THANH HẢI, Dr ĐINH MINH TUẤN, MEDIC MEDICAL CENTER, HCMC,VIETNAM.

 

03 women 62 yo, 41 yo and 27 yo with disphagia were detected as abdominal ultrasound, barium swallow, and endoscopic upper GI diagnostics and managements as ballooned dilatation.

Ultrasound revealed dilated 1/3 lower part of the esophagus which terminated at the cardia of the stomach. And its existed not any tumor outside nor tumor of the gastric wall. It appeared like the bird beck sign of the barium swallow on the XRay films.

One patient  (case 01) relapsed after 4 months managed esophagial dilatation by balloon.

CASE 01: A 61 year-old woman in malnutrition as achalasia for one year with esophagial dilatation from the neck to upper part of the stomach.

Barium swallow images of achalasia ballonned showed relapsed achalasia after 4 months.

CASE 02: Woman 41 year-old with nausea, lost of weight  for one year due to achalasia.

CASE 03: Girl 27 year-old with dysphagia for one year as achalasia. 

CASE 787:TUBERCULOSIS of RIGHT AXILARY LYMPH NODE and RIGHT 3rd Digital Flexor Tendon, Dr PHAN THANH HAI, Dr NGUYEN THI TRINH, MEDIC MEDICAL CENTER,HCMC, VIETNAM

A 22 year-old girl with inflammation of her right axillary lymph node for 2 days  and the right elbow and the 3rd flexor digitorium for 5 months. But it failed in management in 2 hospitals.

Ultrasound  and  axillary lymph node biopsy at Medic Center detected  TB inflamation of the right axillary  lymph node and the right 3rd flexor digitorium.

 After the TB management for 6 months the TB inflammation of the lymph node and the right flexor digitorium were controlled successfully.

CASE 786: ACCESSORY BREAST TUBERCULOSIS, Dr PHAN THANH HAI, Dr NGUYEN THI THAO HIEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 31 year-old woman with her left axillary swollen for one week.

Ultrasound detected an 54x51 mm axillary abscess on left side with microcalcification that maybe an accessory breast abscess.

 

Result of biopsy was a soft tissue abscess.

An antibiotic regimen was done for one month.

Biopsy at that time was TB inflammation of the left accessory breast.

CASE 785: COLONOURINARY BLADDER FISTULA, Dr PHAN THANH HAI, Dr NGUYEN NGHIEP VAN. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 71 year-old man with dysuria for one month but failed in management of infectious urinary system. The patient noted foaming at his penis after urination.

Ultrasound detected gas in urinary bladder and thickening of sigmoid colon. May it exists a fistula of colon and urinary bladder as appearance ò foaming at the penis.

Endoscopy revealed colonic diverticula.

 

Cystoscopy showed acute cystitis but not ruling out a colonobladder fistula.

MSCT confirmed the tract between the sigmoid colon and urinary bladder and colonic diverticula.

Surgery detected an abscess between sigmoid colon and bladder. But there was not any fistula of the urinary bladder. A left colonoectomy was performed.

Result of histopathology of the specimen was fibrotic inflammation of colonic wall and diverticulum.

CASE 784: SKIN ULTRASOUND for PACHYDERMOPERIOSTOSIS [PDP], Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 26 year-old man with lion- like face [dermatological face]  and drumstick- like fingers [digital clubbing](hypertrophic osteoarthropathy) for 6 years.

X-rays films show thickening of the periosteum of ribs, upper and lower limb bones.

  

Skin ultrasound with 23 MHz probe reveales thickening of subcutanous layer and skin of forehead # 5mm, neck #1mm, cheek #3 mm. It exists  distorted structures as hyperechoic and hypoechoic layers in appearance without vascularisation.

             Cheek (L) and  neck (R) skin.
 

      

        Forehead skin # 5 mm of the patient (L) and                evidence # 2mm (R).

Skin biopsy result is related to Tourain-Solente-Gole syndrome (pachydermoperiostosis) which is a rare hereditary disorder affecting to bone and skin.

Pachydermoperiostosis (PDP) is a form of primary hypertrophic osteoarthropathy (see this term), a rare hereditary disorder, and is characterized by digital clubbing, pachydermia and subperiosteal new bone formation associated with pain, polyarthritis, cutis verticis gyrata, seborrhea and hyperhidrosis (from Orphanet).

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