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Sunday, 29 June 2014

CASE 264: ASCITES, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 31yo  3 days ago epigastric pain.

She came to MEDIC  for  gastroscopy and result was  gastritis, but ultrasound of abdomen  detected free  fluid of ascites around border of liver  and  small stone in gallbladder (see  ultrasound  images).



Liver was normal,  and ultrasound  at pelvis detected  one mass  on the left side of uterus, round,  5cm diameter, solid mass  with  small vessel  inside  and  RI low ( see  ultrasound images). Sonologist  susgested  an ovary tumor  in rupture.




MSCT with CE of this mass on  left lateral of uterus...with  CE enhance  like a  nidus of  pregnancy in rupture with  a lot of blood  clots  in abdomen ( see 3 CT pictures).





Blood tests  :  CA-125  rising 125 UI/mL  and  betaHCG  rising 134UI/mL
WBC 15K  with neutro 75%, Hct  29%.

Emergency  operation  in  BINH DAN hospital  detected  hemoperitoneum due to rupture of  tubal pregnancy (photo).



DISCUSSION: 
Epigastric pain is a common indication to gastroscopy that was not available for this case.
ULTRASOUND of  ABDOMEN  MUST BE  FIRST CHOICE for CASE.
BLOOD TEST  CA-125 RISING  NO  MEANING TO  OVARY  CANCER.
Beta HCG was  most  sensitive  for  diagnosis of this case.


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