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Wednesday, 30 April 2014

CASE 252: NECK PAIN in LEMIERRE'S SYNDROME, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.



Girl 13 yo, for one week sore throat and  fever, being  treated with antibiotics, now pain at right neck.
Ultrasound at the neck detected on right side some lymph nodes 2-3 cm at posterior SCM. And internal jugular vein dilated, big diameter 2, 2 cm black lumen, no flow,  cannot compressible (see US pictures of CCA and IJV on right side).






Meanwhile, on  the left neck,  there were normal flow of CCA and IJV ( see video clip).

CDI OF CCA AND IJV on R NECK

video






VIDEO 2: CROSSECTIONAL


video

What is your emergent thingking? What is the lab you must execute evaluation ?.


Blood tests: WBC= 15k, neutro 40%, CRP=20mg/l  very high,   D-Dimer=500ng/ml. Bacteriology  blood culture is on the way.
Based on CLINICAL INFECTION and  LAB REPORTS, and ULTRASOUND  IMAGES of THROMBOSIS OF IJV, suggestion  of  LEMIERRE SYNDROME.
Urgent treatment with  IV ANTIBIOTICS and ANTICOAGULATION  DRUGS.


REF..HISTORY OF PROF  ANDRE ALFRED LEMIERRE.



After one week treated with antibiotics and anticoagulant, the flow intra right IJV returned.
See CDI and MSCTA images.


Saturday, 26 April 2014

CASE 251: PAIN at RIGHT HIP, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 52 yo with history of pain at his right hip  joint 2 years prior, recently the pain is getting more severe, cannot walking (photo).


Plain XRay film of the pelvis looked like normal right and left hip joints.


Upon ultrasound  the right hip joint showed  widering of  the hip joint space with fluid collection, and abnormal echostructure of  the head of femoral bone (see 3 ultrasound pictures at right hip).  





Ultrasound examination of the right hip report was abnormal  in suggesting  arthrosis of right hip joint).
MRI of  the hip joint showed that right femoral head  in necrosis and hydarthrosis, and  small change also at left hip joint.





MRI report is aseptic necrosis of femoral  head  on right and left sides. 


Anatomy of vascular supply of femoral  head : 2  anterior  and posterior  pictures.



Monday, 21 April 2014

CASE 250: LOST of DENTAL PROSTHESIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 68 yo (photo) after  drinking a lot of  alcohol, he detected  lost of  dental prosthesis  and dysphasia and apnea,  like  cardiac  ischemia.




 He  came seeing cardiologist for dissolve his cardiac problem, but it was not getting better (echocardio image).






Chest XRay on PA  was normal, but  on LATERAL VIEW  there was something  in retrocardiac space (chest  XRay).



MSCT scan detected  foreign body in the midlle of his esophagus ( see 4 CT  pictures).






Endoscopy  detected at the middle esophagus  one dental  prosthesis made stuck  this site (see photo).



Treatment   emergency   at ENT  hospital. Endoscopy  removed  this  dental  prosthesis   that had lost 3 weeks  before.  Nasogastric  feeding, and wait for  progress. 

 

See  photo of dental prosthesis.