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Thursday, 24 July 2014

CASE 267:PELVIC MASS and MELENA, Dr PHAN THANH HẢI, Dr LÊ ĐÌNH TÍN, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  37 yo in urgency by melena and  hypotension.
Ultrasound of  abdomen first detected  one 6cm mass  at  the pelvis, well bordered  (US image 1: mass  near  the  urinary  bladder  wall, US 2: very hypoechoic with linear probe 12MHz, US 3 elasto: this mas soft and inhomogeneous, and video hypervascular mass).




video


MSCT with CE of this mass showed rapid and high CE enhancement (see 3 CT images).





There were no relation between the mass with GI tract lumen.
 Blood test  Hct  20%  post blood transfusion.  And gastroscopy and colonoscopy: NAD (nothing abnormal detected).
Today, laparotomy found out the mass in the small bowel wall, with vascular congestion. And there was one site eroding the mucosa layer of intestine. Maybe bleeding from this site (see operation images).










Discussion:

Ultrasound first  presented best application for this emergency case. First, sonologist detected one cystic mass at the right pelvis, with linear probe 12 MHz;  but in using of curve  probe 3.5MHz showing a solid  mass in appearance and hypervascular mass on Doppler. Elastoscan also said this mass being a  soft mass. MSCT with CE reported this mass in fast and high contrast enhancement. At the mesenteric border no  bleeding site detected at this time, suggesting a GIST tumor in case of GI tract bleeding. Endoscopy of GI tract was complementary tool for negative detection.
Operation was set on time.

Microscopy  report with IHS is small bowel GIST.


Tuesday, 8 July 2014

CASE 266: COLO-COLIC INTUSSUSCEPTION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 38 yo, epigastric pain crisis on  periodic treatment  like gastritis but not response.

Ultrasound first in emergency  at MEDIC detected one mass  near  gallbladder with  multilayer cover as  OINION SIGN, and a central cyst.
This mass was  in transverse colon.  Sonologist  suggested a colocolic intussusception  (see 04  ultrasound  images and video clip).





video


Do you have any idea about the cyst in an intussusception mass?.

MSCT   with CE showed this  mass in transverse colon with cystic mass  looked like   appendicular mucocele.



Emergency laparotomy performed right hemicolectomy,   macroscopic specimen was appendicular mucocele [see photo]..




Microscopic report was  mucocele  appendicular  due to  fibrosis of appendix.


REFERENCE:  Case 181 Medic case.


Thursday, 3 July 2014

CASE 265: FISH BONE IN GALLBLADDER: Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 49 yo, pain in RUQ one week ago like gastric ulcer.

Ultrasound of  abdomen suggested gastric cancer  invasive to gallbladder and liver.

Gastroscopy and biopsy ruled out gastric cancer.

MSCT with CE detected  abscess due to perforated fundus of gallbladder and one  foreign body like a fish bone, 3cm in length,  intra gallbladder (see 3 CT pictures).





Ultrasound of  abdomen again for verify diagnosis also made same  information which was  abscess due to fish bone penetrating through gallbladder wall to liver border.
(see 2 ultrasound images and video clip).



Blood tests were normal.

video


Operation laparotomy removed abscess and gallbladder necrosis with fish bone inside abscess (see 3 photo).





REFERENCE: Case Report