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Wednesday 30 August 2017

CASE 449: LIVER TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM





Man 77yo, in  general check up  by ultrasound  detected  one round mass 5 cm in  segment 6 of liver with Left  kidney cyst and big prostate  (US 1, US 2, US 3, US 4).






MSCT of liver with CE=   showed this liver tumor  well bordered, quick CE   and  delay wash out CE that looked like HCC by radiologist  (CT1, CT 2, CT 3, CT 4).





Blood tests = HCV , HBV non detected. Wako test =  3 negative.




In MSCTA, vascular supply of the tumor comes from left gastric artery.




Operation laparotomy  removed this tumor  that macroscopic feature likes liver normal tissue of liver.


Microscopic report  is hepatic adenoma.



Monday 21 August 2017

CASE 448 : FEVER and ASCITES, Dr PHAN THANH HẢI, Dr NGUYỄN PHÚ HỮU, MEDIC MEDICAL CENTER, HCMC,VIETNAM


Woman 40 yo with one week  fever,  abdomen pain  and distention..
Clinical examination ruled out  surgical needs , chest  X-ray is normal.



  • Ultrasound of abdomen = liver, biliary system,  kidney are normal, huge amount of  ascites volume with cloudy fluid  (us1 , us2, us3 pelvis  us4 ovary).






CT scan of abdomen  =  No tumor detection [ ct1,frontal view, ct2, ct3  cross section].





Blood tests =  WBC  15k with 13,3 k neutro, CRP= 25.9,  amylase, CEA , CA 125  are  normal level.  But Widal test is  positive th;1/320
Ascites punction= yellow  clear,   analysis =  ADA= 19.5 ng/mL,  CA125 :396 UI/mL, CEA: 0,8UI,  albumine =3.9 mg/mL



After 2 weeks treated with antibiotics;   response is good,   no fever  but ascites  is  distention after  aspiration  many times.
Summary=   Fever with typhoid  but ascites  still  persistent after one month.

Discussion :   Fever and   Widal test positive  is  Typhoid fever, treated response with antibiotics, but ascites  is still  progressing, so that  is not feature of Typhoid fever (one  expert of infectious disease says). Ascites analysis  can rule out  pancreatitis,  tuberculosis and  cirrhosis.  With CT , ultrasound  don't  detect any tumor intra abdomen. Then the short  way for diagnosis is  laparoendoscopy  for biopsy.



Laparoendoscopy  detected  multiple white spots intra parietal peritoneum,  most common in diaphragma area  (see foto)  suspected peritoneal carcinomatosis.


Microscopic result is malignant mesothelioma.


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Wednesday 16 August 2017

CASE 447: RETROPERITONEUM CYST, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 20 yo with abdomen distention at  right subcostal region,  no pain  no fever.
Ultrasound of abdomen detected  one big mass in retroperitoneum, multiseptation and  multiloculated in connection with troubled fluid inside.
US 1=  longitudinal scan  over right kidney.
US 2 = crossed sectionnal scan over aorta.
US 3 = longitudinal  scan over spine.
US 4 = longitudinal  scan at  pelvis.





MSCT of  abdomen with CE:





CT 1 = sagital scan of  cystic mass  retroperitoneum.
CT 2 = frontal scan  of this mass  is cystic homogeneous.
CT 3 = frontal view of  this mass  and  gastrointestinal mass arround.
CT 4 =  aorta  no deplacement.       


Normal blood test and  all biocancer markers.

Open operation laparotomy  surgeon detected this cystic tumor in retroperitoneum , thin wall and  old blood  inside.
 Removed  this mass.



Microscopic result is benign 
 cavernous hemangioma.





Thursday 10 August 2017

CASE 446: KILT SYNDROME, Dr PHAN THANH HẢI, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 35 yo,  hematuria repeated  many times with  many  dilated subcutaneous veins on the abdomen wall [photo].


US of  kidneys   showed  righ and left kidney looked like hydronephrosis. But cannot detected the cause ( US 1, US 2)   US 3  =  CDI of  renal artery;  US 4 = spectral Doppler of pyramid arteries; US 5 = varicosis in urinary bladder wall.






CT of kidney without CE ( CT 1)=   HU of pelvis kidney  = 8 UI
CT 2  with CE ,  CT 3: secretion phase; CT 4= small ureter on R and L sides.







 MRI 1, MRI 2= kidney non CE   showed pelvis kidneys dilated and fluid collection around  2 kidneys.



Ultrasound of the leg = dilated chronic  deep vein thrombosis.

Conclusion= absence of IVC  suprarenal with DVT of  the legs, it is  K I L T syndrome.
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