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Friday, 15 June 2018

CASE 498: GALLBLADDER ABSCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN ONE MONTH  AGO WITH  EPIGASTRIC PAIN AND  LOCATED AT MURPHY POINT AND FEVER.
  
ULTRASOUND  DETECTED ONE MASS  IN HEPATIC BORDER ,  SIZE 5CM  ( US 1).


US  OBLIQUE SCANNING OF THIS MASS  IS THICKENING BORDER LIKE  AVOCADOS FRUID ( US 2).


US 3 : LIVER SCANNING OF THIS TUMOR  MADE BENDING   HILUS OF LIVER.


US 4 : ELASTOSCANNING OF THE WALL CODED  HARD PATTERN.

THERE WAS NO BLOOD INSIDE MASS AND ONE STONE  IN THE WALL OF THIS MASS  MADE THOUGHT IT GALLBLADDER.



CT SCAN WITH CE= CT1 : CROSSED SECTION  OF THIS
HYPODENSE MASS.


CT2 , CT3 :   FRONTAL VIEWS.




MRI OF ABDOMEN SHOWED THIS CYSTIC MASS, WITH ITS
VERY THICKENING WALL.


BLOOD TESTS = WBC:  1,9 K  WITH  8.9% NEUTRO,  CRP  96.8 ng/mL.
PRE OPERATIVE  DIAGNOSIS IS GALLBLADDER  ABSCESS WALLED OFF DUE TO STONE.
PHOTO OF MACROSCOPIC SPECIMEN IN   OPERATION FOR REMOVING GB ABSCESS.


  
CONCLUSION =  INFLAMMED GALLBLADDER NECROSIS BY STONE CAUSED OBSTRUCTION OF THE NECK OF GALL BLADDER.

Saturday, 9 June 2018

CASE 497: MULTIPLE SKIN LESIONS AND SUBCUTANEOUS ABCESS TUBERCULOSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Man  47 yo  with pain at RLAQ at palpation   looked  like   appendicitis  and  skin of right leg  inflammed red and bulleous  growth  with multiple nodules.( see photo of abdomen and  leg skin).


Ultrasound  of abdominal wall and the leg skin  lesions detected many small hypoechoic nodules with  size 1-3 cm,  well bordered  no vascular inside lesion.  Elastoscan is cystic lesion  (US 1, US 2, US 3, US 4, US 5, US 6 skin).






Ultrasound guided puncture showed pus   and operation removed this mass  looked like caseum. 
Pus analysis  no bacteria. ADA very high 691.1. But PCR of BK negative.



BIOPSY  OF SKIN LESION   REPORTED  TUBERCULOSIS.

SUMMARY:  IT IS CASE OF MULTIPLE SKIN LESIONS  AND SUBCUTANEOUS ABCESS DUE TO TUBERCULOSIS.

Monday, 4 June 2018

CASE 496: POST-PARTUM PELVIS ABSCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Woman 29yo experienced  a cesarean operation  for 9 days  with normal primigest  terminal.

And she had got fever and pain at pelvis  and diarrhea (see photo).


US 1 scan at  pelvis :  longitudinal scan  shows that  fluid in abdominal walll as an abscess and a big uterus.


US 2  scan at pelvis :  air in abdominal wall and inside uterus.

US 3: reverberation by the air in abdominal wall.


MSCT with CE   =  CT 1: CROSSED SECTION : AIR  IN ABDOMEN WALL.


CT2 : AIR IN UTERUS.

CT3 : AIR AROUND UTERUS AND  PUS AROUND  PELVIS.



BLOOD TESTS=  WBC  30K  NEUTRO 23.7%  hsCRP 120.5( n 5mg/l).


EMERGENCY  DIAGNOSIS IS PELVIS ABSCESS PULL OUT THE ABDOMEN WALL.
OPERATION  LAPAROTOMY  FOR  REMOVING OF PUS   AND  HYSTERECTOMY.