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Saturday, 26 December 2020

CASE 601= MALIGNANT LIVER TUMOR BUT WAKO TEST NEGATIVE, Dr PHAN THANH HẢI, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

Male patient 43yo with HBV infection for years but only follow-up now detected right lobe indeterminated tumor #30x23mm at subsegment VIII on ultrasound. Doctors thought benign tumor because of WAKO test negative.





MSCT confirmed a focal fatty infiltration on right lobe in different diagnostic of a liver tumor.




One month later, MRI with Primovist detected  liver tumor at VIII segment, T1 low  tumor signal than mesenchymal signal, but T2 higher than liver. Wash-out is typically same HCC  (7sec, 7min and 30min).





The tumor is close to IVC and between right and middle  hepatic veins that will invade vessels if delayed management.




Open surgery to remove tumor in anterior lobe of liver. Histopathologic report is liver cell carcinoma, trabeculated pattern.





CONCLUSION: MRI with Primovist is best choice for small liver HCC with negative WAKO test.

Monday, 21 December 2020

CASE 600: MIRIZZI SYNDROME, Dr PHAN THANH HẢI, Dr PHAN NGUYỄN THIỆN CHÂU, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 62yo with RUQ pain for 1 month failed  managed as gastritis. Ultrasound at local hospital detected GB stone so the patient came to MEDIC to reexamination.





Ultrasound at Medic Center detected big GB stone # 24mm and CHB dilatation, thought about GB stone and Mirizzi syndrome.




MSCT confirmed later GB stone in cystic duct and Mirizzi syndrome.





Lab tests CA 19-9=145,5U/mL, Bilirubin raising esp direct bilirubin.



Patient was sent to Binh dan hospital to manage the GB stone.

Bình dan MRI confirmed GB stone and Mirizzi syndrome.




Surgery was done to remove GB stone, cholecystectomy and Kerh drainage for C H D.