CASE 847: ANOTHER CASE of FHC, Dr PHAN THANH HẢi, Dr TRẦN CHÍ ĐỦ, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 18 year-old woman with PID  and RUQ pain from HV hospital asked for a pelvic MRI at Medic Center.

MRI with CE  detected PID both two sides and  thickening of hepatic capsule as perihepatic inflammation  that supposed a case of Fitz-Hugh- Curtis syndrome.

MRI and MSCT with CE could detect FHC but  ultrasound  determined the perihepatic inflammation while it exists the fluid enough around the liver.

Violon-strings [pseudo septa] adhesions between liver surface and abdominal wall and fluid may be seen in two cases of  Van Dongen.

 FHC was described since 1930 as PID and painful perihepatic area inflammation  which had been managed with antibiotics for some days. The hepatic pain may due to infected from  Chlamydia, Gonococcus,  Trichomonas  or TB genital peritoneum in pelvic region that were going up to the hepatic peritoneum but the hepatic tissue and bile ducts being intact.

   

REFERENCE 

1. https://www.sciencedirect.com/science/article/abs/pii/002822439390181B

2. CASE 351: A Case of FHC syndrome.

https://www.ultrasoundmedicvn.com/2015/12/case-351acute-abdomen-post-partum-dr.html

CASE 845-846: LUNG TB and EXTRAPULMONARY [EP]TB, Dr PHAN THANH HẢI, Dr NGUYỄN TẤN DŨNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Case 01:

A 50 year-old  diabetic woman with chest pain and cough for one week.

TB lung was revealed on chest XRay film.

Breast ultrasound detected a right breast tumor, BI-RADS 4B. And a right axillary lymph node.

Lung MSCT confirmed TB lungs. BK sputum positive.

But the mammary biopsy result was a TB mastitis.

Case 02: 

A 58 year-old man with epigastric pain.

Chest XRay revealed TB lung.

Abdominal ultrasound noted nothing. BK sputum negative.

But colonoscopy detected a colonic mass at the splenic angle of the left colon.

Result of left colonic mass biopsy was a TB of the left colon.

We learnt that the need of combination of some modalities together to diagnose an infectious syndrome.

Starting from a pulmonary localisation (primary infection), M. tuberculosis can spread to other organs during a silent phase, usually soon after primary infection. Active TB can develop in many other parts of the body, particularly in lymph nodes, meninges, bones and joints, kidneys, genital organs and the abdominal cavity.

Approximately 16% of global TB cases are classified as EPTB, although this figure varies according the local epidemiology [1]Citation 1.World Health Organization. Global Tuberculosis Report 2020. Geneva: World Health Organization; 2020.

REFERENCE:

https://medicalguidelines.msf.org/en/viewport/TUB/english/2-2-extrapulmonary-tuberculosis-20320217.html

CASE 844: MAMMARY PAGET'S DISEASE, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, MEDIC MEDICAL CENTER, HCMC VIETNAM

 A 60 year-old woman with an erosive inflamed right nipple and bad feelings of searing, prutitus, hemorrhagia for one year which was failed in treatment. 

 

Ultrasound revealed the right nipple swollen and edema of the tissue underneath but no tumor of the right breast. A right axillary lymph node was noted.

Mammography detected no tumor.

Results of biopsy in the second time were Paget disease of the right breast nipple and a ductal breast carcinoma in situ grade 3.

Surgery was done for the right mastectomy.

REFERENCE:

From Wiki 

Paget's disease of the breast is difficult to diagnose by physical exam alone due to its resemblance to dermatitis and eczema. One helpful differentiator is that eczema tends to affect the areola first, and then the nipple, whereas Paget's disease of the breast typically begins at the nipple and spreads outwards. In addition, nipple eczema is typically responsive to topical steroid application, while Paget's disease of the breast will not improve with topical steroid use.^[4]

Mammogram and biopsy with cytopathology are common confirmatory tests.^[11] In biopsy, a tissue sample removed from the affected area is then examined under the microscope by a pathologist, who distinguishes Paget cells from other cell types by staining tissues to identify specific cells (immunohistochemistry).^[5]