A 22 yo female patient with a mass of right abdomen which was detected by ultrasound check-up and thought to be a mesenteric tumor or a lymph node in mesentery. It was well-bordered and vascular structure without any symptom.
MSCT confirmed the 14x17mm mesenteric tumor in right abdomen with CE enhancement.
Open surgery removed the mass from posterior space of right colonic mesentery.
Microscopic result is a Castleman disease in mesentery, which is an uncommon lymphoproliferative disorder that may be localized to a single lymph node (unicentric) or occur systemically (multicentric).
It was a second case at Medic Center.
The first case of Castleman disease was posted in 2010.
CASTLEMAN DISEASE in RETROPERITONEAL SPACE at MEDIC CENTER
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Thursday 15 May 2014
Saturday 10 May 2014
CASE 253: GOSSYPIBOMA (TEXTILOMA) POST CAESAREAN SECTION for a YEAR, Pham Hong Dong,M.D; Nguyen Duc Duy Linh,M.D; Phu Van Tuot,M.D; Nguyen Ngoc Xuan Giang,M.D., MEDIC Binh An Kien Giang Hospital
A 26 year-old female patient who had complained
mild pain at her pubic region presented lower abdominal pain a
month prior. She overwent a caesarean
section a year ago for delivery her child.
Ultrasound findings:A cystic mass (about 83x46 mm) containing distinct internal hyperechoic wavy, striped structures.
CT Scan abdomen: A mass of 11 x 9 cm with
thicken enhancing walls was seen in pelvis.
But diagnosis of gossypiboma
was made and at laparotomy: a surgical sponge (18x22 cm) with adjacent
inflammatory tissue and pus were removed successfully.
DISCUSSION:
A diagnosis of gossipiboma pre-op seems to be very difficult
that always need skill and experience. Because of imaging findings of gossypiboma are
nonspecific and complexe so the right diagnosis in pre-op is still acchived about 1/3 of
cases in literature.
But whenever an unknown mass into abdomen with exist surgical scare that should dissolve it may be a gossypiboma or not.
Wednesday 30 April 2014
CASE 252: NECK PAIN in LEMIERRE'S SYNDROME, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Girl 13 yo, for one week sore throat and fever, being treated with antibiotics, now pain at right
neck.
Ultrasound at the neck detected on right side some lymph nodes 2-3 cm at posterior SCM. And internal jugular vein dilated, big diameter 2, 2 cm black lumen, no flow, cannot compressible (see US pictures of CCA and IJV on right side).
Ultrasound at the neck detected on right side some lymph nodes 2-3 cm at posterior SCM. And internal jugular vein dilated, big diameter 2, 2 cm black lumen, no flow, cannot compressible (see US pictures of CCA and IJV on right side).
Meanwhile, on the left neck, there were normal flow of CCA and IJV ( see
video clip).
CDI OF CCA AND IJV on R NECK
VIDEO 2: CROSSECTIONAL
What is your emergent thingking? What is the lab you must execute evaluation ?.
Blood tests: WBC= 15k, neutro 40%, CRP=20mg/l very high, D-Dimer=500ng/ml. Bacteriology blood culture is on the way.
Based on CLINICAL INFECTION and LAB REPORTS, and ULTRASOUND IMAGES of THROMBOSIS OF IJV, suggestion of LEMIERRE SYNDROME.
Urgent treatment with IV ANTIBIOTICS and ANTICOAGULATION DRUGS.
REF..HISTORY OF PROF ANDRE ALFRED LEMIERRE.
After one week treated with antibiotics and anticoagulant, the flow intra right IJV returned.CDI OF CCA AND IJV on R NECK
VIDEO 2: CROSSECTIONAL
What is your emergent thingking? What is the lab you must execute evaluation ?.
Blood tests: WBC= 15k, neutro 40%, CRP=20mg/l very high, D-Dimer=500ng/ml. Bacteriology blood culture is on the way.
Based on CLINICAL INFECTION and LAB REPORTS, and ULTRASOUND IMAGES of THROMBOSIS OF IJV, suggestion of LEMIERRE SYNDROME.
Urgent treatment with IV ANTIBIOTICS and ANTICOAGULATION DRUGS.
REF..HISTORY OF PROF ANDRE ALFRED LEMIERRE.
See CDI and MSCTA images.
Saturday 26 April 2014
CASE 251: PAIN at RIGHT HIP, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Man 52 yo with history of pain at his right hip joint 2 years prior, recently the pain is
getting more severe, cannot walking (photo).
Plain XRay film of the pelvis looked like normal right and left hip
joints.
Upon ultrasound the right hip
joint showed widering of the hip joint space with fluid collection, and
abnormal echostructure of the head of
femoral bone (see 3 ultrasound pictures at right hip).
Ultrasound examination of the right hip report was abnormal in suggesting arthrosis of right hip joint).
MRI of the hip joint showed that
right femoral head in necrosis and hydarthrosis, and small change also at left hip joint.
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