Nam 28 tuổi với đau HC(P) Đại tràng lên Khối cạnh ĐT kèm nhiểm Thậm nhiễm quanh ĐT Viêm ruột thừa lạc chổ Brief review of Epiploic Appendagitis Rare inflammatory and ischemic condition Results from torsion or spontaneous venous thrombosis of one of the appendices epiploicae ischemia or infarction of the appendix epiploica & localized inflammation Sudden, severe, focal abdominal pain, mimic other conditions such as appendicitis Can be managed conservatively CT: 1- 4-cm, oval, fatty pericolic lesion with surrounding mesenteric inflammation Adjacent cecal wall thickening and compression Rarely, a central highattenuation "dot" within the inflamed appendage; corresponds to the thrombosed vein (17) Diffuse largeB-cell lymphoma Brief review of round solid mesenteric masses Malignant solid tumors have a tendency to be located near root of mesentery benign solid tumors in periphery near bowel! Metastases especially from colon, ovary (most frequent neoplasm of mesentery) Lymphoma Leiomyosarcoma (more frequent than leiomyoma) Neural tumor (neurofibroma, ganglioneuroma) Lipoma (uncommon), lipomatosis, liposarcoma Fibrous histiocytoma Hemangioma Desmoid tumor (most common primary) Figure(s) 60/M Chief complaint: jaundice, fever and chill *not hach *day Gallbladder carcinoma Brief review of gallbladder carcinoma Most common biliary cancer Associated with: (1) Gallstones in 64 - 98% Gallbladder carcinoma occurs in only 1% of all patients with gallstones! (2) Porcelain gallbladder (in - 60%) (3) Inflammatory bowel disease (predominantly ulcerative colitis) (4) Familial polyposis coli (5) Chronic cholecystitis Growth types: replacement of gallbladder by mass (37 - 70%) focal / diffuse asymmetric irregular thickening of GB wall (15 - 47%) polypoid / fungating intraluminal mass with wide base (14 25%) Differential diagnosis see note below Figure(s) 45/M Chief complaint: general weakness Addison disease caused by adrenal tuberculosis Brief review of addison disease = Primary adrenal insufficiency 90% of adrenal cortex must be destroyed! Cause: Idiopathic adrenal atrophy (60 - 70%): likely autoimmune disorder Granulomatous disease: tuberculosis, sarcoidosis Fungal infection: histoplasmosis, blastomycosis, coccidioidomycosis Adrenal hemorrhage: anticoagulation therapy, bleeding, coagulation disorders, sepsis, shock Bilateral metastatic disease (rare) Diminutive glands (in idiopathic atrophy + chronic inflammation) Enlarged glands (acute inflammation, acute hemorrhage, metastasis 10 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 ... Remittent incomplete obstruction + bacterial superinfection Multiple crescent- / stiletto-shaped filling defects within bile ducts Complication (1) Bile duct obstruction (conglomerate of worms... desquamation of epithelial bile duct lining with adenomatous proliferation of ducts + thickening of duct walls (inflammation, necrosis, fibrosis) (b) bacterial superinfection with formation of liver... 26% common hepatic duct in 14 - 37% proximal CBD in 15 - 30%, distal CBD in 30 - 50%, cystic duct in 6% Growth pattern: (1) Obstructive type (70 - 85%) U- / V-shaped obstruction with nipple, rattail,