59 y/o male with h/o Large B cell lymphoma, post REPOCH che | Figure 1
59 y/o male with h/o Large B cell lymphoma
post REPOCH chemo, and splenectomy, pancreatectomy for extranodal dz. Liver lesions present before and after therapy. LDH normal. MRI post contrast, Fused PET/CT and ultrasound.....Diagnosis?
Case 1
70 y/o female. Presented in ED abdominal pain and vomiting intermittent X 5 weeks CT scan done found to have bowel obstruction. Lap surgery done apple core mass found at IC valve. 4.5 cm Mass and 14 lymph nodes removed. Bowel resection done. Biopsy show adenocarcenoma 14/14 lymph negative for cancer and clear margins all around. Oncologist staged at 2a (t3N0m0) High risk features noted on biopsy 1. Obstruction 2. Lymphovascular invasion. Also on original ct scan multiple hepatic cysts seen in left lobe and 0.9cm ill defined hypo density in right hepatic lobe containing punctate density too small to characterize further. Oncology is ordering liver MRI to evaluate liver further to rule out mets. Also recommending oral chemo. Patient is otherwise healthy no medical history. Treatment plan? Is Stage 2 grey area? Are ct results concerning for mets? Is liver mri a good diagnostic tool to look at liver?
Case 2
48 years old Egyptian female had done sigmoidectomy. Then PET CT showed multiple hepatic focal lesions (3 or more) the largest was 2.7 × 1.8 cm. The patient received FOLFIRI for 6 cycles and by PET CT the largest became 1.4 cm. Then the patient had Radiofrequency and by Triphasic CT, the largest was 3.5 cm. She had xeloda for 5 cycles and Triphasic CT was done after third cycle, showed variable responses of focal lesions, the largest measures 2.8 × 2 cm. Then she had FOLFOX for 4 cycles and Triphasic CT showed: the largest measures 5×4 cm & enlarged porta hepatis lymph node 43 mm (C19.9 was elevated with xeloda and FOlFOX). What is the best line of treatment that should be followed?
Case 3
A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.
Case 4
A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.
Case 5
A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.
Case 6
Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?