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Re: clinical problem From: Ann Polin (charna@uswest.net) Wed Jan 6 08:58:55 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: clinical problem" Previous message: Joe Cutchin: "Re: clinical problem" Maybe in reply to: Natalie Sohn: "clinical problem" Next in thread: James S Smeltzer MD: "Re: clinical problem" Reply: James S Smeltzer MD: "Re: clinical problem" Not done very often, but if mass is not found to be of uterine or ovarian nature after performing vag ultrasound, then observing vaginal ultrasound images while performing water enema on patient might help to delineate culdesac mass better. Natalie Sohn wrote: > I would like to hear some expert opinion on the following case: > 64 year old post menopausal female in good health getsreferred by her > primary care doc ( actually the nurse practitioner) for post menopausal > spotting. Pap, mammo all normal. My exam reveals a mass which > displaces the cervix way upward ( you cant visualize it at all with the > speculum--and endo biopsy is impossible. Rectal exam reveals the mass ( > and/or uterus?) above the rectum and shes guiac neg. There is no > ascities and ca125 is wnl. The radiologist wanted me to order a ct scan > but I dont feel this is necessary since this most likely uterine or > ovarian neoplasm clearly needs to come out.(Ido these cases with a > gyn-onc who can stage these tumors adequately.)I am not sure if this is > malignat or benign. r/o colon tumor ?-although this seems highly > unlikely. My one reservation about ordering these tests is that the the > hmo medical directors might delay my case ruling out distant spread when > none exists. ( such a thing happened recently to me and there was a 4 > week delay-- that woman had ovarian cancer. Any insights? My point here > is how would additional testing in this case alter management? > > -- > nsohn -- Ann Polin, BS, RDMS Program Chair Diagnostic Ultrasound, B243 Bellevue Community College 3000 Landerholm Circle SE Bellevue, WA 98007-6484 (425) 603-4181 apolin@bcc.ctc.edu Next message: art fougner, md: "Re: clinical problem" Previous message: Joe Cutchin: "Re: clinical problem" Maybe in reply to: Natalie Sohn: "clinical problem" Next in thread: James S Smeltzer MD: "Re: clinical problem" Reply: James S Smeltzer MD: "Re: clinical problem"

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