Re: clinical problem
From: James S Smeltzer MD (gaperina@mindspring.com)
Wed Jan 6 15:56:58 1999
Ann,
This is a nifty idea I've always wanted to try! Jim Smeltzer, MD, FACOG
At 10:00 AM 1/6/1999 -0600, you wrote:
>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
>
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