Re: clinical problem
From: DuBose, Terry (DuboseTerryJ@exchange.uams.edu)
Wed Jan 6 16:43:58 1999
It is great for ruling on a dermoid vs stool too. Try to get some air
bubbles in the enema water, makes for a good show.
Peace, Terry J. DuBose, M.S., RDMS, FAIUM
University of Arkansas for Medical Sciences, USA
http://www.io.com/~dubose/
http://www.uams.edu/CHRP/dmshome.htm
http://www.obgyn.net/us/panel/dubose_us.htm
---
> -----Original Message-----
> From: James S Smeltzer MD [SMTP:gaperina@mindspring.com]
> Sent: Wednesday, January 06, 1999 4:58 PM
> To: Multiple recipients of list
> Subject: Re: clinical problem
>
> 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
> >
