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Wednesday, 26 November 2014

CASE 284: DIFFUSE LYMPHOMA, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 76yo, swollen R. neck, axilla and supraclavicular area for ½  month, no pain nor fever.
Ultrasound detected  R. maxillary angle, carotid chains and supraclavicular nodes, size of 20-43mm. Round, poor liked cystic, vascular, noncalcified, lost-hilus nodes. Small nodes was homogenous, but  big one was inhomogenous, with necrotic areas and hyperechoic fibrous septa.




R. axillary node, big size od 50x40mm, lost-hilus node, inhomogenous with  necrotic and vascular solid areas.

In epigastric region, sonologist  detected a poor node, size of 25mm. No lymph node in groins and L.axillary area.


Thought about lymphoma and different  diagnosing of TB nodes.

Chest X-Rays and pharyngoscopy were  intact. 

Pathologic immunohistology staining result: HMMD: CD 20 (+), CD 3 (-), CD 30 (-).  DIFFUSE LARGE B CELL LYMPHOMA.



DISCUSSIONS=
Ultrasound has the role of detection and diagnosing of lymphoma quite exactly based on liked cystic pattern of node.  Non edema surrounding fatty tissue helps ruling out acute inflamed node or infested TB node.

Ultrasound can approach multi area of body that evaluates staging so helping of treatment planning as fast as possible.



Tuesday, 25 November 2014

CASE 283: SCARPA TRIANGLE MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



WOMAN 28YO  DETECTED HERSEFT  AT THE  RIGHT GROIN (SCARPA'S TRIANGLE)  ONE MASS  GROWING BIGGER  FOR 3 MONTHS WITHOUT PAIN  NOR TRAUMA.

ULTRASOUND  FOUND IT OUT  FIRST  BEING  A MASS WHICH WAS MULTILOBULATED, INTRAMUSCULAR, HYPOVASCULAR AND  HARD  IN ELASTOGRAPHY ULTRASOUND ( SEE  4 IMAGES).







MRI WAS DONE  FOR MAKE  SURE DIAGNOSING OF  MUSCLE TUMOR THAT WAS EXTENDING  INTO  MEDIAN COMPARTMENT  OF THE RIGHT THIGH (see 2 MRI images).



MSCT  DETECTED THE  HEAD OF  FEMUR BONE AND ILIAC BONE IN  EROSION.



PET- CT  MADE POSITIVE  FDG  CAPTURE OF THIS TUMOR.


WHAT IS YOUR SUGGESTION OF DIAGNOSING FOR THE CASE BY MANY DIAGNOSTIC MODALITIES?

Thursday, 20 November 2014

CASE 282: SUPRAPUBIC MASS, Dr PHAN THANH HẢI-Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 45 yo, 3 months after operation  for repairing left  inguinal  hernia,  pain in micturition and  polykiuria; clinical palpation  detected one mass  at suprapubic area.
Ultrasound  detected  this mass being a cyst, size of 10cm with many  bodies hyperechoic  intra cystic, which were looked like  foreign  bodies  ( see 4  US pictures). This  mass was  intra  abdominal  wall in  compression to urinary bladder.







MRI  of pelvis with gado reported  a  mass which was liked an abscess with  viscous fluid content  and cannot see  intracystic structure.






What is your suggestion for diagnosis of the suprapubic mass?

Thursday, 6 November 2014

CASE 281: INSULINOMA, Dr PHAN THANH HẢI-Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 39yo  after  delivering her  second  baby, she  had  hypoglycemia  repeatedly  and  more  frequently.  But ultrasound  of pancreas  many time with many sonologists  cannot detect  abnormal in pancreas (see 3  ultrasound pictures  at Medic).






video

MRI  with gado detected  a small mass  of 1 cm in diameter  at the  head  of  pancreas ( see 3 MRI pictures)




Operation was done  for removing  this mass  and for  microscopic report.




After  removing  the mass of  pancreas,  the  sugar blood was getting  stable and returning to norma value.



Microscopic report was an insulinoma. 

TODAY PATIENT  DISCHARGED FROM HOSPITAL.

IN FASTING  INSULIN WAS  8.1 UI/ML  IN COMPARISON TO PRE-OP VALUE OF 50.9UI/ML.

Tuesday, 4 November 2014

CASE 280: FETUS ONE KIDNEY in HYDRONEPHROSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman in pregnancy  31 yo  PARA 2002. First time cesarian delivery, but  now  check for the second delivery. Prenatal ultrasound that  detected  oligoamniotic  and  but fetus having only one right hydronephrosis [see image US 1, US 2 ].




Urinary bladder was  normal and cannot find out the left fetal kidney (US 3 video  showed the facial fetus and  his nose and mouth  in normal respiration).

video

Fetal MRI  made sure that  only one abnormal  right fetal kidney, small and cannot find out the left fetal kidney [see MRI 1, frontal section  MRI 2  section, MRI 3, sagital section, MRI 4.)




Prenatal 36 weeks  detected  renal  malformation  with agenesis of kidney.

DISCUSSION:
In this case,  fetus has only one  kidney  in  hydronephrosis.
The mother  has to undergo a cesarian deliverying  and  strict  survey the neonate, and if  the  hydronephrosis is  still progressing, an emergency  endostent by JJ is method for  reduction of intrarenal pressure.
It is  look like  POTT SYNDROME, this  baby needs   DNA gene examination.

Monday, 27 October 2014

CASE 279: RETROPERITONEAL PELVIC TUMOR, Dr PHAN THANH HẢI- Dr LÊ TUẤN KHUÊ. MEDIC MEDICAL CENTER, HCMC, VIETNAM

MALE PATIENT 42 yo, from CA MAU PROVINCE, GETTING  HIS LOWER ABDOMEN BIGGER  AS 3 MONTH WITHOUT ANY SYMPTOM.

HE WAS TRANSMITTED TO CANCER HOSPITAL AND BINH DAN HOSPITAL.

ON CYSTOSCOPY HIS URINARY BLADDER WAS PRESSED FROM OUTSIDE.

ULTRASOUND AT MEDIC DETECTED A HUGE MASS IN PELVIS, CENTRAL NECROSIS.



AT BINH DAN HOSPITAL, COLONOSCOPY WAS PERFORMED AND THE RESULT WAS SIGMOID COLITIS.



AND CT of BINH DAN HOSPITAL REVEALED A HUGE RETROPERITONEAL MASS IN PELVIC REGION.



OPERATION  WAS DONE TO REMOVE THE TUMOR WHICH WAS of 15X20cm IN SIZE FROM ANTERIOR OF URINARY BLADDER TO PROMONTORY of SACRUM.




THE RESULT of HISTOPATHOLOGY AND HISTOIMMUNOLOGIC STAINING WAS A SCHWANNOMA.


REFERENCE:


Wednesday, 8 October 2014

CASE 278: UNKNOWN ASCITES, Dr PHAN THANH HẢI-Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 30 YO   ABDOMINAL PAIN  SOME MONTHS AGO,   ABDOMEN WAS DISTENTION AND  CANNOT EATING, NO FEVER  NO TRAUMA OR TUBERCULOSIS IN  HISTORY.
ABDOMEN ULTRASOUND  DETECTED ASCITES  WITH  BOWEL  ADHERENCE IN MASS, LIKE COCOON  SIGN ( 2 VIDEO).





video








video




MSCT of ABDOMEN WITH  CE REVEALED  NORMAL LIVER  WITHOUT TUMOR ( SEE  CT  3 PICTURES).






PUNCTURE of ASCITES SHOWED OLD  BLOODY  FLUID. ANALYSIS RESULTED NORMAL AMYLASE,  ADA, AND  CA 125.


PATIENT WAS ADMITTED HOSPITAL IN  EMERGENCY FOR  BOWEL  SUB-OBSTRUCTION.


LAPAROSCOPIC OPERATION   DETECTED  OLD BLOOD  WITH  ADHERENT FIBRIN  WHICH MADE BOWEL  AS A BALL (COCOON),  CANNOT FIND OUT THE BLEEDING SITE. NO TUMOR DETECTABLE, AND BIOPSY OF  ONE  OF PARIETAL PERITONEAL AREA THICKNESS.

MICROSCOPIC REPORT WAS  HEMORRHAGIC PERITONITIS.



WHAT IS THE  PLAN OF TREATMENT FOR THIS PATIENT ?.