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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).





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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 ?.

Thursday, 2 October 2014

CASE 277: CLOSE BY KNEE JOINT TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 21 YO   PAIN  NEAR  THE  LEFT   KNEE  AFTER  PLAYING  FOOTBALL.
 X-RAY FIRST OF LEFT KNEE AREA D ETECTED ONE MASS  INTRA
MUSCLE WITH  CALCIFICATION  AND ADHERENT TO FEMUR BONE  WITH SIGN OF PERIOSTEAL  EROSION.





ULTRASOUND OF THIS MASS  REVEALED  HYPOECHOIC PATTERN WITH CALCIFICATION INTRA MASS,
HYPOVASCULAR,  SIZE  ARROUND 4 CM.






ELASTOGRAM  SHOWED THAT MASS WAS HARD AND CENTRAL NECROSIS.







MRI  OF THIS MAS PROVED COMING FROM THE FEMUR BONE AND IN   EXTENSION OUT  TO
MUSCLE, LOOKED LIKE  BONE TUMOR (SEE  MRI 1, 2, 3 ).





PET CT   MADE STAGING  THIS TUMOR WAS  LOCAL  INVASION   HIGH
UPTAKED  18 FDG, SUSPECTED OSTEOSARCOMA.






OPEN  SURGERY  BIOPSY FOR  MAKING SURE  DIAGNOSIS.

WAIT FOR MICROSCOPY REPORT.


MICROSCOPIC REPORT WAS  PERIOSTEAL SARCOMA.

WHAT IS  PLAN of TREATMENT FOR THE  21 YO YOUNG PATIENT?  


Friday, 26 September 2014

CASE 276: PTC, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female 29 yo,  getting big neck  faster.





 Last  year she got some  small colloidal  cyst on right lobe. But at this time ultrasound detected hypoechoic mass on right lobe,  #34x60x24mm with many small cysts inside, calcified and hyperechoic nodules and  vascular network between cysts which was thought to be colloidal cysts.  







With elastoultrasound ARFI, lesion was harder than the surrounding, black color on VTI and blue code on Esie Touch. Elastographic velocity was higher , V=2.7à 3.14 m/s than the surrounding, v=1.28m/s. It suggested a malignant lesion on elastographic US.




Microscopic result of FNAC was PTC.


Discussion: An interesting  case of PTC with appearance of many small cysts which make confusion to colloidal cysts. Clinical findings which helped to diagnose are tumor getting bigger faster on one lobe of thyroid. And ARFI elastoUS  keeps the predictive role in diagnosing exactly for this case.

Saturday, 13 September 2014

CASE 275: LUNG MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



BOY 5 YO   3 DAYS AGO   FEVER AND COUGH.

PEDIATRIC DOCTOR  REQUESTED  BOOD TESTS  FOR  RULE OUT  DENGUE FEVER AND  CHEST  XRAY.
RESULT   RETURNED  QUICKLY (SEE   BLOOD TESTS  AND CHEST XRAY).




DISCUSSION:
FEVER AND RISING OF WBC  WITH  MORE NEUTRO CELLS  ARE  ACUTE
INFECTION, WE CAN RULE OUT  DENGUE FEVER.
BUT THE CHEST X-RAY WAS ABNORMAL, ONE RADIOLOGIST  SUGGESTED  LUNG TUMOR. AND HE  REQUESTED THORAX CT SCAN.



ULTRASOUND  OF  THE CHEST  BY TRANSTHORACIC  DETECTED THIS MASS AT THE LEFT LUNG  WHICH WAS  SOLID  ECHOTRUCTURE  LIKE HEPATIC TISSUE.
IT HAD AIR IN THE MASS AND  VESSELS  WERE NOT BENDING ( SEE ULTRASOUND  IMAGES  WITH  CDI AND VIDEO)
  


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Sonologist suggested consolidation pneumonia.
For make sure diagnosis we performed
low dose CT Scan  without CE (see CT pictures).





Radiologist reported that a lobular pneumonia in  consolidation phase of the left lung.
Antiobiotic treatment is in urgency.


After one week treated with antibiotic, the clinical of patient recovered very well. CRP  dropped to 32ng/mL. Chest X-Ray has got near normal status and lung ultrasound  had changed  structure. (See  chest X-Ray and ultrasound pictures of the left lung).