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Saturday, 25 February 2017

CASE 419: PELVIC TUMOR, BS JASMINE THANH XUÂN, BS VÕ NGUYỄN THÀNH NHÂN, BS LÂM CẨM TÚ, BS PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

      36yo female patient, 13 days delayed period, was diagnosed left side ectopic pregnancy. HCG=2786mUI/mL. Patient were re-examination at Medic.
      Embryonic sac inside uterus d# 8mm, 2 normal ovaries and rules out EP.
      During Transvaginal Ultrasound exam, incidental mass was detected, sized # 35 x 40mm, rich echo. It located beside left ovary, hypervascular supplied was identical which reassemble a kidney. On abdominal view, 2 kidneys and other organs were normal. During consultation, 9/11 doctors thought a third pelvic kidney which is rare but possible.
      After reconsultation, patient wants abortion so we move on to CT exam. In arterial phase, the mass enhanced and shows connection with sigmoid colon and in late phase, rules out pelvic kidney diagnosis. CT Virtual Colonography was performed, air was pumped to inflate colon for better view. On 3D image, the mass reveals as polyp within sigmoid lumen.

      Next, the patient underwent endoscopic colon: demonstrated a bledding, 25cm away from anus, very mobile polyp with long stalk. Sample biopsy confirmed normal tubular polyp.

A studied case was represented around 11 doctors via email which was diagnosed exactly by MSCT and confirmed by colonoscopy.


























 Bài học 3: email hội chẩn.










CASE 418: CHEST PAIN in KAHLER DISEASE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 59 yo with chest pain  at sternum.
Cardiac ultrasound  suspected  cardiac ischemia, but  EKG  is normal.




Blood  test in  emergency  report   troponin I HS is high 60ng/ml  
CT scan  cardio-thorax detected sternum is  erosion.


Blood test  again  after 2h troponin I HS is dropped to 53ng/ml   and troponin  T HS is 82ng/mL.,  PTH is  12ng/mL,  BETAMICROGLOBULINE 4254 ( high)    AND  KAPPA GLOBULINE detected in electrophoresis.

CONCLUSION   TROPONINE rise  ABNORMAL in KAHLER disease, not  due to cardiac  infarction..

REFERENCES= 2 TEXTs.


Monday, 13 February 2017

CASE 417: BLACK SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Woman 60yo with small skin  tumor at  righ antebrachial region which appeared 40 years ago, but now changing the color in black skin  without  pain, and hard in palpation.
(see  foto).


Ultrasound  of this tumor with 12 MHz linear probe.
 US 1: this tumor is underskin cover with  strong attenuation. Size of 1 cm.


US2 :  in CDI with very little small vascular signals.


US3: Changing of  angle of the probe, this tumor is  very high colored  like artifact.


US4:  In  this angle  twingling artefact appeared very strong.


Video  represented  twingling color of this tumor.

video

Operation with local anesthesia removed this mass that is metalic object.

Summary= It is  a foreign  body  made of metal  which was under skin for a long time made strong twingling Doppler artifact.

Reference:   Twinkling artifact on color doppler sonography.   AJR 2003,180:215-220.



Sunday, 5 February 2017

CASE 416: RETROPERITONEUM HEMATOMA, Dr PHAN THANH HAI, VNT NHAN, NT TRANG,TC QUYEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Woman 56 yo with epigastric pain and anemia, RBC= 2.99m/L Hct= 28%
Normal colonoscopy.
US of  abdomen  detected one retroperitoneum mass near the head of pancreas, looked like hematoma ( US 1, US 2 ,US 3).




MSCT with CE confirmed  this mass is  retroperitoneum hematoma, maybe due to  rupture from a small aneurism of  gastroduodenal artery (CT1, CT 2, CT 3 CT 4  3D reconstruction).






Emergency  DSA  detected  the abnormal.variation of  hepatic artery and  small aneurysm of  gastroduodenal artery had stopped bleeding.


Survey this case for  Hct dropped  to 25% and  operation for control bleeding by  ligation this small ruptured aneurysma . 

Post-Op is in  well recovery . 


Conclusion: Easily diagnosed ruptured retroperitoneum aneurysm  by  combining of ultrasound, CT and, DSA.

Thursday, 2 February 2017

CASE 415 : BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM




Woman 57 yo, herselft  detected one mass at central left breast.
US 1: hypoechoic mass with size of  2cm at central left breast and one small nodule nearby which is sister tumor.


US2: CDI, this mass is hypovascular.


US3: Doppler PW of supply artery : PSV = 23cm/s  s/d=2.7. RI=0.62.


US4: ElastoUS, this mass is very hard. No axillary node detectable.



Mammo xray: this mass is no calcification, spiculated, classification BI-RADS 4.



Biopsy core reported this tumor is very hard.
Microscopic report with  histo immuno staining is  ILBC ( invasive lobular breast carcinoma). T2NoMx.



Summary: It is typical a breast cancer ILBC.