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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)
  


video


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).



Thursday, 11 September 2014

CASE 274: PTA OR NOT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



WOMAN 50YO, AFTER 5 YEARS TREATED HYPERTHYROIDISM AS STABLE STAGE,  BUT  BLOOD TESTS DETECTED  PTH VALUE VERY HIGH  AND  HYPERCALCEMIA. IT  SUGGESTED HYPERPARATHYROIDISM (SEE BLOOD TEST RESULT).




ULTRASOUND DETECTED ONE MASS AT  RIGHT LOWER LOBE, HARD WITH
ELASTO, AND HYPOVASCULAR, SIZE OF 2 CM.




MRI WITH GADO CE, ALSO CONFIRMED  ONE MASS AT  LOWER  POLE OF
THYROID GLAND, SUSPECTING  PTA, SIZE ARROUND 2 CM.





IN PREOPERATION  ENDOCRINOLOGIST  REQUESTED GAMMA SPECT  MIBI.
BUT THE REPORT WAS  NOT ABNORMAL ISOTOPE, MEANING  NOT  PTA.
(SEE  SCAN MIBI UPTAKE) . 


Discussion:
This case  is  very complexe; the clinical onset  was hyperthyroidism , medical treatment was   good response. But  in biology  blood test is evident about hyperparathyroidism. Ultrasound  and MRI  made the same  diagnosis of  PTA.   But  gamma SPECT scan MIBI is  negative; it cannot  rule out  PTA , so operation was done  for  remove this tumor.

And  pathologist  diagnoses PTA ( see  pathology report).
Review  in internet:  many  cases with  SPECT scan MIBI  were  negative.. And  indication  for   this scan helps to make  clear  Indication and Interprettation..
Conclusion:
For  diagnosis  PTA , the gamma scan MIBI not  rule out  clinical  diagnosis.

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