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Monday, 25 May 2015

CASE 315: SPONTANEOUS PORTO-SYSTEMIC SHUNT, Dr PHAN THANH HAI, Dr NGUYEN THI ANH HONG, Dr LE THONG NHAT, Dr TRAN LAM

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case 315

Woman  63 yo,  5 years ago  had been treated  diabetes  not  control blood  sugar. Patient  has  some  subcoma  crisii and had been treated in many  hospitals, now she  is in somnolence, easy in sleeping  after eating but cannot sleep at night.
MRI of  the brain, radiologist  detected  hyperintense  T1 at basal ganglion area, susgested  hepato-encepalopathy (image MRI).


Checking  the liver by blood tests, liver function is still good,  but ultrasound of  liver  detected  porta-hepatic vein shunting  very high flow ( see US image 1 dilatation cystic  intrahepatic, US 2, color Doppler: Shunting porta-hepatic and US video).




video

MSCT angio of  liver with  3 phases: arterial phase shows that not abnormal venous  phase : dilated  the  porta-hepatic  anastomosis like snake. In 3D CT reconstruction  confirmed a  high flow porta-hepatic shunting).





Bood test reports  this time  no ceton , high NH3 = 88.89 micromol/mL (normal  18-72).
Conclusion: It is  a high flow  spontaneous  porta-systemic  shunting appeared as hepatic encephalopathy in clinical examination.

REFERENCE:

Saturday, 23 May 2015

CASE 314:CALCIFIED LIPOMA of CALCANEUS TENDON and SOLEUS MUSCLE - - Dr PHAN THANH HẢI- Dr LÊ THANH LIÊM- Dr Nguyễn Đức Duy Linh; Dr Nguyễn Ngọc Xuân Giang – BÌNH AN GENERAL HOSPITAL_KIÊN GIANG_VIỆT NAM.

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case-314-lipoma-calcification-of-calcaneus-tendon-and-soleus-muscle-

A 30 year-old woman with history of mass within the right heel region 2 year ago, no pain  and normal walking.
ULTRASOUND
Ultrasound found an echogenic mass in the calcaneus tendon and soleus muscle, hypovascular.
The surface of the mass was close to the Achilles tendon, well-defined with the capsule. Deep surface was very difficult to survey. Intra the mass there was an hyperechoic structure with strong shadowing, like bone. Ultrasound did not determine that there was continuity between the mass with calcaneus tendon or not.
Sonologist suggested a diagnosis of chondro-osteoma and organized synovial cysts of the ankle. Dx: Lipoma calcification.

CT SCAN
MSCT detected a lesion in the soleus muscle, density of fatty tissue, 10x4cm in size, around of achilles tendon, clear capsule, rounded border, with a very high-density nodule inside, looked like the bone. The lesion was not associated  with the calcaneus bone and the leg bone. Radiologist suggested a diagnosis of calcified lipoma.


OPERATION
Surgery was conducted in next day. Macroscopic image looks like the lipoma with calcified nodule inside.


Waiting for  microscopic results.

REFERENCE:

CASE 313: FISH BONE APPEARING in NECK, Dr PHAN THANH SƠN, Dr NGUYỄN ĐỨC DUY LINH, Dr NGUYỄN NGỌC XUÂN GIANG, BÌNH AN HOSPITAL, KIÊN GIANG

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case-313-fish-bone-appearing-in-NECK

Male patient 79 yo had foreign body on right neck (see pictures).
HISTORY
4 days before of hospitalization, during dinner with stingrays, in sneezing, a 79 yo patient took out and in some fish parts, and then feeling caught something in his throat but still eating.
Morning after he went to hospital as felt felt like a head of bone at his right neck.

ULTRASOUND

 Ultrasound at right neck revealed a fish bone in soft tissue, echogenic line in subcutaneous edema around the fish bone, but no vascular.

ENT ENDOSCOPY


 ENT endoscopy detected edema of right piriformis recess due to fish bone perforating outside from the throat.

CT SCAN
CT–Scan confirmed the fish bone in the right neck, not injured the right vessels of the neck.




The fish bone was removed out of the right neck, with 2.8 cm long of size.


Fish food is very interesting, but sometimes lead to dangerous situation like the case, specially for old patient. 

REFERENCE;


Monday, 18 May 2015

CASE 312: FETAL BODY HYPEREXTENSION, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr ĐẶNG VĨNH PHÚC, Dr TÔ MAI XUÂN HỒNG

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case-312-fetus-hyperextension

Female 33yo with cutaneous allergy from age of 20, now in 3rd pregnancy. 2 first girls are normal and no abnormal history of family. She has been treated  allergy while was  in 12 weeks of gestation [medrol, cefixin, antihistamine) for one month and changing to Prednisone pommade.



She was recorded the 3rd pregnancy with 2 OB ultrasound examinations at 12 weeks and 18 weeks: Fetus with normal attitude, heart rate 158b/min, nuchal translucency NT=1.1mm,  normal fetal vertebral column.





But  the 3rd OB ultrasound examination, in 23th week, detected a  micrognathia, abnormal  curved attitude of vertebral column, hyperextension,  which appeared in days of follow-up. 2 small lungs in small thorax, a few movements of 2 upper and lower limbs and fingers in extension time by time in uterus.  But other viscera  of fetus were normal.









MRI detected loss of septum pellucidum.






The parturient was sent to HV hospital for a prenatal care, and  an amniotic fluid analysis was done . FISH test showed no abnormal chromosome of 13th, 18th, 21th , X and Y,  and karyotype result in 4 weeks next. In one week follow-up in hospital, with many sonologists, fetal  attitude no change which made thorax  more compressed, small stomach and polyhydramnios due to fetus cannot swallow.
Because of  nothing change for one week,  the poor pregnancy had to be end.


DISCUSSION
Fetus in 23 weeks with malformation= abnormal hyperextention of vertebral column and four limbs and micrognathia, no septum pellucidum.  FISH test showed normal  13, 18, 21, X , Y chromosomes. (Double test and Triple test  not yet performed).
In birth, micrognathia, fingers in gripping, curved vertebral column looked like abnormal 18th chromosome.


Few in literature of abnormal curved vertebral column of fetus, there was 2 papers but the vertebral column changes normal at birth without malformation, and babies remain well.

Monday, 11 May 2015

CASE 311 : ACUTE HEMIFACIAL PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC.

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Boy 14 yo, 7 days ago, pain at left  hemifacial and  fever.



ENT doctor  after  rhinoendoscopy said, but  one week with treatment  no response.

Emergency consultation  with  ultrasound  paranasal sinus ( us 1 imge= transversection scan  with 3.5 MHz laydown position at left  maxillary, showing  the sinus filling  with fluid /  us 2 imge=  at  right  sinus no fluid  only intrasinus air/  us 3 image=   in  comparison to  image  of sinus  scan ultrasound of R and L  maxillary / us 4 image = scanning in  sitting position ).





Ultrasonologist  suggested  acute  sinusitis of  maxillary.

MSCT  confirmed  this US diagnosis.


Blood tests  also  make  sure an acute infection.



Summary of case 311: quickly  scaningn ultrasound  at  paranasal sinus  make  exactly diagnosis  acute  sinusitis  in  emergency room.

REFERENCE:

Saturday, 9 May 2015

CASE 310: CAMEL HUMP'S SIGN of THE NECK, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-310-camel-humps-sign-dr-phan-thanh-hai


Woman 31 yo,   4 months ago detected  left postero-lateral of the neck swelling, no painful  (see foto).


XRays of the neck:  normal cervical spine bone (xray1, xray 2).


Ultrasound  of this mass  revealed  intra trapezius muscle,  echo  very poor, hypovascular,   crossing  middle line of the neck ( us 1, us 2).




MRI of  the neck  with gado, found out this mass  intra trapezius muscle  well- bordered and  enhanced with gado, and central necrosis.






Core biopsy was done. Wait for histoimmunostaining report.

Biopsy  tumor  report  is  rhabdomyosarcoma.




Saturday, 2 May 2015

CASE 309: RENAL TRANSPLANT, Dr PHAN THANH HẢI, MEDIC MEICAL CENTER, HCMC, VIETNAM

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Male patient 76 yo,  with right  renal transplant 7 years ago, now he detects urine volume lesser than  500ml for 24 hrs, and nephrologist  requested  ultrasound screenning of  greff  kidney  in urgency and blood tests for kidney investigation.

Ultrasound found out  the  kidney greff at  right pelvis, size of 13cmx 9 cmx 7.5cm,   echo structure  liked normal, no  hydronephrosis,  and color Doppler   study of  the  vascular supply for this kidney  is  good   with  RI = 0.71.







What is your  suggestion  after  ultrasound examination for the case?.
 BLOOD TEST RESULTS=  NORMAL RENAL FUNCTION.

REFERENCES: 
ref 1 , ref 2