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Wednesday, 26 February 2014

CASE 237: HORSESHOE TUMOR, Dr PHAN THANH HẢI - Dr NGUYỄN TUẤN VINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 57 yo, diabetes and  gallbladder stone. He's got Murphy's pain.
Abdominal CT with CE detected the  horseshoe kidney with tumor of 3cm.( Fig.CT 1).

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Ultrasound  for  evaluation of this tumor  was hypoechoic, at the  left part of  horseshoe kidney and hypovascular( Fig. US 1, US 2).



MSCT 640 slices performed with CE again for staging  of this tumor (see 4 CT pictures).







One urologist  said no biopsy.
Operation  for  removing left part of  horseshoe kidney.

Macroscopic appearance of  tumor  is well-bordered into parenchyma of kidney.  Microscopic report is clear cell carcinoma.

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Friday, 21 February 2014

CASE 236: LYMPHOMA MIMICKING PANCREATIC TUMOR and METASTASIZING LYMPH NODES in ABDOMEN and NECK, Dr LÊ THANH LIÊM - Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

        58yo  male patient, slight fever  and  fatigue for 6 months, a lymph node on right neck getting bigger.  
           Lymph node at supraclavicular area was hypervascular and looked-like a cyst on color Doppler ultrasound. 

      Ultrasound  of abdomen detected epigastric tumor between left lobe of liver and pancreas, hypervascular and celiac vessels penetrating the tumor. Some nodes were  around the tumor, and body of pancreas not well-bordered. 







     Ultrasonologist thought about lymphoma infiltrating in abdominal cavity and neck,  but keepng a different diagnosis with pancreatic tumor metastasizing abdominal and neck lymph nodes.
       MSCT confirmed lymph nodes lymphoma in abdomen and no pancreas tumor but lower density of the body.


     FNAC of neck lymph node and the result was big B cell lymphoma. So this is another case of big B cell lymphoma with the evident of neck FNAC result.




Sunday, 16 February 2014

CASE 235: PERIAORTIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

Man 63 yo,  medium arterial hypertension with umbilical battement with the heart beat.

Ultrasound of abdomen detected  kidney on 2 sides  in hydronephrosis due to ureteral compression by the mass covering arround the abdominal aorta. Of which structure was echo-poor looked like a cyst. The aorta was pull up near the umbilicus (see 5 ultrasound pictures ).






MSCT with CE (4 CT pictures); CT 1..kidney hydronephrosis, CT 2, CT 3, CT 4 .. intratumor abdominal aorta.






Blood tests were normal WBC, PSA, CEA, with beta MICROGLOBULIN was 2298ng/ml (N <2164

Urologist  suggestion was retroaortic lymphoma and he put 2 jj stent intra ureter and operation for biopsy this mass.
Open operation detected this mass being fixed and covering aorta and compressing completely causing collaped  IVC.( see foto per op.1 and 2..right ureter with jj stent inside).


Pathology report was big B cell lymphoma.

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Sunday, 9 February 2014

CASE 234: A LATERAL MASS of the NECK, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 56 yo for a long time being follow up with thyroid nodule, now he detected the palpable mass on right neck,  sited at middle SCM.
Ultrasound suspected lymph node with B mode ultrasound (image 1,2: thyroid nodule) on right side of the neck.



For ruling out a thyroid cancer, a FNAC was performed for the thyroid mass and the result was colloidal goiter.


MRI of the neck also suspected this mass between carotid internal and external arteries ( 2 MRI pictures).



For diagnosing this neck mass we did CDI for guiding FNAC, but this mass was very high vasculature and situated between ICA and ECA. (See 2 CDI images  of cross section and longitudinal scanning this mass).



MSCT ANGIO was done to see carotid artery on right side was encarcerated by this tumor with very high vascular structure.
Diagnosis is CAROTID BODY TUMOR ( See 3 MSCTA images).




 
Operation  removed  completely  this  tumor in safety and  microscopic  with  immmunohisto staining  report  that  a  paraganglioma  tumor.

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Monday, 3 February 2014

CASE 233: ABDOMINAL MASS AFTER TRAUMA, Dr PHAN THANH HẢI - Dr PHÙ VĂN TUỐT, BÌNH AN HOSPITAL, VIETNAM

MAN 23 YO, for ONE WEEK UNDERWENT A BLUNT TRAUMA NEAR PARAUMBILIC AREA BY BICYCLE ACCIDENT, HE WAS GETTING WORSE MORE AND MORE  BY VOMITTING, AND CANNOT EATING. 

CLINICAL EXAMINATION OF ABDOMEN REVEALED A MASS OVER RIGHT KIDNEY, POSITIVE REBOUND TENDENESS ( PHOTO).


ULTRASOUND in FIRST LINE SHOWED THE STOMACH WAS DILATED. THE  MASS WAS AT DUODENUM D2-D3, SIZE OF 5 CM, CYSTIC STRUCTURE BUT NO FREE FLUID IN HIS ABDOMEN ( 3 U/S IMAGES).




XRAYS of ABDOMEN in STANDING POSITION and BARIUM MEAL  SHOWED THAT DOUDENUM  in OBSTRUCTION.




MSCT of abdomen: this mass was from duodenum wall,  cystic structure,  size of 5 cm. Radiologist made diagnosis  of hematoma intraduodenum wall without bleeding into abdomen.






Medical treatment by nasogatric suction  and  wait and see the progress.
 
AFTER 4 DAYS for  NASOGASTRIC SUCTION and IV FLUID REPLACEMENT, NASO GASTRIC TUBE HAD BEEN REMOVED and XRAY BARIUM MEAL for  BEING SURE NO OBSTRUCTION of  DUODENUM. HE CAN DRINK and  EAT  and  RECOVERY STAGE DURING SO FAST (see XRay barium meal on  Jan 24, 2014).
IT IS FIRST STEP of  SUCCESS of MEDICAL TREATMENT for HEMATOMA DUODENAL WALL POST TRAUMA.

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