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Monday, 28 December 2015

CASE 356 : COLO-COLIC INTUSSUSCEPTION, Dr PHAN THANH HẢI, Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 56 yo, acute  colic pain at  right  upper quadrant of  abdomen,  crisis and  vomitting 3 days ago.
Ultrasound  scanning of liver

US1: Ultrasound detects big mass  near gallblader liked a bowel loop dilated.


US 2: Right colon dilated  with  multiple layers  which is oignon sign.


US3. Coecum moved  up near liver  connected with one cystic mass.


US 4  Cystic mass  with  multiple  rings  [oignon sign],  typical of  mucineous cyst  of appendix.


CT scan abdomen detected  right colon  moving up  with  coecum  intussusception (CT1 frontal  section;, CT2, sagital section; CT3, frontal section).




Emergency  operation with diagnosis  colo-colic intussusception  by  appendicular mucocele.
See specimen of operation by right colectomy.


Microscopic report  is appendicular mucocele. 
Reference:

Saturday, 26 December 2015

CASE 355: PAROTID GLANDS TUBERCULOSIS, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HO CHI MINH CITY, VIETNAM


A female 19 yo patient, student, swelling and pain in the parotid glands about a week, not fever.


Ultrasonography showed multiple structures within the parotid glands on 2 sides, hypoechoic, well-defined, measuring approximately 5 - 12 mm, with the umbilical node. She was diagnosed inflammation of the parotid glands and antibiotics for ten days  (cephalosporin 3 and fluoroquinolon).


But parotid glands swelling continuosly, ultrasound images  with more nodules in the parotid glands,and antibiotics for ten days again. In next follow-up visit parotid glands biopsy was done, and result showed chronic salivary gland inflammation.
Patient was sent to hospitalization Ho Chi Minh city in dentomaxillofacial center for 2 weeks of antibiotics as Sjogren syndrome. Parotid glands still  swollen and had discharge line to detect skin.  And she returned to MEDIC for parotid gland ultrasound.

Ultrasound image showed multiple hypoechoic structures with fluid inside, well-defined, proliferative vascular supplying, created road detect skin.

MSCT with CE showed parotid gland hypertrophy, having multiple lesions with fluid density in the central area.



Parotid gland biopsy showed salivary gland with Langhans great cells.


Parotid gland fluid examination showed high ADA and PCR/ TB (+).



Tuesday, 22 December 2015

CASE 354: RIGHT KIDNEY TUMOR, Dr PHAN THANH HẢI-Dr TRẦN LÃM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  37 yo, screening by  MSCT total body  non CE  detected  abnormal  border of upper pole of right kidney (images CT 1, CT 2).



Phased  CT CE find out  this mass being tumor of upper pole of right kidney, size  of3,5 cm with the rim border but non fatty tissue in structure (CT 3, CT4).



Ultrasound for verifying of this mass is mixed echoic, hypovascular supplying, not invasion to hilus of right kidney (US 1, US 2( longitudinal scanning), US 3 (cross-section).




What is your  suggestion of diagnosis, and biopsy or not?

Urologist  says no biopsy, clinical  imaging  looks like  RCC. Planning to surgery, partial nephrectomy (see macro).



MICROSCOPIC REPORT  IS  RCC (RENAL CELL CARCINOMA).



Thursday, 17 December 2015

CASE 353: SCALP SKIN TUMOR, DR PHAN THANH HẢI,Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM


MAN  37 YO. HISTORY:  KNOWN THAT SMALL TUMOR  AT OCCIPUS  AREA.OF SCALP FOR 20 YEARS . BUT THIS  YEAR  THIS TUMOR IS GETTING BIG  SIZE
 OF10CM, NO PAIN.

ON CLINICAL EXAMINATION THIS TUMOR IS HARD IN PALPATION ( FOTO).


ULTRASOUND  OF THIS TUMOR  BY LINEAR PROBE 10MHz : THIS TUMOR IS SOLID, THICKENING ABOUT 1- 2 CM, HYPOECHOIC, HYPOVASCULAR.

 ELASTOSCAN US   IS HARD  OF 22kPa.  NO EROSION IN  BONE  BELOW  ( SEE US 1, US 2, US3, US 4).





ONE DERMATOLOGIST   SUGGESTED  SEBACEOUS NEAVUS.

OPERATION REMOVED THIS TUMOR ( SEE  MACRO).



Microscopic result is syringoma.


Report of  another case ( Dr Le thong Luu) soft  tumor of the thigh ( foto). 
Ultrasound is  cystic  tumor, but  macro and  microscopic report post op is  syringoma.






Tuesday, 15 December 2015

CASE 352: PROSTATE TUBERCULOSIS , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  49yo, dysuria, clicinal examination  detected  big lymph node on his left nec( foto).



Ultrasound  examination of  the neck: normal thyroid  gland, size of  lymph node of  2cm,  hypoechoic  without hilus  on color doppler ( US 1).



On elastoscan, center of this  lymph node is hard  22kPa.



Ultrasound  scanning of pelvis  detected prostate having  one hypoechoic mass   at  right lobe ( US 3).




 US scanning  at epigatric area detected one mass ellypsoid of  3 cm lying over aorta (US 4).


Sonologist suggested a prostate cancer with metastasis to  lymph node.

CT scan with  CE revealed the mass in prostate  hypovascular, no contrast enhancement. looked like  necrosis or abscess.





Biopsy of  this cervical lymph node is tuberculosis lymphadenitis  (photo )


Punction of  prostate mass  removed pus specimen, and  examination this pus with PCR is TB positive and  high ADA.
Blood test  PSA is 2.05 ng/mL.

CONCLUSION:  this case is  tuberculosis prostate and lymph node looked like  prostate cancer metastasis to cervical lymph node.


Wednesday, 9 December 2015

CASE 351:A CASE of FITZ-HUGH-CURTIS SYNDROME , Dr PHAN THANH HAI - Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 24 yo post partum,  pain at right pelvis and fever. But one day after, pain  at  liver region, palpation is very painful  at Murphy point liked  cholecystitis.
Ultrasound of abdomen  cannot  detect   cause of pain, no stone in gallbladder , no thickening of the wall of gallbladder, no free air or free fluid at  Morrison space (see US pictures 1,  2).


Ultrasound at pelvis  revealed  thickening  of pelvic  peritoneum and hypervacular  at right  uterine tube ( US 3).


MSCT of  abdomen without  CE cannot detect  abnormal ( CT 1);  with CE  injection, in delay  phase  radiologist  reported  abnormal perihepatic contrast  enhanced.








Blood tests :  high CRP of 104.89ng/ml, WBC normal.

Suggestion for this case : perihepatitis and PID [pelvic inflammatory disease] means   FITZ-HUGH-CURTIS SYNDROME.


THIS PATIENT HAD BEEN TREATED BY ANTIBIOTICS,  CLINICAL STATUS RESPONSED VERY WELL, NO MORE PAIN AND  NO FEVER, AND  DISCHARGED  HOSPITAL AFTER  3 DAYS.


REFERENCE: FHC SYNDROME.