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Tuesday, 20 June 2017

CASE 438: RENAL HILUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Female patient 21 yo detected high blood pressure of 17/10 cmHg.
Ultrasound of abdomen detected  one mass at  upper pole of left kidney with  size of 3.5 cm. This mass  covers  left border of aorta, left renal hilum and adrenal fossa (US 1, US 2, US 3).




MSCT with CE= CT 1, CT 2,  CT 3, CT 4 (3D vascular)=    this tumor  covers the hilar kidney, very high CE enhancement. Radiologist says  adrenal tumor.





Blood test=catecholamine blood and  24 hrs urine analysis detected nothing abnormal
Metanephrine  blood =102 unit  (n= 90),  in urine = low 42 unit.
Operation  by laparotomy=

 Picture 1= this tumor  covers  the  left renal hilum.


Picture 2= Nephrectomy with tumor specimen.



Sunday, 11 June 2017

CASE 437: LIVER TUMOR, Dr PHAN THANH HẢI, Dr VƯƠNG THỪA ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Female patient 16 yo with epigatric pain.

Blood test=  HP positive.
Ultrasound  detected  left liver tumor.

US 1 =  longitudinal scanning of  left lobe of liver:   solid tumor , size  of 10 cm with central necrosis.

US 2 =  subcostal scanning :   tumor covers left liver lobe.

US 3  = color Doppler :  vascular supplying  of  this tumor.


US 4 =  elastoscanning of this tumor = 10,5-15 kPa.  


MSCT with  CE: CT 1, CT 2 =  artery and vein phases, CT 3 =  frontal view of this tumor from left liver.





Blood tests=  no infested HBV, HCV, Wako tests 3 negative.


PRE OPERATIVE  RADIOLOGIST AND SURGEON  SAY THAT  LIVER FOCAL NODULAR HYPERPLASIA (FNH).

OPERATION WAS DONE FOR RESECTION OF THE TUMOR (SEE  MACRO).




Macroscopic is  FNH.



Liver tumor FNH or HCC


Reference: Macro FNH and  flow chart of identification FNH-HCA-HCC.



Friday, 9 June 2017

CASE 436: SOLITARY KIDNEY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 32yo  with acute pain at  right renal fossa.
Emergency ultrasound:
US 1 = right kidney  hydronephrosis, no left kidney.
US 2 =  crossed section of  right kidney.
US 3 =  right  ureter dilated and stone of 1.5 cm in diameter.
US 4 = color Doppler  twinkling artifact  with stone.



US 5 = in  urinary bladder , urine jet only on right site.


US 6 =  cystic mass at the left wall of urinary bladder.



MSCT with CE=  
CT1:  fron tal view,  right  kidney  hydronephrosis no left kidney.
CT 2:  sagital view   the stone in right ureter.

CT 3:  3D view.
CT 4:  vascular malformation of agenesis of left kidney.




Saturday, 3 June 2017

CASE 435: CERVICAL LYMPH NODES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Female patient 23 yo detected  submandibilar nodes with history of recurrent sore throat. And some palpable  left cervical  nodes along  of SCM. No fever, nor pain.
US 1: hypoechoic, no hilus left submandibular nodes.


US 2: scanning  along  left site SCM, small hypoechoic nodes.


US 3: hypervascular  color Doppler .


US 4. high flow vascular  intranodes without defected area.


US 5: spectral Doppler  high RI and PI.


US 6: elastoscanning of  inhomogeneous nodes, central low kPa.


Biopsy of  the big submandibular node.
Blood tests=  normal WBC, CRP,  but high beta microglobuline 3200 UI, and  normal LDH, ferritine.

Microscopic report of this biopsy is tuberculosis  lymph nodes with LANGEHANS  MACROPHAGE CELLS.




SUMMARY :TUBERCULOSIS CERVICAL LYMPH NODES.

Monday, 29 May 2017

CASE 434: TESTIS TUMOR, Dr PHAN THANH HẢI - Dr LÊ TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Man  36yo with right testis tense.
Ultrasound scanning of  right scrotum  detected big testis focal lesion,  round,  size of 3cm
US 1  color doppler  not  hypervascular, well bordered.

US 2 CDI: hypovascular tumor.

US 3  elastoscan of  this tumor is inhomogeneous with some parts very hard.


MRI  with gado: MRI 1, 2, 3: this tumor  very low gado enhanced.




Radiologist suggested epidermoid  cyst.
Blood tests =  normal   AFP  and   HCG.
Operation   resection of  right testis (see  macro 1, 2).



Microscopic report is epidermoid cyst.


Tuesday, 23 May 2017

CASE 433: GIANT RETROPERITONEUM LIPOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.




Woman 44yo nullipareous, with abdomen  distention, and  clinical  suspected   ovary tumor.
US scanning of abdomen detected  all bowell loops in deplacement to left flank.

US 1: epigastric scanning detected  right kidney near left lobe liver.


US 2: big solid mass, hyperechoic  like  fatty tissue.


US 3, US 4  color Doppler  of this mass showed from  retroperitoneum which extended from the epigastric  to pelvis but  no deplacement of abdominal aorta.



MRI  with  gado:  This  big mass is in retroperitoneum deplaces right kidney to liver (MRI 1, MRI 2, MRI 3,  MRI 4 , MRI 5).  








Radiologist reports  that  retroperitoneal lipoma or retroperitoneal liposarcoma.
Operation removed this mass easily (see macro).



Microscopic report is lipoma.
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