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Sunday, 22 October 2017

CASE 458: PERIAORTIC LYMPHOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Man 77 yo with  renal  hydronephrosis  and  insufficiency, EGFR= 11 ml/mn.
US scanning of abdomen:
US 1, US 2=2 kidneys hydronephrosis  no stone.




US 3  crossed section of aorta: Periaortic  thickening  by  hypoechoic ring.


US 4  longitudinal  scan of  abdominal aorta.
US 5: CDI.
US  6 :  scan at aorta bifurcation, CDI   longitudinal  scanning of  aorta.





CT of abdomen non CE=
CT 1=2 kidneys  hydronephrosis.
CT 2  = frontal view,   aorta is covered by the mass.
CT 3 =sagittal view.




Blood test =  betamicroglobulin 12,577UI(n=2,164)  ferritin  621ng (n =400) 

Summary: 

Suspected  periaortic retroperitoneum  lymphoma in  compression of ureter  to make renal insufficiency. Wait for biopsy of  the inguinal nodes for  histo immuno stainning.

Sunday, 15 October 2017

CASE 457: AML KIDNEY TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN HOÀNG ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man 45 yo, ultrasound screening  detected left kidney tumor.
US 1: tumor of lover pole of left  kidney,  size 4 cm,  hypoechoic pattern.
US 2:  CDI, hypovascular mass. 
US 3:  crossed section  of this left kidney tumor.
US 4:  elastoscan of this tumor is 12kPa.





MSCT with CE
CT 1:  crossed section  this tumor is low CE.
CT 2: CT density HU  is low  
CT 3:  well limited bordered tumor.



MRI  showed  the intratumoral  fatty tissue and radiologist  suggesting AML kidney tumor.


Laparoscopic operation of web resection of this tumor ( see macro1).



Microscopic result  is  AML kidney tumor.

REFERENCE:


Friday, 6 October 2017

CASE 456 : LEG GAS GANGRENE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM













Man 41 yo,with  history of liver cirhosis and ascites. 3 days fever and pain at left swollen leg.
      [Foto1]. 



    Clinical suspected lower limb DVT

  • Ultrasound  ruled out DVT ( US 1=artery and vein at left inguinal), US 2   fluid collecting 
       between muscle quadriceps; US 3  scanning at calf  detected intramuscular  air
        US 4 air and  level.




MSCT non CE detected   air in calf muscles
CT 1  crossed section;  CT 2  sagittal scanning   


Blood test, WBC  no rising;    blood culture  detected  gram  negative bacillus, 
  •  For 24 hours after  hospital admission  patient was dead with  bullous legs [Foto2].




Blood culture identifies Aeromonas caviae.
REFERENCE :




Wednesday, 4 October 2017

CASE 455: FINGER TUMOR, Dr PHAN THANH HAI, Dr TRUONG TRI HUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Woman 54 yo,  4 months  ago  detected  one mass, at 4th finger of right hand,  slow growth,  no pain,  no disturbing movement.of this finger  (see  photo1, 2).



X-Rays  of AP and lateral views of 4th finger  = bone is  normal but  periosteum changing this mass to a soft tissue tumor ( xrays 1, 2).




Ultrasound   scan of this mass is hypoechoic like a cyst of lateral finger, from the tendon,  size 3 cm of length (US 1).
US 2  CDI of  vascular supplying arround this tumor means  a solid tumor
US 3  crossed section  of the arround vascular tumor.
US 4 mass is soft  on elastoscanning , arround 30 kPa.




OPERATION REMOVED TOTAL TUMOR.

MACROSCOPIC  REPORT BY SURGEON LOOKED LIKE  XANTHOMA, BUT  MICROSCOPIC REPORT IS  GEANT CELL TUMOR of TENDON SHEATH.


Sunday, 1 October 2017

CASE 454: IVC STENOSIS, Dr PHAN THANH HẢI, Dr TRỊNH DUY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Woman 30 yo with 3 times of miscarriage, she came to MEDIC for a check- up (foto  subcutaneous veins).


Ultrasound of abdomen and pelvis:  normal uterus size.




US 1 = big liver caudate lobe 
US 2 = IVC  stenosis at  upper portion of liver
US 3 = crossed section of IVC no flow with hepatic vein.

MSCE with CE:






CT 1=  normal uterus structure.  CT2  = IVC  contrast filling  short portion cannot go upper to liver portion.  CT3 =  crossed section of  dilated subcutaneous abdominal veins. CT4 = crossed section= IVC no contrast in liver portion and abnormal late phase of liver vein, 
CT 5  = surface abdomen skin.


TREATMENT  ANGIOINTERVENTION;   DILATATION of STENOSIS AND STENTING.




Summary  =  IVC abnormal  stenosis near  diaphragm and  many venous collateral returning ways. 

REFERENCE: