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Thursday, 23 March 2017

CASE 424 : LUNG TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM


Woman 54 yo  with chest pain.Chest x-ray  detected  one round mass  at right lung.(  chest x-ray AP). 



Ultrasound  of the right lung represented this mass  is  hypoechoic  like  cyst (US).



MSCT CE (CT 1, CT 2, CT 3) =  this  mass is  well bordered, size of  6 cm,  adherent to the chest wall, with  pleural effusion, no contrast enhancement.





Blood test of  all  cancer markers are negative.
What is your  suggestion for diagnosis  for the right lung mass?.


Operation  VAST
REMOVing TUMOR and CENTRAL NECROSIS  in macroscopic view 
MICROSCOPIC IS  ADENOCARCINOMA



Sunday, 19 March 2017

CASE 423: BLACK EYEBROW SIGN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


50 yo woman, after trauma at her right face, she cannot see by ptosis of right upper eyebrow (photo).


Ultrasound scanning of the orbit and right eye are normal but cannot see the orbit when the probe is put on the upper eyebrow, because there is air into right upper eyebrow while the show-down does not appear on left eye ( US 1, US 2).



MRI of  the orbit  confirmed the normal right eye  but one black ellipse covered the right eye extend to skin of temporal area. It is air under eyebrow skin ( MRI 1, MRI 2, MRI 3  MRI 4).





CT scan of the right orbit  detected  fracture of orbit bone and black eyebrow sign appeared again due to air emphysema in right upper eyebrow.



Conclusion: Ultrasound, MRI, CT  can detected  black eyebrow sign  due to orbital blow-out fracture.



Monday, 13 March 2017

CASE 422: TESTIS TORSION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM



Boy 18 yo  3 days ago..onset pain at left  scrotum  after  sport playing.
No fever but changing of color  skin of  left scrotum ( foto).


Ultrasound in emergency:
US 1:  avascular testis  in comparison  left side  to right side.


US 2:  very soft left testis on elastoscan.


US 3 :  left cord is cut of vascular supply to left testis.



Blood test : WBC 12k 28   Neutro 8k25  CRP= 0.58 
Clinical examination and  emergency ultrasound showed  intra vaginalis torsion of left testis
Operation   detected black left testis,  avascular  for a long time, then   resection of left testis.



Conclusion:  Torsion of testis in long time  due to delayed diagnosis  and testis necrosis that  must  be removed the testis torsion.

                                                  

Friday, 3 March 2017

CASE 421: EPIGASTRIC HERNIA, Dr PHAN THANH HẢI, Dr DƯƠNG NGỌC THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Woman 57 yo   detected on mass below  the xyphoid  process at middle line. 
Ultrasound  scan of the  epigastric region of abdomen  with  curve  probe 3.5 MHz.
US1: longitidinal scan  detected the  defected  abdomen wall  and the mass is  connected into abdomen.


US 2: crossed section.of.this mass.


US 3  scanning of this mass with  linear probe  10 MHz.  Diameter of the orifice #   1.5cm. And  fatty tissue  is pulled out the abdomen by this orifice.


US 4 :  crossed section of this mass.


Sonologist  diagnosed  epigastric hernia.
Operation showed this mass is built  by  fatty tissue and  epiploid of transverse colon.




Picture reference.


Wednesday, 1 March 2017

CASE 420: Mid-aortic Dysplastic Syndrome in young patient with hypertension. Dr.Phan Thanh Hải Phượng, Dr.Trần Lãm.


Young female patient came to clinic with chief complaint intermittent claudication for months. On
clinical exam salient abnormality is mild hypertension 150/80mmHg, legs skin has few telangiectasia.
Doppler ultrasound in legs shown normal venous system and monophasic waveform throughout
FEMORAL arteries-> POSTERIOR TIBIAL arteries. So, the stenosis must from above and compensate with collaterals since high diastolic velocity tell us (PIC 1).

On abdominal ultrasound exam, monophasic waveform in both ILIAC arteries and aortic dilation at
bifurcation, above that, no obstruction detected (PIC 2).
 
Noticed AORTA quite small from below SUPERIOR MESSENTERY artery, transitional point is subtle d=7.3->6.9mm (PIC 3,4). Renal arteries aliasing in both side, high PVS R=189cm/s L=193cm/s at α=60 degree, RIR=6.3, normal interlobular waveform AT<0,07s, they could suggest the stenosis range 50-69% (PIC 5).

CTA confirmed the stenosis and large collateral pathway in pelvic.(PIC6) Most narrow aorta diameter d=6mm, Aorta diameter below stenosis=17.4mm. Right renal artery d=4.8mm, Left renal artery=3.1mm  As this occurred in young patient it could possibly Mid-aortic Syndrome or type II TAKAYASU disease.



The two disease differentiated by histopathology of inflammatory change, which is present in Takayasu arteritis but not in MSD.  Lacking of signature US sign “macaroni” or ”halo sign”, CTA no sign of lumen thickness, Takayasu is less favored in this case.


Patient currently treated with hypertension controller since the legs are perfused by the large collateral.


Mid-aortic dysplasia syndrome (MDS), is a rare disease characterized by constriction of abdominal aorta and its branches, therefore, is also known as abdominal aortic coarctation. Patients usually die due to progressive severe hypertension before age of 35–40 if left untreated. Etiology is unknown but embryological theory, failure in fusion of the paired dorsal aorta during the fourth week of gestation
may cause MDS. Acquired conditions such as infection, obliterative panarteritis, neurofibromatosis,
retroperitoneal fibrosis, fibromuscular dysplasia, mucopolysaccharidosis and Takayasu’s arteritis have been incriminated in MAS. Approximately 60% of cases, no etiology can be found. The renal arteries are involved in about 90% of the cases, the coeliac axis and superior mesenteric artery in 35–50%, while the inferior mesenteric artery is almost never affected. A common histopathological finding in idiopathic
MDS is fibroplasia of the intima and internal elastic lamina distortions with a lack of inflammatory
changes that characteristically distinguish it from Takayasu’s arteritis. [1]

1. Saha K, Saha D, Ranjit P, Sarkar S, Mondal RRS, Thiyagrajan G. Mid aortic dysplastic syndrome as a rare cause of hypertension in young. International Journal of Case Reports and Images 2013;4(10):563–566.