CASE 223: BIG IVC, Dr PHAN THANH HẢI- Dr NGUYỄN KIM THÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN  33 yo  PECTUS EXCAVATUM,  ONSET OF  EPIGASTRIC PAIN  WITH  RADIATION  TO BACK  DORSAL SPINE.

ULTRASOUND OF ABDOMEN  DETECTED  BIG IVC  WITH  SIZE  OF =2.4-2.7cm,  ECHOGENIC  BLOOD FLOW.

 

SPECTRUM DOPPLER OF IVC SHOWED TRIPHASIC PATTERN WITH PV  11.2cm/s.

TEE 3D  CARDIAC  REPORT WAS NORMAL.

WHAT IS  CAUSE  OF BIG  IVC ?

MSCT of abdomen showed that IVC  is dilated in  going to heart,  diameter of 2.9-3.3 cm.

What is your suggestion ?.

REFERENCE  IN INTERNET OF  THE CASE ABOUT PECTUS EXCAVATUM AND IVC IS SAME AS  THIS CASE,  SUGGESTED  IVC  DILATED  DUE TO  PE (PECTUS EXCAVATUM).

CASE 222: LIVER MULTIPLE SPOTS due to COLON CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 31 yo  onset fever one month ago but not control by antibiotics. Pain in liver region.

Ultrasound  detected  some round spots  like  liver abscesses.(US  B mode, CDI, Elasto).

MRI  with  gado CE detected  also  many  round  spots,   same size of  2 cm, with central necrosis looked like metastasis.

Blood tests=   WBC rising of 20k with 85% neutro, negative sero amibe, normal CEA.

Colonoscopy for detection of primary cancer disclosed, at splenic angle of colon, infiltrated induration lesion which was suspected colon tumor .

 And biopsy with microscopic report was colon cancer.

Summary; this case is colon cancer metastases to liver.   

CASE 221:ELASTOSCANNING of FACIAL SKIN SPOT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

MAN 59 YO, 3 MONTHS AGO THE FACIAL SPOT GETTING GROWTH FASTLY  AND BLEEDING. THERE WERE 2 SPOTS ON RIGHT AND ANOTHER ONE ON LEFT SITE. [SEE IMAGE 1,2].

HIGH FREQUENCY ULTRASOUND WITH ELASTOSCAN SCANNING HAD  DEEP PENETRATION UNDERSKIN  AND HARDER PATTERN WHICH SUGGESTED BASAL CELL CARCINOMA INVASIVE. [ULTRASOUND IMAGES 1,2,3 BELONGED  LEFT SPOT, IMAGE 4 WAS RIGHT SPOT].

Biopsy the mass, microscopic report  is  BCC  (Basal cell carcinoma).

Discussion: Elastoscan map preop of  skin lesion  is  best evaluation for guiding of  biopsy and planning operation  .

REFERENCE:.Elastoscan of skin.

CASE 220:SMALL BOWEL G. I. S T.: Dr LÊ THANH LIÊM, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male 65 yo, occult blood stool  (+) in check-up,  then underwent  colonic endoscopy to confirm colon tumor, but only colonic polyp was detected.

Ultrasound pre endoscopy disclosed  a hypoechoic mass in LLQ, semilunar shape, with size of 28x25mm which  one part of contour was regularly round and another part close by lumen gas inside a loop of small bowel . There was vessels into this mass. 

The LLQ mass was thought to be a GIST of small bowel.

CEA rising of 5.38ng/mL

MSCT confirmed  the small bowel GIST later.

Surgery was done, macroscopic result was mural tumor of small bowel. 

Microscopy and immunohistostaining were proved for GIST tumor of small bowel.

CASE 219: RETROPERITONEAL TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN HỮU CHÍ, CHILDREN HOSPITAL 1 and MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Girl 6 yo, recurrent abdominal pain. Ultrasound detected one ovoid mass at the head of pancreas with size of 3x5cm, solid and well-bordered.

Image 1: this mass and IVC.

Image 2: CDI relation with right renal hilus.

Image 3: this mass expanding artery and renal vein.

Image 4:echo structure this mass is inhomogeneous, microcalcification and

hypovascular supplying.

MSCT  with CE: clear borders and  location of  this mass.

Blood tests were normal .

What is your suggestion based on  ultrasound and CT images?

PRE-OPERATION  THERE WERE  3  SUGGESTIONS OF DIAGNOSIS, AS  RETROPERITONEAL TUMOR, ADRENAL  GLAND TUMOR AND PANCREATIC TUMOR OF  PROCESSUS  UNCINATUS.

THIS CASE  WAS OPERATED REMOVING  THIS TUMOR EASILY.  IT  HAD APPEARANCE OF HEAD OF MEDUSA  (SEE  FOTO). THE STRUCTURE  INSIDE THE TUMOR WAS IN  RED COLOR  LIKED  BONE MARROW TISSUE.

MICROSCOPIC REPORT IS NEUROBLASTOMA.