CASE 869: KNEE SOFT TISSUE TB, Dr PHAN THANH HAI, Dr MA NGUYEN MINH TUNG, Dr VO HIEU THANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 53 year-old woman with right knee pain for 8 weeks limited movement and failed in anti-inflamed treatment. She went through lymph node TB in her childhood.

Liver and kidney functions were normal, normal CRP,  only positive QuantiFERON- TB.

Ultrasound noted swollen soft tissue of the right knee, blurred contour,  poor vascularised. Bone were intact.

X-rays of the chest and the right knee were still nothing.

But MRI detected the lesions of the soft tissue of the right knee.

Core biopsy result was a TB soft tissue of the right knee.

The anti-TB treatment was done,  the right knee pain released after ten weeks, and no limitation of the right knee movement.

MRI post anti-TB treatment showed the successful management as the  exact diagnostic and attack treatment.

Knee pain due to infected TB which is unusual should be think about when failed in traditional treatment.

CASE 868: CERVICAL VERTEBRAE TB and ANTERIOR MEDIASTINAL ABSCESS, Dr PHAN THANH HẢI , Dr NGUYỄN HOÀNG PHƯỚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 43 year-old man with neck pain progressing to his shoulders for 3 months. 

Neck ultrasound detected a # 180x65x25mm hypoechoic mass with sludge which was anterior of the neck spine from C4-7 that noted an TB neck abscess.

X-Rays detected an anteroir mediastinal mass,  damages of cervical spines and neck soft tissue lesion.

MSCT and MRI confirmed a TB abscess from C6 to T4 and damages of  the body of cervical spines from C7 to T4.

TB of cervical spine is rare entity of  MSK inflammation due to infected Mycobacterium tuberculosis which is the causative organism damages the body and disc of cervical spines and forms cold abscess. If untreated it could paralyze upper limbs or go out in fistula.

CASE 867: NEUROENDOCRINOLOGICAL PROSTATE CANCER, Dr PHAN THANH HẢI, Dr VÕ HIẾU THÀNH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 52 year-old man with dysuria for months.

Ultrasound TRUS detected prostatic hypertrophy and mixed echogenic like a tumor. Decision for biopsy of 12 specimen. PSA: 5.48ng/mL.

MRI noted prostatic tumor which invaded the bladder neck and pelvic lymph nodes.

Immunohistological staining proved a very rare neuroendocrinological prostatic cancer with fast progress [Ki 67 positive 95%].

Neuroendocrinological prostatic cancer is still a very rare entity thar detected lately as PSA being in low value.

CASE 866: PHPV and CATARACT, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN , MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 08 year-old female child with her left cloudy eye [leukocoria] from her first year of life.

Ultrasound detected left microphthalmos, left cataract and persistent hyperplastic primary vitreous [PHPV].

MSCT noted left ocular fluid in high density, while the left optic nerve and the left orbit were intact.

PHPV is synonymous with Persistent Fetal Vasculature that is the preferred term prior to Morton F. Goldberg’s 1997. PHPV is unilateral, associated with cataract. PHPV causes cloudy lense, retinal detachment, microphthalmos and strabismus.

CASE 865: PSEUDOANEUVRYSM of FACIAL ARTERY, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM , MEDIC MEDICAL CENTR, HCMC, VIETNAM

A 55 year-old man with his left swollen face and covered in bruise post trauma for one week.

Ultrasound detected edema and hematoma of facial soft tissue with dimension #42x27x22mm. Then Doppler ultrasound revealed aliasing sign of the left facial artery which was in high velocity Vmax # 165 cm/sec, and having to and pro flow pattern.

MSCT confirmed the # 30x14cm left facial arterial  pseudoaneuvrysm, lumen:14.4mm with its wall thickening #15 mm.

Stenting the left facial artery to solve its pseudoaneuvrysm.

Ultrasound with Doppler technic in first line may detect the vascular damage in case of trauma of the soft tissue.

CASE 863-864: CARDIA ESOPHAGUS CANCER, Dr PHAN THANH HẢI , Dr NGUYỄN QUANG HUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases one 57 year-old woman and one 38 year-old mam with loss weight and epigastric pain in fail of treatment as gastritis.

Ultrasound detected thickening of the cardia wall and metastase lymph nodes.

MSCT confirmed the cardia cancer but anapath result noted gastritis with infected HP of one case.

Case 01: Woman 57 year-old epigastric pain, nausea and loss of 7kg for 2 months.

Ultrasound deftected metastase lymph nodes #15-10m close by stomach and upper GI endoscopy noted cardia cancer. Biopsy result was carcinoma invaded the esophagus. The female patient died in hospital as the end stage.

Case 02: A 38 year-old man with epigastric pain, GERD, and loss of 10 kg of weight fof 4 months.

MSCT and endiscopy confirmed cardia cancer.

But results of 2 times biopsy were chronic gastritis.

At the third biopsy via endoscopy the result was the poorly differentiated  adenocarcinoma invaded the esophagus.

The patient went through chemotherapy management.

CASE 862: ARTERIAL HYPERTENSION due to RENAL ARTERIAL STENOSIS, Dr PHAN THANH HẢI , Dr TRẦN THỊ THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 39 year-old man, 63 kg of weight,  with ATH 230 mmHg [systolic].

Ultrasound detected the right renal arterial stenosis at 2 sites  > 50% and  the smaller right kidney # 82x41x38 mm than the left one.

Doppler ultrasound noted aliasing of the right renal artery with parvus tardus flow pattern.

Vascular MSCT confirmed the small right kidney and stenosis of the right renal artery at the beginning and middle parts due to thickening of the right renal arterial wall.

Right renal angioplasty and stent insertion of the right renal artery was performed.