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Monday, 17 June 2019

CASE 555 :R_CCA Obstruction, Dr PHAN THANH HAI, Dr DUONG XUAN TUNG, Dr PHAN THANH HAI PHUONG, Dr LE THI THANH THAO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Woman 66yo with past history  of 10 years ago had been treated by radiation of the neck as NPC.
Now her chief complaint is headache.

ULTRASOUND OF THE NECK   DETECTED R CCA OBSTRUCTION  COMPLETELY BUT R/ECA STILL HAD FLOW.
US1, US2, US3 =  R -CERVICAL ARTERY  HAD FLOW UP.




MSCT ANGIO OF THE NECK ARTERY.

CT1   ( DISCONTINUE RCCA )  CT2   CERVICAL SINE ARTERY  
CT3  3 D  VASCULAR OF THE NECK  WITH ANASTOMOSIS.




CONCLUSION= RADIATION OF THE NECK INDUCED STENOSIS of  R-CCA.

REFERENCE  CASE REPORT

Sunday, 2 June 2019

CASE 554: PULMONARY AVM, Dr PHAN THANH HAI, Dr TRAN THUY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


A 40 YO WOMAN in ANNUAL HEALTH CHECK UP, SHE HAS RECOGNIZED DULL LEFT CHEST PAIN FOR MANY YEARS.

US1: IN CROSSED SECTION OF SPLEEN AND LEFT LOWER PULMONARY LOBE INCIDENTALLY NOTES THAT A CYSTIC LESION IN LOWER LEFT LUNG TISSUE AND PLEURAL EFFUSION.



US2:  CDUS IN THIS CYSTIC LESION REPRESENTS YIN-YANG SIGN.


US3: SPECTRAL DOPPLER TRACE FROM THIS CYSTIC CONFIRMING ARTERIAL BLOOD FLOW.



US 4, US 5: THERE IS A PULMONARY ARTERIAL AND VENOUS FLOW BESIDE THE CYST.



MSCT CE:
CT1, CT2: FRONTAL VIEW CONFIRMS AN ANEURYSM IN THE LEFT LOWER LOBE WITH AN FEEDING ARTERY AND A DRAINING VEIN.


RADIOLOGICAL DIAGNOSIS IS A PULMONARY ARTERIOVENOUS MALFORMATION CASE.

OPEN SURGERY REMOVED LOWER  LOBE OF LEFT LUNG AND THE PULMONARY AVM.

MICROSCOPIC REPORT IS HAEMORRHAGE OF PULMONARY VASCULAR CONGESTION.



Conclusion:
This is a pulmonary AVM case incidentally found out in a pleural effusion that was discovered by ultrasound and confirmed by MSCT later.

Saturday, 1 June 2019

CASE 553: MANTLE CELL LYMPHOMA, DR PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC. VIETNAM.


Woman 40 yo, 2 years ago  detected at left frontal  area over eye brow a tumor slow growth, no pain  hard palpation (photo).




CT scan of the head,  this tumor is out of skull bone  below the skin  3 cm.
CT1 CT2 with ce,  this tumor had ce enhancement  



Ultrasound of this tumor.
US 1  with Bmode  this mass is hypoechoic very black look like a cyst,   with mirror effect  ( us 1)  US2  cdi  it had vascular    
US 3  with pdi   detected vasculature intra tumor  US4  with SMI many small vascular







US 5  video of SMI.

Ultrasound suspected lymphoma.
Open surgery removed this tumor and histology with immuno histo chemystry is  MANTLE CELL LYMPHOMA.

NOTA: Mantle cell  is  cell  from the mantle zone of lymph node.



Sunday, 26 May 2019

CASE 552: ULTRASOUND OF A CYSTIC NECK MASS, DR PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


WOMAN 46 YO  HAD BEEN DIAGNOSED A RIGHT NECK MASS, CYSTIC APPEARANCE WITH PUNCTURE ASPIRATION REMOVED YELLOW FLUID MANY TIMES FOR 3 YEARS.  

NOW SHE  RECOGNIZED THIS MASS REFORMING AND GETTING BIGGER ( SEE FOTO).




ULTRASOUND OF THE NECK SHOWS THYROID IS NORMAL, and   CYSTIC MASS LOCATED AT LATERAL OF RIGHT NECK   ALONG OF SCM MUSCLE.

US1= (CROSSED SECTION)

US2 = LONGITUDINAL SCANNING  WITH SUPERB MICROVASCULAR IMAGING [SMI] TECHNIC  SHOWS THAT MICROVASCULAR PATTERN OF TUMOR 
US3=  LONGITUDINAL SCANNING WITH CDI TECHNIC.




US4=  VIDEO  WITH  SMI TECHNIC  SHOWS VERY HIGH VASCULAR SUPPLY  FOR THE MASS.


MSCT WITH  CE  OF THE NECK=

CT1:  THE MASS IS LATERAL OF  COMMUN CAROTID ARTERY [CCA].

CT2:  THIS MASS APPEARES  MIXED CYST AND SOLID STRUCTURE.

CT3:  LONGITUDINAL SCANNING OF THIS MASS WITH CALCIFICATION OF THE WALL.




CT AND ULTRASOUND CANNOT  MAKE SURE DIAGNOSTIC for THIS CYSTIC MASS.

FNAC   REPORTS CANCER CELLS IN CYSTIC MASS   BUT CANNOT SHOW THE ORIGINAL OF THESE CELLS.


FNA OF THE FLUID AFTER  FNAC AND QUANTIFIED THYROGLOBULIN IN FLUID IS VERY HIGH THAT HELPS MAKE DIAGNOSTIC OF THYROID CYSTIC CANCER IN ECTOPIC SITE.



REFERENCE


Saturday, 18 May 2019

CASE 551: PNEUMOPERITONEUM POST CTC, Dr PHAN THANH HAI, Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


WOMAN 68YO  WITH  FOBT TEST POSITIVE  TO DO  VIRTUAL CT COLONOGRAPHY. 
REPORT OF CT DETECTED FREE AIR IN ABDOMEN CAVITY, AND NO DETECTED TUMOR IN COLON (SEE  CTC , CT1).


   
CLINICAL EXAMINATION OF THE ABDOMEN IS NOT PAINFUL BY COMPRESSION, NO CHANGE  VITAL STATUS.  
US  SCANNING DETECTED FREE AIR  IN HYPOGASTRIC AREA AND  LIVER BORDER ( US1).


TREATMENT   FOLLOW_UP   THE STATUS  NO EATING BY MOUTH 24 HRS.  REVIEW  AGAIN THE VITAL STATUS  NO PERITONITIS   
MSCT AGAIN  DETECTED THE FREE AIR IN ABDOMEN IS  REABSORPTION (CT2). 



ULTRASOUND OF ABDOMEN AGAIN DON'T SEE  FREE AIR  IN THE PERITONEUM.




CONCLUSION=   CTC  BY CO2  COMPLICATION IS PNEUMOPERITONEUM  NO DETECTED TUMOR IN COLON OR SITE OF PERFORATION. NO NEED OPERATION.

WAIT AND SEE.

REFERENCE : CASE of CAT SCRATCH COLON.



Monday, 13 May 2019

CASE 550: ULTRASOUND FOR BUCCAL TUMOR, DR PHAN THANH HAI, DR TRAN THI THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


WOMAN 63 YO  DETECTED AT RIGHT FACIAL BUCCAL AREA  ONE MASS  THAT DEFORMED HER FACE,  NO PAIN FOR 3 MONTHS  (SEE FOTO).




ULTRASOUND=   

US 1: SCANNING OVER TUMOR,  NEAR MASSETER MUSCLE  and OVER  BUCCALIST MUSCLE  EXISTS ONE  HYPOECHOIC MASS MOVING BY PRESSING OF THE PROBE, THAT LOOKED LIKE FLUID, BUT ON DOPPLER NO DETECTED ANY VESSELS.

US 2 : VIDEO IN OPENING OF THE MOUTH and THIS MASS IS MOVING.


US 3: OPENING OF SUPERB MICROVASCULAR IMAGING [SMI] SCANNING (CANON  APLIO A I 450)  DETECTED  MORE SMALL VESSELS, THEN  IT IS NOT FLUID  BUT LIKED FATTY TISSUE.

  
SONOLOGIST SUSGESTED FATTY PAD PROCESS ( BUCCAL FATTY PAD).
  
OPERATION REMOVED FATTY MASS.


MICROSCOPIC  REPORT IS FATTY TISSUE.


ANATOMY OF BFP ( BUCCAL FAT PAD).