CASE 916: COMPLICATED DIVERTICULITIS, Dr PHAN THANH HẢI, Dr NGUYỄN QUANG HUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 71 year-old diabetic man with lower abdominal pain for one week.

Ultrasound detected an # 46x57mm abscess close by the sigmoid colon and above the urinary bladder.

Lab data: HbA1c: 7.79 H, FBS: 5.49mmol/L , WBC: 9.03x10^9/L, CRP: 26.78g/L.

MSCT confirmed an abscess which connected with one of diverticula.

Abscess of a inflamed diverticule of colon is a rare entity. 

Complicated diverticulitis occurs when inflammation of small inflamed pouche (diverticulitis) of the colon leads to secondary structural issues—such as an abscess, perforation, fistula,  or stricture.

Key Ultrasound Findings in Diverticulitis

When assessing suspected diverticulitis, transabdominal ultrasound typically looks for:

• Colon Wall Thickening: Colonic wall thickness greater than 4 mm over a segment.
• Outpouchings: Outpouchings (diverticula) sticking out from the colon wall.
• Inflamed Fat: Non-compressible, bright (hyperechoic) fat surrounding the affected colon segment.
• Localized Tenderness: Direct tenderness when pressure is applied with the transducer over the affected colon segment.

CASE 915: LIVER CANCER post 10 year-treated -HCV- infection, Dr PHAN THANH HẢI, Dr PHAN HỮU BỘI HOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 70 year-old woman with history of 10 year-infected HCV. She underwent a treated HCV process  in three months and well remaining.

Ultrasound has been followed her liver at her local province. But in an ultrasound examination at Medic Center she was noted her METAVIR in F4 classified with micronodular pattern and a node of the right lobe and an one another in the left lobe.

  

Lab data showed AntiHCV positive, platelets low result  and GAAD score positive.

MRI confirmed a #19x18mm HCC of the right liver  on a liver of cirrhosis and a # 2, 3mm nodule in the left lobe.

The patient went through a RFA  (radio frequency ablation) for the liver tumor and chemotherapy in hospital. She was under a treated liver cancer management.

Liver cancer may appear whenever post antivirus 

management.

REFERENCE;

CASE 914: INVERTED PAPILLOMA: Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  63 year-old woman with dizziness and headache in general check-up. She went up a right nephrectomy ten years ago. She denied hematuria and using any chemical agent or smoking.

Ultrasound detected a # 9x6mm small nodule at the  triangle of urinary bladder which was nearby the orifice of the left ureter.

Bladder endoscopy confirmed the bladder tumor on the left side.

 

Result of biopsy was an uroepithelial carcinoma.

MSCT noted the removed right kidney and a papilloma of the urinary bladder.

Endoscopic heated resection of the tumor and bladder irrigation were done for the female patient.

The last diagnosis was an inverted papilloma.

In this case the SWE ultrasound technique was not applied. SWE could predict the malignancy and tumor staging by evaluation the stiffness of the tumor and the invasion through the detrusor muscular layer of the bladder. But it is still rarely published paper on this topic nowadays.

CASE 913: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI , Dr HỒ TẤN ĐẠT, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 71 year-old woman in check-up for 4 times.

Ultrasound in the first time was not interesting.

In the second time ultrasound noted  a cyst in the left lobe of the liver.

  

MSCT resulted some hepatic cysts.

Ultrasound in the third time detected a right lobe mass maybe a liver tumor and a left lobe cyst.

But MSCT replayed a hepatic hemangioma.

In the fourth time ultrasound thought about a # 44x30mm liver tumor including HCC.

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But the result of lab data with WAKO test was negative intead of the marker AntiHBc positive.

On hepatic MRI the result was  a #55x40 mm bile duct cancer of the right lobe of liver.

Surgery removed the right lobe liver tumor and the last diagnosis was a an  CCA, intrahepatic cholangiocarcinoma.

After 5 months post op, CCA speaded as multifocal in the liver and a chemotherapy management was done.

Cholangiocarcinoma (CCA) is challenging to diagnose early due to its ambiguous clinical presentation and highly aggressive nature. Consequently, if a suspected liver hemangioma exhibits rapid growth, an MRI should be performed to confirm the diagnosis.

CASE 912: SUBMUCOSAL GASTRIC PSEUDOTUMOR, Dr PHAN THANH HAI, Dr TRAN LAM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 84 year-old woman with diarrhea and tormina (colicky pain).

Ultrasound noted only gallblader stone anf fatty liver.

Gastroendoscopy detected a gastric submucosal tumor.

Medical management stopped diarrhea but was failed to reduce the tormina.

MSCT detected a fishbone in the gastroduodenal wall.

Gastroscopy in second time detected the foreign body in the  gastric wall maybe fishbone.

Endoscopic surgery and open surgery removed the fishbone from the stomach.

Intramuscular fishbone is rarely entity that ultrasound and endoscopy could not detect.

CASES 910-911: MAY-THURNER SYNDROME, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC VIETNAM

Two cases of young girl with left leg edema were detected thrombosis of the left iliac vein.

CASE 1: A 28 year-old woman with left leg edema for 1 week. D-Dimer: 4,830 ng/mL

CASE 2: A 22 year-old girl with left leg edema for 3 weeks, D-Dimer: 3,840ng/mL.

REFERENCES:

 From Radiopeadia

May-Thurner syndrome refers to a chronic compression of the left common iliac vein (CIV) against the lumbar vertebrae by the overlying right common iliac artery (CIA), with or without deep venous thrombosis 2.

Although both left and right CIVs lie deep to the right common iliac artery, the left CIV has a more transverse course and is predisposed to compression whereas the right CIV ascends more vertically and is therefore not similarly predisposed. 

CASES 908-909: THYROID MICROCALCIFICATION: Sole Sign of PTC, Dr PHAN THANH HẢI, Dr NGUYỄN THỊ THẢO HIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Two cases of thyroid nodules with microcalcifications were diagnosed PTC. But thyroid parenchyma with microcalcifications is not ruled out thyroid carcinoma.

CASE 1: A 30 year-old pregnant woman with malinant cervical lymph nodes. 

CASE 2: A 23 year-old girl with neck pain for 3 days.

Thyroid nodule with mivrocalcifications with metastase lymph nodes.

Microcalcification diffuse in the thyroid parenchyma with cervical lymph node is a malignant ultrasound finding of thyroid examination.

REFERENCES: