CASES 910-911: MAY-THURNER SYNDROME, Dr PHAN THANH HAI, Dr NGUYEN NGHIEP VAN, 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 HAI, Dr NGUYEN THI THAO HIEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Two cases of thyroid nodules with microcalcifications were diagnosed PTC. But thyroid 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:

CASE 907: PARAGANGLIOMA close by URINARY BLADDER, Dr PHAN THANH HAI, Dr TRAN MOC HIEP, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 44 year-old hypertensive man with flushing, sudation while passe out water for 2 months. HTA : 177/109mmHg, P: 72p per min.

Ultrasound detected a hypoechoic mass which pushed in the bladder from behind may be a fibroma or a lymph node. The patient denied to manage his status.

One year later the patient came back with another chief complaint. Ultrasound noted the 32×18mm mass nearby his bladdermaybe a pheochromocytoma.

MSCT confirmed  the pheochromocytoma close by the bladder.

Surgery removed the mass with a part of the bladder. Histology of the specimen proved a paraganglioma.

The patient remains well post-op.

CASE 906: NEUROENDOCRINE TUMOR, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 42 year-old woman with epigastric pain and left flank tumor which was suspected as a # 100x182mm tumor at the pancreatic tail.

But MSCT noted the # 110x117mm tumor was in the mesenterium near the left flank which suspected a mesenteric tumor or a paraganglioma.

Lab data was not interested.

Surgery removed the tumor and the specimen was diagnosed as a paraganglioma tumor which needs to perform a immunohistochemistry [IHC] staining for a final diagnosis.

CASE 905: LUMP of GOUT in HAND, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 An old man suffers from gout for a long time with his tophus [stone] lump on the right hand but now  that makes pain and he could not move the second finger. EULAR Gout Score # 15 (>8.0).

X-ray and MRI show the erosions of the metacarpal and proxical phalanx bones of the second finger close the tophus lump.

And a 33MHz ultrasound probe notes the tophus lump in hand in more details.

Joint deformity and limitation of motion in affected joint may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic renal failure. 

https://medlineplus.gov/ency/imagepages/19833.htm

REFERENCES:

https://goutclassificationcalculator.auckland.ac.nz/

https://pmc.ncbi.nlm.nih.gov/articles/PMC11348250/n

https://radiopaedia.org/articles/gout

CASE 904: UTERINE SARCOMA, Dr PHAN THANH HAI, Dr NGUYEN THI TRINH, MRDIC MEDICAL CENTER, HCMC, VIETNAM

 A 57 year-old woman with bloting for 2 months and uterine fibroma which was known about 6 years. She got also hyperthyroidism but no clue of tuberculosis.

Ultrasound detected a #104x72mm uterine tumor, some #19×13 and 16x12mm necrotic inguinal lymph nodes and malignant ascites.

Lab data:

DISCUSSION:

Sarcoma of uterus always gets  big size rapidly, solitary,  its great dimension > 8 cm, cystic necrosis.

CASE 904: RECURRENCE of PHEOCHROMOCYTOMA, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAMADRENAL TUMOR

 A 34 year-old arterial hypertension woman with HTA, tachycardia, fatigue, headache. She had undergone an endoscopic surgery 18 years prior for pheochromocytoma.

Ultrasound detected a # 25mm hypoechoic tumor nearby the IVC. Some surgical clips of prior surgery were seen close the tumor.

MRI confirmed a recurrence of pheochromocytoma.

She was removed the recurrent pheochromocytoma by via robot surgery.