CASE 884-885-886-887: THYROID FOCAL LESIONS, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Case A: Cyst of isthmus of thyroid with disseminated crystals, no vascularisation.

Case B: Cyst of left lobe of thyroid reduced  naturally its size in one year.

Case C: Hemorrhagic cyst of left lobe after medical therapeutic management for 5 days: reduced size and clearly septation inside.

Case D:

Focal thyroiditis  non vascular Doppler signal of the right lobe in a Basedow case: painfull but no colored on hypercolored background.

Some ultrasound interesting findings have to know on focal thyroid examination.

CASE 888-889-890: RENAL HYPERPARATHYROIDISM, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC VIETNAM.

 Three cases of renal hyperparathyroidism detected by ultrasound.

CASE A:

A woman with hypercalcinosis, renal stones and increasing PTH value but 2 times ultrasound misdiagnosed.

A parathyroid tumor at the upper pole of the left lobe of thyroid later reviewed by ultrasound.

CASE B: 

A 36 year-old man with renal insufficiency on stage 5, PTH high value. Ultrasound detected secondary parathyroid tumors both 2 sides.

CASE C: 

A 46 year-old man with RI and PTH high value due to renal hyperparathyroidism. Ultrasound detected 2 side parathyroid tumors.

Sizes, numbers and structures of renal hyperparathyroidism seem to be not influenced by the blood phosphat and PTH value.

REFERENCE:

 Pathogenesis of secondary hyperparathyroidism in CKD. Progressive loss of renal mass impairs renal phosphate excretion, which causes an increase in serum phosphorus. Abnormalities in serum phosphorus homeostasis stimulate FGF23 from bone. Higher serum FGF23 levels in addition to decreased renal mass cause a quantitative decrease in synthesis of 1,25(OH) 2 D. High serum FGF23 levels decrease the activity of the 1a-hydroxylase enzyme. 1,25 (OH) 2 D deficiency decreases intestinal absorption of calcium, leading to hypocalcemia, which is augmented by the direct effect of hyperphosphatemia. Hypocalcemia and hyperphosphatemia stimulate PTH release and synthesis. The lack of 1,25(OH) 2 D, which would ordinarily feed back to inhibit the transcription of prepro-PTH and exert an antiproliferative effect on parathyroid cells, allows the increased PTH production to continue. Current therapeutic methods used to decrease PTH release in CKD include correction of hyperphosphatemia, maintenance of normal serum calcium levels, administration of 1,25(OH) 2 D analogs orally or intravenously, and administration of a CaSR agonist (e.g., cinacalcet).

CASE 883: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HAI, Dr HO TAN ĐAT, MEDIC MEDICAL CENTER, HCMC VIETNAM.

 A  71 year-old woman with a  #40x30mm right lobe hepatic tumor in 3 times of examination.

Ultrasound noted a hemangioma or HCC. MSCT noted a hemangioma in 2 times.And MRI, a cholangiocarcinoma.

Lab data showed  values of AFP, CA 125, CA 19-9 in normal range.

But after a hepatectomy, the surgical specimen of liver tumor was a cholangiocarcinoma.

Reference:

Gaillard F, Knipe H, Silverstone L, et al. Cholangiocarcinoma. Reference article, Radiopaedia.org (Accessed on 07 Feb 2026) https://doi.org/10.53347/rID-1114

CASE 882: FETAL HYDROPS, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 25 year-old woman with the first normal pregnancy, but in the 21th week there was her fetal hydrops: pleural effusions both two sides, ascites and body edema.

Prenatal ultrasound detected fetal hydrops and helping guided thoracocentesis in 3 times for every  10 days.

At the 25th week, the fetus came back to normal status, no pleural effusion nor ascites and edema.

Amniotic fluid biopsy results no sign of infection. 

And no abnormal structure of the fetus to find out.

The continuity of follow-up are in progress for the case of unknown ascites and pleural effusion of the fetus in a normal pregnancy.

REFERENCE:

https://www.childrenshospital.org/conditions-treatments/hydrops-fetalis

CASE 880-881: ACHALASIA, Dr PHAN THANH HẢI , Dr ĐINH MINH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases in women with epigastric discomfort and weight loss for one year.

Ultrasound and barium swallow test detected achalasia and confirmed later by gastroendoscopy.

CASE 1: Woman 30 year-old with loss of weight for one year.

CASE 2: Woman 27 year-old, weight loss for one year.

Esophagial dilation manoeuver were done for dilpatation of the narrrowed esophagus.

DISCUSSION:

After the esophagial dilation may get fibrosis of the narrow esophagial part.

And there were cases of pseudoachasia due to hernia and esophasial cancer.

CASE 878-879: ADRENAL TUMOR, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ MỸ HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Two cases of right adrenal tumors in women detected spontanously by abdominal ultrasound and confirmed later by MRI [case 1] and MSCT (case 2).

Based on ADRENAL-RADS the two adrenal tumor were classified.

CASE 1: A 30 year-old HTA woman for 7 years; going to Medic in an hypertensive crisis # HTA=212/90mmHg, with a right adrenal tumor # 25x16mm on emergency ultrasound.

Surgery was done: Malignant cortex adrenal tumor. Post-op 2 months, coming back normal arterial tension and hormones.

CASE 2:  A 50 year-old woman in check-up,  with adrenal tumor # 21x23mm.

Surgery removed a right  adrenal adenoma.

CASE 877: ABDOMINAL PAIN due to FISHBONE: Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC , VIETNAM

 A 55 year-old man with abdominal pain for 3 days in right flank.

Ultrasound noted a  #46x12mm fluid-filled appendix.

But MSCT detected a wall-off transverse colon abscess with a # 14mm transwalled colonic fishbone.

Open surgery was done for removed partial colon with a fishbone.