Total Pageviews

Monday, 15 July 2019

CASE 558: OVARIAN TUMOR but RISING CA 19-9, Dr PHAN THANH HAI, Dr LE DINH TIN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


WOMAN  39YO  SINGLE, WITH  PELVIS PAIN


ULTRASOUND  DETECTED  LEFT OVARY CYST  SIZE 4 CM, CLASSIFIED IOTA 3   SUSPECTED  ENDOMETRIOSIS OF LEFT OVARY.  

US 1=   CYST  MIXED   SOLID.
US2 = ELASTO  SUSPECTED  BENIGN CYST.



ROUTINE BLOOD TEST   HAD  CA19-9  VERY HIGH VALUE  MORE THAN 1000 UI, CA 125 = 32 UI.



MSCT OF ABDOMEN WITH CE 

CT1:  PELVIS   HAD CYST OF LEFT OVARY  LOOKED LIKE SIMPLE CYST. 
CT2 :IN UPPER ABDOMEN,  LIVER,  BILIARY SYSTEM AND PANCREAS ARE NORMAL.




LAPAROOPERATION   REPORTED  LEFT OVARY CHOCOLATE CYST  THAT SUSPECTED  ENDOMETRIOSIS.


MICROSCOPIC REPORT OF THIS CYST IS   ENDOMETRIOSIS CYST.


LAB TEST AGAIN AFTER 2 WEEKS  OF OPERATION  THE CA19-9 DROPPED DOWN TO 123 UI.

CONCLUSION :  ENDOMETRIOSIS CYST RISED VERY HIGH CA-19-9 VALUE  WHICH IS RARE CASE

UNKNOWN REASON. 

REFERENCE CASE .



Sunday, 7 July 2019

CASE 557: LEG TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Man 51 yo  detected  his right ankle  pain and swollen, difficult to walk  ( see photo). There is a   mass at achille tendon with small skin nodule ).






Ultrasound  scan of  this mass.
US 1=  this mass is solid, #5 cm  round bordered, displacing achille tendon)
US 2 = vascular supply from peripheric wall   
US 3 =  SMI can see  more vascular structure intra tumor   
US 4  = ultrasound detected big lymph node at right inguinal region





US 5  video : Doppler of vascular supply this lymph node suspected metastasis.





X-Rays  the right foot :  the bone is normal.

Biopsy of the lymph node  at right inguinal region is  metastasis from sarcoma.


Saturday, 29 June 2019

CASE 556: LUNG TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


MAN 62 YO  GETS  GENERAL CHECK- UP   EVERY YEAR .
CHEST X-RAYS DETECTED ONE NODULE AT LEFT LUNG, SIZE 1 CM  ( CHEST XRAY).




MSCT CE OF THE LUNG.
CT 1 =    FRONTAL VIEW  THE NODULE AT LEFT LUNG FROM THE PLEURAL SPACE.
CT 2= CROSSED SECTION  WITH  CE ENHANCEMENT.



ULTRASOUND   DETECTED THIS MASS ROUND HYPOECHOIC, HYPOVASCULAR   PATTERN.

OPERATION REMOVED THIS MASS    MICROSCOPIC REPORT IS INFLAMATION PSEUDO TUMOR.


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