CASE 539: DENGUE FEVER and ASCITES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 25 YO WITH 3 DAYS  FEVER  AND EPIGASTRIC DISTENTION.

ULTRASOUND  FIRST :  

US 1: HEPATOMEGALY.  

US 2: GALL BLADDER WALL IS THICKENING 3 MM  NO STONE.

US 3:  FLUID IN MORRISON SPACE ( LIVER KIDNEY SPACE).

US 4: FLUID AROUND RIGHT KIDNEY.

US 5: IN PELVIS  BIG VOLUME OF ASCITES.

US 6: NORMAL SPLEEN WITH FLUID IN HILUS.

CHEST X-RAYS SHOWS  SMALL FLUID IN COSTO-PLEURAL SPACE.

BLOOD TESTS  SHOW   WBC HIGH, CRP HIGH  PLATTELETS  DROPPED TO 19K.          

ELISA  DENGUE FEVER TESTS  POSITIVE FOR IgG  AND IgM.

EMERGENCY ADMISSION IN INFECTIOUS TROPICAL HOSPITAL.

REFERENCES:

Role of ultrasound in Dengue hemorrhagic fever in Vietnam

http://www.vusta.vn/vi/news/Thong-tin-Su-kien-Thanh-tuu-KH-CN/Gia-tri-cua-sieu-am-bung-trong-sot-xuat-huyet-Dengue-21155.html
Ultrasound Findings in Dengue Hemorrhagic Fever

CASE 538: SUBMERGED MEDIASTINUM GOITER TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 59 yo, for 10 years, underwent an operation of removing tumor at left lobe of thyroid.

Now she suffers from cough and  change of the speaking voice.

Chest X-Rays shows one mass at upper part of retrosternum.

Ultrasound  of the neck: 

US 1: crossed section of the right big thyroid lobe with tumor.

U S 2 : this tumor is prolonged from retrosternum. to mediastinum.

US 3: CDI with  hypovascular tumor.

US 4: longitudinal tumor scan.

Blood tests: normal thyroid function.

MSCT with CE:

CT 1, CT 2, CT 3                                                                                                                                                            Section  at level of neck  upper sternum  and middle  sternum   this tumor  from right lobe thyroid  calcification.

CT 4 : sagittal,  C T 5 : frontal section.

Isotopic Tech 99m  scan  made  diagnostic is thyroid tumor with cold nodule come from r ight lobe of thyroid gland.

Operation by the way sternotomy  removed this tumor well bordered,  central solid and cystic parts very highly calcified.

Conclusion:  Goiter tumor  submerged in mediastinum.

MICROSCOPIC REPORT IS  NODULAR GOITER.

CASE 537: GASTRIC LYMPHOMA, Dr PHAN THANH HAI, Dr LE THI THANH THAO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 63 yo with gastric ulcer being treated for a  long time but not getting better. 

Gastroendoscopy  found a crater ulcer of antrium  but  in 2 times of biopsy only chronic inflamation.

Ultrasound scanning in epigastris  detected antrium thickening of the wall  and hypoechoic (US 1).   

US 2 : many lymph nodes around antrium.  

US 3: CDI, vascular supply for antrum.

US 4: longitudinal scanning of antrum  is  thickening of  the gastric wall.

MSCT scanning of abdomen.

CT 1= crossed section of   antrum with the mass.

CT 2 = scanning with position rotation of antrum showed stenosis.

Radiologist and sonologist diagnostics were gastric cancer.

Operation of gastrectomy.

Specimen 1= antrum tumors.  

Specimen 2 =

Opening of gastric lumen there wered 2 lesions at antrum and body of stomach.

Microscopic report with immuno-histo chemistry  staining is B cell lymphoma  of antrum and infiltrated lymph nodes.

CASE 536: BILATERAL PERIRENAL LYMPHANGIOMATOSIS, Dr PHAN THANH HAI, Dr TRUONG DINH KHAI , Dr NGUYEN ANH TUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

FEMALE  PATIENT 16 YO IN  HEALTH  CHECK-UP  BY ULTRASOUND  DETECTED ASCITES.
MSCT WITH CE FOR DIAGNOSIS= 
CT 1 : CROSSED SECTION DETECTED  2 KIDNEYS BEING PULL UP.

CT 2 : CROSSED SECTION  UPPER    2 CYSTS  RETROPERITONEUM.

CT 3  : SAGITTAL  VIEW, KIDNEYS DEFORMATION AND DEPLACEMENT.

CT 4 : 2 CYSTS RETROPERITONEUM

CT 5 : 3D VIEW  URINARY SYSTEM NORMAL  

RADIOLOGIST SUSPECTED  URINOMA.    PUNCTION ASPIRATION, THE FLUID IS NOT URINE BUT LIKE LYMPHATIC COLLECTION.

ARTER  PUNCTURE ASPIRATION  AND SCLEROTHERAPY.  

MRI 1=THE FLUID IS STILL UPPER  POLE OF  RIGHT KIDNEY AND AROUND LEFT KIDNEY. 

MRI 2 = VASCULAR SUPPLY FOR 2 KIDNEYS IS NORMAL.

ULTRASOUND REVIEW AFTER ONE YEAR.

US 1, US 2:   RIGHT KIDNEY.

US 3, US 4 : LEFT KIDNEY  SHOWED VASCULAR SUPPLY OF 2 KIDNEYS IS NORMAL AND  RENAL FUNCTION IS NORMAL.

CONCLUSION=  IT IS BILATERAL PERIRENAL LYMPHANGIOMATOSIS.

CASE 535: LOWER LEG TUMOR, Dr PHAN THANH HAI, Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC VIETNAM.

MAN 57 YO  DETECTED  ONE MASS AT LOWER LEFT LEG, 10 CM ABOVE THE ANKLE JOINT . 

THE MASS IS MOVING IN WALKING, BUT NO PAIN.

ULTRASOUND  ( US 1)  WITH LINEAR PROBE 5 MHz,   THIS TUMOR  IS INTRA SOLEUS MUSCLE,  ROUND

# 3 CM, CENTRAL NECROSIS.

US 2 WITH CURVE PROBE 5MHz  THIS TUMOR  BORDER IS  ROUND.

US 3 : TUMOR INHOMOGEOUS WITH CENTRAL NECROSIS.

US 4:  TUMOR   CLOSE BY A VASCULAR  STRUCTURE.

MRI  WITH CE=

MRI 1:  CROSSED SECTION VIEW,  THE LOCALISATION OF THIS TUMOR.

MRI 2:  LONGITUDINAL SCAN VIEW  THE TUMOR WITH  POSTERIOR TIBIAL ARTERY.

MRI 3: LOW VASCULAR SUPPLY AROUND  TUMOR.

RADIOLOGIST  REPORT IS SUSPECTED  NEURINOMA TUMOR.

CORE BIOPSY  OF THIS TUMOR REPORT IS SCHWANNOMA.