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Wednesday, 24 April 2019

CASE 546: LUNG CANCER, Dr PHAN THANH HAI, Dr HUYNH TRAC LUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


MAN 52 YO WITH  PROLONGED COUGH.     
CHEST X-RAYS DETECTED A  MEDIASTINUM TUMOR.



MSCT with CE  =
CT  LUNG 1:   FRONTAL VIEW:  LARGE NECK BY LYMPH NODES. MEDIASTINUM  ENLARGED BY MANY LYMPH NODES  AND LEFT LUNG TUMOR.




CT 2 :  CROSSED SECTION,  TUMOR OF LEFT LUNG WITH LYMPH NODES in MEDIASTINUM.

CT 3: LEFT LUNG TUMOR .

CT 4: SUPRACLAVICULAR LYMPH NODES  BOTH 2 SIDES.


ULTRASOUND OF THE NECK   
US 1=  BIG LYMPH NODES AT RIGHT SUPRACLAVICULAR AREA.


US 2 = AT LEFT SUPRACLAVICULAR  AREA , NODE SUSPECTED  METASTASIS.



BLOOD TESTS =CYFRA 21-1 : 3.05 ( N=  3.3)  PROGRP : >5000 pg/ml( N=65)
ACTH  282 pg/ml (N= 7-63)    CORTISOL  23 pg/ml (N=  6.2-19.4)
Biopsy of  right supraclavicular  lymph node.

HISTOLOGY REPORT WITH  IMMUNO STAINING IS  SCC.( NEUROGENIC ENDOCRINE TUMOR).


REFERENCE    Pro-GRP  [Pro-gastrin-releasing peptide] TEST for small cell carcinoma.


NOTA= VUD published 2 cases of SCC from 07 cases of lung tumor topic.

Friday, 12 April 2019

CASE 545: AORTIC DISSECTION, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


Man 72 yo with epigastric pain and back pain.
Ultrasound of abdomen   detected   aortic  dissection.  
US 1 : longitudinal scan of aortic  epigastric area  having of septation intra aortic lumen, double lumen sign,  to lower division.



US 2 ,  US 3 : Doppler  flow.  



US 4 : crossed section,  Doppler flow  of
echocardiography detected dissection of aorta.


MSCT angio= CT 1   crossed section  of  aortic arch
CT 2= crossed section of aorta shows double lumen in  epigastric area.
CT 3 =longitudinal scan of aorta.   
CT 4 = 3D  view of  aortic  thoraco-abdomen.




Conclusion : ultrasound detected thoraco-abdomen aortic dissection.

Treatment :  Intervention of stenting graft for aortic arch.

NOTA= In a survey of AAA at Medic Center for 10 years (1990-2000), 246/987 cases of AAA dissecting were detected and documented by ultrasound and CT scanning confirmed, # 24.9%, that had been prothesis grafting later in Binh dan hospital.

Monday, 1 April 2019

CASE 544: GASTRIC PERFORATION DUE TO FISHBONE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.


MAN 53 YO WITH EPIGASTRIC PAIN HAS BEEN  TREATED AS GASTRITIS BUT NO RESPONSE.
ULTRASOUND OF ABDOMEN  DETECTED ONE ECHOGENIC BODY AT ANTRUM. 

US1/US 2 LOOK LIKE  FOREIGN BODY.




MSCT of ABDOMEN  ALSO  DETECTED  FB(  FORGEINE BODY )  3 CM  AT ANTRUM  


CT 1 /CT2 :SAGITTAL  SHOW THAT PENETRATING THE WALL ofANTRUM TO PANCREAS.



CT3  3D VIEW.

EMERGENCY GASTROENDOSCOPY  REMOVE ONE FISHBONE 3 CM.

Nota= VUD published 18 cases of fishbone ingestion, including 4 cases of perforation of stomach that were removed endoscopically 2 cases.