CASE 913: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI , Dr HỒ TẤN ĐẠT, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 71 year-old woman in check-up for 4 times.

Ultrasound in the first time was not interesting.

In the second time ultrasound noted  a cyst in the left lobe of the liver.

  

MSCT resulted some hepatic cysts.

Ultrasound in the third time detected a right lobe mass maybe a liver tumor and a left lobe cyst.

But MSCT replayed a hepatic hemangioma.

In the fourth time ultrasound thought about a # 44x30mm liver tumor including HCC.

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But the result of lab data with WAKO test was negative intead of the marker AntiHBc positive.

On hepatic MRI the result was  a #55x40 mm bile duct cancer of the right lobe of liver.

Surgery removed the right lobe liver tumor and the last diagnosis was a an  CCA, intrahepatic cholangiocarcinoma.

After 5 months post op, CCA speaded as multifocal in the liver and a chemotherapy management was done.

Cholangiocarcinoma (CCA) is challenging to diagnose early due to its ambiguous clinical presentation and highly aggressive nature. Consequently, if a suspected liver hemangioma exhibits rapid growth, an MRI should be performed to confirm the diagnosis.

CASE 912: SUBMUCOSAL GASTRIC PSEUDOTUMOR, Dr PHAN THANH HAI, Dr TRAN LAM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 84 year-old woman with diarrhea and tormina (colicky pain).

Ultrasound noted only gallblader stone anf fatty liver.

Gastroendoscopy detected a gastric submucosal tumor.

Medical management stopped diarrhea but was failed to reduce the tormina.

MSCT detected a fishbone in the gastroduodenal wall.

Gastroscopy in second time detected the foreign body in the  gastric wall maybe fishbone.

Endoscopic surgery and open surgery removed the fishbone from the stomach.

Intramuscular fishbone is rarely entity that ultrasound and endoscopy could not detect.

CASES 910-911: MAY-THURNER SYNDROME, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, 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.

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 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 HẢI, Dr NGUYỄN THỊ THẢO HIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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

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