CASE 577: TOS (THORACIC OUTLET SYNDROME), Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 52 YO WITH  PAIN AND COLD FEELING OF RIGHT HAND.

ULTRASOUND   DETECTED NO PULSE AT RADIAL ARTERY  AND THROMBOSIS OF HUMERAL ARTERY JUST TO SUBCLAVICULAR ARTERY WITH DILATATION  AND ZIN-ZANG FLOW.

MSCT ANGIO  SHOWED STENOSIS AT RIGHT  SUBCLAVICULAR ARTERY DUE TO RIGHT CERVICAL RIB  C7 COMPRESSION.

CONCLUSION=  THORACIC OUTLET  SYNDROME  WITH COMPLICATION OF THROMBOSIS ARTERY.

OPERATION FOR  RESECTION OF THE RIB  AND REMOVING OF THROMBUS.

REFERENCE :

CASE 576:ECTOPIC LIVER TISSUE or ADRENAL TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC,VIETNAM.

Man 46yo in general check- up by  CT total body was detected a tumor # 3 cm at right adrenal area.

CT 1  crossed section  the tumor near the liver border  

CT 2  tumor near pancreas head  

CT 3  frontal view  the tumor  3 cm far from upper pole R renal  near IVC.

Ultrasound  detected  this mass well bordered, solid structure, d #  3 cm  (US 1, US 2,  US 3).

Diagnostics of CT and ultrasound  are adrenal tumor  

Blood test  is normal hormone from adrenal gland

Laparoscopic surgery in retroperitoneum removed this tumor ( ope pictures , and macro 1, macro 2).

.

Microscopic report is liver tissue.

Summary : It is an ectopic liver tissue in adrenal area.

REFERENCE CASE STUDY

CASE 575: LYMPH NODE TUBERCULOSIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 35 YO  PAIN AT   PERIUMBILICAL  AREA OF ABDOMEN.

US SCAN   

US 1:  ONE MASS  NEAR LEFT SITE OF  UMBILICUS  WITH  SANDWICH SIGN.

US 2: MANY LYMPH NODES HYPOECHOIC,  SIZE 2-3 CM  WITH STRUCTURE CHANGE AND NO HILUS.

US 3: SAME  STRUCTURE  OF LYMPH NODE IN MESENTERIUM.

US 4: 2 BIG LYMPH NODES AT THE LEFT SUPRACLAVICULAR AREA.

CHEST X-RAYS SUSPECTED TUBERCULOSIS AT RIGHT LUNG.

CT SCAN OF ABDOMEN WITH CE    

CT 1= FRONTAL VIEW OF ABDOMEN, THIS MASS IS  NEAR ABDOMINAL AORTA.

CT 2 = CROSSED SECTION.

CT 3  = FRONTAL VIEW OF THE LUNG 

BIOPSY REPORT OF THE BIG LYMPH NODE AT THE L NECK IS TUBERCULOSIS.

SUMMARY=  MULTIPLE LYMPH NODES APPEARED IN SAME TIME WITH LUNG TUBERCULOSIS.

CASE 574: THORACIC WALL HERNIA, Dr PHAN THANH HAI, Dr TRAN MINH DUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN  52 YO  3 MONTHS AGO,  PAIN AT L THORACIC NEAR  L BREAST NIPPLE   AFTER TRAUMA, COUGH MAKING VERY PAINFUL AND  L BREAST GETTING BIGGER  THAT LOOKS LIKE TUMOR   (PHOTO 1: NORMAL BREATH, PHOTO 2  AFTER COUGHING and  VIDEO CLIP in COUGHING).

ULTRASOUND  AT  LEFT THORACIC WALL  DETECTED  ONE  MIXED STRUCTURE MASS  BY RUPTURE OF THE THORACIC WALL MUSCLE  WITH FLUID ( US 1).  

US 2: THE  HERNIA  OF THE LEFT LUNG TO THIS AREA IS SEEN  CLEARLY BY COUGHING , BUT IN NORMAL BREATH  THIS HERNIA IS COVERED BY HYPERECHOIC  STRUCTURE MASS ( US 3)

MSCT OF THE LUNG WITH VALSALVA  MANEUVER   DETECTED  INTERCOSTAL MUSCLE  RUPTURE AND  HERNIA FROM THE LUNG GETTING OUT   ( CT1 CT2 CT3).

SUMMARY = THIS CASE IS THORACIC WALL HERNIA AFTER TRAUMA.  THE PATIENT HAD BEEN OPERATED FOR PROTHESIS REPAIRING THE THORACIC WALL HERNIA.

CASE 573: BILIARY HAMARTOMA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 51 YO FOR 5 YEARS CHOLECYSTECTOMY BY GALL BLADDER  STONE, NOW GETTING PAIN IN LIVER.

US SCANNING : GALL-BLADDER HAD BEEN REMOVED. CBD DILATED   OF 3CM IN DIAMETER   WITH DILATATION R/L BILIARY DUCTS IN LIVER  AND  THERE  ARE SOME  SMALL SPOTS LIKE CYST # 0.5 CM.  CBD  IS  STENOSIS AT ODDI AREA  AND NO TUMOR OF PANCREAS.

US1   BW US   US2 CDI 

MRI OF LIVER   

MRI 1  CROSSED SECTION OF LIVER   

MRI 2   CBD DILATED WITH MANY SPOTS  LIKE CYSTS IN LIVER   THAT  ARE HAMARTOMA OF BILIARY CANALS.

ERCP  CANNOT  ENTER THE CBD  (FOTO1, FOTO2)

OPERATION  REPORT   IS  CYST OF CBD AND STENOSIS  OF CBD AT ODDI SPHINTER.

 AND BIOPSY OF MANY SMALL NODULES AT SURFACE OF LIVER   (FOTO CBD).

PROCEDURE OF  ROUX- EN- Y  FOR  ANASTOMOSIS OF CBD AND  DUODENUM.

CONCLUSION = IT IS  HAMARTOMA OF BILIARY SYSTEM  WITH MANY SMALL LIKE -CYSTS OF BILIARY SYSTEM   AND STENOSIS OF CBD  DUE TO  STONE.

CASE 572: PROSTATE CANCER, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 45yo  with pain at sternum. SPECT bone scan detected multiple bone lesions (SPECT photo).

Ultrasound at sternum detects osteolytic lesions. 

Blood test=  PSA rises 92 ng/mL

Transabdominal Ultrasound of prostate  

US 1   section  prostate in small size 

US 2  sagital view also prostate in small size without abnormal focal lesions 

US 3 elastoscan detected abnormal zone inside prostate  

US 4 sagital elastography mapping one zone with kPa high,  #C50 kPa

Biopsy with TRUS elasto guiding;   report is prostate cancer, classified of Gleason core 7

Summary=  US elastoscanning of prostate guiding for biopsy is more accuracy than conventional TRUS guiding alone.

CASE 571: LUNG CYST, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 37YO  COUGH AND PAIN AT LEFT LUNG. 

CHEST X-RAY   DETECTED ONE MASS BILOBULATED ROUND  BORDER  # 3 cm.

TRANSTHORACIC ULTRASOUND SHOWED A CYST  WITH   CLEAR  FLUID.

MSCT  REPORT IS CYST WITH THE CALCIFIED WALL, SOLID STRUCTURE INSIDE CYST .

CT 1   CROSSED SECTION.  CT2  FRONTAL VIEW.   CT3  LUNG WINDOW .

OPERATION REPORT IS AN INFECTED CYST WITH PUS.