CASE 774: THORACIC AORTIC PENETRATION DUE TO A FISH BONE, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH , and FELLOW DOCTORS from BINH DAN HOSPITAL, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 

A 35 year-old woman with chest pain for 5 days who failed in gastritis management.

Abdominal ultrasound was nothing, but GI endoscopy detected 1/3 midle of esophagus in edema and narrowing of the lumen that may be perforated by a foreign body. The endoscopic examination must be stopped in waiting for a MSCT.

MSCT revealed a #34×2 mm fish bone which penetrated the esophageal wall to the thoracic aorta that made a critical pseudoaneurysm of the thoracic aorta.

The female patient was transmitted rapidly to Binh dan hospital. A planed management was conducted in emergency for reconstructing the thoracic aorta, sewing the hole of  the thoracic esophageal perforation and removing the fish bone.

Thoracic surgery was done successfully for reconstructing the thoracic pseudoaneurysm,

sewing the penetrated esophageal wall

and removed the fish bone with 2 sharp ends.

The woman remains well post op.

REFERENCE:

CASE 773: PCC MIMICKING RENAL CYSTIC TUMOR, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 61 year-old diabetic man in  annual check-up with a #15-17mm left renal cyst known by non CE MSCT for years.

MSCT of full body detected a #21x16mm left adenal tumor, a thyroid cyst, some renal cysts and a #17mm renal  tùm or  which moderately captured CE that cannot rule out a renal tumor.

He has got a thyroid tumor#19mm and a colon polyp.

Coronary arteries were slightly stenosis.

Lab data were not interested except an endocrinal adrenal tumor.

Endoscopic surgery removed the left papillary cell carcinoma PCC and a hafl of the left kidney.

and the left adrenal tumor.

Histopathological results were the PCC of the left kidney and the left endocrine cortical adrenal tumor.

CASE 772: THYROID CANCER METASTATIC to ESOPHAGUS ?, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A  47 year-old diabetic man, hoarsening, with thyroid tumor on the left lobe.

Ultrasound represented a # 49x34 mm solid mass, blurred contour, strong posterior shadowing, close to cervical esophagus with thickening wall.

He had got the lefl vocal paralysis.

MSCT and endoscopy detected  an esophageal tumor at 1/3 middle part, invading the left lobe of thyroid.

Histopathogical results were an esophageal cancer, poor differentiazed squamous cell carcinoma.

Patient died some weeks later in chemotherapy management.

 

CASE 771: BOWEL G.I.S.T, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

A 38 year-old woman with a # 47x58 mm GIST of her small bowel at LUQ, and later MSCT confirmed it.

The author would like to describe the sonographic appearances of a bowel GIST: echo mixed, with hypoechoic or cystic areas in case of large tumor. The adhered GIST from one side developes out of the lumen, exophytic, while the other side is intact. Endoscopic ultrasound could represent the layers of the wall of the tumor and help to guide the tumor biopsy.

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Merriam- Webster

exo​phyt​ic  : tending to grow outward beyond the surface epithelium from which it originates. used of tumors compare endophytic.tending to grow outward beyond the surface epithelium from which it originates.

CASE 770: INSULINOMA (PNET, PANCREATIC NEUROENDOCRINE TUMOR), Dr PHAN THANH HẢI, Dr TRẦN THỊ TRÚC PHƯƠNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 66 year-old diabetic man with hypoglicemic crisis after meal 3-4 hours, Whipple's triad positive.

Lab data: FPG low, C-peptid (fasting) elevated

Ultrasound detected a  # 20#6.5mm mass at the pancreatic tail and some hepatic cyts.

.

Cystic lesion of the pancreas tail # 2.6x2.2 mm with Doppler sign.

MSCT confirmed a 32x20mm PNET at the tail of pancreas: tissue density, highly captured contrast media.

Histoimmunopathologic stainning was a pancreatic neuroendocrine tumor [insulinoma].

References:

CASE 769: APPENDICULAR MUCOCELE, Dr PHAN THANH HẢI , Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 62 year-old woman in check-up with her past history of surgery for an intracrania hemorrhagia and ovarian cyst.

Abdominal ultrasound detected a RLQ cystic mass #47×27mm beside the right colon which filled off debris that maybe a mucocele or a  pseudomyxoma peritonei.

Lab data were normal.

MSCT confirmed an # 42x22 mm appendiceal mucocele.

Surgery removed  a cystic mass at the end of the appendix.

Histopathological result was mucocele low grade.

Reference:

CASES 767, 768: PARATHYROID TUMOR, Dr PHAN THANH HAI, Dr LY VAN PHAI, Dr VO THI THANH THAO, Dr HO KHANH ĐUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of pararthyroid tumor were spontanously detected by ultrasound with renal stones, bone mineral density [BMD] measurement for osteoporosis  and the neck tumor.

Case 767: A 58 year-old woman with renal stones on abdominal ultrasound who went through neck ultrasound, BMD measurement and parathyroid hormone (PTH) lab data.

Her PTH was coming back post-op.

Case 768: Female patient 57 year-old with neck tumor.

References: