CASE 862: ARTERIAL HYPERTENSION due to RENAL ARTERIAL STENOSIS, Dr PHAN THANH HAI, Dr TRAN THI THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 39 year-old man, 63 kg of weight,  with ATH 230 mmHg [systolic].

Ultrasound detected the right renal arterial stenosis at 2 sites  > 50% and  the smaller right kidney # 82x41x38 mm than the left one.

Doppler ultrasound noted aliasing of the right renal artery with parvus tardus flow pattern.

Vascular MSCT confirmed the small right kidney and stenosis of the right renal artery at the beginning and middle parts due to thickening of the right renal arterial wall.

Right renal angioplasty and stent insertion of the right renal artery was performed.

CASES 858-861: SOLID PSEUDOPAPILLARY NEOPLASM of the PANCREAS, Dr PHAN THANH HAI et al, MEDIC MEDICAL CENTER, HCNC, VIETNAM.

 4 cases of solid pseudopapillary neoplasm of the pancreas  at Medic Center in girls (10-15 year-old) and (23-25 yo) women. 

Ultrasound detected cystic tumor of the pancreas first then  MSCT at last confirmed the cystic pancreas tumor.

1 case in a 10yo girl with 7 cm cystic tumor at the tail. 1 case of 15yo girl with 8cm tumor at the body, 1 case in a 25 yo woman, #9 cm at the head, 1 case of a 23yo woman, #5 cm at the body-tail of the pancreas.

All of the 4 cases went through surgery and the patients remained well post-op.

REFERENCES:

CASES 856-857: TB MASTITIS, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of breast abscess failed in prolonged treatment, but at last were cured successfully in TB management.

CASE 01: A 28 year-old woman  with left swollen breast abscesses without pain nor fever. Drainage and antibiotic treatment were not response for 6 months.

Ultrasound detected some necrotic cystic masses, hypoechoic  non vascularized in the left breast and some inflamed axillary lymph nodes.

Tthe TB PCR result of pus was negative.

But FNAC result was positive with Langhans cells.

CASE 02: A 33 year-old with breast abscess.

FNAC in the first time resulted breast abscess.

And tuberculous mastitis in the second time.

TB mastitis is still complex in diagnostic sometimes has to  setting up a trial treatment.

DISCUSSION on the DIAGNOSIS of BREAST TUBERCULOSIS  CASES at MEDIC:

1/ Besides the clinical situations, the diagnosis of TB breast based primarily on ultrasound (90%, therefore mainly), mammography, biopsy (most breast tuberculosis is only accurately diagnosed by histology with granulomatous lesions, caseous necrosis, Langhans macrophage cell) and Ziehl–Neelsen acid-fast bacilli staining (low positive rate).

Other imaging modalities  used  to determine the extent of the disease  for orientational and differential (rather than diagnostic) notations. However, mammography keeps difficult to differentiate the malignancy mass from the breast tuberculosis.

2/ The most common form of TB breast is the extended form. Sclerosing and carcinomatosis associated with breast tuberculosis have never been encountered.

Figure 3 types of breast tuberculosis: extended, nodular and fibrotic (Figure by Dr. Nguyen Duy Thu, Breast tuberculosis and Imaging Diagnosis) .

3/ With Shear Wave Elastography ultrasound: Use elastography to diagnose differentially in ultrasound imaging for breast tuberculosis (and breast cancer). Breast tuberculosis has very hard code at the periphery, elasticity E= >120kPa (red), while the central area is softer, heterogeneous, with  elasticity E= 60kPa (green or no signal). In soft tissue cancer with necrotic areas, the opposite result means: the color map tends to be red (hard) and spreads evently from the outside to the mass center. The elastogram mapping helps to selecting of the biopsy site to avoid a pseudonegative result.

REFERENCES:

https://www.ultrasoundmedicvn.com/2024/10/case-786-accessory-breast-tuberculosis.html

https://www.ultrasoundmedicvn.com/2025/03/case-818-breast-tb-node-dr-phan-thanh.html

https://www.nguyenthienhung.com/2012/01/lao-vu.html

CASE 855: FULL TB INFECTION with INCREASING CANCER MARKERS, Dr PHAN THANH HẢI, Dr PHẠM LÊ DIỄM CHI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 18 year-old weakness man with neck nodes  and abdominal pain.  Thin, pale, height 165cm, weight 39kg. Pain but not existing abdominal guarding.

Ultrasound noted cervical lymph nodes and nothing detected in the abdomen. They were inflamed nodes but may due to infiltrated lymphoma.

But full body MSCT revealed many inflamed organs may suffer from TB infection.

Lab data showed positive TB in phlegm and increasing abnormally values of some cancer markers: CA-19.9, beta 2 microglobulin and CA-125 . The last one helps differentiating a pulmonary TB from other lung infections as published on medical literature.

The patient remains well after going through the anti-TB course of treatment.

CASE 854: FITZ- HUGH-CURTIS SYNDROME with High Value of CA 125, Dr PHAN THANH HẢI, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC VIETNAM

 A 32 year-old woman with epigastric and RUQ pain for 5 days.

Ultrasound detected PID both 2 sides,  many white spots in the liver and small amount of fluid in the pelvis. CRP and CA -125 was in high value : 365U/mL.

MSCT  confirmed the PID and inflamed hepatic pericapsule of FITZ- HUGH-CUTTIS syndrome. Liver may got multifocal of hemangioma.

A medical management has been done for this  external patient.

Reexamination of  3 times noted decreasing of PID and CEA value:135U/mL.

CASE 853: FISHBONE INDUCED APPENDICITIS, Dr PHAN THANH HẢI, Dr NGUYỄN NGỌC XUÂN GIANG, BÌNH AN HOSPITAL KIÊN GIANG - MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 77 year-old man with epigastric pain for 5 days then going down to the RLQ. He got no fever.

Ultrasound detected an 29.7x6mm inflamed appendix with a foreign body inside it. 

WBC 8.1x10 ^ 9 /L but CRP 46.17mg/L.

MSCT confirmed the appendicitis in an elderly patient with a fishbone inside.

Surgery was done and it existed a fishbone inside the inflamed appendix.

CASE 852: ACHALASIA, Dr PHAN THANH HAI, Dr VO NGUYEN THUC QUYEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 55 year-old woman with 5kg weight loss for 3 month as dysphagia.

Ultrasound detected cervical esophagial dilatation and positive bird beak sign of the cardial esophagus. It existed no tumor outside of the cardia of the stomach but having only a liver hemangioma in the left lobe.

Barium swallow on X-ray noted a rat's tail sign and esophagial dilatation that proved achalasia.

MSCT confirmed the achalasia.

The patient will going through a cardioesophagial ballooning and medical management.