CASE 829: ACCESSORY TARSAL NAVICULAR BONE, Dr PHAN THANH HẢI, Dr MÃ NGUYỄN MINH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 48 year-old man with his swollen right ankle pain for one month. His past history was an arterial stenting and denies any clue of trauma or arthritis.

Vascular ultrasound of the right ankle noted normal result  but it existed  an amount of collected fluid around his right ankle.

Lab data and tarsal X-ray were normal.

But MSCT and MRI detected an accessory tarsal navicular bone of the right foot. It also was an impingement syndrome at the right ankle due to the appearance of the accessory tarsal navicular bone and its articulation.

There was a degenerative arthritis between the two navicular bones.

Patient is a medicine fellow who denies any the  injected corticosteroid nor surgery, only applying the physical therapy.

REFERENCE:

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.resurgens.com/education/accessory-navicular%23:~:text%3DAccessory%2520navicular%2520syndrome%2520is%2520a,risk%2520of%2520a%2520foot%2520injury.&ved=2ahUKEwiF5vjN8amNAxWCn68BHQzwDYYQFnoECCAQBQ&sqi=2&usg=AOvVaw2_-ljlxkaDUHGdyGejfjHD

https://www.foothealthfacts.org/conditions/accessory-navicular-syndrome-(1)

CASE 828: COLONOURINARY BLADDER FISTULA due to DIVERTICULITIS , Dr PHAN THANH HẢI, Dr NGUYỄN KIM HIẾU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 51 year-old man with dysuria with bloody urine for 2 weeeks.

Ultrasound detected thickening wall of sigmoid colon which adhered the urinary bladder. And there was a fistula between with air into the urinary bladder.

MSCT  and cystoscopy confirmed a colonourinary fistula.

Result of specimen post-op of the endoscopic surgery was a perforated diverticulitis which made a fistula into the  urinary bladder wall.

CASE 826-827: PARATHYROID TUMOR, Dr PHAN THANH HẢI, Dr LÝ VĂN PHÁI, BS HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Two cases of parathyroid tumor detected by ultrasound. The parathyroid tumor were solid, hypoechoic pattern while in normal case of  parathyroid gland may seen with hyperechoic pattern. Sometime it is mimicking as a thyroid nodule.

PTH and  blood calcium were decreased their values when the parathyroid were removed.

 

Case 1

Case 2

CASE 825: SEMINAL VESICLE TUMOR, Dr PHAN THANH HAI, Dr NGUTYEN MINH THIEN, MEDIC MEDICAL CENTER. HCMC VIETNAM

A 44 year-old HBV-infected man with dysuria for months but no fever.

TRUS detected a mass # 34x37mm beside the right seminal vesicle.

But 2-time-biopsy results were not related to a retroperitoneal cancer.

 The mass was getting bigger so a pelvic 

 surgery was done to remove the mass.

 

The final result post-op was an retroperitoneal epithelial cyst. 

 

CASE 824: THYMUS CARCINOMA, Dr PHAN THANH HẢI, Dr HUYNH ĐứC TH ỤC ĐOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 57 year-old man with thoracic wall pain for 6 months  that failed in analgesic management. No dign of myasthenia .

MSCT detected  destruction of the sternum and an anterior mediastinum tumor maybe thymic cancer.

Core biopsy with guided ultrasound results were poor differentiated thymus carcinoma.

Histoimmunochemistry staining confirmed a thymic squamous cell carcinoma.

CASE 823: PERFORATED STOMACH due to FISHBONE, Dr PHAN THANH HẢI , Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 61 year-old man with epigastric pain last month.

Ultrasound detected accidentally a # 26 mm fishbone which perforated his stomach. On transverse section the fishbone looked like a gastric ulcer. Lab data were in normal values.

MSCT confirmed a fishbone perforating the stomach with the free end into the abdominal cavity.

Endoscopic surgery removed the fishbone from the pyloric wall of the stomach to the peritoneum.

CASE 822: TUBERCULOSIS of KNEE SOFT TISSUE, Dr PHAN THANH HẢI , Dr NGUYỄN SÀO TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 43 year-old female nurse with her right knee pain and slight swelling during 3 months. Her 20 year old history noted she got TB cervical lymph nodes.

Ultrasound detected a #36x35mm mass of the right lateral femoral muscle [biceps femorii] at the 1/3 lower thigh. The muscular mass has unclear border, mixed echogenic and hypovascular. Maybe  it was a tuberculous myositis ?

There was edema of the synovial membrane into the knee joint # 46x48 mm. 

No fluid collection nor bone destruction existed of the right knee joint.

MRI confirmed the right knee mass which was between the femoral biceps and popliteal muscle but could not differentiate  hemangioma, tenosynovial giant cell tumor, soft tissue sarcoma...from each others.

Core biopsy was done and the result was a TB knee soft tissue inflammation which had TB cysts composed caseum and degenerated Langhans cells and lymphocytes.

A TB -treatment -8 -month regimen  for the nurse was planned.