CASE 234: CAROTID BODY TUMOR, A LATERAL MASS of the NECK, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 56 yo for a long time being follow up with thyroid nodule, now he detected the palpable mass on right neck,  sited at middle SCM.

Ultrasound suspected lymph node with B mode ultrasound (image 1,2: thyroid nodule) on right side of the neck.

For ruling out a thyroid cancer, a FNAC was performed for the thyroid mass and the result was colloidal goiter.

MRI of the neck also suspected this mass between carotid internal and external arteries ( 2 MRI pictures).

For diagnosing this neck mass we did CDI for guiding FNAC, but this mass was very high vasculature and situated between ICA and ECA. (See 2 CDI images  of cross section and longitudinal scanning this mass).

MSCT ANGIO was done to see carotid artery on right side was encarcerated by this tumor with very high vascular structure.

Diagnosis is CAROTID BODY TUMOR ( See 3 MSCTA images).

 

Operation  removed  completely  this  tumor in safety and  microscopic  with  immmunohisto staining  report  that  a  paraganglioma  tumor.

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CASE 233: ABDOMINAL MASS AFTER TRAUMA, Dr PHAN THANH HẢI - Dr PHÙ VĂN TUỐT, BÌNH AN HOSPITAL, VIETNAM

MAN 23 YO, for ONE WEEK UNDERWENT A BLUNT TRAUMA NEAR PARAUMBILIC AREA BY BICYCLE ACCIDENT, HE WAS GETTING WORSE MORE AND MORE  BY VOMITTING, AND CANNOT EATING. 

CLINICAL EXAMINATION OF ABDOMEN REVEALED A MASS OVER RIGHT KIDNEY, POSITIVE REBOUND TENDENESS ( PHOTO).

ULTRASOUND in FIRST LINE SHOWED THE STOMACH WAS DILATED. THE  MASS WAS AT DUODENUM D2-D3, SIZE OF 5 CM, CYSTIC STRUCTURE BUT NO FREE FLUID IN HIS ABDOMEN ( 3 U/S IMAGES).

XRAYS of ABDOMEN in STANDING POSITION and BARIUM MEAL  SHOWED THAT DOUDENUM  in OBSTRUCTION.

 

MSCT of abdomen: this mass was from duodenum wall,  cystic structure,  size of 5 cm. Radiologist made diagnosis  of hematoma intraduodenum wall without bleeding into abdomen.

Medical treatment by nasogatric suction  and  wait and see the progress.

 

AFTER 4 DAYS for  NASOGASTRIC SUCTION and IV FLUID REPLACEMENT, NASO GASTRIC TUBE HAD BEEN REMOVED and XRAY BARIUM MEAL for  BEING SURE NO OBSTRUCTION of  DUODENUM. HE CAN DRINK and  EAT  and  RECOVERY STAGE DURING SO FAST (see XRay barium meal on  Jan 24, 2014).

IT IS FIRST STEP of  SUCCESS of MEDICAL TREATMENT for HEMATOMA DUODENAL WALL POST TRAUMA.

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CASE 232: SORE THROAT AFTER COFFEE DRINKING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 50 yo more severe sore thoat after drinking black coffee cup, then she came to ENT hospital for endoscopy, CT of the neck: nothing detection while the neck was swelling, painful and fever. It is LEMIERRE's syndrome.

 MEDIC ultrasound of the neck detected on left lobe of thyroid one echo rich line, long of 3 cm, in an abscess and another abscess on right lobe of thyroid also.

Sonologist said it was a toothpick penetrating to the left thyroid gland.

 
WBC rising of 15k with 87% neutro and CRP was  high : 36mg/L.

MRI at the neck was done and detected a black line as the toothpick.

Emergency endoscopy detected the stuck toothpick in the throat and removing it out (see photo).

 This patient was treated with antibiotic and nasogastric feeding.

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CASE 231: INTRALIVER TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 36 yo with long history of acute hypertension crisis.

Ultrasound of abdomen for check-up detected one mass at left lobe  of liver,  size of 11 cm-8,5 cm which had  round border  with central mass being thought  a scar necrosis( 2 pictures). Sonologist suggested a FNH or HCC.

Blood tests are normal AFP,  not infected HBV ,or HCV.

MSCT with CE of this tumor was well–bordered, blood supplying from liver tissue around, hypervascular with rapid washed-out contrast. This tumor had displaced liver vein. Radiologist diagnosis was a liver tumor as HCC.

Ultrasound guided biopsy was reported that a HCC.

Operation removed this tumor completely and it was not a liver tumor, but was one tumor outside liver .

Microscopic report was malignant pheochromocytoma.

Do you review if  those pictures  are correct with the end report or not?

CASE 230:CONTRALATERAL BREAST CANCER (CBC), Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 64 YO, 10 YEARS BEFORE SHE WENT THROUGH RIGHT MASTECTOMY BY BREAT CANCER [ T2N1MX ]. HISTOLOGY REPORT POST OP WAS DUCTAL CARCINOMA , NOS, ER, PR NEGATIVE. NO CHEMO NOR RADIOTHERAPY.

NOW SHE DETECTED BY HERSELF ONE MASS AT LEFT BREAST. ON ULTRASOUND IT WAS A TUMOR WITH CALCIFICATION, SIZE OF 4 CM AND BIG AXILLARY NODE (2 IMAGES).

MAMMOGRAPHY ALSO SUSPECTED MALIGNANT TUMOR.

MSCT OF THORAX : NO RECURRENT ON RIGHT SIDE, THE LEFT BREAST HAD TUMOR NEAR THE NIPPLE AND AXILLARY NODE. NOTHING DETECTED ANOTHER LESION OF OTHER ORGAN.

WHAT IS YOUR IDEA ? IT IS METASTASIS TO LEFT BREAST FROM THE FIRST BREAST CANCER OR SECOND CONTRALATERAL BREAST CANCER? 

POST OP  mastectomy and removing  10  lymph nodes. Microscopy reported  that  ductal carcinoma with  metastasis  axillary lymph nodes.  It had same  histology  with   cancer   right breast  10 years  before, so it was   second  breast  cancer,  a  contralateral  breast cancer  after  10 years.
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CASE 229: UMBILICAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Girl 7 yo detected umbilical foramen distention many years ago {see photo}. No clinical symptome.

On utrasound scanning it was well - bordered cystic tumor with septation. Color Doppler showed small vascularized intraseptal tumor(2 images).

MSCT with CE, tumor was not related with intra abdomen; its structure was very high contrast enhanced in late phase.( 3 images)

This case had been examined by many doctors. At first one sonologist suggested umbilical hernia, second senologist diagnosed as lymphangioma, another sonologist said hemo-lymphangioma. One radiologist said as dermoid cyst or fibroma. In operation removing this mass (see photos).

MICROSCOPIC REPORT IS HEMANGIO-LYMPHANGIOMA.

CASE 228: Thyroid Toxicosis Periodic Paralysis, Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM

Thyroid Toxicosis Periodic  Paralysis

Man 47 yo,  3 times  paralysis  at  get up in the  morning, he  came to hospital  for  emergency  perfusion  potassium and to  MEDIC  for check- up.

Ultrasound  of abdomen  no abnormal  detected,  no adrenal tumor, but  ultrasound  of thyroid gland is black , CDI hypervasular , typical of  hyperthyroidis .and  soft  with  elastoscan.

Blood test are very low TSH  , high T3, T4, TPO.

EMG was signal of  hypokalemia.

This case is TpP. Medical treatment of anti thyroidism  is requested.

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