CASE 345: LEFT RENAL VENOUS ANEURYSM, Dr NGUYỄN NGHIỆP VĂN-Dr VÕ NGUYỄN THÀNH NHÂN,MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-345-left-renal-venous-aneurysm-

Female 27yo from Baclieu province, suffered from left side lumbago, which was getting worse in effort

No history of trauma. Entered 121 hospital,  Cantho hospital but status not changing then went to Medic

Center

Sonologist said left kidney AVM which caused left renal vein dilatation of 48mm in diameter.

MSCT with CE was done that IVC appeared early with taken CE of aorta and presented a huge renal vein on left side.

DISCUSSIONS

•      Left renal vein aneurysm presented commonly on left side, and true renal vein aneurysm ( absence of media tunica) which was rare, from now on about 10 cases in literature.

•      Etiology of aneurysm of left renal vein : hypertrophy of the tunica media with fibrotic thickening) : AVM ( post trauma, RCC ), intrarenal AVM, AVM of aorta and renal vein (in case of renal vein behind AAA).

For prevention of lung venous embolism, rupture of aneuysm... patient was repaired in Cho Ray left renal AVM by coiling and getting well .

Left venous aneurysm disappeared totally post op.

CASE 344 :LEFT GROIN TUMOR, Dr PHAN THANH HẢI, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-344-left-groin-tumor-

Man 33 yo, detected  left groin  having  a mass  slow growth for 1 year, no pain ( see foto).

Ultrasound  scanning of this mass=

US1: more  calcification  and  very strong shadowing, but  femur bone was intact.

US 2:  tumor had  cystic part  and hypovascular

US 3  elasto scanning=  inhomogeneous  structure tumor

MSCT  without CE=

CT 1 structure  of tumor from  ischium bone extension to  muscle.

CT 2 ischium bone was destroyed  by tumor.

CT 3..3D view of this tumor.

Core biopsy  of this tumor  with report is  osteo-enchondroma.

CASE 343: TB AXILLARY NODES, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-343-tb-axillary-nodes-

Woman 49 yo, on mammography screening detected  many  left axillary nodes and calcification, no  detected tumor in mammary gland (see mammogram).

Ultrasound  of left   axillary  found  many  lymph nodes,   sizes of 1-2 cm,  round

and  calcification  inside node ( US picture 1). 

CDI cannot  detect  hilus  of nodes, no vascular signal  in  nodes, ( US 2, US 3). Elastoscan  US of this  node was hard,    17.3 kPa ( US 4)

MRI  with  FAST SCAN   DWI..made sure  no tumor intra  left  breast and  

axillary nodes.

Biopsy   removed one  big node with  structure  inside  look liked  caseum.

Microscopy result was   tuberculosis  with  typical  big cell  LANGHANS.

CONCLUSION: Tuberculosis of axillary lymph nodes..

CASE 342 : FRONTAL LUMP, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-342-frontal-lump

MAN 65 YO  ONE YEAR AGO  DETECTED  AT  RIGHT FRONTAL A SMALL MASS UNDER SCALP  SLOWLY GROWING WITHOUT PAIN.

ULTRASOUND FINDINGS=

US 1:TUMOR  DESTRUCTING   FRONTAL BONE, SIZE OF 2CM.

US 2:  HYPERVASCULAR TUMOR.

US 3:ELASTOSCAN OF TUMOR OF 36.3kPA.

US 4.  ULTRASOUND FINDINGS OF  LIVER TUMOR OF 5 CM.

US 5: ELASTOSCAN  OF LIVER TUMORS = HARD,  55.9 kPA

MSCT  BRAIN=  3  CT PICTURES SUSPECTED  METASTASIS TO FRONTAL BONE.

BLOOD TESTS=   HCV POSITIVE  AND WAKO TEST  WASE  STRONG POSITIVE WITH DCP. IT MEANS  HCC.

FNAC  OF THE  FRONTAL TUMOR WAS  HCC METASTASIS.

CONCLUSION:  HCC IN LIVER  METASTASIS TO  FRONTAL BONE.

REFERENCE

CASE 341: THYROID TOXIC ADENOMA, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 41 yo male patient with chronic fatigue syndrome and  nervousness, irritability; sometimes  he feels muscle weakness and hand tremor  for three months and getting severe in ten days. Wants to check up his liver and nervous system. 

Abdominal ultrasound revealed nothing abnormal. Because of his symptoms, sonologist also perfomed a thyroid ultrasound.

Thyroid ultrasound showed that  right lobe and  upper portion of  left lobe were normal in size with smooth margin and homogeneous echotexture, normal blood flow in Doppler ultrasound.

But  lower portion of the left lobe had a 5 cm, mixed cystic-solid nodule with hypervascular, isoechoic in peripheric part and nonvascular cystic degeneration in center part of tumor.

On Doppler US,  inferior thyroid artery showed  peak systolic velocity in  left lobe is 122.7 cm/s, five times more than one of right lobe 24.3 cm/s. So,  sonologist suspected  nodule in  lower left lobe maybe a toxic thyroid adenoma, which is cause of  hyperthyroidism.

Blood tests were done and confirmed the diagnosis with low level of TSH and high level of Free T3, Free T4.

Measuring the peak systolic velocity of inferior thyroid artery in both side to diagnose toxic thyroid adenoma. Do you think we can diagnose toxic thyroid adenoma by ultrasound?

CASE 340 : UMBILICAL TUMOR, Dr PHAN THANH HẢI, Dr LÊ THÔNG LƯU, Dr NGUYỄN THị KIM UYÊN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-340-umbilical-tumor-

Woman 45 yo, PARA 2002, normal spontaneous vaginal deliveries,no cesarean operation  nor history of hormonal contraception. 

2 years ago  she  detected  her umbilicus swelling some days before her menses and continuous pain  during  the entire of her period in some times bleeding.

In clinical  examination  the umbilicus  deformed  by one mass which were bluish-black, hard and not  hot (see 2 photos).

Ultrasound findings of this mass=

US1: this mass was well bordered, localized in cavity of  navel. Structure of mass was solid, size of  2.68 cm.

US 2:  in CDI, vascular supplying from peripheral part of mass.

US 3:  in elastography:  hard mass in comparison to muscle.

US 4 : uterus and pelvis were not intact.

Preoperative diagnosis is primary endometriosis. Removed this tumor. See macroscopic specimen.

Microscopic report: ENDOMETRIOSIS.

CONCLUSION: This  is  a case of   PRIMARY  ENDOMETRIOSIS in umbilicus.

REFERENCE:

CASE 339: INTRAMUSCULAR TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-339-intramuscular-tumor-

Man 51 yo  detected  himself  swollen at  left  scapula region, no pain for 2 years (photo). 

The tumor  was  underskin and ovoid shape.

Ultrasound  of this mass was  localized   in  trapezius muscle, well bordered,  size of 10cm. CDI  no abnormal blood  flow. Elasto scan was  slow  kPa (7.7kPa) in  comparison to muscle 22.9 kPa.

MRI  scan= MRI 1,tumor  well bordered with  density as  fatty tissue, MRI 2, MRI 3).

Operation  was done  for removing of  the tumor.

Microscopic report of this tumor is LIPOMA.