CASE 551: PNEUMOPERITONEUM POST CTC, Dr PHAN THANH HAI, Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 68YO  WITH  FOBT TEST POSITIVE  TO DO  VIRTUAL CT COLONOGRAPHY. 

REPORT OF CT DETECTED FREE AIR IN ABDOMEN CAVITY, AND NO DETECTED TUMOR IN COLON (SEE  CTC , CT1).

   

CLINICAL EXAMINATION OF THE ABDOMEN IS NOT PAINFUL BY COMPRESSION, NO CHANGE  VITAL STATUS.  

US  SCANNING DETECTED FREE AIR  IN HYPOGASTRIC AREA AND  LIVER BORDER ( US1).

TREATMENT   FOLLOW_UP   THE STATUS  NO EATING BY MOUTH 24 HRS.  REVIEW  AGAIN THE VITAL STATUS  NO PERITONITIS   

MSCT AGAIN  DETECTED THE FREE AIR IN ABDOMEN IS  REABSORPTION (CT2). 

ULTRASOUND OF ABDOMEN AGAIN DON'T SEE  FREE AIR  IN THE PERITONEUM.

CONCLUSION=   CTC  BY CO2  COMPLICATION IS PNEUMOPERITONEUM  NO DETECTED TUMOR IN COLON OR SITE OF PERFORATION. NO NEED OPERATION.

WAIT AND SEE.

REFERENCE : CASE of CAT SCRATCH COLON.

CASE 550: ULTRASOUND FOR BUCCAL TUMOR, DR PHAN THANH HAI, DR TRAN THI THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 63 YO  DETECTED AT RIGHT FACIAL BUCCAL AREA  ONE MASS  THAT DEFORMED HER FACE,  NO PAIN FOR 3 MONTHS  (SEE FOTO).

ULTRASOUND=   

US 1: SCANNING OVER TUMOR,  NEAR MASSETER MUSCLE  and OVER  BUCCALIST MUSCLE  EXISTS ONE  HYPOECHOIC MASS MOVING BY PRESSING OF THE PROBE, THAT LOOKED LIKE FLUID, BUT ON DOPPLER NO DETECTED ANY VESSELS.

US 2 : VIDEO IN OPENING OF THE MOUTH and THIS MASS IS MOVING.

US 3: OPENING OF SUPERB MICROVASCULAR IMAGING [SMI] SCANNING (CANON  APLIO A I 450)  DETECTED  MORE SMALL VESSELS, THEN  IT IS NOT FLUID  BUT LIKED FATTY TISSUE.

  

SONOLOGIST SUSGESTED FATTY PAD PROCESS ( BUCCAL FATTY PAD).

  

OPERATION REMOVED FATTY MASS.

MICROSCOPIC  REPORT IS FATTY TISSUE.

ANATOMY OF BFP ( BUCCAL FAT PAD).

CASE 549: RENAL CYSTIC TUMOR, Dr PHAN THANH HAI, Dr NGUYEN PHUOC TOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 38 yo with annual health check up ; 3 years ago ultrasound detected  right renal cystic tumor growing bigger for year. 

NOW,   US 1: LONGITUDINAL SCANNING OF  RIGHT KIDNEY  NOTES THAT A CYSTIC TUMOR AT UPPER  POLE OF RIGHT KIDNEY.

US 2: CDI  IN CROSSED SECTION OF RIGHT KIDNEY.

US 3:  LONGITUDINAL SCANNING OF RIGHT KIDNEY WITH CDI.

MSCT CE    

CT1 : CROSSED SECTION OF RIGHT KIDNEY CYSTIC TUMOR  WITH FINE SEPTATION.

CT 2 : FRONTAL VIEW OF   RIGHT KIDNEY.

CT 3 : TUMOR  COVERS  UPPER POLE OF RIGHT KIDNEY TO  HILUS OF RIGHT KIDNEY.

CT4=  SAGITTAL VIEW OF RIGHT KIDNEY.

RADIOLOGIST  SAYS CYSTIC TUMOR OF RIGHT KIDNEY  TOO BIG  THAT COVERS MORE RIGHT KIDNEY in  BOSNIACK III  CLASSIFICATION.

THIS PATIENT PLANS TO  NEPHRECTOMY OPERATION.
MRI of THIS CASE  REPORTED   CYSTIC TUMOR OF RIGHT Kidney,  SIZE 5 CM, BOSNIACK IV.

OPERATION  BY ROBOT,   RETROPERITONEAL RESECTION OF RIGHT KIDNEY.   

SEE MACRO  

OP 1: SURFACE OF  R KID  NO INVASION OUT OF  KID BORDER

OP 2 : SAGITTAL SECTION, TUMOR IS CYSTIC NO SOLID PART INTRA TUMOR.

MICROSCOPIC REPORT IS BENIGN CYST.

REFERENCE =  BOSNIACK CLASSIFICATION  AND HISTORY.

CASE 548: APPENDICITIS in PREGNANCY, Dr PHAN THANH HAI, Dr DANG VINH PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 37YO IN GESTATION 16 WKS,  10 DAYS AGO PAIN IN RLAQ.

ULTRASOUND   

US1  PREGNANCY 16WKS  

US2  CROSSED SECTION AT RLAQ  SUSPECTED  APPENDICE RETROCOLON ASCENDING.

US3  LONGITUDINAL SCAN   APPENDICE  EDEMA.

BLOOD TESTS:  WBC  9,2K WITH 75% neutro. CRP  110ng/mL.

MRI  IS DONE.   

MRI1  CROSSED SECTION.

MRI2  CROSSED SECTION AT COLON ASCENDING.

MRI3  SAGITTAL VIEW.

 MRI4  FRONTAL VIEW.

RADIOLOGIST SAYS RETROCOLON APPENDICULAR ABSCESS.

EMERGENCY OPERATION   

OP1,2.

CONCLUSION=   IN PREGNANCY   US AND MRI  CAN DO DIAGNOSTIC  for RETROCECAL APPENDICITIS.

REFERENCE: AJOG DEC 2006, APPENDIITIS IN PREGNANT PATIENTS:  DIAGNOSTIC EFFICACY OF ULTRASOUND vs MRI.

CASE 547: MONDOR'S DISEASE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 60YO WITH PAIN AT RIGHT UPPER QUADRAN OF RIGHT BREAST. 

ULTRASOUND DETECTED  ONE MASS  NOT CLEAR BORDER  WITH ONE TUBULAR STRUCTURE  LOOKED LIKE  A  THROMBOSIS  OF VEIN .

PRESSURE OVER THERE IS PAINFUL.

(US1).

CROSSED SECTION  THIS STRUCTURE ( US 2) .

US 3 : WITH COLOR DOPPLER  THIS STRUCTURE IS NEARBY AN ARTERY.

US 4 : WITH PDI  THIS MASS IS NO FLOW IN COMPRESSION.

US 5 : ELASTOGRAPHY  THIS STRUCTURE IS HARD BORDER .

MAMMOGRAPHY XRAY   

M1   THE RIGHT BREAST VASCULAR STRUCTURE  HAD BEEN DILATED 

M2  ZOOM THIS MASS .

M3  ANOTHER VIEW 

SUMMARY = ONSET PAIN  NOT TRUE A MASS TUMOR  WITH   TUBULAR STRUCTURE  AS A VEIN THROMBOSIS. THE DIAGNOSTIC IS  MONDOR'S  DISEASE.

Image history of Dr Henri MONDOR.

CASE REPORT PDF.

CASE 546: LUNG CANCER, Dr PHAN THANH HAI, Dr HUYNH TRAC LUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 52 YO WITH  PROLONGED COUGH.     
CHEST X-RAYS DETECTED A  MEDIASTINUM TUMOR.

MSCT with CE  =
CT  LUNG 1:   FRONTAL VIEW:  LARGE NECK BY LYMPH NODES. MEDIASTINUM  ENLARGED BY MANY LYMPH NODES  AND LEFT LUNG TUMOR.

CT 2 :  CROSSED SECTION,  TUMOR OF LEFT LUNG WITH LYMPH NODES in MEDIASTINUM.

CT 3: LEFT LUNG TUMOR .

CT 4: SUPRACLAVICULAR LYMPH NODES  BOTH 2 SIDES.

ULTRASOUND OF THE NECK   

US 1=  BIG LYMPH NODES AT RIGHT SUPRACLAVICULAR AREA.

US 2 = AT LEFT SUPRACLAVICULAR  AREA , NODE SUSPECTED  METASTASIS.

BLOOD TESTS =CYFRA 21-1 : 3.05 ( N=  3.3)  PROGRP : >5000 pg/ml( N=65)

ACTH  282 pg/ml (N= 7-63)    CORTISOL  23 pg/ml (N=  6.2-19.4)

Biopsy of  right supraclavicular  lymph node.

HISTOLOGY REPORT WITH  IMMUNO STAINING IS  SCC.( NEUROGENIC ENDOCRINE TUMOR).

REFERENCE    Pro-GRP  [Pro-gastrin-releasing peptide] TEST for small cell carcinoma.

NOTA= VUD published 2 cases of SCC from 07 cases of lung tumor topic.