CASE 606: EXTRAHEPATIC MULTIPLE CHOLANGIOCARCINOMA, Dr VÕ HIẾU THÀNH, Dr NGUYỄN THỊ BÍCH NGỌC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Female patient 31yo, loss of weight, RUQ and epigastric pain for some months with unknown cause of dilatation of intra-extrahepatic biliary tree. 

At Medic Center, ultrasound shows a distention of gall bladder #132x62 mm without stone and some 10 - 17mm no vascular sign polyps. Furthermore there was a # 10 mm dilated common bile duct without stone downward to pancreas head. 

Intrahepatic biliary tree dilated slightly without stone. 

MRCP performed and detected CBD in dilatation then

collapsed near pancreatic head. Intra and 

extrahepatic biliary tree dilated. 

Gallbladder wall irregular thickening with mass # 17mm. Nodes exist around pancreatic head.

Uncinate processus of pancreas head has high 

signal of contrast capture in T2FS. No dilatation of pancreatic duct. Radiologist thought about terminal part of CBD tumor invades uncinate processus of pancreas head. 

Pancreaticoduodenectomy operation of Whipple 

removed duodenopancreatic bloc. 

Histopathologic results are 1/ poor differentiated 

adenocarcinoma of CBD invades duodenum, 

pancreas and nerves and 

2/ poor differentiated adenocarcinoma of gallbladder  invades peritoneal epithelium and vessels. Somes metastatic lymph nodes 4/4 and 6/7 nodes. 

 

CONCLUSION= A rare case of multiple cholangiocarcinoma because it exists in young 31 yo female patient 

[usually in 50 yo or over patient]

 metastazing to pancreas, lymph nodes, nerves and vessels. Limits of technics of ultrasound makes ultrasound not reliable to find out cause of biliary duct obstruction and pancreas lesion than MRCP with contrast. Maybe elastography ultrasound and endoscopic ultrasound could detect more but unfortunately that not in use in this interesting case. 

 

 

CASE 605: SPLENIC ARTERY ANEURYSM, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER HCMC, VIETNAM

Female patient, 50yo, in general check-up by ultrasound incidentally had been detected a mass 23.5x25.55mm nearby the hilus of her spleen. This cystic structure has Doppler signal inside with zinzang sign. Sonologist thought about a cystic form of  aneurysm of splenic artery.

MSCT at Medic confirmed a sacciform aneurysm of splenic artery with calcifications,

Operation was done to remove the spleen and aneurysm.

Splenic artery aneurysm occurs in approximately 0.1% of all adults. It is estimated that 6% to 10% of splenic artery aneurysms will rupture, and 25% to 40% of those ruptures will occur during pregnancy, especially during the third trimester. Risk factors for rupture include portal hypertension and pregnancy.

Splanchnic Vessel Aneurysm at MEDIC

https://www.slideshare.net/hungnguyenthien/splanchnic-vesselaneurysms?qid=d9f6f654-e6c7-42ce-8104-5cd4b9f9a4bc&v=&b=&from_search=2

CASE 604: E M S of GALLBLADDER NECK STONE, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC,VIETNAM

Male patient 50yo with pain at right costal border in coughing.

Emergency medical sonography (EMS) detects small stone # 6mm at the GB neck and some cholesterol polyps. GB size = 76x37mm, slight edema of  GB wall with hypervascularization due to inflamation. Common bile duct is not dilated.

MSCT non CE confirmed stone at the GB neck and GB wall thickening.

Laparocholecystectomy removed gallbladder with many stones.

CONCLUSION= Emergency medical sonography is an  efficient tool for diagnosis  of a RUQ pain case but that is non radiation in comparison to MSCT.