CASES 727-728-729: SUBCLINICAL ABDOMINAL AORTIC ANEURYSM, Dr PHAN THANH HẢI, Dr TRẦN MỘC HIỆP, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 3 cases (1 female,  2 males ) with subclinical abdominal aortic aneurysm [AAA] were incidentally detected firstly by abdominal ultrasound, and confirmed later by MSCT. 

Surgery repaired abdominal aorta with Y tube silver graft and all of patients were well post-op.

Case one: 

A 61 year-old man with hematemesis, normal BP: 120/80 mmHg, but  gets hypogastric pain. AAA # 60x90 mm from renal artery level to iliac artery.

Case 02:

A 71 year- old woman with lordosis for a check-up,  BP :125/80 mmHg. AAA # 60X103 mm from renal artery level in risk of rupture, and iliac artery aneurysms.

Case 03:

A 78 year-old man with sleep trouble, BP :124/79 mmHg. AAA# 40x70 mm and iliac artery aneurysm.

DISCUSSIONS:

Elderly patients complaining of lumbago, lower limb weakness, erectile problems in males, or occasionally feeling of "a heart in the abdomen" may have a silent abdominal aortic aneurysm. 

In our facility, the annual incidence of subclinical abdominal aortic aneurysm is around 10%. Additionally, the AAA dissection may occur in 10% of those AAA.

In Vietnam, applying ultrasound first, POCUS in particular, may be useful in identifying the AAA (and then MSCT to confirm) that helps preventing the elderly patient's death. Sonologists should make it a practice to check for abdominal aortic aneurysms before concluding the ultrasound examination.

REFERENCE:

Nguyễn Thiện Hùng, Phan Thanh Hải et al (1998): Ultrasound for diagnosing abdominal aortic aneurysm and prognosis in 10 years, Journal of Medicine Practice of Medicine and Pharmacy Society in HCM City:3:pp 3-7.

CASE 726: BOWEL TUMOR, Dr PHAN THANH HẢI, Dr PHAM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC,

 A 55 year-old woman with anemia and dark stool complained epigastric and subcostal pain for one year.

Ultrasound detected a bowel tumor # 20-40mm above aorta, hypoechoic without vascular signals maybe bowel GIST. 

MSCT confirmed  a #20×43 mm bowel GIST.

Surgery removed the tumor. Histopathological result is GIST (spindle cell tumor).

DISCUSSIONS 

GIST of the GI tract can be found by ultrasound, particularly from the bowel wall. Three cases from the bowel—one from the rectum, one from the stomach—are being revealed at Medic Center.

However, using chemohistopathological staining and histopathological results, MSCT plays a crucial role in the diagnosis of GIST of gastrointestinal tract.

CASE 725: INFECTED HBV and HCC, Dr PHAN THANH HẢI, Dr HỒ TẤN ĐẠT, MEDIC MEDICAL CENTER, HCMC , VIETNAM

A 53-year-old man who had been infected with HBV since 2011 arrived at Medic Center because of rumors that he had liver cirrhosis, but he refuses any knowledge of illness. 

Ultrasound detected  a # 30 mm liver tumor in the left lobe and in caudate lobe of the liver and F4 on Fibroscan while his clinical status is almost nothing abnormal detected.

 

 

Lab data noted  a HCC high risk (WAKO test).

MSCT confirmed liver tumors and chronic hepatitis

 

The man died in hospital 6 months later. 

DISCUSSIONS:

 

HBV infection causes liver cancers which are highly prevalence in Vietnam.

In HCM city the seroprevalence of HBV is still high, ranging from 8 to 13 percent. On the other hand, 70% HBV patients have no symptoms which may develop the liver cancer at a later stage.

It must be identified the  infected HBV cases in the community as soon as feasible and the family members must get care and vaccination. Patients with HBV infection require monitoring every three to six months for detection liver cancer  in order to treat them quickly and save them from dying.

CASE 722-723-724: PULMONARY EMBOLISM Induced by LIMB THROMBOSIS, Dr PHAN THANH HẢI, Dr NGUYỄN TUYẾT VÂN, MEDIC MEDICAL CENTER, HCMC. VIETNAM.

 3 cases [1 man, 2 women] with dyspnea and lower limb edema and tachycardia represented pulmonary embolism. Both of them had lower limb venous thrombosis while the two women have been using oral contraceptive drugs for over 5 months. The male patient took unknown drugs for painful lower limbs and calf cramps.

Case 01: Man 39 year-old with calf cramps. Past history of left leg trauma. Dyspnea for 3 days. Tachycardia and venous thrombosis of lower limb on ultrasound. Troponin slightly rising.

Unremarkable chest X-ray. 

MSCT confirmed PE.

Case 2: Woman 33 year-old  with asthenia and dyspnea and edema of lower limbs. Oral contraceptive taken for 5 months. D-Dimer and troponin rising.

Case  3: Woman 42 yo with oral contraceptive taken for 6 months. Swollen left leg with pain, but without dyspnea.

Pulmonary embolism  (PE) may occur in case of lower limb venous thrombosis and dyspnea. Ultrasound could reveal  the venous thrombosis, cardiac status, and chest MSCT confirmes the PE. Troponin rises in 50% of PE cases in the early 40 hours which is a significant sign of the high mortality.

REFERENCE 

CASE 720_721: MEDIASTINAL LIPOMATOSIS, Dr PHAN THANH HẢI, Dr NGUYÊN TUYẾT VÂN, Dr HÔ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Case 01:A 19 year-old man with  fever and dyspnea for one month.

Cardiac ultrasound could not explore the anterior of the heart but no ventricular hypertrophy was noted.

Abdominal ultrasound revealed a right pleural effusion and the right lung in solid, hyperechoic pattern.

Chest X-RAY noted an anterior mediastinal tumor that covered the heart, maybe a mediastinal lipoma.

MSCT  confirmed an anterior mediastinal tumor.

But the patient and his family denied surgery.

Case 02: 15 years before, a 54 year-old man  with a tumor which enlarged the anterior mediastinal space on the chest X-ray film.

Cardiac ultrasound detected an anterior mediastinal mass and non cardiomegaly.

MSCT confirmed an anterior mediastinal mass.

Surgery removed the anterior mediastinal lipoma.

Chest X-RAY film post-of came back normally with no mediastinal tumor. 

Mediastinal lipoma is a rare benign entity which may detect incidentally with dyspnea, difficult speaking and swallowing.

Heart shadow is large on chest X-RAY  film but EKG and ultrasound are normally appearances.

MSCT detected exactly the tumor which has fatty density of 95 HU.

And it needs any further invasive technique to diagnose and management. 

Reference:

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