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CASE 346: THYROID NODULE or PTC, Dr LE THANH LIEM-Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM
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CASE 347: APPENDICOLITH, Dr PHAN THANH HAI, Dr LY VAN PHAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Woman 60 yo, pain at RLAQ for one month and was treated with medicine but not resolving her problem.
Ultrasound scanning of abdomen detected at RLAQ one mass with thickening of the wall and hypervascular ( see US images 1, 2,3,4)
WBC is normal, CRP is raised of 16.55ng/mL.
MSCT with CE detected one mass near coecum area with tiny stone ( CT images 1, 2).
Operation for removing of this mass.
It is a retrocoecal appendicitis with abssess and stone in appendiceal lumen [ appendicolith].
REFERENCE
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CASE 348:STRUMA OVARII, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Woman 57yo, in general check-up ultrasound detected right ovarian tumor [image US 1( B mode), size of 5 cm, round border and central necrosis with vascular covered around ( US 2). US 3 elastoscan of this tumor is hard= 53 kPa and inhomogeneous.
MSCT non CE: Right ovarian tumor was round border, central necrosis, no ascites and uterus is in normal structure (CT 1, CT 2, CT3).
Blood test = ROMA test is normal.
OPERATION FOR REMOVING THIS TUMOR.
IT IS RIGHT OVARIAN TUMOR, WELL BORDERED, HARD, NO INVASION TO AROUND PELVIS ( PHOTO MACRO).
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IT IS RIGHT OVARIAN TUMOR, WELL BORDERED, HARD, NO INVASION TO AROUND PELVIS ( PHOTO MACRO).
MICROSCOPIC REPORT IS STRUMA OVARII.
REFERENCE:
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CASE 349: TESTIS TUMOR, Dr PHAN THANH HAI- Dr LE THONG NHAT, MEDIC MEDICAL CENTER, HCMC, VIETNAM
MAN 42 YO, ONE MONTH AGO, PAIN IN ORAL SINUS, DIFFICULT EATING AND 2 DAYS PAIN AT LEFT TESTIS [FOTO IN ORAL TUMOR AT PALATINE].
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ULTRASOUND OF LEFT TESTIS PRESENTED BIG AND HOT (US 1, B MODE B&W, CROSS SECTION OF LEFT TESTIS HYPOECHOIC INFILTRATION; US2, COLOR DOPPLER IS HYPERVASCULAR OF ONE PORTION OF TESTIS; US3, LONGITUDINAL SECTION OF LEFT TESTIS;
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US4 ELASTOSCAN THIS HYPOECHOIC IS 10,5 kPA).
FNAC OF THIS MASS OF LEFT TESTIS HAVING ABNORMAL CELLS.
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BIOPSY OF THIS TUMOR IN ORAL IS B CELL LYMPHOMA.
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MY DIAGNOSIS IS B CELL LYMPHOMA STAGE 4.
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CASE 350: SKIN TUMOR, Dr PHAN THANH HAI - Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Woman 78 yo, presented small nodule of upper lip, slow growing for 1 year, no pain, no itching. Palpation of this tumor was hard, size around 2 cm( see foto).
OPERATION REMOVED THIS TUMOR EASILY WITH WELL BORDERED ( SEE FOTO MACRO)
MICROSCOPIC IS BASAL CELL CARCINOMA [BCC] WITH IMMUNO HISTO STAINNING.
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CASE 351:A CASE of FITZ-HUGH-CURTIS SYNDROME , Dr PHAN THANH HAI - Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Woman 24 yo post partum, pain at right pelvis and fever. But one day after, pain at liver region, palpation is very painful at Murphy point liked cholecystitis.
Ultrasound of abdomen cannot detect cause of pain, no stone in gallbladder , no thickening of the wall of gallbladder, no free air or free fluidat Morrison space(see US pictures 1, 2).
MSCT of abdomen without CE cannot detect abnormal ( CT 1); with CE injection, in delay phase radiologist reported abnormal perihepaticcontrast enhanced.
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Suggestion for this case : perihepatitis and PID [pelvic inflammatory disease] means FITZ-HUGH-CURTIS SYNDROME.
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THIS PATIENT HAD BEEN TREATED BY ANTIBIOTICS, CLINICAL STATUS RESPONSED VERY WELL, NO MORE PAIN AND NO FEVER, AND DISCHARGED HOSPITAL AFTER 3 DAYS.
REFERENCE: FHC SYNDROME.
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CASE 352: TUBERCULOSIS PROSTATE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Man 49yo, dysuria, clicinal examination detected big lymphnode on hisleft neck ( foto).
Ultrasound examinationof the neck: normalthyroid gland,size of lymphnode of 2cm, hypoechoic without hilus on color doppler( US 1).
On elastoscan,center of this lymphnode is hard 22kPa.
Ultrasound scanning ofpelvis detected prostate having one hypoechoicmass at right lobe ( US 3).
US scanning at epigatric areadetected one mass ellypsoid of 3 cm lyingover aorta(US 4).
Sonologist suggested aprostate cancer with metastasis to lymphnode.
CT scan with CE revealed the mass in prostate hypovascular, no contrast enhancement.looked like necrosis or abscess.
Biopsy of this cervical lymphnode is tuberculosis lymphadenitis (photo )
Punction of prostate mass removed pus specimen, and examination this pus with PCRis TB positiveand high ADA.
Blood test PSA is 2.05 ng/mL.
CONCLUSION: this case is tuberculosis prostate and lymphnode looked like prostate cancer metastasis to cervical lymph node.
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CASE 353: SCALP SKIN TUMOR, DR PHAN THANH HẢI,Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM
MAN 37 YO. HISTORY: KNOWN THAT SMALL TUMOR AT OCCIPUS AREA.OF SCALP FOR 20 YEARS . BUT THIS YEAR THIS TUMOR IS GETTING BIG SIZE OF10CM, NO PAIN.
ON CLINICAL EXAMINATION THIS TUMOR IS HARD IN PALPATION (\SEE FOTO).
ULTRASOUND OF THIS TUMOR BY LINEAR PROBE 10MHz : THIS TUMOR IS SOLID, THICKENING ABOUT 1- 2 CM, HYPOECHOIC, HYPOVASCULAR.
ELASTOSCAN US IS HARD OF 22kPa. NO EROSION IN BONE BELOW ( SEE US 1, US 2, US3, US 4).
ONE DERMATOLOGIST SUGGESTED SEBACEOUS NEAVUS.
OPERATION REMOVED THIS TUMOR ( SEE MACRO).
WHAT IS YOUR DIAGNOSIS FOR THE CASE?.
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CASE 354: RIGHT KIDNEY TUMOR, Dr PHAN THANH HẢI-Dr TRẦN LÃM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Man 37 yo, screening by MSCT total body non CE detected abnormal border of upper pole of right kidney (images CT 1, CT 2).
Phased CT CE find out this mass being tumor of upper pole of right kidney, size of3,5 cm with the rim border but non fatty tissue in structure (CT 3, CT4).
Ultrasound for verifying of this mass is mixed echoic, hypovascular supplying, not invasion to hilus of right kidney (US 1, US 2( longitudinal scanning), US 3 (cross-section).
What is your suggestion of diagnosis, and biopsy or not?
Urologist says no biopsy, clinical imaging looks like RCC. Planning to surgery, partial nephrectomy (see macro).
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MICROSCOPIC REPORT IS RCC (RENAL CELL CARCINOMA).
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MICROSCOPIC REPORT IS RCC (RENAL CELL CARCINOMA).
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CASE 355: PAROTID GLANDS TUBERCULOSIS, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HO CHI MINH CITY, VIETNAM
A female 19 yo patient, student, swelling and pain in the parotid glands about a week, not fever.
Images of parotid gland ultrasonography showed multiple structures within the parotid glands on either side, hypoechoic, well-defined, measuring approximately 5 - 12 mm, with the umbilical node. She was diagnosed inflammation of the parotid glands and indicated for ten days of antibiotic treatment (cephalosporin 3 and fluoroquinolon).
But parotid glands swelling continuosly, ultrasound images still showed images more nodules in the parotid glands,and antibiotics for ten days again. Next follow-up visit parotid glands biopsy was done, and result showed chronic salivary glands inflammation.
Patient was sent to hospitalization Ho Chi Minh city in dentomaxillofacial center for 2 weeks of antibiotics as Sjogren syndrome. Parotid glands still swollen and had discharge line to detect skin. And she returned to MEDIC for parotid gland ultrasound.
Ultrasound image showed multiple hypoechoic structures with liquid inside, well-defined, proliferative vascular supplying, created road detect skin.
MSCT with CE showed parotid gland hypertrophy, having multiple lesions with fluid density in the central area.
Parotid gland biopsy showed salivary gland with Langhans great cells.
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CASE 356 : COLO-COLIC INTUSSUSCEPTION, Dr PHAN THANH HẢI, Dr VÕ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Man 56 yo, acute colic pain at right upper quadrant of abdomen, crisis and vomitting3 days ago.
Ultrasound scan at liver:
US1.detects big mass near gallblader liked a bowel loop dilated.
US 2: right colon dilated with multiple layers which is oignon sign.
US3. Coecum moved up near liver connected with one cystic mass.
US 4 cystic mass is liquid with multiple rings [oignon sign] typical of mucineous cyst of appendix.
CT scan abdomen detected right colon moving up with coecum intussusception (CT1 frontal section;, CT2, sagital section;CT3, frontal section).
Emergency operation with diagnosis colo-colic intussusception by appendicular mucocele.
See specimen of operation by right colectomy.
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CASE 357: PELVIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Female 15 yo, pain at pelvis, no mentrial cycle.
Ultrasound of pelvis one sonologist suggested ovarian tumor.
review of ultrasound:
US1: cystic structure in pelvis, long 20cm, morphology like a hourglass, upper portion near bifurcation of abdominal aorta.
US2: cross-section..of the mass : fluid and debris inside.
US3. Cross- section, the wall of the upper part is thiskening.
US4 with linear probe: wall is thickening in comparison to the lower part.
Ultrasound report suggested a hematometriocolpos.
MRI of pelvis detected this mass with old blood inside.
Diagnosis is imperforated hymen and hematometriocolpos.
ObGyn doctor treated by incision of hymen for drainage of this old blood.
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CASE 358: LESSER OMENTUM TUMOR, Dr PHAN THANH HAI , Dr VAN UYEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Women 30yo, general check- up .
Ultrasound detected a tumor on border of liver near gallblader which deplaces left gastric curvatureand is from retroperitonealspace. Its structure are solid and cysticparts, size arround 10cm ( see ultrasound us1.. cystic part tumor in border liver; us 2..near gallblader; us 3..long scan left lobe liver and tumor.).Sonologist cannot diagnosethis tumor from lesser omentum.
MSCT with CE of this tumor is mixed structure, cystic, fatty,and calcification [ CT1..section, CT 2 frontal section , CT3 sagital ). Suggession fromradiologist is teratomatumor or lipoma necrosis.
MRI with gado( MRI 1..struture is more fat tissue., MRI 2..with fat suppression , MRI 3 frontal view). Radiologist says teratomaof retroperitoneum, in lesser omentum area.
Blood test of all cancer markersarenormal.
Laparo-operation= 
picture 1( retrogastric tumor well bordered)
picture 2macro
picture macro 3, opened specimen, solid and cystic tumorand fluid inside like milk)
Microscopic report of this tumor is teratoma maturation.
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CASE 359: RIGHT HIP PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Women 72 yo, pain at right hip in walking for 2 months , no trauma, no fever.
Ultrasound of right hip joint( us 1 scan, us2, us 3 cross- section).
Plain XRay in AP view for comparison of right to left hip joint ( XRay image) no abnormal detected.
CT scanning ( CT 1: cross section of head of femoral bonedeformation atrightside, CT2: frontal view, CT3 3D view).
MRI of hip joint in comparison of right to left femoral headbone.
Final diagnosis is AVN ( avascular necrosis of femoral head)
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CASE 360: RIGHT KIDNEY TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Man 38yo 2 years ago intermittent hematuria, today acute right renal colicky pain.
Ultrasound in emergency detected big right kidney and fluid collection arround kidney.
Pelvic kidney has a collected hyperechoic mass which made dilated ureter.
CDI ultrasound detected no Doppler signal in vascular renal cortex ( US 2)
MSCT with CE=CT1: frontal view= right kidney too big without contrast supplying.
CT 2: frontal view, pelvis of right kidney is covered by enhanced contrast mass just to dilated ureter.
CT3, CT 4: cross- sectional view: pelvis and ureter detected intralumen one enhanced contrast structure liked a tumor.
CT 6: 3D vascular view= no vascular supplying to right kidney.
Report by radiologist is bleeding intra right urinary system with ureter obstruction by tumor, suspected TCC.(TRANSITIONAL CELL CARCINOMA)
Emergency operation of right nephrectomy and ureterectomy.
Macroscopic specimen showed tumor in obstruction of distal ureter.
Microscopic report TCC ( transitional cell carcinoma hight grade malignancy.
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CASE 361: TUMOR of MUSCLE RECTUS ABDOMINIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Woman 33yo, 4 months after cesarian operation detected a mass near umbilicus on right side, fixed palpation,
Ultrasound.scanning of this mass revealed intra abdominal wall mass, from lower part of rectus abdominis muscle. ( US 1, US 2. US 3 ( linear probe), video) . Video clip shows this tumor from anterior abdominal wall ).
On MRI, this tumor is solid, size of 12 cm, structure looked like uterine myoma.
( MRI1, MRI2, MRI3).
Discussion:
At first, diagnosis from one OBGY doctor is endometriosis post c-section. But another sonologist from Obgy hospital is pediculate fibroma of uterus. One radiologist looking MRI says tumor of rectus abdominis muscle same as fibromuscular mass.
Operation for remove this tumor; operator reported this tumor was well bordered, hard,
and developered from rectus muscle, not from the middle line if c-section.
Macro.view of section surface look like fibroma.
Operation for remove this tumor; operator reported this tumor was well bordered, hard,
and developered from rectus muscle, not from the middle line if c-section.
Macro.view of section surface look like fibroma.
Discussion 2: In past history she had been first c-section for first delivery 3 years ago. During second pregnancy, this patient known having fibroma of uterus from doctor ObGyn. It is mistaken prenatal diagnosis. Her past history is very important issue for diagnosing today.
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CASE 362: ACUTE FEMALE PELVIS PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTE
Women 21 yo, single, acute hypogastric pain, polykiuria, urine analysis no abnormal.
Ultrasound scanning in pelvis showsuterus normal in size with endometrium thickening, fluid arround uterus looks like blood(US 1) and on right site uterus one mass round of 5 cm with multiple cystic( US 2),US 3 color doppler this mass is normal vascular , US 4 PW Doppler of right uterine artery with RI IS 82.
Sonologist alerts there is bleeding intrapelvis and suspected rupture of right ovary cyst.
MSCT with CE : Uterus is no pregnancy intrauterus ( CT1), this mass at right parameter is cystic central and the wall is thickeningwith blood arrounding.
Radiologist diagnosis is hemoperitoneum due to rupture of corpus luteinic at the right ovary, blood volume arround 100ml.
Blood test makes sure beta HCG is negative.
Clinical finding is acute pelvis pain in female single patient, ultrasound quickly detected bleeding intra pelvis and blood test for rule out ectopic pregnancy.
Ultrasound is best diagnosis and follow up this case no need CT in this case
This patient was admitted OBGY hospital for surveyin 3 daysand dischargelater.
Conclusion: in female acute pelvis pain ultrasound is first choice FOR diagnosis about corpus luteinic rupture bleeding, beta HCG confirmsfor diagnosisof MITTELSCHMERZT SYNDROME.
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CASE 363: MURPHY'S SIGN POSITIVE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNA
Woman 32 yo, 3 days ago, fever and pain at right upper quadrand of abdomen with MURPHY SIGN POSITIVE in clinical palpation.
Report of ultrasound in emergency from a province hospital was cholecystitis necrosis and peritonitis ( US picture).
At MEDIC, reviewed ultrasound shows US 1: CDI revealed big gallbladder and edema of the wall, no stone, no perforation. CBD is no dilatation, no hypervascular.
US 2: fluid collecting in Morrison’s space extending to right iliac fossa.
US 3:normal scanning at pancreas area.
Patient reports painful in pressing of ultrasound probe over gallbladder area .
Sonologist suggested edema of the gallbladder wall and ascites maybe due to hemorragic fever reaction.
Blood tests confirmed low WBC, low platelets, and Dengue test IgG positive.
Based on ultrasound picture and blood tests, diagnosis was infected Dengue; gallbladder edema only due to reaction. And the management for the case is medical follow-up in progress of disease.
Reference:
Acute Acalculous Cholescystitis and Ascites [Dengue Fever stage III]
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Reference:
Acute Acalculous Cholescystitis and Ascites [Dengue Fever stage III]
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CASE 364: LUNG LOOKED LIKE LIVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM
Woman 62 yo, cough and dyspnea, weakness of left side of her body 2 weeks ago.
Chest XRay first.( see pleural effusion at right lung).
Ultrasound of thorax:
US1=liver normal with mass at lower portion of right lung
US 2=liver and right lung looked like liver structure (hepatization).
US 3= scan at right thorax: pleural effusion and lung solid mass.
US 4= with 10MHz linear probe looking of visceral layer of pleural membrane having irregular nodular mass.
US 5 = this lung mass is hard like liver.
US 6= very low vascular supplying.
CT scan of lung non CE.: CT1=cross section, CT2 = frontal view, CT 3= many nodular metastasis at right and left lung.
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CT4= brain scan with suggestion of metastasis at right brain..
Punction of pleural space removing yellow fluid ( foto).
Analysis of fluid = ADA very low, ruling out lung tuberculosis.
Do you thing this case is lung cancer metastasis to the brain?
REFERENCE:
Ultrasound detection of Lung Hepatization
REFERENCE:
Ultrasound detection of Lung Hepatization
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CASE 365: MULTIPLE INTRAMUSCULAR TUMORS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.
Woman 60 yo being treated lymphoma large B cell stage IV by chemotherapy for 5 months.
One week ago she herself detected many subcutaneous nodules palpable at forearm right and left, neck and right parotid area, no painful.
ULTRASOUND=
US 1=tumor intramuscular right forearm, round border, very low echo density.
US 2=cross-section, lesion at forearm.
US 3=CDI Doppler vascular structureof this mass, hypervascular.
US 4=longitudinal scanning with CDI.
US 5=CDI with PW, RI= 0,70.
US 6 = small intramuscular nodule at posterior of neck.
US 7= SWE of mass in right parotid.
Do you thing it is lymphoma in muscle?
Biopsy of this mass is large B cell lymphoma, same as result pre-treatment.
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Conclusion: LYMPHOMA LARGE B CELL AT THE DIFFUSE STAGE CAN MAKE MULTIPLE NODULES IN MUSCLES.
Reference:
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Reference:
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