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CASE 366 : LUNG HEPATIZATION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

March 1, 2016, 5:30 am
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Man 60 yo, cough, dypsnea.
Chest X-rays:(picture:very  bright left lung).
 


Ultrasound  scanning position on the back (photo)
U S 1: scanning of the upper  portion of left  lung, air  inside solid mass.


U S 2: lower portion of the mass= echostructure  looked like structure of liver.


U S 3:vascularity ofthis mass.


U S 4 :small mass arround in  lobar bronche  is  consolidation of the lung, no pleural effusion.


CT 1  scanning  with  CE detected  the mass  in left upper lobar bronche enhanced with CE.


Conclusion: Lung  consolidationon ultrasound  looked like  liver(hepatization of the lung)


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CASE 367 : INTRAORAL TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

March 13, 2016, 4:22 am
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Boy  04 yo, difficulty  swallowing for 3 months.  No fever, no pain. Clinical  ENT  doctor’s examination  is suggestion of tonsil  tumor at right side  (photo).


X-Rays of  the neck AP and lateral view: this mass  is  calcified,   irregular border,   precervical spinal bone, size of  4 cm( film 1, 2)



US examination of this mass:
US 1: Longitudinal scan  the mass with  strong shadowing cannot  inside this mass.

  
US 2: Cross-section view.



US 3: Relation of this mass with carotid and  cervical spinal bone.


CT scan= CT 1:sagittal view , CT 2:  cross- section  with PA view,  CT3: cross-section with AP view.






Based on clinical, X-Rays , ultrasound and CT, what is your diagnosis?
Based on  X-Rays and CT  some doctors  suggested  teratoma of oropharynx, or enchondroma.
MRI ( 2 pictures sagittal and  section) radiologist  diagnosis is  chondroma.





Operation today  removed one  hard mass   looked like  stone.
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CASE 368: METRORRHAGIA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 19, 2016, 2:09 am
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Women 52 yo  post menopause  2 years, vaginal bleeding.
US1:  cross- section  of uterus, normal size uterus   with  thicknening  endometrium ( more than 2cm).

US2:  CDI  no abnormal  uterine vascular supply.


US 3:thickening endometrium and cystic mass at cervix.


MRI  with gado.
MRI1= uterine cavity is  large  and thickening  endometrium,  some filling defected at fundus of uterus.


MRI2=longitudinal scan showed  the  abnormal endometrium  penetrated to uterus muscle.




Based on  clinical status , ultrasound and MRI, ObGy doctor suggested that  endometrium carcinoma..
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CASE 369: DUODENUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

March 22, 2016, 1:28 am
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Man 60 y.o., health check-up  by ultrasound of  abdomen detected  one mass  nearby gallbladder, size around 3-4 cm.
US 1: this mass  near  gallbladder and  duodenal bulb.

US 2: no  relation to  liver hilus.

  
Endoscopy report that  lumen of duodenum D2 is compressed by external mass (see endoscopy picture).


MSCT  of abdomen with CE
CT1:  this mass is  from  duodenum D2.

CT2 :  patient in rotation  for good vision of pyloris and duodenum mass at D2.


CT3: sagittal section of this mass is CE enhanced.


Preoperative diagnosis is duodenum wall tumor which was  suggested to GIST.

Operation  resection of  tumor and  performed gastro-enterostomy.


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CASE 370:PLEURAL EFFUSION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

March 29, 2016, 8:25 am
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Man 21 yo  fever and  cough , thorax pain in breathing
Chest XRays suspection  of pleural effusion.


CT scan  with CE of the chest:
CT1: cross- section=.pleural effusion both 2 sites.
CT2 .frontal section.
CT3:  frontal section in anterior  mediastiumdetected  one mass at retrosternum.




Blood test of WBC not raising.
Pleural tap  removed yellowishliquid, but  analysis was lower ADAlevel.



What is your  suggestion  and action in next step?
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CASE 371: BCCAO (BILATERAL COMMON CAROTID ARTERY OCCLUSION) Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM

April 2, 2016, 4:08 am
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Man 38yo, high BP with headache,





 psoriasis only on hands (see foto of hands),



 in  routine ultrasound screening of  vascular neck detected  bilateral common carotid  stenosis completely with dilated  vertebral arteries  both 2 sites (see  US 1,2= R-L.CCA, US 3-4=R-L/ I+ECA, US 6-7= R-L/ Vert.A).










MSCT Angio showed that completely obstruction of right and left CCA.


Patient has not loss of vision or any neurological symptom.

Blood test on DDMERE [D-DIMER] wasin normal level of 270 ng/mL.

Discussion: Do you see the BCCAO case  looked like this ? What is the cause of disease?
Reference: One case of BCCAO.

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CASE 372: SITE-PORT METASTASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

April 8, 2016, 7:23 am
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Woman 50yo, 6 months before  had beenlaparohysterectomy by endometrium carcinoma.  One  week  ago  she detected  pain  at  RLQ area at the  site of puncture for operation before (photo). 


Ultrasound scan  with  curve  probe for  this mass is hypoechoic structure in the wall of abdomen(US 1).



US 2  CDI  vascular supply from  the muscle arround, 


and
US 3  scanning with  linearprobe = this mass is  in abdominal wall.


MSCT with CE of this mass is enhanced with contrast  and  located in abdominal wall(CT 1, CT2).




Core biopsy of  this mass withmicroscopic report is adenocarcinoma






in metastasis on the site which was laparoscopic tapof endoscopic operation.

DISCUSSION...IT IS METASTASIS AT  ABDOMINAL WALL  AFTER  LAPARO-PORT -SITE. AFTER  6 MONTHS THIS TUMOR  IS GETTING GROWTH VERY FAST.

REF PDF.

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CASE 373: PHEOCHROMOCYTOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

April 16, 2016, 9:48 pm
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Diagnosis of this case is pheochromocytoma which  based on clinical,  ultrasound, CT and  blood test. This patient is  waiting for  operation with very caution.








Woman 55 yo with blood pressure rise  crisis for 5 years,  max 20/10cm Hg, medical treatment cannot control in stable. Ultrasound of abdomen detected one round mass  at  left adrenal area, ..size of 8cm  well bordered, cystic with septation ( US 1, US 2).



MSCT with CE=  CT1: sagittal plan this mass at  adrenal fossa  deplaced  left kidney. CT2:  normal vascular  supply to kidney . CT3: crossed section of.this mass inhomogeneous  in contrast enhancement.





Blood test shows very high  catecolamine of 24 hours in urine  and metanephrine in plasma is 1521.53/mL  (normal <90 ng/mL).

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Operation removed the tumor (see macro 1,2).

MICROSCOPIC REPORT  IS  PHEOCHROMOCYTOMA.






POST OP   BLOOD PRESSURE IS STABLE.

Reference:
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CASE 374: MALIGNANT PHEOCHROMOCYTOMA and CUSHING SYNDROME, Dr LÊ TUẤN KHUÊ, Dr NGUYỄN MINH THIỀN, Dr PHẠM THẾ ANH, Dr PHAN THANH HẢI, MEDIC MEDICAL CETER, HCMC, VIETNAM

April 20, 2016, 1:42 am
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Woman, 20 yo, discovered HTA  in pregnant at 16 weeks
 5-months before this hospitalization: pregnant  in 28ws, sudden obstetrical  seizures in Ca Mau hospital.  Diagnosis of eclampsia / hypertension / 28w pregnant. Treatment: cesarean section.
 After surgery , patients changed  body shape, round, fat face, neck, stretching skin, increasing weight gain, examination findings adrenal gland tumor  in Can Tho General Hospital, then transferred to Binh Dan hospital.
In clinic examination, obesity, Cushing syndrome,  other organs detect no abnormalities. HTA being treated.


Blood and urine catecholamine increasing, blood and urine cortisol increasing, ACTH reducing.





MSCT: right adrenal tumor.

CONCLUSION=  Female patient 20 yo, hospitalized for weight gain and  HTA, Cushing syndrome. Reducing of  blood ACTH and metanephrine; catecholamine and cortisol secretion increasing in blood, and urine.
Surgery removed right adrenal tumor. Pathological result is malignant pheochromocytoma.




 Secreted adrenal neoplasms - suppression of axis of  adrenal pituitary.

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CASE 375: UTERUS MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

April 24, 2016, 3:29 pm
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Woman 33 yo PARA 1011  underwent C-section 3 years [ 2013]  now  ultrasound detected  in 6weekpregnancy. But  she would like to  evacuatethe embryonic sac  by curettage . Then 3 weeks later  she  get pain at her pelvis.
Ultrasound  again  detected one hypervascular  mass  at the neck of uterus ( see 3 USimages).








And beta HCG of  blood test is  high.




MRI  uterusof this mass  suspected  gestation at neck  uterus  in the scar of cesarian section before.







Open operation  for hysterectomy confirmed  cervical pregnancy  in  C-section scar.
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CASE 376: UREMIC ASCITES, Dr PHAN THANH HẢI- Dr VĨNH PHÚC- Dr JASMINE THANH XUÂN

May 1, 2016, 5:31 am
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Woman 30 yo with total colectomy by  colon poliposis for   2 years ; one month ago  she  detected  ascitesunknown origineat MEDIC [19, April]. Ultrasound   showed that high volume ascites,normal liver and.kidney(see 4 pictures ultrasound).



CT of abdomen with CEalso cannot detected the cause ofascites;  she underwent laparoscopic biopsy of peritoneum and report was non specific chronic inflamation.
One week  later  [ 25,April, 2016] she got acute abdomen pain..and  came toMEDIC again.
CT of abdomen with CE detected  left kidney  hydronephrosis 2nd degreeand one mass  of 5 cm in retroperitoneum  near  abdominal aorta bifurcationobstructed left ureterloodk like   urinoma (see  CT 1 and  ultrasound imagesof this mass(see US2).




Abdominal tapremoved  pink  ascites fluid and analysisreport= ADA negative,  high protein, normal amylase, urea= 36.04mg/dL,creatinine  3.2 mg/mL (normal <1mg/ml).



Summaryof this case:  ascites  with CT and ultrasound detected  urinomaand high creatinin in ascites that proved an uremic ascites.
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CASE 377: OMENTUM PSEUDOTUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

May 8, 2016, 3:10 pm
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Woman 44 yo  pain  at  RLQ  and fever for  2 weeks, being treated  ambulatory with antibiotics.In clinical examination of  abdomen wall at RLQ is edema,  induration and pain in compression.
Ultrasound  shows the abdomen wall  thickening with edema and fluid in muscle
(us 1); no  air or  blood supply of this  site  (us2), us 3: the great omentum  is  thickening  and adherent to  abdominal wall; us4= small intestine  walled-off.





MSCT with CE= the  wall of abdomen is edema  and great omentum is  coveredRLQ site(CT1);   CT2: edema of abdomen wall; CT3: sagittal view.






Blood tests: WBC rised to 20k; highCRP=  30ng/mL.
Clinical  diagnosis is  suspected  plastron appendiculaire .
Normal coecum is looking in colono-endoscopy.


Operation for removing a very big hard mass of great omentum, (see macro1, 2)
and report of surgeon is  lookedlike  tumor.
MICROSCOPIC REPORT IS  INFLAMATION  ..NO TUMOR CELL.


CONCLUSION: INFLAMATION of PSEUDOTUMOR from GREAT OMENTUM.


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CASE 378: BLACK SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

May 14, 2016, 6:21 am
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Woman 44 yo,  3 years ago after removinga small skin tumor [2005] at the  left back  with the result of skin hemangioma, this site is growinganother black tumor foto), size  arround 3 cm.

 Ultrasound of skin tumor= US 1:solid tumor, inhomogenous structure, located subcutaneous to superficial muscular  fascia.


US 2: very high vascular structure of this tumor  oncolor Doppler.

US 3: PowerDoppler  very high flow, lower RI of  artery  in tumor.


US4: PW Doppler of  the main artery supplyof this tumor= very high flow,highPI. 



What is your  diagnosis for this cases?  It isarecurrentblack tumor.


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CASE 379: ECTOPIC PANCREAS TISSUE in JEJUNUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNA

May 18, 2016, 6:15 am
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Man 41 yo, headache,high BP, clinical looked like  pheochromocytoma.
Ultrasound detectednothingabnormal in abdomen.
CT scan of  abdomen  with CE detected small tumor in jejunum wall size of 2.5 cm, very high contrast enhancement(see CT1).


Blood test  is not  clear diagnosis.



2 weeks after CT with C E again also detected  this tumor in same size(see CT2).


Gastro-colono endoscopy  is normal,  report  no polyp detected. Laparoendoscopy detected  this tumor is  in jejunum wall..( lap1, lap 2 , ope.. ) 






and resection  this tumor(see macro 1,2)



Surgery report is small intramural tumor of jejunum,20 cm far from  D3, well bordered looked like ectopicpancreatictissue. Microscopic report is  ectopic intramural jejunum pancreas tissue. 



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CASE 380: PEDUNCULATED GASTRIC TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

June 1, 2016, 7:06 am
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Woman 54 yo  general check-up by abdominal ultrasound detected  one mass  at  left  upper  abdominal  area(US 1:   longitudinal scanning of  spleen and tumor).


US2: tumor and left kidney, longitudinal scanning.


US 3: cross-sectional  scanning, tumor inner  of left kidney.


Gastroscopy is normal.


MSCT scan  with CE:  CT 1tumor  nearby great curvature of stomach, CT2:tumor near  pancreas and stomach.



Report of  radiologist is  retroperitoneum tumor.
MRI  made clear  relationof tumor and left adrenal gland..( MRI 1), MRI 2tumor is near  gastric border.



Laparoscopic  detected this tumor came from  the wall of great curvature  of stomach(laparostomy image).


Macroscopic tumor is solid structure.



Microscopic report is  GIST tumor  with potential  median malignancy.



Conclusion: difficulty in pre- op  diagnosis one exophytic pedunculated gastric GIST tumor


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CASE 381 : HIP PAIN in APPENDICITIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

June 5, 2016, 2:10 am
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Woman 56 yo,pain in RLAQ 1 week ago, ambulatory treatment, pain in the back and to the right hip,difficulty in walking.
XRay of  the  right hip looked like fracture.

MRI showed that R. hip no fracture but  fluid  collection in retroperitoneum space, intrapsoas  muscle to pelvis and to righ thigh with intramuscularair detection( MRI 1, 2 , 3 ).





Ultrasound  examination of pelvis  detected cystic  mass with air inside  likely anabscess..( US 1,US 2, US 3 detected air inmuscle of righ thigh).




The sonologist  diagnosis is  abscess of the right thigh muscle.
Blood tests= very high WBC= 19,6 k  with neutrophil 1,3 k, hsCRP=  207.9ng/ml/.
Emergency CT scan of abdomen  and hip, thighdetected   retroperitoneum  abscess from the  coecum extending to liver and the righ thigh with air in muscle ( CT 1, CT 2, CT3)





Emergency operation confirmed  abscess due to necrosis of retrocoecumappendix  with perforation of cecum  extending to liver and the righ thigh.

REFERENCE:




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CASE 382 :LIPOSARCOMA METASTASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

June 11, 2016, 3:02 pm
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Woman  29 yo,  2 years before  had been removed  right leg tumor but did not to know what kind of thiswas, no pathology  report but now she  feelsshortness breathing.
MSCT of total body  detected  many masses in mediastinum, left breast, retroperitoneal abdomen and right buttock (See  CTscanning).


Ultrasound scanning for  verifying this mass (US1); 






US 2:In epigastrum



US 3: retroperitoneum mass displaced left kidney,  



US 4:  mass in left breast, 



US 5:  mass in right  buttock.




Biopsy of the mass in right buttock  is  liposarcoma.




Conclusion:  Multiple sites in the body of liposarcoma metastasis .

REFERENCE:



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CASE 383: SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

June 19, 2016, 4:49 am
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Man 31 yo  with history of 2 weeks ago, onset at the left hand, itchyingskin and induration then  color skin changed  from red to  brown with many  eruptednodules on the skin, and  stopped  at the left shoulder [see  foto1, 2, 3, and foto4( bleedding  under nail of finger 4,and 5).


No fever but easy bleedding from this nodule.
Ultrasound  of this nodule showed  from subcutaneous, echo  poor ( US 1)
CDI US  2,US 4: blood supply  this nodule is from the deep vessel, hypervascularliked a ring.


Blood test is no  changing of   WBC,and HIV  negative.

What is your  suggestion for  diagnosing this case ? 

One  dermatologist  suggested it is Sarcoidosis. Comparing with  picture atlas.


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CASE 384 : NEONATE PERINEUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

July 2, 2016, 10:14 pm
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Neonate female 02 day-old   detected  one mass  in perineum, size of 10cm, soft in palpation [see 2 fotos].


Ultrasound  scanning of  this mass=  US1: structure of this mass is cystic  septation  with solid part.

US 2 : vessels in septation.

US 3 :sacrum and  the mass.


Sonologist  suggestion is  cystic lymphangioma.
MRI  report  is   fatty  content, cystic part  not connected to spinal  canal. 



Radiologist  suggestion is  sacro-coccygeal teratoma.

Operation  removed  this mass with  solid structure and cystic part [see foto].



Report by surgeon is  mature  sacro coccygeal teratoma type 1.



MICROSCOPIC REPORT   IS MATURE  TERATOMA.
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CASE 384: NEONATE PERINEUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

July 2, 2016, 10:14 pm
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Neonate female 02 day-old   detected  one mass  in perineum, size of 10cm, soft in palpation [see 2 fotos].


Ultrasound  scanning of  this mass=  US1: structure of this mass is cystic  septation  with solid part.

US 2 : vessels in septation.

US 3 :sacrum and  the mass.


Sonologist  suggestion is  cystic lymphangioma.
MRI  report  is   fatty  content, cystic part  not connected to spinal  canal. 



Radiologist  suggestion is  sacro-coccygeal teratoma.

Operation  removed  this mass with  solid structure and cystic part [see foto].



Report by surgeon is  mature  sacro coccygeal teratoma type 1.



MICROSCOPIC REPORT   IS MATURE  TERATOMA.
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