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CASE 559: WARTHIN TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

July 23, 2019, 4:04 am
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MAN 62 YO WITH HISTORY OF 2 YEARS AGO  SLOW GROWTH AT RIGHT PAROTID GLAND  NO PAIN NO DISTURBE  OF MASTICATION. 


ULTRASOUND  REPORT

US 1: ONE MASS AT SUPERFICAL LOBE OF RIGHT PAROTID GLAND # 3 CM HYPOECHOIC.
US 2 :  DILATATION OF SALIVARY DUCT.
US 3 : SMI  SHOWS MORE VASCULAR MICROSTRUCTURE NO LYMPH NODE AROUND.





US 4 : ELASTOSCAN THIS TUMOR IS SOFT PATTERN.


MS CT with CE = THIS TUMOR IS ENHANCED VERY HIGH, WELL LIMITED  BORDER, CT 1 CT2 CT3 .




OPERATION for PAROTIDECTOMY.  SEE MACRO  TUMOR IS NECROTIC CENTRAL


MICROSCOPIC REPORT IS WARTHIN TUMOR.


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CASE 560: TUMOR IN HORSESHOE KIDNEY, Dr PHAN THANH HAI, Dr PHAN THI HUONG. MEDIC MEDICAL CENTER, HCMC, VIETNAM

August 11, 2019, 4:21 am
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WOMAN 30 YO in ROUTINE CHECK-UP.
ULTRASOUND of ABDOMEN DETECTED RIGHT  SITE KIDNEY TUMOR   ON THE  HORSESHOE KIDNEY.
US1  RIGHT KIDNEY ONE MASS IN PELVIS OF KIDNEY, SOLID. SIZE 3-4 CM.


US2  CROSSED- SECTION   THIS  HORSESHOE KIDNEY  OVER AORTA
US3  LEFT KIDNEY IS NORMAL.

MSCT CE   
CT1  HORSESHOE KIDNEY


CT2  THE TUMOR INTRA CENTRAL RIGHT KIDNEY  


CT3  HORSESHOE KIDNEY   WITH CE NORMAL PERFUSION. 


CT4  VASCULAR SUPPLY FOR  HSK


OPERATION for  RESECTION of  RIGHT PART OF HSK  ( see SCHEMA of OPERATION)


SPECIMEN OF OPERATION  (macro1, macro2).





Wait for  microscopic histology report of this tumor.

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CASE 561: THYROID CANCER, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

August 22, 2019, 2:53 am
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MAN 38Y0  GENERAL CHECK-UP  ULTRASOUND IN THE NECK  DETECTED ONE MASS AT LEFT THYROID GLAND.0
US 01:  CROSSED SECTION  AT THE LEFT LOBE THYROID HAD ONE MASS, ROUND, BORDER 3 CM , MIXED STRUCTURE WITH CYSTIC AND SOLID PARTS.


US 02: LONGITUDINAL SCAN LEFT LOBE   WITH HALO RIM ARROUND THIS MASS.


US 03: DETECTED  SMALL LYMPH NODE  NEAR LEFT CCA #1CM.


US 04: IN CDI  VASCULAR SUPPLY THIS MASS IS VERY HIGH.


US 05: ELASTOGRAPHY STRAIN  THIS MASS VERY HARD  SCALE .


FNAC   SUSPECTED  CANCER OF THYROID.


WAIT FOR OPERATION OF TOTAL THYROIDECTOMY.
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CASE 562: CARDIAC CT DETECTED BREAST TUMOR, DR PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

August 26, 2019, 4:51 am
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WOMAN 54 YO in  BEING PERFORMED CT CORONARY ANGIO  SAME TIME  RADIOLOGIST DETECTED ONE MASS AT LEFT BREAST   ( CT)


MAMMOGRAPHY  ALSO  DETECTED ONE MASS 4 CM ROUND BORDER   NO CALCIFICATION INTRA MASS ( MAMMO 1, MAMMO 2 ).



ULTRASOUND: US 1  MASS AT L BREAST IS HYPOECHOIC, THE BORDER IS ROUND 
US 2  CDI  NO MORE BLOOD SUPPLY  
US 3  ELASTOGRAPHY STRAIN TECHNIC,  THIS MASS IS  SOFT  
US 4  ELASTOSCAN   THIS MASS  NOT INVADED AROUND NO LYMPH NODE  AXILLARY





CORE BIOPSY  REPORT IS  FIBROCYSTIC CHANGE . 


SUMMARY: SAME TIME CT CARDIAC  DETECTED INCIDENTILOMA BREAST TUMOR. 


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CASE 563: ILEOCECAL TUBERCULOSIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

August 28, 2019, 11:07 pm
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MAN 41 YO  with CLINICAL COMPLAINT about HYPERPERISTALTIS AT RLAQ due  to SUB-OCCLUSION OF BOWEL. 
ULTRASOUND  AT  RLAQ   
US1  SHOWS THICKENING of THE WALL OF ILEUM   
US2 COECUM WALL
US3  MANY LYMPH NODES AROUND ILEO-COECAL AREA





MSCT WITH CE    
CT1  CROSS SECTION THE COECUM , THICKENING OF THE WALL AND SOME LYMPH NODES  ENHANCED CE 
CT2  = FRONTAL VIEW OF  ILEO-COECUM


COLONO ENDOSCOPY   REPORTS  STENOSIS AT ILIO-COECAL JUNCTION ( PHOTO ENDOSC).


OPERATION OF  LAPAROSCOPY AT  FIRST   DETECTED COECUM  CHANGES SURFACE  NODULAR  ( IMAGE LAPARO)
SURGERY RESECTION of the USPSTF's COECUM AND 50CM OF ILIUM  ( FOTO MACRO)




MICROSCOPIC REPORT IS  TUBERCULOSIS OF  ILIO-COECUM AND  LYMPH NODES.


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CASE 564: VAGINAL CUP, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 5, 2019, 2:33 am
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Woman 35 yo  goes to general ultrasound check up .
Ultrasound scans at pelvis detected  uterus  had IUD T shape.
 U S 1  cervix deformation looks like tumor on longitudinal scan with   some echogenic things around the vagina.

U S 2  longitudinal scan  cervix  and vagina


U S 3:  crossed section scan  cannot see well  cervix by echogeneicity prothesis


 U S 4: scan at uterus  detected T shape IUD.



MSCT scan  detected a vaginal cup covered over cervix.




Conclusion:  we should know  some abnormal pictures due to vaginal cup.
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CASE 565: SUPRARENAL AORTIC ANEURYSM, Dr PHAN THANH HAI, Dr LE TU PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 15, 2019, 2:54 am
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Man 72 yo with pain at RUAQ.


CHEST X-RAYS AND  SPINE  X-RAYS CANNOT DETECTED  ABNORMAL.

US SCANNING OF EPIGASTRIC AREA  DETECTED ONE MASS NEAR AORTA IN RETROPERITONEUM  # 4 CM   WITH DOPPLER  FLOW IN THIS MASS
US 1: PW DOPPLER SHOWS ARTERY FLOW PATTERN
US 2: THIS FLOW IS CONNECTED TO AORTA.






MSCT CE AORTA   
CT1 = CROSSED SECTION AND FRONTAL VIEW  THIS  MASS IS ANEURYSM WITH  BLOOD CLOT INSIDE  
CT2 = 3D VIEW  THIS SITUATION IS  CLOSE  BY SMA AND RENAL ARTERY 



EMERGENCY ADMITTED TO HOSPITAL FOR  TREATMENT PLANNING.
Operation for devascularization  SMA and renal artery  (DSA 1)AND  PUT STENT IN AORTIC ANEURYSM (DSA 2).


AFTER OPERATION  IN ICU  ULTRASOUND POCKET AT BEDSITE WITH BUTTERFLY IQ  MAKES SURE AORTIC FLOW.




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CASE 566: PERIVASCULAR TUMOR, Dr PHAN THANH HAI, Dr HO CHI TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 24, 2019, 9:50 pm
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WOMAN 36YO  DETECTED  ONE MASS AT THE LEFT THIGH,  PAINFUL  PALPATION.
ULTRASOUND OF  THIS MASS.

US1:  THE PERIVASCULAR TUMOR  OF FEMORAL ARTERY  HAD HYPOECHOIC PATTERN ,  SIZE 4 CM  AND THE FEMORAL ARTERY IS INTO THIS MASS.
US2 : THE FEMORAL VEIN  DILATED  BUT  FEMORAL ARTERY IS NOT STENOSIS
US3 : COMPRESSION OVER THIS TUMOR  THE FEMORAL VEIN IS COMPRESSIBLE  
US 4:  CROSSED SECTION THIS MASS  THE ARTERY LUMEN STILL HAD FLOW.  
SONOLOGIST SUSPECTED  THE TUMOR OF PERIVASCULAR FEMORAL ARTERY.




MRI  THIS MASS  SHOWED  THIS TUMOR FROM THE WALL OF ARTERY  ( MRI1) 
MRI2  VEIN DILATATION.



CT ANGIO: LEFT FEMORAL ARTERY IS  NORMAL FLOW .

CONCLUSION = THIS TUMOR  IS PERIVASCULAR MAYBE  LYMPHOMA.
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CASE 567: TESTICULAR TORSION, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI,MEDIC MEDICAL CENTER, HCMC, VIETNAM

September 30, 2019, 7:29 pm
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BOY 17 YO  PAIN AT LEFT TESTIS.  EMERGENCY DIAGNOSIS IS ORCHITIS . MEDICAL TREATMENT FOR 20 DAYS  BUT STILL PAIN  AT LEFT TESTIS.


ULTRASOUND  CHECKS SCROTUM  
US1 =  AT LEFT TESTIS   SIZE 4CM  HYPOECHOIC TESTIS,  HYPERECHOIC EPIDIDYME   WITH SMALL FLUID AROUND TESTIS.


US2 =  COLOR DOPPLER NO VASCULAR SIGN IN LEFT TESTIS   BUT HIGH  VASCULARIZATION  IN TESTICULAR CORD.


US3 = CROSSED SECTION VASCULARIZATION ONLY ONE PART OF EPIDIDYME


US4 = ELASTO US OF LEFT TESTIS  BY STRAIN TECHNIC  IS  VERY HARDENING  INHOMOGENOUS IN
COMPARISON TO RIGHT TESTIS  


US5  = CDI  POOR VASCULAR SIGN IN LEFT TESTIS  


US6 =  ELASTO OF RIGHT IS  SOFT TESTIS HOMOGENEOUS  STRAIN  SCORE



CTCE  OF TESTIS  HYPOPERFUSION AT LEFT TESTIS  


ULTRASOUND  REPORT IS  TORSION OF LEFT TESTIS AVASCULAR NECROSIS  

EMERGENCY OPERATION DETECTED AND REMOVED LEFT TESTIS NECROSIS IN BLACK .
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CASE 568: SUBACUTE THYROIDITIS DE QUERVAIN, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 21, 2019, 1:24 am
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Man 76 yo with past history of 10 years  partial nephrectomy for RCC of left kidney.
General check up in present time detected one mass in thyroid left lobe, size 4cm x 3 cm.  





US1: crossed section of left lobe  thyroid=  solid tumor with microcalcification, inhomogeneous structure.
US2 : one small lymph node near jugular vein.
US3 : CDI = hypervascular tumor.
US4 : elastostrain scanning =  mapping color of this tumor, hard with high kPa.
Ultrasound report  is TIRADS-4 . 
FNAC   REPORT IS  TUBULAR STRUCTURE  OF THYROID TISSUE.


OPERATION  FOR LEFT THYROIDECTOMY.
MACROSCOPIC  SPECIMENS.



Microscopic report is  SUBACUTE THYROIDITIS DE QUERVAIN.

REFERENCE CASE    SUBACUTE  THYROIDITIS DEQUERVAIN--GRANULOMATEOUS CELL  THYROIDITIS


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CASE 569: RLAQ MASS, DR PHAN THANH HAI. MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 25, 2019, 1:10 am
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Woman 44yo with pain and periodic hyperperitaltism at RLAQ for 6 months.








ULTRASOUND  DETECTED AT R LAQ ONE MASS  (US 1)  THIS MASS IS  HYPOECHOIC MULTILOCULATED # 4 CM.   
US2: AROUND THIS MASS  NEAR CECUM SOME ANSES OF BOWEL DILATED.
US3: PW SHOWS THIS MASS IS LYMPH NODE WITH SANDWICH SIGN. 
US4: ONE ILEUM PORTION DILATED THICKENING of THE WALL with MATERIALS INSIDE LOOK LIKE THE KIDNEY.
MSCT WITH  CE   




CT1:  CROSSED SECTION OF  THE THICKENING WALL  OF ILIUM  
CT2 : CROSSED SECTION   THE  MASS  AT ANGLE ILIUM-COECUM  LOOK LIKE  MESENTERIC LYMPH NODES
CT3:  FRONTAL VIEW  IS  TUMOR AT ILUM WITH BIG LYMPH NODES 
GASTRO-COLONOSCOPY IS NORMAL
BLOOD TEST  TUBERCULOSIS WITH QRFERONE TEST IS NEGATIVE, BETA2 MICROGLOBULIN IS  NORMAL  


CONCLUSION: THE TUMOR OF ILEUM WITH BIG LYMPH NODES AROUND  LOOK LIKE MALT. 

OP REPORT IS RESECTION of THIS MASS of ILEUM AND COLON ASCENDING, END TO END ANASTOMOSIS.
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CASE 570: PTA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 26, 2019, 11:55 pm
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Woman 35 yo with small trauma and pain at right limb for one month  (photo).


X-rays show that fracture of the radius but the bone cortical abnormal very think
 (X ray 1, X ray 2). 





Ultrasound made sure that  fracture of the  humerus bone and mass arround the fracture  (US 1, US 2).



Ultrasound of thyroid gland detected one hypoechoic mass look like a cyst #3 cmx 4 cm  at  left lobe (US 3).

Abdomen ultrasound   shows  kidney nephrocalcinosis  and  big cyst at upper pole of left kidney (US 4,  US 5).





Blood tests = PTH very high  976pcg/mL  ( n=  16-65),  calcium =  3,1 mos 

Summary=  Suspecting  PTA,  wait for operation.

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CASE 571: LUNG CYST, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 28, 2019, 4:41 am
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WOMAN 37YO  COUGH AND PAIN AT LEFT LUNG. 
CHEST X-RAY   DETECTED ONE MASS BILOBULATED ROUND  BORDER  # 3 cm.




TRANSTHORACIC ULTRASOUND SHOWED A CYST  WITH   CLEAR  FLUID.


MSCT  REPORT IS CYST WITH THE CALCIFIED WALL, SOLID STRUCTURE INSIDE CYST .





CT 1   CROSSED SECTION.  CT2  FRONTAL VIEW.   CT3  LUNG WINDOW .


OPERATION REPORT IS AN INFECTED CYST WITH PUS.
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CASE 572: PROSTATE CANCER, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 6, 2019, 5:17 am
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Man 45 yo  with pain at sternum. SPECT bone scan detected multiple bone lesions ( spect photo).



Ultrasound at sternum detects osteolytic lesions. 


Blood test PSA rises 92 ng/mL

Transabdominal Ultrasound of prostate  US 1   section  prostate in small size 



US 2  sagittal view also prostate in small size without abnormal focal lesions 



US 3 elastoscan detected abnormal zone inside prostate  




US 4 sagittal elastography mapping one zone with kPa high,  #50kPa



Biopsy with TRUS elasto guide;   report is prostate cancer classified Gleason core 7



Summary=  US elastoscanning of prostate guide for biopsy is more accuracy than conventional TRUS guide alone.

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CASE 573: BILIARY HAMARTOMA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 17, 2019, 4:46 am
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WOMAN 51 YO FOR 5 YEARS CHOLECYSTECTOMY BY GALL BLADDER  STONE, NOW GETTING PAIN IN LIVER.

US SCANNING : GALL-BLADDER HAD BEEN REMOVED. CBD DILATED   OF 3CM IN DIAMETER   WITH DILATATION R/L BILIARY DUCTS IN LIVER  AND  THERE  ARE SOME  SMALL SPOTS LIKE CYST 0.5 CM.  CBD  IS  STENOSIS AT ODDI AREA  AND NO TUMOR OF PANCREAS.
US1   BW US   US2 CDI 



MRI OF LIVER   
MRI1  CROSSED SECTION OF LIVER   
MRI2   CBD DILATED WITH MANY SPOTS  LIKE CYST IN LIVER   THAT  ARE HAMARTOMA OF BILIARY CANALS.



ERCP  lCANNOT  ENTER THE CBD  (FOTO1, FOTO2)



OPERATION  REPORT   IS  CYST OF CBD AND STENOSIS  OF CBD AT ODDI SPHINTER.
 AND MANY SMALL NODULES AT SURFACE OF LIVER  BIOPSY (lFOTO CBD).


PROCEDURE  IS ROUX EN Y  FOR  ANASTOMOSIS OF CBD AND  DUODENUM.

CONCLUSION =IT IS  HAMARTOMA OF BILIARY SYSTEIM  WITH STONE STENOSIS OF CBD AND MANY SMALL LIKE -CYSTS OF BILIARY SYSTEM.
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CASE 574: THORACIC WALL HERNIA, Dr PHAN THANH HAI, Dr TRAN MINH DUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 24, 2019, 12:24 am
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MAN  52 YO  3 MONTHS AGO,  PAIN AT L THORACIC NEAR  L BREAST NIPPLE   AFTER TRAUMA, COUGH MAKING VERY PAIN AND  L BREAST GETTING BIGGER LOOK LIKE TUMOR   (PHOTO 1: NORMAL BREATH, PHOTO 2  AFTER COUGHING and  VIDEO CLIP in COUGHING).








ULTRASOUND  AT  LEFT THORACIC WALL  DETECTED  ONE  MIXED STRUCTURE MASS  BY RUPTURE OF THE THORACIC WALL MUSCLE  WITH FLUID ( US 1).  



US 2: THE  HERNIA  OF THE LEFT LUNG TO THIS AREA IS SEEN  CLEARLY BY COUGHING , BUT IN NORMAL BREATH  THIS HERNIA IS COVERED BY HYPERECHOIC  STRUCTURE MASS ( US 3)




MSCT OF THE LUNG WITH VALSALVA  MANOEUVRE   DETECTED  INTERCOSTAL MUSCLE  RUPTURE AND  HERNIA FROM THE LUNG GOING OUT   ( CT1 CT2 CT3)



SUMMARY = THIS CASE IS THORACIC WALL HERNIA AFTER TRAUMA.  THE PATIENT HAD BEEN OPERATED FOR REPAIRING THE THORACIC WALL HERNIA BY PROTHESIS.
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CASE 575: LYMPH NODE TUBERCULOSIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

November 30, 2019, 5:19 am
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MAN 35 YO  PAIN AT   PERIUMBILICAL  AREA OF ABDOMEN.
US SCAN   
US 1:  ONE MASS  NEAR LEFT SITE OF  UMBILICUS  WITH  SANDWICH SIGN.


US 2: MANY LYMPH NODES HYPOECHOIC,  SIZE 2-3 CM  WITH STRUCTURE CHANGE AND NO HILUS.


US 3: SAME  STRUCTURE  OF LYMPH NODE IN MESENTERIUM.


US 4: 2 BIG LYMPH NODES AT THE LEFT SUPRACLAVICULAR AREA.



CHEST X-RAYS SUSPECTED TUBERCULOSIS AT RIGHT LUNG.



CT SCAN OF ABDOMEN WITH CE    

CT 1= FRONTAL VIEW OF ABDOMEN, THIS MASS IS  NEAR ABDOMINAL AORTA.


CT 2 = CROSSED SECTION.



CT 3  = FRONTAL VIEW OF THE LUNG 





BIOPSY REPORT OF THE BIG LYMPH NODE AT THE L NECK IS TUBERCULOSIS.




SUMMARY=  MULTIPLE LYMPH NODES APPEAR SAME TIME WITH LUNG TUBERCULOSIS.
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CASE 576: ADRENAL TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC,VIETNAM.

December 4, 2019, 10:32 pm
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Man 46yo   general check- up by  CT total body     detected tumor # 3 cm at  right adrenal area..
CT 1  cross section  the tumor near the liver border  
CT 2  tumor near pancreas head  
CT 3  frontal view  the tumor  3 cm far from  upper pole R renal  near IVC.





Ultrasound   detected  this mass well border   solid structure   3 cm   (US 1, US 2,  US 3).




CT and ultrasound  diagnostics are adrenal tumor  
Blood test  is normal hormone from adrenal gland
operation  laparo retroperitoneum   removed this tumor  (ope)  and macro 1, macro 2.



Wait for  pathology report.


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CASE 577: TOS (THORACIC OUTLET SYNDROME), Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

December 16, 2019, 6:06 am
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MAN 52 YO WITH  PAIN AND COLD FEELING OF RIGHT HAND.


ULTRASOUND   DETECTED NO PULSE AT RADIAL ARTERY  AND THROMBOSIS OF HUMERAL ARTERY JUST TO SUBCLAVICULAR ARTERY WITH DILATATION  AND ZIN-ZANG FLOW.



MSCT ANGIO  SHOWED STENOSIS AT RIGHT  SUBCLAVICULAR ARTERY DUE TO RIGHT CERVICAL RIB  C7 COMPRESSION.





CONCLUSION=  THORACIC OUTLET  SYNDROME  WITH COMPLICATION OF THROMBOSIS ARTERY.


OPERATION FOR  RESECTION OF THE RIB  AND REMOVING OF THROMBUS.

REFERENCE :


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CASE 578: CYSTIC TERATOMA OF THE LUNG, Dr PHAN THANH HAI, Dr NGUYEN TUAN VU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

December 29, 2019, 11:14 am
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WOMAN 29YO  WITH RIGHT LUNG  PAIN.    
CARDIAC ULTRASOUND DETECTS NORMAL HEART  AND A BIG MASS  COVERED RIGHT LUNG  ( US1).   





US 2 : THE MASS IS ROUND WITH SIZE 30CM.





US 3 : CDI  NO VASCULAR IN TUMOR .



US 4 : ELASTO  IS SOFT   LIKE A CYST  NO SEPTATION NO HARD TISSUE.




CHEST X-RAYS= THIS MASS COVERED THE RIGHT LUNG  NO PLEURAL  FLUID.


CT OF THE LUNG    
CT1 : SAGITTAL VIEW, THIS MASS IS INSIDE RIGHT LUNG
CT2  : CROSSED SECTION,   THIS CYSTIC  CONTENT IS VISCEOUS FLUID.


Operation  removed this cyst with chocolate fluid.



Reference


  
SUMMARY  =  CYSTIC TERATOMA OF THE LUNG.
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