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CASE 641: SMALL BREAST TUMOR, Dr JASMINE THANH XUÂN, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, Dr TRẦN THỊ HỒNG VÂN, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

July 7, 2022, 1:50 am
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A 46 yo female patient goes to Medic center in breast ultrasound screenning.
Breast ultrasound detects an [4x10mm] echo mass, irregular border, inclined axis, with microcalcifications on the right breast.
The right breast mass comes from a tubular breast with microcalcifications inside.



There is not vascular signal in the right breast mass  on Doppler ultrasound.
Elastoultrasound strain score 3, ratio B/A=3.57.


Mammography= On right breast it exists a mass # 10 mm, high density, blurre border with microcalcication foci ingathering.



Breast MRI  with gado= Mass of right breast with high signal on T2W2 and low on T1W1, non captured CE, and some breast cysts both 2 sides.
Axillary lymph nodes are inflammed nodes.

Breast thermography: Nothing abnormal detected,  due to it is a small tumor.




Result of core biopsy of the right breast tumor= Invasive breast carcinoma of no special type, grade 2.

 
CONCLUSIONS=

Small size  breast tumor <10mm  may  be revealed early in yearly screenning.

Size, location, characteristic findings will be informed with multimodalities of diagnostic imaging= ultrasound, MRI, thermography and core biopsy.

Pathohistological result is appropriate evident for  breast tumor diagnosing.
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CASE 642: ZENKER DIVERTICULUM, Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG, Dr LÊ HỮU LINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

July 15, 2022, 3:17 am
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 A  67 yo male patient with multinodular goiter in reexamination.

Ultrasound Medic revealed a cyst with air inside in posterior of right  thyroid lobe




CT with CE confirmed the cyst in contrast which is in connection to esophagus on the right side. A Zenker diverticulum was noted.


A Zenker's diverticulum is an outpouching that occurs at the junction of the lower part of the throat and the upper portion of the esophagus. The pouch forms because the muscle that divides the throat from the esophagus, the cricopharyngeal (CP) muscle, fails to relax during swallowing.


https://www.mountsinai.org › zenkers-diverticulum





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CASE 643: MUCUS SECRETION versus ENDOLUMINAL TRACHEA TUMOR, LÊ HỮU LINH MD, MEDIC MEDICAL HCMC, VIETNAM

July 15, 2022, 9:52 pm
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A 63 year-old male patient goes to the doctor because of bloody sputum in coughing for some days with feeling of suffocation. There was no sign or symptom of other organs. CBC was in normal range, coagulation tests were within normal range. 







Chest CT scan in a local hospital showed a small nodule at the posterior wall of the trachea which was suspected a tracheobronchitis or a papilloma of the trachea. 

His wife and his familial doctor also want having a bronchoscopy for the patient at MEDIC.







3 days later, patient no longer spitted bloody sputum, and completely seems to be healthy. The pulmonologist decided to repeat chest CT and virtual bronchoscopy for the patient. Chest CT at MEDIC showed tracheal lesion disappeared.

DISCUSSION:

Characteristics to detect a mucus secretion in trachea:

•       Small size.

•       At posterior wall of trachea (supine position during CT scan procedure).

•       Small air shadow within the nodule suggesting mucus secretion.

•       It will be transformed or disappeared after coughing.

 

CONCLUSION:

Mucus secretion in trachea can be mistaken with endoluminal trachea tumor.

Their characteristics on chest CT should be put under caution. And a repeated CT scan made after coughing may help detecting a mucus secretion. Thanks of that we could avoid unnecessary invasive procedure for patient. 

Reference case: 

A case with chest CT showed multiple nodular lesions that were both upper lobes, indicated a pulmonary tuberculosis. And it existed a small nodule at posterior wall of trachea. After coughing, repeated CT scan showed the nodule of trachea disappeared.






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CASE 644: HEPATIC ABSCESS due to PERFORATED CHOLECYSTITIS with STONES, Dr DƯƠNG NGỌC THÀNH, Dr LÊ THANH LIÊM, Dr NGUYỄN HỮU QUỐC, Dr TRẦN THỊ HỒNG VÂN, Dr VÕ NG THÀNH NHÂN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

July 21, 2022, 6:24 am
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 A 56 year-old female patient suffered from epigastric pain for one month with out fever. WBC 18,880/L , hCRP 129.5mg/L.

Ultrasound of abdomen revealed an abscess of liver that came from a cholecystitis due to stone. Gall bladder wall thickening was perforated that connected to the abscess. And there were stones in CBD and cystic duct.






Abdominal CT confirmed an abscess of liver due to perforated cholecystitis with biliary stones [segment IV- V].  It existed perforation of gall bladder, and stones of commune bile duct and cystic duct.



A medicinal regime was tried for 5 days.



MRI was done before a surgical treatment.




Endoscopic surgery at first but it did to change to open surgery to take away the hepatic abscess, that was in GB bed. Inflammed GB adhered to liver, mesentery and duodenum that has been dissected difficultly. 

Surgeons performed partial cholecystectomy, and Kehr drainage after removing stones in CBD and in cystic duct.



DISCUSSION and CONCLUSION:


Hepatic abscess due to perforated cholecystitis with biliary stone is still a rare entity. Ultrasound could detect successfully cholecystitis due to biliary stone  [84-97 % sensitive, and 95-97% specific] that seems to be higher than CT or MRI does.

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CASE 645: ULTRASOUND BUTTERFLY in EMERGENCY ROOM, MEDIC MEDICAL CENTER , HCMC, VIETNAM

July 22, 2022, 9:33 pm
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ABSTRACT

A 35 year-old female patient with twin pregnancy by IVF is in ER of Medic Center that goes through a examimation of check-up by Butterfly ultrasound, and D-heart  for her EKG of 2 fetus and mother heart.
The brains of fetus 26ws and 29ws on fetus ultrasound are normal, but it exists a doubt of club foot for one fetus.
MRI detects fetus brains normal.
Amniocentesis thinks about an heterozygosity of chromosome 18.


















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CASE 646: WARTHIN'S TUMOR, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr NGUYỄN TUẤN CƯỜNG, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

August 7, 2022, 8:05 pm
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A 69 year-old male doctor patient with sputum cough for one week went over to Medic for a check-up.




Ultrasound detected hepatosplenomegaly, and thickening of the wall of sigmoid colon with lymph nodes inside abdomen. On the neck, a parotid tumor at the lower pole (tail of parotid) exists on the right side.








Pathologic result of sigmoid colon was tubular adenoma and slight dysplasia.

Gastroendoscopy revealed an ulcer at lesser curvature and edema of gastric corpus.

Core biopsy of the parotid tumor proved Warthin 's tumor of the right parotid with pathologic result.


ABSTRACT

A male doctor 69 year-old patient with sputum cough for one week.  He got a submandibular mass in suspecting lymphoma or parotid tumor. But on the neck, ultrasound revealed parotid tumor that was concluded a Warthin 's tumor with pathological result of core biopsy.

Morever the doctor patient suffers from a benign tumor of sigmoid colon, gastritis with ulcer and hepatosplenomegaly, and fortunatly gets over the lymphoma haunting.

References

1. Warthin Tumor: Papillary Cystadenoma Lymphomatosum "occurs in the tail of the parotid in aged men". [DeGowin's Diagnostic Examination, 2004].


2. 




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CASE 467: PILOMATRIXOMA of MALHERBE, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, Dr LÊ THÔNG LƯU, Prof. NGUYỄN SÀO TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

August 11, 2022, 6:40 am
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A 11 year-old female patient with a small cyst on left side of her neck for 5 months. A TB regimen started for a while.



Ultrasound detected a cyst of subcutaneous layer on left side of the neck, well-limited, round, with a dark line adhered the skin. Echostructure is mixed: cystic and some trabecular thicker semisolid structures inside which are like septation. It exists some septa with colored signal arterial type.





Discussion:

Common cystic lesion in subcutaneous layer adhering the skin usually named sebaceous cyst, epidermoid cyst. But in this case, a very small dark incontinuous in upper border of the cyst helps thinking to a skin hair. That is the key of a pilomatrixoma which is still a rare entity of habit in clinic.


The cyst was entirely removed.





Histopathogic result is a benign tumor of
the hair follicle matrix, name Pilomatrixoma or  Calcifying Epithelioma of Malherbe.


References:






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CASE 648 : SKIN ULTRASOUND, Dr PHAN THANH HẢI, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC , VIETNAM

September 5, 2022, 10:40 pm
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 A 90 year-old male patient with a painless node at right angle of his mouth. His past history was a left kidney cancer that had been cured for 5 years.



Skin utrasound  by VINNO M86 system with linear probe 16MHz and 23MHz. 

Focal cystic lesion # 9x4mm,  represented mixed structure in subcutaneous layer, with fluid, non vascular, well limitted capsule. Elastography was green code that means a medium hardness. A benign mucous cyst was noted.







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CASE 649: CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ THANH THẢO, Dr TRẦN CHÍ ĐỦ, Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIET NAM.

September 27, 2022, 1:27 am
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 A  68 year-old male patient with jaundice in ruling out of head of pancreas tumor from Tra vinh province went to Medic Center for an exact diagnosis before a surgical treatment.

Ultrasound ruled out pancreatic tumor and noted intrahepatic bile duct dilatation and 2 sides pleuresia. Gallbladder was not big with some sludge.  Wall of bile duct thickening # 6-7mm, hyperechoic, CBD diameter 1.24mm existed 0.66--1.2 mm bile sludge at the beginning of CBD. Sign of bile duct tumor was unclear.









Later biliary MRI performed and the result was a tumoral infiltration in bile duct  that made collapse biled duct at the hepatic umbilicus leading to dilatation of intrahepatic bile ducts. Maybe there was an other thought about of stricture of bile duct due to cholangitis.





Surgery was done that detected bile duct tumor #1x2 cm.  Removed bile duct tumor, GB,  and  connecting hepatic duct  to jejunum by Roux-en-Y. Anapath was CholangioCarcinoma grade 2 invasive.


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CASE 650: SOFT TISSUE TUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

September 28, 2022, 11:30 pm
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A 52 year-old patient with a mass at her right frontal region, no pain, no changed skin color.
Ultrasound detected a subcutaneous hypoechoic with vascular signals which was noted a vascular tumor but not invasive frontal  bone. Elastography was medium hard than other tissue around.












Wait for histoanapathologic result.



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CASE 651: PERITONEAL ABSCESS DUE TO FOREIGN OBJECT (FISH BONE), Dr PHAN THANH HẢI, Dr CHÂU NGỌC MINH PHƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

September 29, 2022, 4:21 am
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A 67 year-old male patient, presented with periumbilical and left lumbar pain for one month that was not response to treatment.

Abdominal ultrasound detected one mixed echogenic mass in the left lumbar mesentery with the diameter of 84 x 47mm. The conclusion was: Suspected mesenteric infarction (Differential diagnosis: Intra-abdominal Abscess) – Hepatic Steatosis – Abdominal Aortic Atherosclerosis.



MSCT of the abdomen showed a foreign object similar to a toothpick near the abdominal wall, right above the umbilicus, with a lenghth of 21 mm. The greater omentum surrounded the foreign object forming a mass with the diameters of 60 x 45 mm.

During operation, surgeons removed a foreign object which was highly suspected as a fish bone after dissecting the abscess in the greater omentum. The two adhering loops of small intestines were separated and reinforced with stitches.

 

  


 


Conclusion: Physicians should be on high alert when patients with abdominal pain not responding to the treatment. Abdominal ultrasound and MSCT help guiding the appropriate diagnosis for the case.


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CASE 652: MILIA, Dr PHAN THANH HAI, Dr LE THANH LIEM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 2, 2022, 7:35 pm
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A 70 yo male patient got a small white spot # 5 mm without pain on left side of his mouth for 3 months
Dermatologist thought about a milia.

Skin ultrasound wih 24MHz probe detected an intradermic layer, well-border, inhomogenous  content, no vessels in and around the lesion. 







On 33MHz probe lesion could be seen more clearly its structure inside.













Removed the milia by puncture and FNAC.
Photo after 24 hours.









 

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CASE 653: PRIMARY MUSCLE LYMPHOMA, Dr PHẠM THỊ THANH XUÂN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

October 13, 2022, 7:02 am
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A 68 year-old male patient with a mass at right neck  in  lung TB regimen for 4 months but still weight loss and sudation. The painful mass existed for 1 month and getting bigger with skin redness.

Soft tissue ultrasound detected a complexe mass #57x43 mm in muscle at right neck from angula of lower maxillary region which distorsed structure, with intramuscular fluid beside cervical vertebral column C4. It existed not any neck lymph node.







MRI  confirmed a right neck tumor invasive to muscle.



Chest CT = no lung invasive, no mediastinal lymph node nor axillary node. Bone marrow biopsy  exist not any malignant cell.

In surgical biopsy for chemohistopathology of the tumor resulted small cell lymphoma (C83).




The patient was  treated TB lung completely and then continued lymphoma chemotherapy. Now the muscular tumor was  smaller 80% and the patient remains well.

Primary muscle lymphoma is very rare entity without characteristic imaging findings but diagnostic imaging keeps a role.

REFERENCES:

Cancer Imaging (2013) 13(4), 448457 DOI: 10.1102/1470-7330.2013.0036
Imaging of musculoskeletal lymphoma
https://www.leukaemia.org.au/blood-cancer-information/types-of-bloodcancer/lymphoma/non- hodgkin-lymphoma/small-lymphocytic-lymphoma/
https://www.cancersupportcommunity.org/chronic-lymphocytic leukemiasmalllymphocytic-lymphoma
https://patientpower.info/the-curious-case-of-cll-and-sll-leukemia-lymphoma-orboth/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400341/
https://ashpublications.org/blood/article/131/25/2745/37141/iwCLL-guidelines-fordiagnosis- indications-for
Muscle lymphoma | Radiology Reference Article | Radiopaedia.org
Hindawi Case Reports in Radiology Volume 2017, Article ID 2068957, 7 pages
https://doi.org/10.1155/2017/2068957
Diagnostic challenge of soft tissue extranodal Hodgkin lymphoma in core-needle
biopsy: case report

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CASE 654: PHYLLODES TUMOR of the BREAST, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr TRẦN THỊ HỒNG VÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

October 20, 2022, 6:08 am
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A 21 year-old female patient herself detects a small mass of right breast from years, but it is getting bigger recently for some months, hard feeling when palpation and painless. The skin of right breast is still normal and no axillary lymph node.

On ultrasound, the right breast tumor # 60x70 mm is in central,  well capsulated, lobulated margins, ovoid, hypoechoic with many echo poor bands / clefts from central to peripheral tumor, medium vascularized. 





MRI detects medium signal on T1W1, high on T2 STIR, contrast well captured, categoried type 2.

Result of core biopsy is a benign phyllodes tumor of the breast (PTB).

On the surface the tumor is nodular, while on section tumor  is lobulated, solid in gray and gray-yellow color.


PTB is a very rare breast tumor in women aged 35 to 55 years. Our patient is younger but the progress of the tumor is the same in the literature: "unilateral, nodular, painless mass which has a history of the mass but that grows rapidly in the short term".


 

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CASE 655: RETROPERITONEAL GANGLIONEUROMA, Dr PHAN THANH HẢI, Dr NGUYỄN KIM HIẾU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

October 22, 2022, 1:57 am
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 A 19 year-old female patient with lumbago and periumbilical pain went to Medic Center for ultrasound examination for 10 days.




Abdomen ultrasound detects a calcified mass, colorless signal, close by the vertebral column on left side which  is thought a TB abscess or a retroperitoneal tumor. On vertebral X-ray films there are erosions of the vertebral bodies T 11 and T 12.







MSCT confirms a tissue density mass, well limited, with calcifications inside, # 11x17x7 cm, medium contrast captured.  From under the diaphragm the mass compresses left kidney and soft tissues around and erodes vertebral bodies T11, T 12. It may be a retroperitoneal neurogenic tumor.




Surgery was done  after ten days of diagnosing made and post-op result is a retroperitoneal ganglioneuroma.


Now the patient remains well and no need any other treatment.

REFERENCES
1. Sawaryn T. Ganglioneuroma of the mediastinum. Pol Tyg Lek 1959;14:867–70. 1959/05/11.
2. Hayat J, Ahmed R, Alizai S, et al. Giant ganglioneuroma of the posterior mediastinum. Interact Cardiovasc Thorac Surg 2011;13:344–5. https://doi.org/10. 1510/icvts.2011.267393. 2011/06/23.
3. Kiflu W, Negussie T. Ganglioneuroma of the Neck: a case report. Ethiop Med J2017;55:69–71. 2017/11/18. 4. Geoerger B, Hero B, Harms D, et al. Metabolic activity and clinical features of primary ganglioneuromas. Cancer 2001;91:1905–13. https://doi.org/10.1002/ 1097-0142(20010515)91:10<1905::aid-cncr1213>3.0.co;2- 4. 2001/05/11.
5. Kizildag B, Alar T, Karatag O, et al. A case of posterior mediastinal ganglioneuroma: the importance of preoperative multiplanar radiological imaging.Balkan Med J 2013;30:126–8. https://doi.org/10.5152/balkanmedj.2012.099. 2013/03/01.
6. Mylonas KS, Schizas D, Economopoulos KP. Adrenal ganglioneuroma: what you need to know. World J Clin Cases 2017;5:373–7. https://doi.org/10.12998/wjcc. v5.i10.373. 2017/11/01.
7 . Yorita K, Yonei A, Ayabe T, et al. Posterior mediastinal ganglioneuroma with peripheral replacement by white and brown adipocytes resulting in diagnostic fallacy from a false-positive 18F-2-fluoro-2-deoxyglucose- positron emission tomography finding: a case report. J Med Case Rep 2014;8:345. https://doi.org/ 10.1186/1752-1947-8-345. 2014/10/17.
8. Sucandy I, Akmal YM, Sheldon DG. Ganglioneuroma of the adrenal gland and retroperitoneum: a case report. N Am J Med Sci 2011;3:336–8. https://doi.org/10. 4297/najms.2011.3336. 2012/04/28.


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CASE 656: BOWEL VOLVULUS due to MESENTERIC CYST, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

November 10, 2022, 5:48 am
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A 23 year-old male patient with periumbilical pain and left flank pain for 5 days and vomiting. 



Ultrasound detects a cystic mass # 17.9x11.2 centimeter from his navel to pubis, and jejunum dilatation with obstruction sign (washing machine sign). The cystic mass contents fluid and septation with vascular sign on its walls. The cause of bowel obstruction was noted by a non-dilated bowel loop at the mesenteric root with whirpool sign.







There is not  bowel malrotation nor duplication cyst, so the ultrasound findings is bowel volvulus due to a mesenteric cyst.

MSCT confirms bowel volvulus due to a mesenteric cyst later.




Open surgery is done after endoscopic investigation. The cystic mass with yellowish fluid and a part of bowel are removed. Patient remains well post-op.




The histopathological report is a benign cyst with inflammation of the mesentery.
 
Bowel volvulus is still a rare entity especially in young adult.  Mesenteric cyst causes bowel volvulus may happen in emergency room in case of ruling out bowel malrotation, urachal cyst, Meckel diverticulum.



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CASE 657: MEDIASTINAL ABSCESS, Dr PHAN THANH HAI, Dr PHAN NGUYEN THIEN CHAU, Dr LE HUU LINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

November 18, 2022, 1:05 am
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A 69 year-old male patient enters Medic Center with ten days of fever,  thoracic pain and trouble ingestion. He was managed as gastritis but nothing change.


Blood tests show an infectious syndrome, while EKG, cardiac ultrasound results are in normal limits.



MSCT represents  a # 3 centimeter mass containing air  which is an upper mediastinal abscess with  some calcified foci inside due to a fistula of 1/3 middle part of esophagus.

Surgeon advises immediatly transferring the patient to a surgery hospital.
Gastroendoscopy shows a thickening lesion of middle esophagus and a normal chest X-Ray.



A MSCT is performed to prove the mediastinal abscess, and a bronchoscopy is done to rule out lesion from lung and airways. 

A decision of conservative treatment with antibiotics and a gastrostomy are noted to keep nourrishing the patient which is lasting from now to a half and one month later.


Mediastinal abscess is in recovery phase, reduces its size with calcifications, in two times of re-examination.




This is a mediastinal abscess case due to middle esophagus fistula which is unveiled the cause. 
Clinical clues are fever and thoracic pain and trouble ingestion. The role of MSCT and endogastroscopy are more clearer than chest X-Ray and cardiac ultrasound. Gastrostomy and medical treatment are well enough to help the patient avoiding an unnecessary operation with risks.
And patient remains well and can eating normally by mouth in happiness. 

May the abscess come back?


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CASE 658: CYST of PROSTATE or FISTULA of INTERNAL ILIAC VESSLES, Dr PHAN THANH HAI, Dr LY VAN PHAI, Dr LE THANH LIEM, Dr HO KHANH DUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 8, 2022, 5:23 pm
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A 67 year-old male patient is detected a small cyst of prostate on the right side by via abdominal ultrasound without any symptom. But on Doppler techniques the real one is a fistula of right internal iliac vessels.
The lesson is a cyst on B-mode may being a dilated vessel on Doppler investigation if sonographer does not apply the Doppler technique to watch a cystic structure.
MSCT and vascular surgery  [vessel collage] proved the  fistula of right internal iliac vessel.








On reexamination, next to the prostate on right side, Doppler ultrasound reveales a # 20x20x24 milimeter aneurysm with arterial low spectral waveform and venous waveform which means a fistula of internal iliac vessels.


MSCT confirms a fistula of the right internal iliac vessels.

An on-line investigation performs with an expert of Binh dan hospital, and this vascular surgeon makes his decision to solve the fistula by collage technique for it, via DSA in his hospital.


The aneurysm of right internal vessel is disappeared on screen while performing of vessel collage technique.



And it exists not any recurrent of right internal iliac fistula on the next 15 days.



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CASE 659: FIBROSARCOMA of Left SCAPULAR REGION, Dr PHAN THANH HAI, Dr LE VAN THO, Dr HO CHI TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 9, 2022, 11:32 pm
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A 19 year-old female patient with a huge mass on her left shoulder for 2 years.

X-ray detects a # 15 centimeter soft tissue mass of left shoulder with invasion left scapulum.                                                  

On ultrasound this is a huge solid mass, echo poor, well limited border, poor vascularized from left axilla to posterior shoulder. Thermography notes high temperature in tumoral region.

MSCT shows a soft tissue sarcoma of left shoulder that invades left scapulum. There is an arterial branch from left subclavian artery going to nourrish the tumor.

MRI confirms the soft tissue sarcoma of left shoulder invasive the left scapulum but glenohumeral joint intact.




Surgery removes the tumor and a lower part of left scapulum  keeping of superior part with glenoid fossa of scapulum.

Histopathologic report is fibrosarcoma low malignancy.


Due to COVID19 pandemic, so late the patient goes to hospital in case of tumor with bone metastasis.
Although the surgical management is successful, the patient will still face in high risk of recurrent of  fibrosarcoma and its metastases.






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CASE 660: PHEOCHROMOCYTOMA, Dr PHAN THANH HAI, Dr PHAM THE ANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 15, 2022, 5:24 am
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A 43 year-old male patient with gastritis and hypertensive crisis, TA=140/100mmHg, P=88b/min.

Ultrasound detects a right adrenal tumor # 41x47milimiter, solid echo poor, less vascularized.


MSCT confirms the right adrenal tumor, with HU density =25 and in late phase of contrast, HU=43.





Surgery removes the tumor carefully in touch due to heart rate and arterial tension going down.





Report of histopathology is a pheocromocytoma of the right adrenal gland.



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