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CASE 661: RCC DETECTED in a Check-up ULTRASOUND, Dr PHAN THANH HAI, Dr NGUYEN PHUOC TOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 17, 2022, 3:03 am
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A 45 year-old male employee in a check-up by ultrasound in his company  is detected occasionally a # 25 mm left renal tumor without signs of lumbago and hematuria.



MSCT later comfirms the 30 mm left kidney tumor at lower pole and anterior face maybe a RCC.





Endoscopic surgery removes the tumor in its capsule by pure enucleation technique.


Result of histopathogy is a clear cell renal carcinoma, grade 2.

Portable ultrasound in control check-up for worker and employee in the company may detect some cases with subclinical symptom. If it exists we will call them going to our center for more informations by other modalities of diagnostic imaging and lab data for a clear diagnosis and available management.



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CASE 662: MYOCARDIAL INFARCTUS with ST non Elevated, Dr PHAN THANH HAI, Dr BUI BINH HUAN, Dr VU BICH DOAN TRANG , MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 22, 2022, 5:38 am
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 A 68 year-old HTA male patient with right chest pain for 8 hours while holding some water buckets.

Troponin I: 648.6 ng/L, CPK MP: 13.32 ng/mL are elevated, but EKG and cardiosonography have no clue of an acute myocardial infarctus.






About 50% patients of unstable angina  [UA] and NSTE MI have no change of EKG in early time while troponin-I elevated during the first 24 hours.

Based on elevated troponin-I and CPK, the patient is transferred to an emergency hospital after a diagnosis of myocardial infarctus is made.

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CASE 663: ENDOMETRIOSIS and DIENOGEST, Dr PHAN THANH HAI, Dr NGUYEN THI XUAN HOA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

December 22, 2022, 11:45 pm
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A 38 year-old female patient, TPAL 1001, with sideropenia, dysmenorrhea and menorrhagia that has been diagnosed endometriosis in uterus and right ovary by transvaginal ultrasound  (TVUS) and pelvic MRI.

On MRI, size of endometriosis in uterus # 5×7 centimeter and, in ovary # 1.5 centimeter.



She is managed for iron deficiency, and her endometriosis with Dienogest 2mg one tablet per day. For 5 months, focal lesions in her uterus and right ovary are getting smaller sizes. Dysmenorrhea appears slightly and she is with the new generation of progestin acceptable menorrhagia.



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CASE 664: 03 CASES of PROSTATE DISORDERS with LOW VALUES of PSA, Dr PHAN THANH HAI, Dr NGUYEN MINH THIEN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

January 5, 2023, 5:48 am
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 3 cases of prostate disorders wit low values of PSA= two cases of TB and one case of carcinoma that concludes prostate cancer may happen with any value of PSA [but not only PSA>4 ng/mL]; although value of PSA being considered a guiding lab data for prostate cancer.

Should base on free PSA, DRE, MRI, elasto ultrasound together for screening prostate cancer, but these lab data and diagnostic imaging not stand for a diagnostic of prostate cancer.

CASE 1





CASE 2





CASE 3:

Chief complaint: only left swollen scrotum.







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CASE 665: INTESTINAL GIST, Dr TRƯƠNG THỊ NGỌC TIẾN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

January 16, 2023, 9:21 am
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 A 55 year-old female patient suffers from a painful epigastric mass for one week. As gastritis management failed, ultrasound reexamines her abdomen.

A 117x67 milimeter mass is detected between liver and right kidney. It has poor structure with some cystic lesions and its center more rich echogeneicity that is thought to be an intestinal GIST. 

Her uterus gets having some fibroma lesions also which have same echogeneicity.


MSCT later confirmes the intestinal GIST and uterine fibroma.


Surgery removes the imtestinal GIST [left specimen] and an uterine fibroma with stalk (right specimen).




Histopathologic and chemohistoimmune staining results are intestinal GIST, and uterine leiomyoma.



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CASE 666: GIANT HYDRONEPHROSIS, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

February 3, 2023, 11:35 pm
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 A 53 year-old male patient with a painless big abdomen was accidentally detected having a right giant hydronephrosis via ultrasound examination. 


As the right dilated kidney was in large size that could not use any classic section to find out the clue of the renal obstruction. But in going down  from the left pelvis and toward right side, ultrasound revealed an evident ureteral stone # 20 milimeter.


Later, MSCT confirmed easier than ultrasound the 20 mm right ureteral stone which caused the right giant hydronephrosis.


The patient went through a right nephrostomy in emergency situation. About 4.5 liters of urine was drained out and then his abdomen getting flatten.

Two weeks later was done an evaluation of the right kidney function via Tc-99m DTPA scan. Ultrasound re-examination noted a distortion of right kidney structure: thickness of renal cortex thinner than 6 millimeter and nonexistent differentiation of renal medulla from cortex of renal parenchyma.







Via endoscopy  right nephrectomy was performed as the right disfunction kidney. 





6 months later value of eGFR rised from 64 to 75 mL/min/1.73m2 , and the patient remains well.
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CASE 667: LEFT KIDNEY UTUC, Dr PHAN THANH HAI, Dr TRAN THANH NGA, MEDIC MEDICAL CENTER, VIETNAM

February 9, 2023, 6:06 am
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A 51 year-old male patient with hematuria for 6 months but since last month he suffered from a full hematuria. Ultrasound detected a hypoechoic mass nearby left inferior renal pole. SMI showed hypervascular pattern inside the mass.

MSCT later confirmed a left renal tumor RCC or oncocytoma and a proximal upper left ureter tumor.

Surgery removed the left kidney, left ureter and a part of bladder as high malignant upper tract urothelial cancer (UTUC).






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CASE 668: THYROID TUMOR, Dr PHAN THANH HẢI, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, VIETNAM.

February 17, 2023, 11:46 pm
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A 64 year-old male diabetic patient with right painfull swollen neck for 2 weeks, he has also got impermanent tinnitus and hoarse voice due to right vocal cord paralysis.



Ultrasound of his neck shows a 29x33 mm big right lobe of thyroid, hypoechoic mixed pattern, poor-limited while the left lobe is intact with its slightly small size #15x17mm. It exists many round and ovale, hypoechoic lymph nodes on both 2 sides of his neck maybe due to metastase or infiltrated lymphoma.


Result of lymph node biopsy is poorly differentiated carcinoma metastase node.



MSCT of neck and chest detect lymph nodes in mediastinum, and on 2 sides of neck that are thought due to metastasis from unknown origin. The  right lobe of thyroid represents undetermined lesion and low captured CE. 




As a poorly differentiated carcinoma of thyroid is a rare entity, a FNAC of right thyroid lobe is performed.


And the result of FNAC of right lobe of thyroid is poorly differentiated thyroid carcinoma.

As the poor status the patient just only undergoes a chemotherapy.

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CASE 669: PROSTATIC CYST or A-V FISTULA, Dr PHAN THANH HẢI, Dr LÝ THANH LÃM, Dr LÊ THANH LIÊM, Dr VÕ NG THÀNH NHÂN, Dr HỒ KHÁNH ÐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

February 23, 2023, 5:56 am
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A 62 year-old male HTA patient with an aliasing cystic lesion close by his prostate without urogenic symptom was revealed by Doppler technique. A note of an pseudoaneurysm of the right internal iliac artery due to A-V fistula is written down, but it has been missed out on it in 3 other examinations in the past.



MSCT and Angio confirm the pseudoaneurysm of right internal iliac artery.



After a vascular collation via pelvic angiography the pseudoaneurysm disappeares.


Without Doppler technique we could be in error or misdiagnose some cystic lesion.
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CASE 670: CHRONIC AORTIC DISSECTION, Dr PHAN THANH HẢI, Dr TRẦN THANH NGA, Dr VÕ NG THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

February 25, 2023, 7:18 am
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A 62 year-old HTA female patient with asthenia,  impermanent chest pain for one month, is diagnosed aortic dissection by color Doppler ultrasound. She has got slightly leg edema for one week before ultrasound examination.

HTA: 150/80 mmHg, HR : 115 b/min.

Ultrasound detects a thick flap inside abdominal aortic lumen which separates the 22 milimeter aorta into 2 colored Doppler code lumens. The aortic dissection presents from thorax to right iliac artery. Blood streams in two lumens of the aorta are different with one velocity of 66 cm/s lower than the other, 166 cm/s. 





AngioMSCT confirmes aortic dissection from aortic arc in the chest to iliac artery in abdomen. The left kidney artery comes from the lower velocity lumen.



Stenting the aortic dissection is the appropriate management for the chronic aortic dissection with antihypertensive treatment.

REFERENCE


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CASE 671: BetaHCG SECRETION by a PULMONARY CARCINOMA, Dr PHAN THANH HẢI, Dr NEANG SI PHATS, Dr HUỲNH TRÁC LUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 10, 2023, 11:51 pm
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A  42 year-old female patient,  TPAL 1001 with critical menorrhegia for one month  and weight loss and anemia. HTA:100/70 mmHg, PA:110 bpm. W = 40 kg H: 155mm, BMI: 16.6.

TVS ultrasound detects only uterine fibroma, but beta HCG highly rising= 69,474 mlU/mL.



Total body MRI detects a 98 mm right lung tumor and a 25 mm uterine fibroma.


Chest X-Ray film represents tumor of the right lung which is thought a beta HCG secretion tumor.



Lung biopsy result is a non small cell adenocarcinoma, stage IIIc, invasive at lung.






As the poor status of the patient, the current clinical management is blood transfusion to improve her life in waiting for a reexamination in a cancer hospital.

REFERENCE:



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CASE 672: HYDATID CYST in MYOCARDIUM, Dr PHAN THANH HẢI, Dr TRẦN THỊ MINH PHƯỢNG, MEDICAL MEDICAL CENTER, VIETNAM.

March 16, 2023, 6:10 am
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A female patient 75 year-old with asthenia and dyspnea for one year. The eosinophil  proportion of white blood cell is of 0.14 and Echinococcus (hydated) IgM Elisa negative is 0.16 index.

Cardiac ultrasound detects a 30 mm simple cyst (Gharbi type I  hydatid cyst) in myocardium at cardiac apex.



MSCT and MRI confirm the cardiac cyst.




Surgery removes successfully the hydatid cyst with larva from heart. 



Microbioparasitology result is A hydatid cyst with larva of Echinococcus sp.



Hydated cyst in myocardium a very rare site coming over that usually appears in liver, spleen, lung ... instead.

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CASE 673: RENAL INFARCTION, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 17, 2023, 11:09 pm
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A HTA female patient 50 year-old with left flank pain, headache and red blood cells in urine for 3 days.



Ultrasound detects a 93x43 milimeter hypoechoic left kidney  without Doppler signal via SMI technique while the right one  110x47 mm is normal.




Elastography of left kidney SWE is in hard code.


MSCT Angio represents left kidney atresia as thrombosis of the left renal artery which leads it to be total obstruction.



It’s a left renal infarction case which is in late inspection.

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CASE 674: BREAST SARCOMA, Dr PHAN THANH HẢI, Dr LÊ THÔNG LƯU, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 23, 2023, 4:59 am
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 A  61 year-old female patient  with right breast tumor and axillary nodes.

Breast ultrasound detects a  # 28x10 mm mass of the right breast BI-RADS 4 B and second tumor of this one, #19×10mm. And elastography ultrasound notes a hard code of it.


Breast MRI represents 2 right breast tumors, BI-RADS 5.


Biopsy of right axillary node is inflammed node, but result of core biopsy of the right breast tumor is poor differentiated breast sarcoma (C 49).



Total right mastectomy is performed,  and the final results are the right breast sarcoma and the chronic inflammed axillary node.

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CASE 675: SCHWANNOMA of C5 ROOT of LEFT BRACHIAL PLEXUS, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

March 24, 2023, 11:25 pm
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A  56 year-old female patient  with left facial numbness [?] for 3 days.

Neck ultrasound at left supraclavicular region detects # 8-19 mm hypoechoic enlargement of left brachial plexus maybe due to schwannoma or neurinoma. While ultrasound examines at the neck region the female patient feels her left upper arm numb sensation (due to affecting the left upper brachial nerves from C 5 root).



MRI confirms a schwannoma tumor #21x12mm of left C 5 root.


Surgery removes the tumor of C 5 root from left brachial plexus which the pathohistology result is the schwannoma of the C5 root.


REFERENCE





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CASE 676: LUNG TUMOR or TB LUNG, Dr PHAN THANH HẢI, Dr LÊ HỮU LINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 10, 2023, 12:58 am
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 A 57 year-old female patient with a left lung (lingula) mass on chest X-Ray film on January 2023 without any symptom.


But its size changes for months on the chest X-ray film (Mars 2023).



Lung ultrasound notes a consolidation region #44x31mm of left lower lobe of lung, with air bronchogramme, and soft code of elastography ultrasound (ARFI technique).









Chest MSCT later confirms the 50 mm left lung mass and biopsy.

Result of biopsy is a TB lung mass with TB cyst, caseous necrosis,  lymph cells  and Langhans cells.


The female patient then starts a TB regimen.

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CASE 677: LUNG TUMOR, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THỤC QUYÊN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 11, 2023, 6:30 pm
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A female patient  with asthenia and pain of her left lung for one month. Her past history is going through 2 times of surgery for left lung tumor, kind of hemagioma (15 years and 4 years before).

Ultrasound notes a #39x54mm septated cyst of her left lung which contents a small amount of fluid , thin capsule, soft code of elastography ultrasound, which leads to thinhk about a post-op cystic lesion.








MSCT confirms a left lung cyst with sludge.




Surgery in the third time for removing the left lung cystic lesion. Gross specimen waits for histopathological result.






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CASE 678: COMPLICATED DIVERTICULITIS, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 13, 2023, 5:52 am
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A 55 year-old female diabetic patient suffers from epigatric pain crisii for 4 days and diarrhea.

Ultrasound detects an amount of abdominal free fluid,  two RLQ abscesses, and edema of peritoneum.






MSCT confirms the peritonitis due to 2 abscesses at the right flank of the abdomen.


A right colectomy is performed as perforation of colonic diverticulitis # 2x2 cm of transverse colon and the other one of cecum.

Subhepatic drainage is made to withdraw fluid out and an artificial anus is done.

 And the female patient remains well.



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CASE 679: ECTOPIC TESTICULAR TUMOR, Dr PHAN THANH HẢI, Dr BÙI HỒNG LĨNH , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

April 14, 2023, 11:57 pm
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 A 53 year-old male patient  having HBV infected with hypogastric pain and without his left testis.

Ultrasound detects a # 76x50 mm hypogastric mass, with Doppler signals, and hard code of elastography ultrasound, 23.8 kPA.



MSCT confirms a 75x60x85 mm left ectopic testicular tumor maybe a seminoma in the pelvic region.



Surgery removes the ectopic testicular tumor from left hypogastric region.



The  microscopic result of the ectopic testicular tumor is a seminoma invading its capsule. 
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CASE 680: CHOLECYSTITIS and GALLSTONE, Dr PHAN THANH HẢI, Dr HỒ KHÁNH ĐỨC, Dr LÊ VĂN TÀI, Dr LÊ THANH TÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

May 9, 2023, 8:20 pm
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 A 70 year-old diabetic male patient with an acute abdominal pain for hours enters the emergency room of Medic Center. His history are gallstone, controlled glycemia and  coronary arterial 2 stents for over 10 years. His EKG shows a life-rhythmic extrasystolic. WBC: 11.4H, CRP:0.4.

Ultrasound represents a 17 mm stone in a # 98x31 mm gallbladder with thickened wall of GB # 5-7mm. SonoMurphy sign positive and no fluid exist around the GB.





The cholecystitis pain reduces rapidly with taken Voltaren, No-Spa after 20 minutes. But a cholecystectomy via endoscopy is planned in regarding his Clopidogrel, diabetic status and the life-rhythmic extrasystolic EKG.

Endoscopic surgery removes a 17 mm pigmented stone within a thicken gallbladder which GB mucosa is in necrosis and hemorrhage. Thicken GB wall leads to cut it into small pieces for removing the gallstone and the inflamed gallbladder.

Pigmented gallstone and gallbladder in small pieces.

Endoscopic image of the inflamed gallbladder.



The patient remains well and discharged in safety after 2 days in hospital.

In reviewing the gallbladder, the gross specimen of GB shows a cholecystitis image more interesting than the ultrasound view. So it makes alert when facing a painful gallstone than a silent stone of gallbladder.

Furthermore there is a proposal that should think about acute cholecystitis while seeing a gallstone in a RUQ painful patient.

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