CASE 866: PHPV and CATARACT, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN , MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 08 year-old female child with her left cloudy eye [leukocoria] from her first year of life.

Ultrasound detected left microphthalmos, left cataract and persistent hyperplastic primary vitreous [PHPV].

MSCT noted left ocular fluid in high density, while the left optic nerve and the left orbit were intact.

PHPV is synonymous with Persistent Fetal Vasculature that is the preferred term prior to Morton F. Goldberg’s 1997. PHPV is unilateral, associated with cataract. PHPV causes cloudy lense, retinal detachment, microphthalmos and strabismus.

CASE 865: PSEUDOANEUVRYSM of FACIAL ARTERY, Dr PHAN THANH HAI, Dr LE THANH LIEM, MEDIC MEDICAL CENTR, HCMC, VIETNAM

A 55 year-old man with his left swollen face and covered in bruise post trauma for one week.

Ultrasound detected edema and hematoma of facial soft tissue with dimension #42x27x22mm. Then Doppler ultrasound revealed aliasing sign of the left facial artery which was in high velocity Vmax # 165 cm/sec, and having to and pro flow pattern.

MSCT confirmed the # 30x14cm left facial arterial  pseudoaneuvrysm, lumen:14.4mm with its wall thickening #15 mm.

Stenting the left facial artery to solve its pseudoaneuvrysm.

Ultrasound with Doppler technic in first line may detect the vascular damage in case of trauma of the soft tissue.

CASE 863-864: CARDIA ESOPHAGUS CANCER, Dr PHAN THANH HAI, Dr NGUYEN QUANG HUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases one 57 year-old woman and one 38 year-old mam with loss weight and epigastric pain in fail of treatment as gastritis.

Ultrasound detected thickening of the cardia wall and metastase lymph nodes.

MSCT confirmed the cardia cancer but anapath result noted gastritis with infected HP of one case.

Case 01: Woman 57 year-old epigastric pain, nausea and loss of 7kg for 2 months.

Ultrasound deftected metastase lymph nodes #15-10m close by stomach and upper GI endoscopy noted cardia cancer. Biopsy result was carcinoma invaded the esophagus. The female patient died in hospital as the end stage.

Case 02: A 38 year-old man with epigastric pain, GERD, and loss of 10 kg of weight fof 4 months.

MSCT and endiscopy confirmed cardia cancer.

But results of 2 times biopsy were chronic gastritis.

At the third biopsy via endoscopy the result was the poorly differentiated  adenocarcinoma invaded the esophagus.

The patient went through chemotherapy management.

CASE 862: ARTERIAL HYPERTENSION due to RENAL ARTERIAL STENOSIS, Dr PHAN THANH HAI, Dr TRAN THI THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 39 year-old man, 63 kg of weight,  with ATH 230 mmHg [systolic].

Ultrasound detected the right renal arterial stenosis at 2 sites  > 50% and  the smaller right kidney # 82x41x38 mm than the left one.

Doppler ultrasound noted aliasing of the right renal artery with parvus tardus flow pattern.

Vascular MSCT confirmed the small right kidney and stenosis of the right renal artery at the beginning and middle parts due to thickening of the right renal arterial wall.

Right renal angioplasty and stent insertion of the right renal artery was performed.

CASES 858-861: SOLID PSEUDOPAPILLARY NEOPLASM of the PANCREAS, Dr PHAN THANH HAI et al, MEDIC MEDICAL CENTER, HCNC, VIETNAM.

 4 cases of solid pseudopapillary neoplasm of the pancreas  at Medic Center in girls (10-15 year-old) and (23-25 yo) women. 

Ultrasound detected cystic tumor of the pancreas first then  MSCT at last confirmed the cystic pancreas tumor.

1 case in a 10yo girl with 7 cm cystic tumor at the tail. 1 case of 15yo girl with 8cm tumor at the body, 1 case in a 25 yo woman, #9 cm at the head, 1 case of a 23yo woman, #5 cm at the body-tail of the pancreas.

All of the 4 cases went through surgery and the patients remained well post-op.

REFERENCES:

CASES 856-857: TB MASTITIS, Dr PHAN THANH HẢI, Dr NẠI THỊ HƯƠNG THOANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Two cases of breast abscess failed in prolonged treatment, but at last were cured successfully in TB management.

CASE 01: A 28 year-old woman  with left swollen breast abscesses without pain nor fever. Drainage and antibiotic treatment were not response for 6 months.

Ultrasound detected some necrotic cystic masses, hypoechoic  non vascularized in the left breast and some inflamed axillary lymph nodes.

Tthe TB PCR result of pus was negative.

But FNAC result was positive with Langhans cells.

CASE 02: A 33 year-old with breast abscess.

FNAC in the first time resulted breast abscess.

And tuberculous mastitis in the second time.

TB mastitis is still complex in diagnostic sometimes has to  setting up a trial treatment.

DISCUSSION on the DIAGNOSIS of BREAST TUBERCULOSIS  CASES at MEDIC:

1/ Besides the clinical situations, the diagnosis of TB breast based primarily on ultrasound (90%, therefore mainly), mammography, biopsy (most breast tuberculosis is only accurately diagnosed by histology with granulomatous lesions, caseous necrosis, Langhans macrophage cell) and Ziehl–Neelsen acid-fast bacilli staining (low positive rate).

Other imaging modalities  used  to determine the extent of the disease  for orientational and differential (rather than diagnostic) notations. However, mammography keeps difficult to differentiate the malignancy mass from the breast tuberculosis.

2/ The most common form of TB breast is the extended form. Sclerosing and carcinomatosis associated with breast tuberculosis have never been encountered.

Figure 3 types of breast tuberculosis: extended, nodular and fibrotic (Figure by Dr. Nguyen Duy Thu, Breast tuberculosis and Imaging Diagnosis) .

3/ With Shear Wave Elastography ultrasound: Use elastography to diagnose differentially in ultrasound imaging for breast tuberculosis (and breast cancer). Breast tuberculosis has very hard code at the periphery, elasticity E= >120kPa (red), while the central area is softer, heterogeneous, with  elasticity E= 60kPa (green or no signal). In soft tissue cancer with necrotic areas, the opposite result means: the color map tends to be red (hard) and spreads evently from the outside to the mass center. The elastogram mapping helps to selecting of the biopsy site to avoid a pseudonegative result.

REFERENCES:

https://www.ultrasoundmedicvn.com/2024/10/case-786-accessory-breast-tuberculosis.html

https://www.ultrasoundmedicvn.com/2025/03/case-818-breast-tb-node-dr-phan-thanh.html

https://www.nguyenthienhung.com/2012/01/lao-vu.html

CASE 855: FULL TB INFECTION with INCREASING CANCER MARKERS, Dr PHAN THANH HẢI, Dr PHẠM LÊ DIỄM CHI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 18 year-old weakness man with neck nodes  and abdominal pain.  Thin, pale, height 165cm, weight 39kg. Pain but not existing abdominal guarding.

Ultrasound noted cervical lymph nodes and nothing detected in the abdomen. They were inflamed nodes but may due to infiltrated lymphoma.

But full body MSCT revealed many inflamed organs may suffer from TB infection.

Lab data showed positive TB in phlegm and increasing abnormally values of some cancer markers: CA-19.9, beta 2 microglobulin and CA-125 . The last one helps differentiating a pulmonary TB from other lung infections as published on medical literature.

The patient remains well after going through the anti-TB course of treatment.