CASE 913: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI , Dr HỒ TẤN ĐẠT, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 71 year-old woman in check-up for 4 times.

Ultrasound in the first time was not interesting.

In the second time ultrasound noted  a cyst in the left lobe of the liver.

  

MSCT resulted some hepatic cysts.

Ultrasound in the third time detected a right lobe mass maybe a liver tumor and a left lobe cyst.

But MSCT replayed a hepatic hemangioma.

In the fourth time ultrasound thought about a # 44x30mm liver tumor including HCC.

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But the result of lab data with WAKO test was negative intead of the marker AntiHBc positive.

On hepatic MRI the result was  a #55x40 mm bile duct cancer of the right lobe of liver.

Surgery removed the right lobe liver tumor and the last diagnosis was a an  CCA, intrahepatic cholangiocarcinoma.

After 5 months post op, CCA speaded as multifocal in the liver and a chemotherapy management was done.

Cholangiocarcinoma (CCA) is challenging to diagnose early due to its ambiguous clinical presentation and highly aggressive nature. Consequently, if a suspected liver hemangioma exhibits rapid growth, an MRI should be performed to confirm the diagnosis.

CASE 912: SUBMUCOSAL GASTRIC PSEUDOTUMOR, Dr PHAN THANH HAI, Dr TRAN LAM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 84 year-old woman with diarrhea and tormina (colicky pain).

Ultrasound noted only gallblader stone anf fatty liver.

Gastroendoscopy detected a gastric submucosal tumor.

Medical management stopped diarrhea but was failed to reduce the tormina.

MSCT detected a fishbone in the gastroduodenal wall.

Gastroscopy in second time detected the foreign body in the  gastric wall maybe fishbone.

Endoscopic surgery and open surgery removed the fishbone from the stomach.

Intramuscular fishbone is rarely entity that ultrasound and endoscopy could not detect.

CASES 910-911: MAY-THURNER SYNDROME, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC VIETNAM

Two cases of young girl with left leg edema were detected thrombosis of the left iliac vein.

CASE 1: A 28 year-old woman with left leg edema for 1 week. D-Dimer: 4,830 ng/mL

CASE 2: A 22 year-old girl with left leg edema for 3 weeks, D-Dimer: 3,840ng/mL.

REFERENCES:

 From Radiopeadia

May-Thurner syndrome refers to a chronic compression of the left common iliac vein (CIV) against the lumbar vertebrae by the overlying right common iliac artery (CIA), with or without deep venous thrombosis 2.

Although both left and right CIVs lie deep to the right common iliac artery, the left CIV has a more transverse course and is predisposed to compression whereas the right CIV ascends more vertically and is therefore not similarly predisposed. 

CASES 908-909: THYROID MICROCALCIFICATION: Sole Sign of PTC, Dr PHAN THANH HẢI, Dr NGUYỄN THỊ THẢO HIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Two cases of thyroid nodules with microcalcifications were diagnosed PTC. But thyroid parenchyma with microcalcifications is not ruled out thyroid carcinoma.

CASE 1: A 30 year-old pregnant woman with malinant cervical lymph nodes. 

CASE 2: A 23 year-old girl with neck pain for 3 days.

Thyroid nodule with mivrocalcifications with metastase lymph nodes.

Microcalcification diffuse in the thyroid parenchyma with cervical lymph node is a malignant ultrasound finding of thyroid examination.

REFERENCES:

CASE 907: PARAGANGLIOMA close by URINARY BLADDER, Dr PHAN THANH HẢI , Dr TRẦN MỘC HIỆP , MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 44 year-old hypertensive man with flushing, sudation while passe out water for 2 months. HTA : 177/109mmHg, P: 72p per min.

Ultrasound detected a hypoechoic mass which pushed in the bladder from behind may be a fibroma or a lymph node. The patient denied to manage his status.

One year later the patient came back with another chief complaint. Ultrasound noted the 32×18mm mass nearby his bladdermaybe a pheochromocytoma.

MSCT confirmed  the pheochromocytoma close by the bladder.

Surgery removed the mass with a part of the bladder. Histology of the specimen proved a paraganglioma.

The patient remains well post-op.

CASE 906: NEUROENDOCRINE TUMOR, Dr PHAN THANH HẢI, Dr VÕ NGUYỄN THÀNH NHÂN, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 42 year-old woman with epigastric pain and left flank tumor which was suspected as a # 100x182mm tumor at the pancreatic tail.

But MSCT noted the # 110x117mm tumor was in the mesenterium near the left flank which suspected a mesenteric tumor or a paraganglioma.

Lab data was not interested.

Surgery removed the tumor and the specimen was diagnosed as a paraganglioma tumor which needs to perform a immunohistochemistry [IHC] staining for a final diagnosis.

CASE 905: LUMP of GOUT in HAND, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 An old man suffers from gout for a long time with his tophus [stone] lump on the right hand but now  that makes pain and he could not move the second finger. EULAR Gout Score # 15 (>8.0).

X-ray and MRI show the erosions of the metacarpal and proxical phalanx bones of the second finger close the tophus lump.

And a 33MHz ultrasound probe notes the tophus lump in hand in more details.

Joint deformity and limitation of motion in affected joint may occur if several attacks of gout occur each year. Uric acid deposits called tophi develop in cartilage tissue, tendons, and soft tissues. These tophi usually develop only after a patient has suffered from the disease for many years. Deposits also can occur in the kidneys, leading to chronic renal failure. 

https://medlineplus.gov/ency/imagepages/19833.htm

REFERENCES:

https://goutclassificationcalculator.auckland.ac.nz/

https://pmc.ncbi.nlm.nih.gov/articles/PMC11348250/n

https://radiopaedia.org/articles/gout