CASE 134: PAINFUL MASS at UMBILICAL REGION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 32 yo, 4 days ago, suddenly got pain at left site of umbilicus, progressive, no fever nor GI trouble.
Emergency ultrasound of abdomen: no free fluid, no free air, at the umbilicus there is one mass near the abdominal wall, along from epigatric area to urinary bladder, hyperechoic, no air inside. Pressing over the mass is very painful (2 images of longitudinal and cros-sectional scan at the left umbilicus).

 

Blood test : elevated WBC of 16k.

Emergency doing abdomen MDCT:  in cross section, sagital views at umbilicus, and frontal view  this mass located from the transverse colon to nearby urinary bladder. It was great omentum.
Suspicion of  a great omentum infarction (see 3 CT pictures).

EMERGENCY OPERATION AT BD HOSPITAL DETECTED GREAT OMENTUM INFARCTION DUE TO VENOUS THROMBOSIS.

REF:1105-Federle-Omental_Infarction.pdf

CASE 133: SCAR of REMOVED BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 57 yo WENT THROUGH A LUMPECTOMY AT THE LEFT BREAST BY CANCER FOR 7 YEARS AND RADIOTHERAPY. NOW SHE NOTICES THE SCAR AT THIS SITE GETTING BIGGER AND HARDER.

ULTRASOUND OF LEFT BREAST AT 5h AREA : THE SCAR HAS STRONG SHADOWING NON COMPRESSIBLE, NO AXILLARY NODE (4 IMAGES).

MRI IS DONE WITH GADO CE DYNAMIC (2 IMAGES).

Resection biopsy of the scar was done, and pathological report was fibrosis and inflamation cell infiltration.
Microscopic result of  the biopsy showed that to be a KELOID.

DISCUSSION:  Caution of the scar on one breast post operation is always more difficult. With CDI ultrasound there is no vascular supply for this scar nor mass in the posterior black shadowing area. Biopsy of course is the choice for a clear diagnosis. 

Reference: POSTERIOR ACOUSTIC SHADOWING in BENIGN BREAST LESIONS

CASE 132:OVARIAN TUMORS and COLON TUMOR TOGETHER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

Female patient 17yo, has been treated at a province hospital as PID for 3 months. Ultrasound at Medic detected 2 ovary tumors in pelvic region with ascites.

Reviewing of scanning, ultrasound disclosed a mass which belonged her R/colon with "umbrella" sign.

Blood test of CA 125=125 UI.
MDCT of abdomen was done with CE.

MDCT showed foreign bodies intralumen of right colon and ovarian tumors.
COLONOSCOPY  detected  multiple polyps of colon which obstructed at right angle of colon.

BIOPSY  made diagnosing of colon cancer.

And  the ovarian tumors maybe were  KRUKENBERG TUMORS  DUE TO COLON CANCER SEEDING.

CASE 131: LEFT SUPRACLAVICULAR NODES, PELVIC TUMOR AND MESENTERIC NODES, Dr PHAN THANH HẢI, MEDIC, MEDICAL CENTER, HCMC, VIETNAM

Woman 36 yo, one month after operation by pelvic abscess, she detected her neck swollen on the left site. Ultrasound the neck and abdomen.

Many lymph nodes were at the left supraclavicular area (Troisier's node), one big and many small hypoechoic around.

 

 
Doppler CDI can see the hilus of the lymph node, and thyroid gland was normal.

At left iliac fossa, ultrasound scan detected the elliptical structure, CDI showed  that the lymph node at mesenteria like sandwich sign.

 
DISCUSSION:
Sandwich sign  in ultrasound  is the same as finding  made by MDCT in  hypertrophy of the lymph node   with the vessel inside this mass.

Ultrasound is the best for diagnosis of  the scenario including very poor echostructure  like cyst  of  LYMPHOMA.

Biopsy of course  is the final  report with histo-chemistry staining.

CASE 130: TRANSPLANT KIDNEY of 13 YEARS: Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 40 yo had transplant kidney for 13 years, now  BUN and creatinine raise. Ultrasound of kidney graft.

Image 1: B mode the graft kidney at right iliac fossa, size of  9,9cm x  6 cm, cortico-medullary index is normal.

Image 2:  CDI hypovascular perfusion of kidney.

Image 3:  Spectral Doppler with RI= 0,57.

Image 4 : Spectral Doppler of arterial waveform at kidney hilus no stenosis.

DISCUSSION: Graft kidney during 13 years, renal function is  getting insufficiency slowly. Ultrasound is the best modality for survey of transplant kidney. The size is normal, no hydronephrosis, vascular supply is low but without evident of renal arterial stenosis. RI is in low value. It is a case of renal fibrosis.

FURTHER READINGS:

Multiwave technology introducing shear wave elastography of the kidney

[Siêu âm SWE định lượng xơ hoá trong bệnh lý thận mạn tính]
ARFI in TRANSPLANTED KIDNEY

CASE 129: THYROID TUMORS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 54 yo, in a  routine check-up,  ultrasound on her neck  showed two nodules in the right lobe of  2cm and the left lobe of 1,7 cm during B mode and CDI examinations. The right nodule was hypervascular but the left nodule had many small calcifications without regional lymph node. FNAC was done.

FNAC RESULTS OF THYROID NODULES WERE COLLOIDAL CYST  ON RIGHT SIDE  AND  PAPILLARY CARCINOMA  ON THE LEFT SIDE.
THE RESULTS ARE CORRECT OR NOT IN CORRELATION WITH  ULTRASOUND IMAGES OR NOT.
MRI  THE NECK  WAS DONE  FOR  MAKE SURE THE CHARACTERIZATION OF THYROID NODULES  WITHOUT  LYMPH NODE.

CASE 128: PERITONEAL CARCINOMATOSIS (EOPPC), Dr PHAN THANH HẢI- Dr LÊ ĐÌNH TÍN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 56 yo, 3 months ago went through a distension of her abdomen.
Ultrasound of abdomen detected an amount of ascitis of known origine, no tumor intra abdomen detectable. Liver was normal, at surface of right kidney had some small round structures like rice grain. In pelvic region the uterus is free of tumor.

Ascites was yellowish fluid, cell bloc cytology was inflammatory cell no malignant cell. ADA test was of 17.8 UI, amylasemia of 684.2 UI which showed very high positive of Roma blood tests.

MRI abdomen was done , the report suspected peritoneal carcinomatosis of unknown origine.

Laparoscopic biopsy showed that many seeding tumor intraperitoneum.

MICROSCOPY RESULT OF  BIOPSY FOR NODULE WAS  CANCER METASTASIS FROM  SUSPECTED OVARY.  IT  WAS  A CASE OF  EOPPC (extraovary primary peritoneal carcinoma).

Reading: 2 cases of EOPPC in MEDIC CENTER

CASE 127: ELONGATED STYLOID PROCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 47 yo, one week ago suffering of pain on his right side of neck after swallowing.
ENT doctor checked him up with NAD [nothing abnormal detected].
Ultrasound of the neck on the right submandibular scanning in middle line detected one hyperechoic structure, size of 3 cm and posterior shadowing which was not detected on the left site of submandibular area scanning.

There was no fluid arround this structure. Pressing with the probe on the structure made patient very painful. Sonologist suggested a foreign body as bone fish.

After the endoscopy results were negative, MDCT was done at  this  area and detected the right  styloid process was too long  (# 4 cm ) in comparison to the left (#3 cm  of length).

This echostructure  is the tip of the right styloid process, a case of EAGLE 's syndrome.

FURTHER READING:

eagle-syndrome