CASE 169: CBD MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 50 YO, ONE MONTH AGO, PAIN AT RUQ AREA,  FEVER AND JAUNDICE PROGRESSING. ULTRASOUND AT FIRST DETECTED THE GALL BLADDER TOO BIG, NO STONE AND DILATED CBD with DIAMETER OF  2.6 CM,  WITH  PENCIL SIGN  AT ODDI AMPULA. [SEE 3 ULTRASOUND  IMAGES].

MDCT  OF ABDOMEN WITH CE  SHOWED  ODDI AMPULA  HAVING  A MASS  WITH CE  (SEE  2  CT IMAGES).

ERCP was done and  detected  ampular  tumor. Biopsy was performed  and  left a stent for biliary decompression.

Microscopic  report  from  biopsy is adenocarcimoma of Vater ampulla tumor.

Reference:  January 1993 Buck and Elsayed, RadioGraphics.

 

CASE 168: NOT HAVING GALLBLADDER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 48 yo in hospital admission by fever and jaundice progressing. Physical examination: pain at right subcostal area, past history was known diabetes and gallbladder stone. Plain abdominal XRay film standing showed ilius status.

Ultrasound of abdomen revealed small fluid collection at the border of liver, and CANNOT FIND OUT THE GALL BLADDER BUT DETECTED ONE  HYPERECHOIC MASS ADHERED TO LOWER BORDER OF LIVER. THE CBD WAS NOT IN DILATATION.

Blood tests with elevated WBC of 16K (90% neutrophil).

MDCT non CE found that the gallbladder without stone nor fluid into gallbladder.

What is your explanation of the ultrasound images for this gallbladder?

Based on clinical  status:  fever, jaundice, pain at right subcostal area, and imaging modalities (abdomen plain film, ultrasound  and MDCT) with  blood tests, the  diagnosis was acute cholecystitis lead to gallbladder empyema. The IV antibiotic resulted clinically good response in medical treatment.

Reference: 

Download: Acute and Chronic GB Inflammatory Disease

CASE 167:THYROID NODULE in a GIRL, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

An 11 yo girl was detected her right neck mass by her mother.
In clinical examination at Children Hospital  she was suspected a thyroglossal cyst, but on ultrasound scan it was a solid tumor with size of 2cm, central cystic necrosis and hypervascular intramass.

 Blood tests were normal and thyroid isotopic scan was a cold nodule.

FNAC WAS DONE AND CYTOLOGY  REPORT  WAS  COLLOIDAL GOITER.

DISCUSSION: ULTRASOUND  WITH  COLOR DOPPLER IS  THE  FIRST CHOICE  FOR  THYROID  EVALUATION, IN COMPARISON TO  ISOTOP SCINTIGRAPHY WHICH IS  NOT IN ROUTINE USAGE  FOR  PEDIATRIC PATIENT.