CASE 490: ANECHOIC CRESCENT' S SIGN OF AORTA DISSECTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 34 yo, now  epigatric pain  with history of  operation for repairing aortic valve since 2008.

Ultrasound of abdomen detected abnormal aorta.          

US 1  crossed- section   aortic  size 3 cm   with anechoic crescent in lumen of aorta

US 2  longitudinal scan  with  Doppler dual gates=  aorta had double  flows in aorta in turbulence.

US 3  video

Ultrasound suspected   dissection of  abdominal aorta

MSCT angio: 

CT 1   crossed section near aortic valve.

CT 2  crossed section over cross aortic   also see “crescent sign" of the wall of aorta,  with double lumen.

CT 3  frontal view.

CT4   full aortic tree =aortic dissection.

Summary:   Anechoic crescent sign in ultrasound or CT of  aortic dissection.

REFERENCES:
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CASE 489: LOST OF CONTRACEPTIVE IMPLANT, Dr PHAN THANH HAI, Dr LE THONG NHAT, Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN  31 YO  HAD BEEN PUT ACONTRACEPTIVE IMPLANT AT THE LEFT BRACHIAL AREA 3 YEARS AGO, BUT NOW THE OB-GYN HOSPITAL CANNOT FIND OUT THE DEVICE FOR REMOVING IT.

 AT MEDIC CENTER, X-RAYS FOUND THIS IMPLANT STILL NEAR THIS PLACE (X-RAY FILM).

ULTRASOUND DETECTED  IT IN BICEPS MUSCLE  ( US 1, US 2 ).

OPERATION REMOVED THE INTRAMUSCLE DEVICE  (PHOTO).

CONCLUSION : CONTRACEPTIVE IMPLANT CAN MOVE  TO ANOTHER SITE POST IMPLANTATION.

REFERENCE   CONTRACEPTIVE IMPLANT MOVE TO THE LUNG.

CASE 488: CT SCANNING INCIDENTAL DIAGNOSIS of RECTUM CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 79 yo  being treated  right kidney stone.  3 years ago, with  ultrasound of abdomen in  black and white images   detected a stone with size 1 cm (US 1, US 2   longitudinal scan and crossed  section of right kidney).

On color Doppler  it exists an AVM  with calcification ( US 3, US 4).

MSCT with CE of abdomen  for   sure  AVM  of right kidney (CT 1,CT 2, CT 3, CT 4, CT 5) , radiologist reported at  CT 3 image  one mass  at  pelvis  like  sigmoid colon  tumor.

Coloendoscopy  confirmed that  rectum tumor  # 16 cm, high from anus.

Biopsy on the way (endoscopic image)

MRI  preop  takes staging of rectum cancer T4 N1 Mx.

Conclusion: Abdomen CT for  diagnosing AVM of right kidney detected incidentally a rectum cancer on AVM and stone kidney patient.

Operation  for  resection of rectum tumor and reanastomosis by stappler (MACRO ).

MACROSCOPIC  REPORT  IS  ADENOCARCINOMA  OF RECTUM.

SUMMARY  = CTA  IS THE BEST DIAGNOSING MODALITY for RENAL AVM  at THE SAME TIME  OF INCIDENTAL DIAGNOSING FOR RECTUM CANCER  WHICH WAS MISTAKED BY ULTRASOUND.

CASE 487: BRAIN AVM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 39yo with headache and epileptic crisis.

TCD Ultrasound: TCD  1  from right temporal to left.

TCD 2: from left to right detected  Doppler vascular signals.

TCD transorbital  R/L   detection of left eye Doppler vascular with spectral pattern   TCD 4

MRI of brain=  MRI1: crossed section, mass vascular at  left brain.

MRI 2:  big  AVM  at left brain

MRI 3:   sagittal section, big vein  drainage from  AVM.

MRI 4 : sagittal  at left  brain..near left orbital area.

MRI 5:  MR angio:   AVM of left brain.

Wait for DSA  treatment.

Conclusion:  TCD ultrasound  of  the brain  detected left brain AVM.

CASE 486: POLAND’S SYNDROME, Dr PHAN THANH HẢI, Dr TRẦM THỊ TÚ HƯƠNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  42 yo with  right breast hard mass,clinical examination of asymetric thorax (photo).

Ultrasound of right breast detected one 5 cm mass, multilobular, hypoechoic  with blood supply arround this tumor ( US 1, US 2 ),  US 3  detected axillary lymph node, US 4  in comparison of right to left chest wall  shows absence of right major and minor pectoralis muscles.

Chest X-Ray : clear right lung in comparison to left  lung due to  right chest wall muscle defect.

Mammography  diagnosis is  breast tumor with  Bi-Rads 4  T2N1Mx.

MRI   made diagnosis of  right breast tumor  with   pectoralis muscle defect of chest wall: it  is Poland’s syndrome.

FNAC of  this tumor  with cytological report of  adenocarcinoma of breast tumor.

Reference  : Case report   Poland ' s Syndrome complicated with breast cancer.