CASE 495: LUNG in MILIARY TUBERCULOSIS, Dr HỒ CHÍ TRUNG, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 45 yo  with  cough  and  back pain. Chest X-rays 1:  diffuse micronodular  at right/left lungs;   X-rays 2:  spinal bone  shows compression of lumbar spine L1 and L 2. Lung US  shows  thickening of   pleural  spaces and  many B- line signs  ( US 1, US 2) US 3:  hypoechoic mass on the left site of  paravertebral L1, and US 4: cystic mass of scrotum. MSCT  of lung and  body with CE: CT1, CT 2: micronodular  lungs CT 3 , CT 4:   spine with  osteolytic appearance CT 5, CT 6:  mass in left psoas muscle. Radiology report is  miliary tuberculosis of the lung and Pott ‘s abscess  and scrotum abscess Puncture  of scrotum abscess   removed the pus like caseum. Analysis of  this pus  =ADA very high  63.64 ng (n<30 in pus). Summary=  It is the case of diffuse tuberculosis.

After 2 months of TB treatment, clinical status processes well. X-Ray film, ultrasound cannot reveal psoas muscle and testis lesions.

  

CASE 494: PRIMARY LIVER LYMPHOMA (PLL),Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  62yo  with 5 months of history of epigastric  pain and  being  treated as gastritis  after gastroscopy. Ultrasound of liver  reported as inhomogeneous fatty liver.

Ultrasound liver  reviews  3 months later :  US 1  manny hypoechoic  focal lesions at peripheral area of liver with   size 2-3 cm  without  bending vascular sign.  (US 1 , US 2  CDI,  US 3   central  liver, US 4 liver elastography of this hypoechoic mass  is hard   41kPa, normal  liver is  18kPa) US 5 : big spleen .

MSCE with CE   detected hepato slenomegaly  with many  nodules  captured contrast in  arterial phases.

No  lymphadenomegalia  in abdomen.

MRI of  liver  with gado  Images with  many  hyperintense areas,  T1  captured  gado enhanced  peripheral   ( MRI 1, 2 ,3 ,4).

Blood tests =   HBV positive  EBV  IGG positive   Wako test negative   

Beta2 migroglobuline rised very high 8,341 UI/  IGG  rised to 2,188 UI   kappa IGG detected . 

Summary:  Based on  US imaging , CT with CE, MRI with CE and blood tests   diagnosis  is  PLL ( primary liver lymphoma ),   wait for  liver biopsy.

REFERENCE Case PLL.

CASE 493: THYROID SMALL PTC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 52 yo, thyroid ultrasound screening detected 2 small nodules of left thyroid gland  in  2015. But now in 2018,  sonologist reported back them being in TI-RADS 5, size=3.5mm. FNCA   made sure that PTC.

Operation is subtotal thyroidectomy.

   

See  macroscopic specimen pictures.

Microscopic report post op made sure again PTC.

Reference  :   medic ultrasound case  276 ptc ,  case 460 ptc,  case 475 ptc.

CASE 492 : APPENDICULAR MUCOCELE, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 65 yo with abdomen distention (photo). For 40 years he underwent a laparotomy in emergency by gunshot.

Ultrasound of abdomen detected at pelvis  one round bordered mass,  size of  20cm. Its structure looked like cyst with many ring layers as an onion skin sign.

US 1: crossed- section at middle abdomen;  US 2 : with CDI,  mass no vascular inside; US 3:  longitudinal scan over aorta; US 4:  multiple ring layers as onion skin sign; US 5 : with  linear probe.

MSCT  scan with  CE : CT 1: this mass is cystic formation from the coecum; CT 2 : frontal view.

Appendicular mucocele  was made for  diagnosing of the pelvic mass. Operation removed one mass with mucus content from appendix.
DISCUSSION:
http://www.ytetunhantphcm.com.vn/vi/hoat-dong/khoa-hoc-dao-tao/82-ban-luan-ve-benh-u-nhay-ruot-thua-mucocele-of-the-appendix

Microscopic report is  mucineous cystadenocarcinoma.

REFERENCE:

https://onlinelibrary.wiley.com/doi/pdf/10.7863/jum.2004.23.1.117

   .

CASE 491: TOOTHPICK MOVING TO RETROPERITONEUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 60 yo with  epigastric pain  one month ago; in  emergency CT of abdomen detected    a  foreign body ( FB) looked like a toothpick penetrating duodenum D2 wall.

But gastroscopy and colonoscopy cannot find  out this foreign body (FB). And  so  do laparoscopy later.

At Medic center,  ultrasound again detected this foreign body (FB) in retroperitoneum  near IVC and aorta (US 1. US 2), very strong shadowing , US 3: longitudinal  FB # 5 cm).

MSCT of abdomen  non CE   (CT1:  crossed section  this FB near aorta , CT 2 : frontal view , CT 3:  3 D view).

Gastroscopic laparoscopy again removed this  toothpick # 5 cm at the wall of D2.

Conclusion : Toothpick  can move to retroperitoneum.
REFERENCES:

In10 years at Medic it exists  5 published cases about toothpick , CASE  20 dec 2008  dr LY PHAI ,   MEDIC ULTRASOUND CASE 232,  CASE 229,  CASE 479 , CASE  491 and 7 other cases.

NHÂN 12 CA NUỐT TĂM XỈA RĂNG: VAI TRÒ SIÊU ÂM CHẨN ĐOÁN