CASE 515: VENTRAL HERNIA, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  78 yo,  cesarian operation for  50 years, with, 2 days ago,  pain at left umbilical area  and everytime  coughing, a swollen mass appearing at the painful site.  

Ultrasound  of  this mass: 

US 1=  longitudinal scan at pelvis  near umbilicus, detected one subcutaneous mass. 

US 2 = left lateral scanning of middle line, shows  the tearing site of rectus muscle and a hernia goes out from it.

US 3 =  linear scanning of  this mass that was builded by great omentum and fluid.

US 4 = thickening of the bowel wall.

Emergency abdomen CT scanning:

CT  1:  crossed section  of  this mass  

CT 2 :  sagittal scanning of this mass

CT 3:  frontal section.

Emergency operation by  ventral hernia with past history of  cesarian operation 

detected  omentum and one bowel loop in ischemia but not necrosis yet.

Repaired this hernia by a mesh prosthesis. And timing is about in 4 hours from diagnostic to operation.

CASE 514: IUD PENETRATING TO URINARY BLADDER, Dr PHAN THANH HAI, Dr JASMINE THANH XUAN, Dr NGUYEN MINH THIEN, Dr NGUYEN TUAN VINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 49yo with pain after urinary miction. PAST HISTORY of BEING PUT T - SHAPE IUD 20 YEARS BEFORE.

ULTRASOUND of PELVIS  DETECTED BIG URINARY BLADDER STONE ( US1)

XRAY of PELVIS  SHOWs THIS STONE  WITH IUD  INSIDE   ( X-RAYs film).

ULTRASOUND  WITH CDI  FINDs OUT TWINKLING  ARTIFACTS  WITH  COMET TAIL SIGN in GREEN AND RED COLORS ( US 2, US 3).

MSCT of  PELVIS  :

 CT 1=  THE  METALIC IUD  INTRA UB WALL.

CT 2:  SAGITTAL VIEW .

CT 3: FRONTAL VIEW : THE  IUD  INTRA UB WALL.

ENDOSCOPY DETECTED THE STONE IN VAULT OF UB.

Operation removed a big stone intra urinary bladder.

CONCLUSION =  IUD  PENETRATING TO UB WALL AND FORMATION OF STONE.

IUD Migration in MEDIC Hoa Hao

CASE 513: KIDNEY TUMOR MIMICKING DROMEDARY HUMP, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 41 yo with  righ kidney was detected abnormally  looked like dromedary  hump in general check up

Ultrasound  CDI:  US 1=  crossed section,  hypovascular pattern mass.

US 2=  longitudinal scan,  this mass liked a hump.

US 3 = elastoUS   inhomogeneous mass.

MSCT with CE, fast enhanced  contrast mass in CT 1, CT2.

MRI  with gado  shows  exophytic mass of the kidney border  (MRI 1, MRI 2).

MRI 3,4 : cystic structure  and bleeding inside.

Radiologis report is cystic tumor of righ kidney, BOSNIAK type 3 

Operation with  robot   removed  tumor in partial nephrectomy.

Operation of  this tumor  at righ kidney looked like  the seal.

 Specimen is cystic  septation,

Microspopic report is RCC.

Reference. Bosniak criteria.

CASE 512: TESTICULAR TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 43 yo  detected left testis swollen slowly.

Ultrasound  of scrotum  finds out  left  testis too big # 4 cm x 5 cm,   solid  hypoechoic looked like a hypovascular cyst.   

US 1=  crossed section,   hypoechoic in  comparison to right testis.

US 2 = hypovascular tumor

US 3 = elastoUS,  solid tumor # 25 kPa.  

MSCT with CE   this tumor is  quick CE enhanced with calcification.

CT 1 :  frontal view

CT 2 : sagittal view

CT 3:  sagittal view of left testis tumor

Blood tests=  beta HCG , AFP = normal levels; LDH=  is 313 (n :246)

Based on clinical , ultrasound, ACD, CT  diagnostic pre op is seminoma.

Operation  removed  tumor (see macro).

Microscopic result  is  seminoma.

DISCUSSION: Why does the testis tumor being hypoechoic looked like a cyst? 

REFERENCE:

CASE 511: LUNG CANCER,Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 60 yo with pain at left  lung after trauma. Chest x-rays detected rupture of 2 ribs

and  one mass at left lung ( see chest x-rays).

CT of  chest with CE

CT 1=   frontal view    

CT 2=  crossed section  

CT 3 = sagittal view

CT 4 with CE= very high CE enhancement.

Ultrasound at left lung  detected a tumor in invasion of the chest wall  (US1)   

US  2 = Color Doppler  shows  vascular supply to tumor   

Blood tests rised:  Cyfra 21-1= 6.02 ( N=  3.3);   CEA=  7.13  ( N= 5).

Biopsy result with CT guided is 
adenocarcinoma of the lung.

Staging of this case  with  MSCT total body detected metastasis of the brain.

Conclusion:    Lung cancer detected accidentally by trauma, stage 4.