CASE 552: ULTRASOUND OF A CYSTIC NECK MASS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 46 YO  HAD BEEN DIAGNOSED A RIGHT NECK MASS, CYSTIC APPEARANCE WITH PUNCTURE ASPIRATION REMOVED YELLOW FLUID MANY TIMES FOR 3 YEARS.  

NOW SHE  RECOGNIZED THIS MASS REFORMING AND GETTING BIGGER ( SEE FOTO).

ULTRASOUND OF THE NECK SHOWS THYROID IS NORMAL, and   CYSTIC MASS LOCATED AT LATERAL OF RIGHT NECK   ALONG OF SCM MUSCLE.

US1= (CROSSED SECTION)

US2 = LONGITUDINAL SCANNING  WITH SUPERB MICROVASCULAR IMAGING [SMI] TECHNIC  SHOWS THAT MICROVASCULAR PATTERN OF TUMOR 

US3=  LONGITUDINAL SCANNING WITH CDI TECHNIC.

US4=  VIDEO  WITH  SMI TECHNIC  SHOWS VERY HIGH VASCULAR SUPPLY  FOR THE MASS.

MSCT WITH  CE  OF THE NECK=

CT1:  THE MASS IS LATERAL OF  COMMUN CAROTID ARTERY [CCA].

CT2:  THIS MASS APPEARES  MIXED CYST AND SOLID STRUCTURE.

CT3:  LONGITUDINAL SCANNING OF THIS MASS WITH CALCIFICATION OF THE WALL.

CT AND ULTRASOUND CANNOT  MAKE SURE DIAGNOSTIC for THIS CYSTIC MASS.

FNAC   REPORTS CANCER CELLS IN CYSTIC MASS   BUT CANNOT SHOW THE ORIGINAL OF THESE CELLS.

FNA OF THE FLUID AFTER  FNAC AND QUANTIFIED THYROGLOBULIN IN FLUID IS VERY HIGH THAT HELPS MAKE DIAGNOSTIC OF THYROID CYSTIC CANCER IN ECTOPIC SITE.

REFERENCE

CASE 551: PNEUMOPERITONEUM POST CTC, Dr PHAN THANH HAI, Dr VO NGUYEN THANH NHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 68YO  WITH  FOBT TEST POSITIVE  TO DO  VIRTUAL CT COLONOGRAPHY. 

REPORT OF CT DETECTED FREE AIR IN ABDOMEN CAVITY, AND NO DETECTED TUMOR IN COLON (SEE  CTC , CT1).

   

CLINICAL EXAMINATION OF THE ABDOMEN IS NOT PAINFUL BY COMPRESSION, NO CHANGE  VITAL STATUS.  

US  SCANNING DETECTED FREE AIR  IN HYPOGASTRIC AREA AND  LIVER BORDER ( US1).

TREATMENT   FOLLOW_UP   THE STATUS  NO EATING BY MOUTH 24 HRS.  REVIEW  AGAIN THE VITAL STATUS  NO PERITONITIS   

MSCT AGAIN  DETECTED THE FREE AIR IN ABDOMEN IS  REABSORPTION (CT2). 

ULTRASOUND OF ABDOMEN AGAIN DON'T SEE  FREE AIR  IN THE PERITONEUM.

CONCLUSION=   CTC  BY CO2  COMPLICATION IS PNEUMOPERITONEUM  NO DETECTED TUMOR IN COLON OR SITE OF PERFORATION. NO NEED OPERATION.

WAIT AND SEE.

REFERENCE : CASE of CAT SCRATCH COLON.

CASE 550: ULTRASOUND FOR BUCCAL TUMOR, DR PHAN THANH HAI, DR TRAN THI THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 63 YO  DETECTED AT RIGHT FACIAL BUCCAL AREA  ONE MASS  THAT DEFORMED HER FACE,  NO PAIN FOR 3 MONTHS  (SEE FOTO).

ULTRASOUND=   

US 1: SCANNING OVER TUMOR,  NEAR MASSETER MUSCLE  and OVER  BUCCALIST MUSCLE  EXISTS ONE  HYPOECHOIC MASS MOVING BY PRESSING OF THE PROBE, THAT LOOKED LIKE FLUID, BUT ON DOPPLER NO DETECTED ANY VESSELS.

US 2 : VIDEO IN OPENING OF THE MOUTH and THIS MASS IS MOVING.

US 3: OPENING OF SUPERB MICROVASCULAR IMAGING [SMI] SCANNING (CANON  APLIO A I 450)  DETECTED  MORE SMALL VESSELS, THEN  IT IS NOT FLUID  BUT LIKED FATTY TISSUE.

  

SONOLOGIST SUSGESTED FATTY PAD PROCESS ( BUCCAL FATTY PAD).

  

OPERATION REMOVED FATTY MASS.

MICROSCOPIC  REPORT IS FATTY TISSUE.

ANATOMY OF BFP ( BUCCAL FAT PAD).

CASE 549: RENAL CYSTIC TUMOR, Dr PHAN THANH HAI, Dr NGUYEN PHUOC TOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 38 yo with annual health check up ; 3 years ago ultrasound detected  right renal cystic tumor growing bigger for year. 

NOW,   US 1: LONGITUDINAL SCANNING OF  RIGHT KIDNEY  NOTES THAT A CYSTIC TUMOR AT UPPER  POLE OF RIGHT KIDNEY.

US 2: CDI  IN CROSSED SECTION OF RIGHT KIDNEY.

US 3:  LONGITUDINAL SCANNING OF RIGHT KIDNEY WITH CDI.

MSCT CE    

CT1 : CROSSED SECTION OF RIGHT KIDNEY CYSTIC TUMOR  WITH FINE SEPTATION.

CT 2 : FRONTAL VIEW OF   RIGHT KIDNEY.

CT 3 : TUMOR  COVERS  UPPER POLE OF RIGHT KIDNEY TO  HILUS OF RIGHT KIDNEY.

CT4=  SAGITTAL VIEW OF RIGHT KIDNEY.

RADIOLOGIST  SAYS CYSTIC TUMOR OF RIGHT KIDNEY  TOO BIG  THAT COVERS MORE RIGHT KIDNEY in  BOSNIACK III  CLASSIFICATION.

THIS PATIENT PLANS TO  NEPHRECTOMY OPERATION.
MRI of THIS CASE  REPORTED   CYSTIC TUMOR OF RIGHT Kidney,  SIZE 5 CM, BOSNIACK IV.

OPERATION  BY ROBOT,   RETROPERITONEAL RESECTION OF RIGHT KIDNEY.   

SEE MACRO  

OP 1: SURFACE OF  R KID  NO INVASION OUT OF  KID BORDER

OP 2 : SAGITTAL SECTION, TUMOR IS CYSTIC NO SOLID PART INTRA TUMOR.

MICROSCOPIC REPORT IS BENIGN CYST.

REFERENCE =  BOSNIACK CLASSIFICATION  AND HISTORY.

CASE 548: APPENDICITIS in PREGNANCY, Dr PHAN THANH HAI, Dr DANG VINH PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 37YO IN GESTATION 16 WKS,  10 DAYS AGO PAIN IN RLAQ.

ULTRASOUND   

US1  PREGNANCY 16WKS  

US2  CROSSED SECTION AT RLAQ  SUSPECTED  APPENDICE RETROCOLON ASCENDING.

US3  LONGITUDINAL SCAN   APPENDICE  EDEMA.

BLOOD TESTS:  WBC  9,2K WITH 75% neutro. CRP  110ng/mL.

MRI  IS DONE.   

MRI1  CROSSED SECTION.

MRI2  CROSSED SECTION AT COLON ASCENDING.

MRI3  SAGITTAL VIEW.

 MRI4  FRONTAL VIEW.

RADIOLOGIST SAYS RETROCOLON APPENDICULAR ABSCESS.

EMERGENCY OPERATION   

OP1,2.

CONCLUSION=   IN PREGNANCY   US AND MRI  CAN DO DIAGNOSTIC  for RETROCECAL APPENDICITIS.

REFERENCE: AJOG DEC 2006, APPENDIITIS IN PREGNANT PATIENTS:  DIAGNOSTIC EFFICACY OF ULTRASOUND vs MRI.