CASE 722-723-724: PULMONARY EMBOLISM Induced by LIMB THROMBOSIS, Dr PHAN THANH HẢI, Dr NGUYỄN TUYẾT VÂN, MEDIC MEDICAL CENTER, HCMC. VIETNAM.

 3 cases [1 man, 2 women] with dyspnea and lower limb edema and tachycardia represented pulmonary embolism. Both of them had lower limb venous thrombosis while the two women have been using oral contraceptive drugs for over 5 months. The male patient took unknown drugs for painful lower limbs and calf cramps.

Case 01: Man 39 year-old with calf cramps. Past history of left leg trauma. Dyspnea for 3 days. Tachycardia and venous thrombosis of lower limb on ultrasound. Troponin slightly rising.

Unremarkable chest X-ray. 

MSCT confirmed PE.

Case 2: Woman 33 year-old  with asthenia and dyspnea and edema of lower limbs. Oral contraceptive taken for 5 months. D-Dimer and troponin rising.

Case  3: Woman 42 yo with oral contraceptive taken for 6 months. Swollen left leg with pain, but without dyspnea.

Pulmonary embolism  (PE) may occur in case of lower limb venous thrombosis and dyspnea. Ultrasound could reveal  the venous thrombosis, cardiac status, and chest MSCT confirmes the PE. Troponin rises in 50% of PE cases in the early 40 hours which is a significant sign of the high mortality.

REFERENCE 

CASE 720_721: MEDIASTINAL LIPOMATOSIS, Dr PHAN THANH HẢI, Dr NGUYÊN TUYẾT VÂN, Dr HÔ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Case 01:A 19 year-old man with  fever and dyspnea for one month.

Cardiac ultrasound could not explore the anterior of the heart but no ventricular hypertrophy was noted.

Abdominal ultrasound revealed a right pleural effusion and the right lung in solid, hyperechoic pattern.

Chest X-RAY noted an anterior mediastinal tumor that covered the heart, maybe a mediastinal lipoma.

MSCT  confirmed an anterior mediastinal tumor.

But the patient and his family denied surgery.

Case 02: 15 years before, a 54 year-old man  with a tumor which enlarged the anterior mediastinal space on the chest X-ray film.

Cardiac ultrasound detected an anterior mediastinal mass and non cardiomegaly.

MSCT confirmed an anterior mediastinal mass.

Surgery removed the anterior mediastinal lipoma.

Chest X-RAY film post-of came back normally with no mediastinal tumor. 

Mediastinal lipoma is a rare benign entity which may detect incidentally with dyspnea, difficult speaking and swallowing.

Heart shadow is large on chest X-RAY  film but EKG and ultrasound are normally appearances.

MSCT detected exactly the tumor which has fatty density of 95 HU.

And it needs any further invasive technique to diagnose and management. 

Reference:

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CASE 719: BREAST ULTRASOUND versus AI on 119 BREAST TUMOR CASES, A COMPARISON of Two METHODS, Dr PHAN THANH HẢI, Dr TRƯƠNG THỊ NGỌC TIẾN, Dr VÕ THỊ PHƯƠNG TRINH, Dr JASMINE THANH XUÂN, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 Of 119 cases of breast tumor enrolled in a comparison report of breast ultrasound by conventional breast  ultrasound and AI at Medic Center;  the authors, between 2 methods, declared AI helps exactly diagnosing the classified  BI-RADS 4c cases while the results of both 2 methods had statistically the same sensibility for all classified BI-RADS. It’s maybe, in our knowledge, the first report concerning AI on breast ultrasound in Vietnam and other southern Asian countries.

But conventional breast ultrasound described more characteristics of the malignancy of  the breast tumor than AI that only based on the 5 classic criterii : boundary, circumscribed, axe, echogeneicity, and tumoral form. However AI could use like a screening tool of ultrasound for the malignant breast tumors. In the protocol, biopsy and, in particular conditions, breast MRI  are gold standard for correct evaluation of breast tumor.

In condition, AI improved the malignancy for cases of classified BI-RADS 4c and over. And the authors said that naturally needs more informed reports of other studies with more tumor breast cases. 

CASE 718: BREAST CARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ LOAN, MEDIC MEDICAL CENTER, HCMC,VIETNAM

A 54 year-old woman with lump feeling in her right breast came to Medic for a breast ultrasound examination.

Breast ultrasound detected a right breast tumor of BI-RADS 3 classified.

But mammography represented a right breast BI-RADS 4 with microcalcifications.

MRI confirmed a right breast tumor classified BI-RADS 4.

FNAC  result was normal  but core biopsy with histochemoimmunologic staining showed an invasive breast carcinoma.

A right mastectomy was done.

CASE 717: MATURE OVARIAN TERATOMA, Dr PHAN THANH HẢI, Dr NGUYÊN PHƯỚC TOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 23 year-old girl in annual general check-up with raised CA 19-9= 230u/mL.

Ultrasound detected a mixed tumor of the right ovary.

MRI confirmed the right ovary teratoma,  which represented  #110×98 ×100mm mass, well -limited capsule,  fatty tissue in majority. And normal chest X-ray. 

Endoscopic surgery removed the right ovary teratoma and  the value of  CA 19-9 came back to normal value=23.9u/mL.

Annual check-up for everyone's  health is really necessary. 

CASE 716: SISTER MARY JOSEPH NODULE and AXILLARY NODE METASTASIS, Dr PHAN THANH HẢI, Dr TRẦN THÙY TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 55 year-old woman with mass at right axilla, and her private physician wanted a lymph node biopsy.

Ultrasound and MSCT detected thickening skin of right areola and swollen right axillary lymph node.

Microscopic result of lymph node biopsy was metastasized adenocarcinoma.

But sonologist noted an umbilical mass, solid, hypervascularized that appeared in the same time of the right axillary nodes.  Then she tried to find out an abdominal neoplasm in remembering a case of Mary Joseph nodule. 

Ultrasound,  colonoscopy and MSCT detected a sigmoid colon  wall thickening due to tumor.

Surgery removed the tumor and microscopic result was a moderately differentiated adenocarcinoma of colon.The colon tumor metastasized to umbilicus and right axillary lymph node.

So we have a case of metastasized axillary lymph node, a Sister Mary Joseph nodule with the origin of sigmoid colon cancer. 

CASE 715: INTRAHEPATIC CHOLANGIOCARCINOMA, Dr PHAN THANH HẢI, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 42 year-old woman without jaundice came to check-up. Her prior history noted managed thyroid cancer for 5 years and detected intrahepatic biliary dilatation 2 years before but the cause still unknown.

Ultrasound revealed  a hyperechoic mass at the hepatic hilus on normal hepatic bed.

MSCT  and MRI confirmed right intrahepatic dilatation and MRI noted cholangiocarcinoma.

Open surgery was done to remove gallbladder, V-VI subsegment of liver, connecting right hepatic duct to small  bowel [Roux-en-Y hepaticojejunostomy].

Microscopic result is cholangiocarcinoma invasive and chronic cholecystitis.