CASE 822: TUBERCULOSIS of KNEE SOFT TISSUE, Dr PHAN THANH HẢI , Dr NGUYỄN SÀO TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 43 year-old female nurse with her right knee pain and slight swelling for 3 months. Her 20 year old history noted she got TB cervical lymph nodes.

Ultrasound detected a #36x35mm mass of the right lateral femoral muscle [biceps femorii] at the 1/3 lower thigh. The muscular mass has unclear border, mixed echogenic and hypovascular. Maybe  it was a tuberculous myositis ?

There was edema of the synovial membrane into the knee joint # 46x48 mm. 

No fluid collection nor bone destruction existed of the right knee joint.

MRI confirmed the right knee mass which was between the femoral biceps and popliteal muscle but could not differentiate  hemangioma, tenosynovial giant cell tumor, soft tissue sarcoma...from each others.

Core biopsy was done and the result was a TB knee soft tissue inflammation which had TB cysts composed caseum and degenerated Langhans cells and lymphocytes.

A TB -treatment -8 -month regimen  for the nurse was planned.

CASE 820-821: PRIMARY THYROID LYMPHOMA (PTL): Dr PHAN THANH HẢI, Dr NGUYỄN TUẤN CƯỜNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 CASE 1 : 

A 40 year-old woman with fatigue, dysphagia and rapidly growing goiter but non weight loss for late months. She got goiter for 10 years.

Ultrasound detected a # 90mm hypoechoic nodule at the isthmus of the thyroid and some cervical lymph nodes.

Biopsy results were a chronic thyroiditis and inflammed lymph nodes.

But the specimen of thyroid post-op was a round cell lymphoma.

CASE 2:

A 44 year-old woman with #5-26mm multinodular goiter with ultrasound exams from 2020 to 2024. But after 5 years, the vascularized left nodule was grown up rapidly to 37 mm. TSH was still in normal values.

But core biopsy result was suspected lymphoma.

Immunohistochemistry result was lymphoma.

She was planed to chemotherapy for thyroid lymphoma.

DISCUSSION:

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CASE 819: LEFT CHEST PAIN and LUNG POCUS, Dr PHAN THANH HẢI, Dr LÊ THỊ THANH THẢO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 67 year-old man with left chest pain progressing for 3 days, coughing and no fever.

Lab data nothing abnormal detected. 

EKG  sinus arrhythmia bradycardia.

CT coronary stenosis 40-30%.

Lung POCUS : Left pleural effusion and thickening left pleura zone L5 with seven B-lines: interstitial pneumonia.

Chest MSCT  later confirmed thickening of posterior basal of left lung.

Lung POCUS helps differentiaziting, in a left chest pain , a pneumonia from an angina pectoris.

CASE 818: BREAST TB NODE, Dr PHAN THANH HẢI, Dr LÂM CẨM THÙY, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 28 year-old woman with fever and pain her left breast for one week.

Ultrasound detected  a  #12x6.6 mm well-border mass  at 3h o'clock with mixed echo, hypovascular and no fistula nor skin red.

FNAC result was chronic inflammed node maybe a TB mastitis.

Microscopic specimen was a tuberculous mastitis with Langhan cells.

TB regimen for 6 months and TB node became a 9x7 mm inflammed node.

CASE 817: BOWEL VOLVULUS due to MESENTERIC LYMPHATIC TUMOR, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 15 year-old asthenic thin boy with crisii of nausea and colicky pain for ( 3 ? ) years. Failed in management of gastritis HP infected.

Ultrasound detected a malrotated mass with mesenteric vessels inside going to the clockwise.

Beside there was a hyperechoic mass in the pelvis with vessels in the mass.

MSCT confirmed the bowel malrotation and a lipoma in the pelvis.

Surgery was done to remove the #12,5x11mm pelvic mass which was a microcystic lymphatic malformation of the mesentery. It adhered the bowel and caused the bowel volvulus.

The boy gained 10 kilogram and had no pain nor nausea postop.

CASE 816 : PROSTATE CANCER RISK and Low F/T PSA Ratio, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 62 year-old man with  low free/total PSA ratio < 10% which is in risk of prostate cancer.

But ultrasound and MRI detected only calcification of prostate.

 The patient belongs the high risk group of prostate cancer in our report 2011 although the normal results of diagnostic imaging.

CASE 815: ACUTE CHOLECYSTITIS and CHOLECYSTILOSIS, Dr PHAN THANH HẢI, Dr LÊ THANH TÙNG, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A  78 year-old diabetic man with a colicky pain at RUQ  and nausea in night. Coughing for one month he has been managed antibiotics in time.

Ultrasound detected  a #94x39 mm dilated gallbladder with an impacted biliary stone at the neck of GB and some 8-13 mm other stones in the inflammed GB (# 6mm thickening of the GB wall, anterior wall partial hypoechoic). It existed an amount of fluid around the inflammed gallbladder.

MSCT confirmed an impacted #14 mm GB stone at the neck of the GB.

Emergency endoscopic surgery was done after 8 hours entering the surgical ICU to remove the inflammed GB and peritoneal pseudomembranes.

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