CASE 224: LEFT SUPRACLAVICULAR MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 41 yo, cough  and  pain at left arm; chest  x-rays suspected lung tuberculosis, then he had been treated as antituberculosis  for 3 months. 

But the pain was getting worse and  one mass appeared at  left supraclavicular  fossa.

X-rays  again  showed this  first rib in erosion on the left site.

Ultrasound scanning at left supraclavicular fossa and disclosed a solid  mass in calcification

 and fluid collection on the right site.

MSCT with  CE  of the lungs detected the mass destructing the first rib. 

Biopsy was done.  

Biopsy  microscopy report  is   adenocarcinoma , it is PANCOAST TOBIAS  SYNDROME.

Ref  PANCOAT -TOBIAS SYNDROME:

History photo of  Dr  PANCOAST K Henry.

CASE 223: BIG IVC, Dr PHAN THANH HẢI- Dr NGUYỄN KIM THÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN  33 yo  PECTUS EXCAVATUM,  ONSET OF  EPIGASTRIC PAIN  WITH  RADIATION  TO BACK  DORSAL SPINE.

ULTRASOUND OF ABDOMEN  DETECTED  BIG IVC  WITH  SIZE  OF =2.4-2.7cm,  ECHOGENIC  BLOOD FLOW.

 

SPECTRUM DOPPLER OF IVC SHOWED TRIPHASIC PATTERN WITH PV  11.2cm/s.

TEE 3D  CARDIAC  REPORT WAS NORMAL.

WHAT IS  CAUSE  OF BIG  IVC ?

MSCT of abdomen showed that IVC  is dilated in  going to heart,  diameter of 2.9-3.3 cm.

What is your suggestion ?.

REFERENCE  IN INTERNET OF  THE CASE ABOUT PECTUS EXCAVATUM AND IVC IS SAME AS  THIS CASE,  SUGGESTED  IVC  DILATED  DUE TO  PE (PECTUS EXCAVATUM).

CASE 222: LIVER MULTIPLE SPOTS due to COLON CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 31 yo  onset fever one month ago but not control by antibiotics. Pain in liver region.

Ultrasound  detected  some round spots  like  liver abscesses.(US  B mode, CDI, Elasto).

MRI  with  gado CE detected  also  many  round  spots,   same size of  2 cm, with central necrosis looked like metastasis.

Blood tests=   WBC rising of 20k with 85% neutro, negative sero amibe, normal CEA.

Colonoscopy for detection of primary cancer disclosed, at splenic angle of colon, infiltrated induration lesion which was suspected colon tumor .

 And biopsy with microscopic report was colon cancer.

Summary; this case is colon cancer metastases to liver.   

CASE 221:ELASTOSCANNING of FACIAL SKIN SPOT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

MAN 59 YO, 3 MONTHS AGO THE FACIAL SPOT GETTING GROWTH FASTLY  AND BLEEDING. THERE WERE 2 SPOTS ON RIGHT AND ANOTHER ONE ON LEFT SITE. [SEE IMAGE 1,2].

HIGH FREQUENCY ULTRASOUND WITH ELASTOSCAN SCANNING HAD  DEEP PENETRATION UNDERSKIN  AND HARDER PATTERN WHICH SUGGESTED BASAL CELL CARCINOMA INVASIVE. [ULTRASOUND IMAGES 1,2,3 BELONGED  LEFT SPOT, IMAGE 4 WAS RIGHT SPOT].

Biopsy the mass, microscopic report  is  BCC  (Basal cell carcinoma).

Discussion: Elastoscan map preop of  skin lesion  is  best evaluation for guiding of  biopsy and planning operation  .

REFERENCE:.Elastoscan of skin.