CASE 525: LIVER ABSCESS, Dr PHAN THANH HẢI, Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male  62yo, with history of removing biliary stones in liver for 10 years. 

Ultrasound in 5 times shows biliary stones intraliver, aerobilia and right liver cyst from liver cirrhosis and splenomegaly patient. Blood tests= WBC:19,800g/L, hs CRP=177.2H. AFP=19.8ng/mL.

He came back Medic for reexamination as pain at RUQ and slight fever in Feb 2018.

Ultrasound suspected a liver tumor  with biliary stones and cirrhosis and splenomegaly.

But MRI thought about a new liver abscess with biliary stones of cirrhosis patient.

He entered CR hospital and  the results of ultrasound and CT  were liver tumor and aerobilia. With the diagnosis of CR hospital on liver tumor necrosis and aerobilia he felt no pain and nor fever after using of prescribed medicine drugs in 17 days.

He came back Medic  2 months later. 

Ultrasound detected no liver tumor, only biliary stones and aerobilia. 

MRI revealed no liver tumor, and in reviewing,  MRI noted a sign of head of cauliflower that means a pyogenic abscess  appearing of peripheral lobulated increasing signal intensity on MRI.

SUMMARY: Ultrasound was in mistake as no pay attention of clinical signs. A tumor necrosis could not be in concordance with infectious syndrome. And patients remained quite well because of resolving of liver abscess.

 REFERENCE:

CASE 524: DOUBLE AORTIC ANEURYSMS, Dr PHAN THANH HAI, Dr VO HIEU THANH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  72 yo with  blood test of PSA high 15ng/mL. MRI  FOR  PROSTATE EVALUATION.

MRI 1 = AT PELVIS, PROSTATE BIG, SUSPECTED  CANCER   PI-RADS 3 

MRI 2 =  GO UP FOR  EVALUATION  LYMPH NODE   DETECTED  ABDOMINAL AORTIC  ANEURYSM THAT HAD BEEN TREATED BY STENT ENDO LUMEN FOR 2 YEARS.

MRI 3 =  MRI RISE TO THORACIC AREA DETECTED ONE MASS  OF ANEURYSM #4 CM  BELONGS AORTIC DESCENDING.

MRI 4 = CROSSED SECTION AT SECOND ANEURYSM.

ULTRASOUND FOR  SECOND LOOK.

 US 1 US 2 : LONGITUDINAL SCANNING AT ABDOMEN AORTA  ANEURYSM.

US 3 AND US 4 : SCANNING AT PARASPINAL THORACIC   WITH  FLOW  EJECTION INTRA ANEURYSM.

SUMMARY = DOUBLE AORTIC ANEURYSMS WERE DETECTED INCIDENTAL BY MRI AND SECOND LOOK BY US.

CASE 523: FIBULAR BONE TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 58 YO  WITH PAIN AT LEFT KNEE  AND SWELLING, DIFFICULTY IN WALKING (PHOTO)

ULTRASOUND   DETECTED ONE BIG MASS HYPOECHOIC FROM THE KNEE JOINT 20 CM LONG  WELL BORDERED  (US1).

US 2 : CDI  SHOWS HYPERVASCULAR.

US 3:  THIS MASS IS FROM THE  FIBULAR BONE OUTGROWTH  INTRA MUSCLE.

US 4: THIS MASS  COMPRESSED THE VASCULAR BENDING.

X-RAYS OF THE  KNEE  SHOWS THE UPPER PART OF FIBULAR BONE BEING EROSION.

MRI OF LEFT KNEE   WITH GADO:

 MRI 1= HYPOINTENSE MASS  LIKE CYST.

MR 2 = THIS MASS WITH CENTRAL NECROSIS.

MRI 3 = CROSSED SECTION   VERY HIGH CONTRAST ENHANCEMENT.

MRI 4 =THIS MASS IS FROM PROXIMAL PART OF LEFT FIBULAR BONE.

RADIOLOGIST SUGGESTED  IT SARCOMA OR GIANT CELL TUMOR.

CORE BIOPSY WAS DONE.

Microscopic report is  giant cell tumor of  fibular bone, proximal part.

CASE 522: MOBILE THORACIC UNDERSKIN TUMOR, Dr PHAN THANH HẢI, Dr ĐẶNG BỬU THẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 54 YO WITH WEAKNESS,  ANOREXIA FOR  ONE MONTH,  NO FEVER  BEING DETECTED ONE MASS AT RIGHT DORSAL AREA, DIFFICULTY IN DORSAL LAYDOWN.

CLINICAL PALPATION of THIS MASS IS ROUND, SOFT, MOVING UNDER SKIN (VIDEO).

CHEST X-RAY FILM IS NORMAL.

ULTRASOUND SHOWS CYSTIC MASS , SIZE 20CM,   WELL BORDERED,  WITH CONTENT LIQUID AND SEPTATION ( US 1, US 2, US 3).

CT SCAN :  THIS MASS IS INTRA THORACIC WALL LOOKS LIKE AN ABSCESS ( CT1, CT2, CT3).

PERCUTANEOUS PUNCTURE  REMOVED SERUM AND BLOOD,   ANALYSIS OF ADA NEGATIVE.

OPERATION  REMOVED THIS MASS  WHICH WAS WELL BORDERED AND HAVING BLOOD  CLOTS INSIDE . 

MACROSCOPIC VIEW LIKES HEMANGIOMA.  

  

MICROSCOPIC REPORT of  THIS TUMOR IS CAVERNOUS  HEMANGIOMA BLEEDING INTRA TUMOR.

CASE 521: MULTIPLE CANCERS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN DOB 1945,  DIABETES WITH HISTORY  FROM  2008   BLOOD TEST  PSA= 5.6ng/mL  9%  TRUS

 DETECTED FOCAL IN PROSTATE AND  BIOPSY MAKE DIAGNOSTIC  PROSTATE CANCER GLEASON 7 

 OPERATION PROSTATECTOMY WAS DONE( SEE TRUS BIOPSY).

IN 2016  WITH RECTORRHAGIA,  CT AND ENDOSCOPY   AND BIOPSY  MAKE DIAGNOSTIC  SIGMA

COLON CANCER.   COLECTOMY  WAS DONE   STAGING  STAGE 1. NO CHEMOTHERAPY POST OP.

( SEE  ENDOSCOPY  )

IN OCT 2018  FOR ROUTINE CHECK -UP,  ULTRASOUND DETECTED  ONE MASS IN HILUS OF LIVER  3 CM 

( US 2) AND  WAKO TEST  MAKE  DIAGNOSTIC  HCC.

MRI OF LIVER  WITH GADO  AND PET-CT  ALSO  DIAGNOSED   HCC.

TREATMENT OF TOCE WAS DONE.

Ultrasound image of the tumor 
after one week TOCE.

SUMMARY = DURING 10 YEARS  3 PRIMARY CANCERS  WERE DETECTED AND MANAGEMENTS..

WHY  ?   

CASE 520: LIVER TUMOR WITH LOW AFP, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 57YO  WITH NO HISTORY OF HEPATITIS.
ULTRASOUND OF ABDOMEN FOR CHECK UP DETECTED ONE MASS AT  RIGHT LIVER , SEGMENT 6, SIZE 3 CM..HY POECHOIC, US1, US 2, US 3 .

MSCT WITH CE, RADIOLOGIST  COULD NOT  SUGGEST WHAT IS THIS

( CT 1).

BLOOD  TESTS= AFP IS  LOW  L3  IS NOT DETECTED  BUT DCP IS HIGH (WAKO TEST).

MRI  WITH PRIMOVIST AND DYNAMIC CONTRAST  GIVE DIAGNOSTIC  OF HCC.

OPERATION FOR LAPARO RESECTION TUMOR.

MICROSCOPIC REPORT IS HCC  UNDIFFERENTED CARCINOMA.

Comparison AFP to DCP in detection of  HCC.