CASE 579: ACUTE APPENDICITIS in PREGNANCY, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 33 yo in pregnancy. PARA 3003 # 24 weeks WITH pain in RLAQ 24 HOURS AGO
  

OBSTETRIC ULTRASOUND PROVED NORMAL PREGNANCY IN  24WKS WITHOUT UTERUS CONTRACTION IN TOCOMETRY (PHOTO TOCO).

EMERGENCY ULTRASOUND  DETECTED APPENDIX IN BIG  LUMEN DUE  TO DILATATION (US 1, US 2, US 3).

BLOOD TESTS:  WBC RISED 9.8K  NEUTRO 40%, CRP 56..

MRI  WITHOUT GADO  DETECTED   BIG  LUMEN DILATED APPENDIX (MRI 1, MRI 2, MRI 3).

 

ENDOSCOPIC  OPERATION REMOVED ACUTE APPENDICITIS.

  

SUMMARY = ACUTE APPENDICITIS IN PREGNANCY IS DIFFICULT TO DIAGNOSE;   US AND MRI  CONTRIBUTING  TO DIAGNOSE  IN DIFFICULT CASE.

REFERENCE : CASE 548, APPENDICITIS IN PREGNANCY  (MEDIC ULTRASOUND CASE 548  PUB 01 MAY-2019)

CASE 578: CYSTIC TERATOMA OF THE LUNG, Dr PHAN THANH HAI, Dr NGUYEN TUAN VU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 29YO  WITH RIGHT LUNG  PAIN.    
CARDIAC ULTRASOUND DETECTS NORMAL HEART  AND A BIG MASS  COVERED RIGHT LUNG  ( US1).   

US 2 : THE MASS IS ROUND WITH SIZE 30CM.

US 3 : CDI  NO VASCULAR IN TUMOR .

US 4 : ELASTO  IS SOFT CODE,  LIKE A CYST  NO SEPTATION NO HARD TISSUE.

CHEST X-RAYS= THIS MASS COVERED THE RIGHT LUNG  NO PLEURAL  FLUID.

CT OF THE LUNG    

CT1 : SAGITAL VIEW, THIS MASS IS INSIDE RIGHT LUNG

CT2  : CROSSED SECTION,   THIS CYSTIC  CONTENT IS VISCOUS FLUID.

Operation  removed this cyst with chocolate fluid.

Reference

  

SUMMARY  =  CYSTIC TERATOMA OF THE LUNG.

CASE 577: TOS (THORACIC OUTLET SYNDROME), Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 52 YO WITH  PAIN AND COLD FEELING OF RIGHT HAND.

ULTRASOUND   DETECTED NO PULSE AT RADIAL ARTERY  AND THROMBOSIS OF HUMERAL ARTERY JUST TO SUBCLAVICULAR ARTERY WITH DILATATION  AND ZIN-ZANG FLOW.

MSCT ANGIO  SHOWED STENOSIS AT RIGHT  SUBCLAVICULAR ARTERY DUE TO RIGHT CERVICAL RIB  C7 COMPRESSION.

CONCLUSION=  THORACIC OUTLET  SYNDROME  WITH COMPLICATION OF THROMBOSIS ARTERY.

OPERATION FOR  RESECTION OF THE RIB  AND REMOVING OF THROMBUS.

REFERENCE :

CASE 576:ECTOPIC LIVER TISSUE or ADRENAL TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC,VIETNAM.

Man 46yo in general check- up by  CT total body was detected a tumor # 3 cm at right adrenal area.

CT 1  crossed section  the tumor near the liver border  

CT 2  tumor near pancreas head  

CT 3  frontal view  the tumor  3 cm far from upper pole R renal  near IVC.

Ultrasound  detected  this mass well bordered, solid structure, d #  3 cm  (US 1, US 2,  US 3).

Diagnostics of CT and ultrasound  are adrenal tumor  

Blood test  is normal hormone from adrenal gland

Laparoscopic surgery in retroperitoneum removed this tumor ( ope pictures , and macro 1, macro 2).

.

Microscopic report is liver tissue.

Summary : It is an ectopic liver tissue in adrenal area.

REFERENCE CASE STUDY

CASE 575: LYMPH NODE TUBERCULOSIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 35 YO  PAIN AT   PERIUMBILICAL  AREA OF ABDOMEN.

US SCAN   

US 1:  ONE MASS  NEAR LEFT SITE OF  UMBILICUS  WITH  SANDWICH SIGN.

US 2: MANY LYMPH NODES HYPOECHOIC,  SIZE 2-3 CM  WITH STRUCTURE CHANGE AND NO HILUS.

US 3: SAME  STRUCTURE  OF LYMPH NODE IN MESENTERIUM.

US 4: 2 BIG LYMPH NODES AT THE LEFT SUPRACLAVICULAR AREA.

CHEST X-RAYS SUSPECTED TUBERCULOSIS AT RIGHT LUNG.

CT SCAN OF ABDOMEN WITH CE    

CT 1= FRONTAL VIEW OF ABDOMEN, THIS MASS IS  NEAR ABDOMINAL AORTA.

CT 2 = CROSSED SECTION.

CT 3  = FRONTAL VIEW OF THE LUNG 

BIOPSY REPORT OF THE BIG LYMPH NODE AT THE L NECK IS TUBERCULOSIS.

SUMMARY=  MULTIPLE LYMPH NODES APPEARED IN SAME TIME WITH LUNG TUBERCULOSIS.

CASE 574: THORACIC WALL HERNIA, Dr PHAN THANH HAI, Dr TRAN MINH DUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN  52 YO  3 MONTHS AGO,  PAIN AT L THORACIC NEAR  L BREAST NIPPLE   AFTER TRAUMA, COUGH MAKING VERY PAINFUL AND  L BREAST GETTING BIGGER  THAT LOOKS LIKE TUMOR   (PHOTO 1: NORMAL BREATH, PHOTO 2  AFTER COUGHING and  VIDEO CLIP in COUGHING).

ULTRASOUND  AT  LEFT THORACIC WALL  DETECTED  ONE  MIXED STRUCTURE MASS  BY RUPTURE OF THE THORACIC WALL MUSCLE  WITH FLUID ( US 1).  

US 2: THE  HERNIA  OF THE LEFT LUNG TO THIS AREA IS SEEN  CLEARLY BY COUGHING , BUT IN NORMAL BREATH  THIS HERNIA IS COVERED BY HYPERECHOIC  STRUCTURE MASS ( US 3)

MSCT OF THE LUNG WITH VALSALVA  MANEUVER   DETECTED  INTERCOSTAL MUSCLE  RUPTURE AND  HERNIA FROM THE LUNG GETTING OUT   ( CT1 CT2 CT3).

SUMMARY = THIS CASE IS THORACIC WALL HERNIA AFTER TRAUMA.  THE PATIENT HAD BEEN OPERATED FOR PROTHESIS REPAIRING THE THORACIC WALL HERNIA.