CASE 640: ISOLATED COMMON ILIAC ARTERY DISSECTION, Dr Lê Văn Tài, Dr Võ Nguyễn Thành Nhân, Dr Nguyễn Tuấn Vũ, Dr Hồ Khánh Đức, Dr Phan Thanh Hải, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A  66 year-old male patient  (170 cm height, 64 kg weight) with thoracic pain was suffering from arterial hypertension [164/84 mmHg, BP 64b/min] for 3 years, and diabetes mellitus for 2 years.

Ultrasound detected aliasing artifact from right common iliac artery [r CIA] which has been a dissection aneurysm # 34x23x20mm with 2 lumens. The peak systolic velocity (PSV) of the false lumen of right CIA was lower than the true one.  It existed atheromatic plaques in the abdominal artery [AA] wall, but it [AA] was not aneurysm. A note of arterial aneurysm dissection of the right common iliac artery [r CIA] was made.

MSCT confirmed the 19x7 mm isolated right common iliac artery dissecting.

By via percutaneous DSA repaired successfully the right common iliac artery dissection with stent.

DISCUSSION and CONCLUSIONS

Isolated common iliac artery dissection is a very rare disease which is detected by chance. The possible causes included atherosclerosis, fibromuscular dysplasia, connective tissue disease, trauma and pregnancy.

It is certainly wherever to look for an arterial aneurysm in a hypertensive old patient in routine workflow not only for abdominal aorta (AAA) but also for other arteries and its branches or inside any abdominal organes.

CASE 637, 638, 639 : SECOND OPINION * X-RAYS-CT-ULTRASOUND, Dr PHAN THANH HẢI, Dr NGUYỄN VĂN CÔNG, Dr HỒ CHÍ TRUNG, Dr TRẦN NGÂN CHÂU, Dr LÊ THANH LIÊM, Dr LÝ VĂN PHÁI, Dr LÊ HỮU LINH, MEDIC MEDICAL CENTER HCMC, VIETNAM.

DISCUSSIONS

Case 1=  Pneumomediastinum

Case 2= Fracture of left clavicule

Case 3 = Sealed - off  right pleural effusion 

Ultrasound could find out the abnormalities of 3 cases above but it need to confirm the diagnosing for them by other imaging modalities.

CASE 636: PARALYSIS of LEFT LARYNGEAL NERVE due to THORACIC ANEURYSM , Dr PHAN THANH HẢI, Dr ĐINH QUYẾT TÂM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

A 56 yo male patient undergoes hoarse voice for 6 months after screaming, now out of breath  talking loud voice.

Laryngoscopy= Left apical arytenoid cartilage  incompletely closed.

Cardiac ultrasound  detected descending thoracic aneurysm witth aortic wall lesions.

MSCT confirmed  atresia of left vocal cord  and descending thoracic aneurysm in saccular form, non dissecting.

The recurrent laryngeal nerve RLN *from vagus nerve * supplies muscles of the larynx with the posterior and lateral cricoarytenoid.

Source **Wikipedia

In the case, descending thoracic aneurysm with aortic wall lesions may damaged the left RLN nearby which makes him the hoarse voice.

CASE 635: LEFT THORACIC WALL BULGING, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 

  A 43 yo female patient found herself a mass of left thoracic wall for one month. It is painful when she  palpates it and moves her left arm. 

 Mammography and breast US in Vietnam detected nothing abnormal. PET-CT in Singapore was normal.

   

DISCUSSION and  CONCLUSION

There are some painful areas of thoracic wall that may appear in unknown microtrauma with any forces. The asymmetry of cartilage cage could be the cause of trauma in contact or due to palpation of patient herself  from her curiosity.

But in the case,  IR thermography could find out  the cause of patient complaint that noted a role of  thermography for thoracic wall bulging.

CASE 634: RECTUM CANCER, Dr DƯƠNG NGỌC THÀNH, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Female patient 55yo loss of weight 7 kg for 4 months with bad feelings of contracting her muscle trying to empty her bowels. There was no blood stool, but existing abnormal uterine bleeding.  Digital rectal exam revealed a rigid, mobile mass at posterior wall that suggested a rectum cancer which took part of 1/3 of lumen of the rectum.

MSCT whole body detected thickening of rectum wall that adhered uterus, captured contrast and blurred fatty tissue around. Results confirmed a rectum cancer invading around with some pelvic lymph nodes.

But ultrasound  and colonoscopy failed  to detect the rectum tumor.

Ultrasound (TVS) only revealed uterine fibroma and cervical polyp. 

It only was in the third time endoscopy detected the rectum cancer. And biopsy results was mucinous adenocarcinoma invaded at rectum.

DISCUSSIONS AND CONCLUSION

  

Clinical findings and MSCT  took the clues for diagnosis of the case, but it need  the concordant endoscopic result to make planning of treatment. It was difficult for endoscopy in this case, but at last it existed an evident of anapathology in the third time of endoscopy.

The female patient went through chemotherapy course and later removed rectum tumor in keeping the sphincter muscle of rectum.

 

CASE 633: TCC of Kidney, Dr PHAN THANH HẢI, Dr TRẦN THỊ BẢO CHÂU, MEDIC MEDICAL CENTER, HCMC VIETNAM.

Female patient 70yo with dysuria but without hematuria.

Ultrasound detected left kidney hydronephrosis grade 2 as a hyperechoic mass # 47x35mm inside renal pelvis that suggested a transitional cell cancer (TCC).

CT Scan:  Soft tissue mass was in renal pelvis and ureter, d= 30 x 50 mm that highly captured contrast media while left kidney was in poor secretion of contrast. CT confirmed a left TCC.

 

 It existed red and white blood cells and bacteria in urine analysis.

Endoscopic biopsy results was high malignancy uroendothelial carcinoma  invaded the renal stroma. 

Surgery removed left kidney and ureter. In longitudinal section  of kidney, left pelvic kidney tumor sized # 5cm which was a necrotic vegetative mass while ureter was intact.

Pathological results : Transitional cell carcinoma poorly differentiated invaded parenchymal kidney. Non existed malignant cell in lymph nodes.

CASE 632: STOMACH TUBERCULOSIS, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH, MEDIC MEDICAL CENTER, HCMC VIETNAM

 

Female patient 32 yo, loss of weight #10kg with epigastric pain and nausea for 2 months. 

She herself took gastric drugs for a while but failed so went to Medic for a new examination.

Ultrasound of abdomen at Medic revealed many lymph nodes that were suspected metastatic nodes and mesenteric thickening; stomach walls infiltrated thickening and slight splenomegaly.

Chest X-rays was normally detected.

Gastric endoscopy showed gastric corpus roughly inflammed. Results of biopsy were  inflammed submucosa layer of stomach and chronic inflammation of duodenum suspected due to TB infection.

 

MSCT confirmed that existed a lot of lymph nodes at hepatic hilus, lesser curvature of stomach, around celiac axis. These nodes maybe belong to TB nodes.

 

Result of biopsy of intraabdominal lymph nodes was TB inflammed nodes.

Discussions and Conclusions

TB of stomach is still a rare entity, which is about 1-2% of GI tract tuberculosis and in 0.5% of  patients contracted with TB. Usually it is secondary after the pulmonary TB infection.

Our patient is now getting better status, gained more 2 kg of weight while being taken TB drugs for 2 months of 6 month-regimen of therapy.