CASE 427 : POLYCYSTIC BREAST, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 27 yo  with history of the left polycystic  breast detecting by herself since April 2016 .  FNAC reported  nothing  abnormal detected, and she went to Medic for 3 times [each in 3 months]  with the same result of polycystic left breast without tumor.  But now she got pain at left breast and decided to reexamination. Ultrasound of the left breast in the 4th examnination showed many small simple cysts but one   of them  is biggest  with  size of 3x 4 cm.  At later time, the biggest cyst with thin wall but  having one   hypervascular  vegetation mass, size #1.5 cm.      US 1:Big cyst with  fine septation.     US 2 :  Small simple cyst.     US 3: Intracystic mass.     US  4: CDI  hypervascular mass. Strain elastography of intracystic mass showed a stiff area (mixed pattern) which was corresponded with a score of 2 (Tsukuba score). FNAC again with no abnormal cell,  only red blood cells.     Liquide analysis: no  abnormal  of markers  CEA, CA 125, CA 15-3.   ABVS ( AUTOMATIC  BREAST  VOLUME  SCANNING) shows the  intracystic tumor   by 3D VIEW.   Operation for removing this big cyst (see macro).    Microscopic report is  benign cyst with  intracystic papilloma.

CASE 426: MULTIPLE TUBERCULOSIS ABSCESSES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male 26yo with umbilicus swelling and pain.

Abdominal ultrasound   detected  abscess of umbilicus  ( US 1, US 2), liver abcess and  left pleural  abscess.

MSCT  confirmed  abscess  of  left pleural, liver and umbilicus.

Blood tests:   WBC 12k, CRP  normal.

Punction of the umbilicus abscess  withdrawed  white thick pus, high ADA test :104 UI/mL

Conclusion: it is multiple abscesses due to tuberculosis.

Reference: ADA.pdf

CASE 425: FRONTAL BONE TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 21 yo with headache, blurred vision and protrusion of frontal area of face  (see photo) for 3 months.

Ultrasound of  frontal area  and eyes detected  hypoechoic  and hypervascular mass which made destruction the frontal bone, but the  orbit  remains intact, while periorbital part was infiltrated by a  hypoechoic structure ( US 1, US 2, US 3).

MRI of the brain and cervical column revealed no intracerebral tumor and the cervical  bone changing structure but not destruction. There is erosion of frontal bone  with mass  under skin of the frontal area.  

Blood test showed very high beta 2 microglobulin.

Suggestion for this case is multiple lymphoma with infiltrating of frontal area.

Reference of a case on  large B-cell lymphoma of the Frontal Bone.

CASE 424 : LUNG TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

Woman 54 yo  with chest pain.Chest x-ray  detected  one round mass  at right lung.(  chest x-ray AP). 

Ultrasound  of the right lung represented this mass  is  hypoechoic  like  cyst (US).

MSCT CE (CT 1, CT 2, CT 3) =  this  mass is  well bordered, size of  6 cm,  adherent to the chest wall, with  pleural effusion, no contrast enhancement.

Blood test of  all  cancer markers are negative.

What is your  suggestion for diagnosis  for the right lung mass?.

Operation  VAST

REMOVing TUMOR and CENTRAL NECROSIS  in macroscopic view 

MICROSCOPIC IS  ADENOCARCINOMA

CASE 423: BLACK EYEBROW SIGN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

50 yo woman, after trauma at her right face, she cannot see by ptosis of right upper eyebrow (photo).

Ultrasound scanning of the orbit and right eye are normal but cannot see the orbit when the probe is put on the upper eyebrow, because there is air into right upper eyebrow while the show-down does not appear on left eye ( US 1, US 2).

MRI of  the orbit  confirmed the normal right eye  but one black ellipse covered the right eye extend to skin of temporal area. It is air under eyebrow skin ( MRI 1, MRI 2, MRI 3  MRI 4).

CT scan of the right orbit  detected  fracture of orbit bone and black eyebrow sign appeared again due to air emphysema in right upper eyebrow.

Conclusion: Ultrasound, MRI, CT  can detected  black eyebrow sign  due to orbital blow-out fracture.

Reference= black eyebrow sign

CASE 422: TESTIS TORSION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Boy 18 yo  3 days ago..onset pain at left  scrotum  after  sport playing.

No fever but changing of color  skin of  left scrotum ( foto).

Ultrasound in emergency:

US 1:  avascular testis  in comparison  left side  to right side.

US 2:  very soft left testis on elastoscan.

US 3 :  left cord is cut of vascular supply to left testis.

Blood test : WBC 12k 28   Neutro 8k25  CRP= 0.58 

Clinical examination and  emergency ultrasound showed  intra vaginalis torsion of left testis

Operation   detected black left testis,  avascular  for a long time, then   resection of left testis.

Conclusion:  Torsion of testis in long time  due to delayed diagnosis  and testis necrosis that  must  be removed the testis torsion.