CASE 156: RENAL CYST or HYDRONEPHROSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 49F PAIN AT LEFT SUBCOSTAL AREA.

 ULTRASOUND ABDOMEN DETECTED LEFT KIDNEY ABNORMAL WITH CYSTIC MASS AT UPER POLE.

WHAT IS YOUR DIAGNOSIS, RENAL CYST OR HYDRONEPHROSIS ? ( 2 IMAGES LONGITUDINAL  AND CROSS-SECTIONAL SCANS WITH B MODE GREYSCALE).

WITH B MODE IT IS VERY DIFFICULT  TO MAKE SURE DIAGNOSIS. WE USE PULSE DOPPLER, IT HAS  WAVEFORM PATTERN.

For  a clear diagnosis, we  use  CDI with  YINGYANG SIGN and  MSCT  UROLOGY which MAKE SURE THAT an AVM at the left kidney.

 

 

Summary= Black and white ultrasound  sometimes  makes mistake on diagnosis  of vascular diseases.

Reference

 

 

CASE 155: GASTRIC ULCER on ULTRASOUND, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 70 YO EPIGASTRIC PAIN FOR ONE MONTH.

FIST STEP IS ABDOMINAL ULTRASOUND FOR CHECKING LIVER, GALL BLADDER WHICH WERE NORMAL.

THEN ONE AIR SPOT WAS DETECTED IN THE WALL OF ANTRUM. THE AIR SPOT WAS STILL AT THIS SITE AFTER CHANGING POSITION; ARROUND THIS AREA THERE WERE  NOT INFILTRATION OR FLUID COLLECTION.

Gastroscopy detected crater ulcer at antrum. Biopsy was done with predictive benign ulcer.

Biopsy report was chronic ulcer with HP positive.

 

Until now ultrasound is not  useful for  diagnosing  gastric ulcer (see  reference).

 

But in some cases of crater ulcer we can make diagnosis as changing patient's position.

CASE 154: URINARY BLADDER TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 19yo, polyuria. Ultrasound abdomen showed a round tumor of 4cm diameter in the wall of urinary bladder, look like ovary tumor in man.

MSCT URO: this tumor protruded into urinary bladder, without disturbing renal function.

Cystoscopy saw this tumor at upper portion of urinary bladder.

Cystoendoscopic resecting of this tumor, surgeon reported a tumor very hard like fibroma.

Discussion:  Based on clinical symtoms, ultrasound, CT, cystoscopy findings I suggest  benign tumor of the urinary bladder wall, look like GIST.   Histoimmunologic stainning report said that a case of fibroma of urinary bladder wall.

 

CASE 153: FLUID AROUND KIDNEYS of FALLOT'S TETRALOGY PATIENT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 22 yo, had been diagnosed  TETRALOGY of FALLOT with typical clubbed finger (image) for 5 years. 

He had complaint of lumbago now and abdomen ultrasound detected abnormal both kidneys with fluid collecting arround, look like urinoma.

(See fotos of ultrasound scannings of right and left kidney).

On  MSCT URO, the kidney function was still good, no rupture or fissure of both 2 kidneys, no hydronephrosis. But the pictures susgested urinoma of 2 kidneys without enhance CE in the fluid around the kidneys.

FOR MAKE SURE DIAGNOSIS, PUNCTURE AND ASPIRATION THE PERIRENAL FLUID WERE PERFORMED. FLUID ANALYSIS REPORT WAS URINE THAT CONFIRMED URINOMA OF BOTH KIDNEYS.

QUESTION: WHY ARE URINOMA BOTH SITES WHILE EXISTING

+NO URINARY SYSTEM OBSTRUCTION, NO TRAUMA IN HISTORY.
+NO CONTRAST DRAINING OUT KIDNEY TO COLLECTING FLUID DURING LATE PHASE OF CT UROLOGY.

Reference: Bilateral Perirenal Urinoma

CASE 152: PLEXIFORM NEUROFIBROMA of URINARY BLADDER on Von RECKLINGHAUSEN PATIENT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 30 yo, hematuria and anemia with many cafe-au-lait skin spots.

Ultrasound of abdomen detected normal kidneys; at pelvis, there was a big mass with size of 25 cm from pubis to umbilicus.
 

Fig. 01 : Cross- sectional scanning of ultrasound.
 

 

This mass was made by many small hypoechoic nodules, hypovascular and no detection of urinary bladder. The mass deplaced uterus to right side.

(Fig.02 : longitudinal US scan, Fig.03: uterus at right side).
 

 

Along sciatic nerve route, scanning of the right thigh disclosed many hypoechoic nodules non compressible (Fig.04).

.

 

MSCT Urology with CE, this mass was urinary bladder with urine contrast inside (Fig. 05-06).
 

Cystoscopy detected inflammation and bleeding site, then performing of biopsy of bladder wall and the tumor of the right thigh.

Microscopic biopsy report from intra-urinary bladder is granuloma inflammation,

and from tumor along the sciatic nerve is neurofibroma (image microscopic).

 

 

Reference from AFIP, plexiform urinary bladder of NF1.

 

 

CASE 151: LEFT BREAST CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Women 58 yo, 5 years before being biopsy of a right breast tumor which was  fibroadenoma, and now she detected herself a breast tumor on the left.

Ultrasound scans at right breast (Fig.1, 2 CDI, PWD) and left breast in which was found a big cystic tumor with septation and axillary nodes on the same side (Fig.3, 4).

Mammography is done showing the left breast tumor with axillary nodes in suspection malignant tumor T2N1.
 

MSCT no CE also suspected breast cancer T2N1Mx.

We performs FNAC of left breast tumor, the result is cancer, but the axillary node is not yet reported.

Do you thing the ultrasound image of this lymph node and CT scan can make diagnosis ?.

Mastectomy is done on left breast with one removed bloc (see 2 pictures).
 

Microscopic lymph node report of this axillary nodes is chronic inflammation.
 

 

Summary:

 

Clasification of TNM  of Breast Cancer  is not based on the images of axillary nodes by ultrasound or mammo or CT, but based on clinical palpation.