CASE 160: CAROTID ULTRASOUND, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  82 yo had been endarterectomy at right carotid artery  5 years ago.

Vascular ultrasound of carotid arteries for  check up.

Images  1, 2 : Right  carotid artery

Images  3, 4 : Left carotid artery

 

Do you see  any abnormalities on these pictures?  

 

 

The image of right carotid after endarterectomy is interesting by the wall ondulation like sea wave, but the flow is good.

On the left carotid , there is  big calcification plaque, and doppler artefact is no flow (see image pw )

 

CASE 159: INTRAMUSCULAR MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 28 yo, one year ago self detected one intramuscular mass of adductor muscle of the right thigh and pain with position sitting.
On ultrasound it is an intraadductor muscle ovoid mass,  size of 2x3cm, hypoechoic, posterior enhancement  and well bordered.

Doppler shows some intratumoral vessels (3  longitudinal section pictures with CDI).

 

 

 

REMOVED TUMOR, MACROVIEW.

 

 

Microscopic result is Schwannoma.
Reference

CASE 158: CYSTIC MASS NEARBY URINARY BLADDER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 19 yo, onset acute abdominal pain, periodic crisis. Ultrasound emergency shows  one cystic mass with multilayer wall, with size of 5cm near urinary bladder. Intralumen of this cyst is one solid mass without vascular detection by Doppler (see 3 pictures US scan.)

MSCT abdomen is done, report this mass is one part of dilated ilium. What is this ?

 

 

 

Emergency operation with diagnosis of  small bowel torsion.

 

 

 

 

 

The surgeon reports that case of  intussusception by a small pediculate polyp.


 

CASE 157: THYROID CYST with COMET TAIL ARTIFACTS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 65 YO DETECTED HIMSELF RIGHT NECK TUMOR.

ULTRASOUND DISCLOSED THAT WAS A CYSTIC TUMOR  AT THE RIGHT LOBE THYROID WITH MANY COMET TAIL ARTIFACTS INSIDE THE CYST.

ASPIRATION THIS CYST REMOVED BROWN COLLOID FLUID.

CELL BLOCK REPORT WAS BENIGN CYST.

WHAT IS THE CAUSE OF COMET TAIL SIGN?

Reference:

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.