CASE 180: AV FISTULA POST OP MIDDLE EAR SURGERY for 10 YEARS, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 30 yo underwent a middle ear surgery for  10 years. After  surgery about  2 years, a posterior ear mass appeared and getting its size bigger .

 There are thrills in the mass, and it is collapsed with palpation.

 Ultrasound detects tortuous dilatation of subcutaneous vasculature at temporoparietal area on right side and around right auricular area, Doppler shows continuous  flow pattern which is thought to be an AV fistula post op.

  MDCT confirms an AV fistula on 1/2 right head which is supplied by superficial temporal artery and drains away by facial and right jugular veins.

CASE 179: CHRONIC DIARRHEA and CAPSULE ENDOSCOPY, Dr PHẠM CHÍ TOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Clinical history=

Female, 91 years old, Nha be district. For 3 months: watery diarrhea without blood (over 10 times/day), no abdominal pain. Treated by many doctors and medical centers, but diarrhea did not stop.

Tropical disease hospital admission: failed treatment after a month and transmitted to Binh dan hospital.

v  Lab test: normal, Abdominal US,  CT scan: normal, UGE : normal, Rectosigmoid endoscopy: normal. Stool test: negative, suggestion : capsule endoscopy.

v  Capsule Endoscopy= Many worms with the appearance of Ankylostoma in jejunum and ileum and inflammed mucosa of small bowel.

Diagnosis=Enteritis due to parasite (maybe Ankylostoma duodenale).  Internet : some case reports like this.

Treatment=

Suggestion : stop using all kinds of drugs including antibiotics, start with Zentel 2 tablets a day/ 3 days. Diarrhea improves in getting down : 10 times and 6 times and 4 times and 2 times. Discharge. Suggestion: repeated Zentel after a week, now normal stool.

Conclusion=

Few case reports, besides anemia, acute or chronic diarrhea sometimes happens. Easy and simple treatment.

But the worm name should be proved by ELISA test for Ankylostoma.

CASE 178: CHORDOMA, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

56-year-old female patient from Tra Vinh province. She's undergoing  low back pain  more than 1 year, recently appeared constipation. Spinal x-ray shows destruction of the sacrococcygeal bone. 

 

Ultrasound shows lesion that is a  heterogeneous hypoechoic solid tumor, size 72 x42 x 62 mm, inner tumor to be calcified.

 

 

MRI shows tumor from sacrococcygeal bone, dimension = 5 x 6.5 x 7cm, high density on T2W1 and low on T1W1.

 

Patient underwent surgery at Cho Ray hospital. Histopathologic report is  chordoma.

 

CASE 177: MEDIC RADIOLOGY CASE 01= Massive Pulmonary Embolism, Dr NGUYỄN VĂN CÔNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 47 yo, admitting to the clinic because of chest pain.

Chest Xray shows no significant finding  beside slightly bulging of L pulmonary artery.

Chest CT scan with contrast at Medic Center shows R pulmonary 90% occluded with thrombus and L upper lobe artery also occluded 30%.

The patient is transferred to Singapore and conservative treated because the clot is too old and well organized.

CASE 176: PARATHYROID TUMOR, Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC VIETNAM

Female patient 49 yo from Phu yen province. Slight edema, 2 leg weakness for 2 years, using wheelchair to many HCM hospitals.

She went to Medic Center in hope to make clear her illness. 

Chest X-Ray: deformation of chest bones and osteoporosis. 

Column vertebra : biconcave of vertebral bodies due to osteoporosis.

Ultrasound at Medic revealed a hypoechoic mass in the lower pole of left lobe of thyroid, and hypervascularization which was thought to be a parathyroid tumor.

PTH highly raising up of 1,048 picog/ml [16-65 picog/ml] and bone scan proved osteoporosis.

In 2 hours post op, PTH dropped down of 47.21picog/ml.

 And microscopic result= Parathyroid Adenoma.

So it is an severe osteoporosis case due to parathyroid adenoma that is unveiled successfully at Medic Center in some days while it lasted for the female patient in 2 years in her wheelchair.

CASE 175: A CARCINOMA of THYMUS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27 yo, one month ago, got cough and dyspnea at night. Chest X-ray showed one mass of 10cm near the apex of the heart.

Chest ultrasound, in sitting position, revealed pleural effusion, like bloody and this mass on chest X-ray was solid and covered the heart.

MDCT  of the lungs  with CE,  this mass belongs to anterior mediastinum and in extention around the pericardium and pleural effusion. Radiologist suggested a teratoma.

Do you agree with the CT diagnosis ?

Thoracotomy  the  case  removed  1.7  liter of  yellowish  fluid, and  tumor looked like  brain tissue.

Microscopic result  is  suggestive of  undiffentiated  thymocarcinoma. 

REFERENCE:

CASE 174: HCC or NOT ? Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 56 yo strickly followed up by HCV, 2 weeks ago fever, chill, pain at liver region. Ultrasound of liver detected one mass at right lobe, size of 10cm with hypoechoic mixed structure inside. Doppler showed hypervascular. 2 fellows in sonology said that to be HCC.

DO YOU THING IT IS HCC WITH 5 ULTRASOUND IMAGES?.

Blood test report:

MDCT of liver without CE and with CE were in suggestion of liver tumor by radiologist report.

Do you thing ultrasound and CT can make diagnosis for this case, or clinical and blood test are the main reasons for diagnosis?.

What could you do next for this patient?.

This patient had been admitted in infectious tropical hospital. Blood test negative for amebiasis, and fasciola hepatica; antibiotic was in perfusion. After 2 days, patient was not in fever. Wait for result of blood culture and ultrasound reviewing the liver mass.