CASE 187: MEDIC RADIOLOGY CASE 04: 170 CORONARY ARTERY CASES SCANNING by MSCT 640, Dr DƯƠNG PHI SƠN-Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

•      170 cases (79 male / 91 female) in our 2 weeks of setting up the new machine.

•      Angina  pectoris and risks of coronary artery disease.

•      Contrast agent: Ultravist, dose <1ml/kg

•      Radiation dosage <1-4 mSv (DLP x K-factor =DLP x 0.014)

•      Appropriate heart rate  < 70 p/min, if existing tachycardia can use Beta Blockers, Diltiazem... to slow down heart rate 

•      Appropriate blood pressure under 140/90 mmHg

•      Patients hold their breath during shooting.

 

CONCLUSIONS:

•     Image quality greatly improved (increased levels of accuracy).

•     Radiation dose reducing 50-90% and extremely low amount of contrast agent (competitive and beneficial to the patient).

•     Cardiac arrhythmia still could be scanning (more advantage than the older generation machines).

•     Shooting and find the cause of the chest pain emergency.

CASE 186: LYNCH SYNDROME OR NOT ? Dr JASMINE THANH XUÂN, Dr HỒ CHÍ TRUNG, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 28yo underwent R hemicolectomy as adenocarcinoma in November 2011 at BD hospital. On 4 April 2013 she came back to BD Hospital to be removed  both 2 ovarian tumors (Krukenberg) for metastase from colon tumor. And after surgery of ovarian tumors for 3 weeks, she detects herself her right breast swollen, hard in palpation but without pain so she returned BD hospital again.

BD hospital ultrasound showed secondary right breast tumors and she was sent to MEDIC to take a mammography.

At Medic, X-Rays detected a breast mass, with high density on RUQ of right breast and were thought to be a BIRADS 4 tumor,

and Medic ultrasound again confirmed 3 hypoechoic nodules of 13-22-8mm at 10h, 11h, 1h, irregular borders, with microcalcifications (BIRADS 4)

and right metastatic axillary nodes,

and some R and L cervical nodes.

MSCT 640 proved a right breast tumor with ROI=25HU and axillary nodes and R pectoralis muscles nodes.

FNAC of right breast tumor was done and microscopic result was adenocarcinoma.

In conclusion, a 28yo female patient which were removed R colon tumor and ovarian tumors due to metastase now has a R breast tumor  BIRADS 4 and R axillary nodes and R and L cervical lymph nodes.

Do you think a case of Lynch syndrome? Is it sure that secondary breast tumors? What to do in the next step ?

Surgery was performed on 24/5. So it was a primary breast tumor, both macroscopic and microscopic findings and not a metastatic tumor of the breast from colon tumor and that may belong to Lynch syndrome. Waiting for genetic test to confirm  the final diagnosis of Lynch syndrome.

CASE 185: MEDIC RADIOLOGY CASE 03: RETROCARDIAC MASS, Dr NGUYỄN VĂN CÔNG-Dr HỒ CHÍ TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

61 yo female patient went to Medic Center for a health check-up be cause her sister recently died from lung cancer.

 

PA and lateral chest XR revealed of a suspicious big mass  of 11x 5cm on L lung base : was that a tumor?

  

An ultrasound examination was performed to know that mass is solid or cystic nature. To our surprise, a typical structure of a kidney is detected by echography in ectopic situation but difficult to certified it is above or under the L diaphragm.

The problem was easily resolved by  CT scan with contrast showed nicely the L kidney well vascularized and preserved function herniated through Bochdalek foramen.

So it was an ectopic thoracic kidney and diaphagmatic hernia.                   

CASE 184:MEDIC RADIOLOGY CASE 02: MEDIASTINAL LIPOMATOSIS, Dr NGUYỄN VĂN CÔNG - Dr HỒ CHÍ TRUNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 54 yo takes CXR for heath check at Medic Center.

Surprisingly we found a very enlarged heart shadow which oblitrated ½ lower chest on both PA and lateral chest XR.

On cardiac ultrasonography, the heart is within normal limits, but there are abnormal structures surrounding the heart with hyperechogeneicity.

We decided to do a thoracic CT scan to clarify the problem.

The result of CT scan shows a very large structure of  fat density occupied all lower half of the chest and confirmed by surgery and pathology: about 2 kg of fat was removed from lower mediastinum due to mediastinal lipomatosis.

CASE 183: LEFT ARM MASS, Dr PHAN THANH HẢI - Dr LÂM CẨM TÚ, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27 yo,  3 months  ago  detected  mass  at  left  arm  ( foto)  no pain  no trauma  history and slowly  growth.

Ultrasound first  seeing  this mass  is  hypoechoic,  intramuscular, well  bordered  with  very  high  pattern color Doppler.

MSCT  with CE  of  this  mass  filling rapidly contrast  agent  that  looked  like  an A-V  MALFORMATION.

OPERATION REMOVES  EN BLOC TUMOR, WELL BORDERED WITH  OPENED SURFACE   IS CONVEX, LOOKED LIKE BENIGN TUMOR.

MICROSCOPIC WITH IMMUNOHISTOLOGIC STAINING REPORT: Hemangioendothelioma, it is  very rare soft tissue tumor.

CASE 182: Malignant Melanoma of Choroid, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 53 yo,  Binh duong province, loss of right vision for 3 months,  ultrasound and OCT of  Eye Hospital think about melanoma of ciliary body.

At  Medic Center, ultrasound detects a right intraocular tumor, size of 12x10mm, at anterior and internal location, echo rich, round border, no calcification, vegetation and nor posterior shadowing.  It is a hypovascular tumor.  There is a right retinal detachment.

 On elastographic ultrasound with eSie Touch and ARFI techniques ( Acuson S2000, Siemens) velocity of VTI is hard in moderate grade, homogenous, in grey color meanwhile tumor is hard and homogenous in eSie Touch ( black and blue).

MRI reveals an intraocular tumor on right eye, which is from ciliary body, size of 12x11mm, low signal on T2W1, and high signal on T1W1 and T1GRE,  lightly catched Gado, and no extraocular invasion. Follow-up  a Choroidal-Ciliary Melanoma.

Surgery was done on 15-4-2013,  microscopic result :malignant melanoma of the choroid.

 

CASE 181: APPENDICULAR MUCINEOUS CARCINOMA and INTUSSUSCEPTION, Dr PHAN THANH HẢI - Dr VÕ NGUYỄN THÀNH NHÂN , MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 73 yo has  pain at  right pelvis for 6 days, crisis, hyperperistalsis. Ultrasound  shows  one cystic mass  nearby  urinary bladder, with size of 4 cm, round  border with the neck connecting to lumen of  intestine.

See 3  ultrasound pictures with 3.5 MHz curve probe, and with  linear probes 12 MHz; this cystic mass has multilayer wall, calcification of the border, the fluid is cloudy. This cystic mass  is  moving  with  hyperperistalsis due to intussusception (3 images).

On MDCT this  mass is cystic,  intra  intestine lumen,  portion of  terminal ilium.

This case has emergent onset. Ultrasound first says that intussusception, but don't know what  the cyst is; MDCT  suggests an appendicular mucocele. Do you agree with the idea ?

Operation is laparotomy which detects  right colon very mobile with one mass at appendix site.

Procedure is right hemicolectomy. In macroscopic dissection, specimen is an appendicular mucocele.  Wait for confirmation of microscopy.

The  clinical  case  of  intussusceptions  in  old  woman  has  the cause. Ultrasound   detects  cystic  mass  close to urinary bladder  which  is  not common cause  for  ileo-colic  intussusception.

 MCDT  reveals   cyctic mass  intra intestinal  lumen with  mural calcification is  the key point  for   diagnosing  this case.

Microscopic report  is mucinous carcinoma of appendix.

REF  : Appendicular Mucocele as Cause of Intestinal Intussusception