CASE 207: GASTRIC DUPLICATION CYST, Dr PHAN THANH HẢI, Dr NGUYỄN THIỆN HÙNG, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 26 year-old male patient  from Kien Giang province with chief complain: nausea and mild epigastric discomfort for 3 years, no vomiting, no fever. Family and his past medical history : nothing abnormal detectable. Physical examination: mild epigastric tenderness,  no mass in the epigastric area.

Undergoing of gastroendoscopy he was revealed a submucosa mass in the antrum which was confirmed  by CT; it was  a fluid-attenuation cystic mass in close  with the stomach wall but report of CT cannot rule out a heterotropic pancreas.

Ultrasound detected an 27x17mm intragastric cyst which adhered the greater curvature. The cyst wall had 2 layers: echogenic inner mucosal lining and hypoechoic outer rim which was contiguous with the muscular layer of the stomach. So we met a muscular rim sign of a  non-communicating GDC (gastric duplication cyst) in adult.

BD Hospital confirmed the non communicating GDC by filling defect on upper gastrointestinal series with barium meal and abdominal endoscopy exploration.

And  laparoscopy  was done to remove the GDC.

Wait for microscopic result.

CASE 206: EPIGASTRIC MASS POST- PROSTATECTOMY for 5 YEARS, Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM

Ultrasound check up  a 62 yo man , who underwent  prostatectomy for 5 years, detected one hypoechoic epigastric mass, size of 5cm in relation with great curvature of stomach. Color Doppler showed vascular supply from gastric artery.

Gastro-endoscopy detected no lesion inside stomach.

MSCT with CE showed this tumor was from gastric wall, and pediculated.

Blood test were normal all cancer markers: PSA, CEA , CA 19-9, CA 72-4.

Operation  laparotomy..showed this tumor is from  the  great curvature of stomach   with  long pedicule. Resection tumor see  macroscopy, wait for  microscopic report.

 

 





CASE 205: MEDIC RADIOLOGY CASE 9= Noncompacted Cardiomyopathy on MSCT 640, NGUYEN TUAN VU, NGUYEN THI KIM SANG, DUONG PHI SON, PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC , VIETNAM

HISTORY

Female patient , 33 yo, presented by severe heart failure for  1 year, previous diagnosis : dilated cardiomyopathy . Decreased S1. audible S3,  2/6 apical systolic murmur.  She was sent to MEDIC for cardiac MSCT to rule out Coronary artery disease.

EKG

Short PR, delta waves, QS in V2-V6, D1 aVL 

ECHOCARDIO+ TDI and 3 D Echocardiography

Decreased LV systolic function , LV diastolic dysfunction , LV diastolic dysfunction

Prominent trabeculae, spongiformed LV , Diagnostic criteria NC/C leyer > 2

Noncompacted cardiomyopathy Echocardiography: Apical 4 C view and Parasternal short axis view

Prominent trabeculations and spongiformed myocardium of LV 

MS CT 640               

Intertrabecular Recesses, Multiple Trabeculae , Predominant location at Apex, mid lateral, mid inferior . NC layer/ C layer > 2,2, Involving >2 segments, Sens. 100%, Spec. 95% (Tomography, volume 6, Issue 5, Sept.-Oct. 2012, pp 346-354)

MSCT 640: 3D Imaging =Trabeculated and spongiformed LV 

 Video clip from apex view

Summary

—  Reported by Engberding and Benber in 1984 :Mutation in LDB3, genetic cardiomyopathy

—  Myocardial sinusoids

—  Severe heart failure, arrhythmias, thrombus formation, sudden death

—  Diagnosis by  Echocardiography, MRI, MSCT

—  Medical treatment ( ACEI, Betabloker, Aspirin, Anticoagulant ), ICD, heart transplant.

—  Long term prognosis is unknown

—  Value of cardiac MSCT in patient with heart failure.

CASE 204: LEFT HUMERUS OSTEOLYSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 42 yo  after playing golf, got pain at  left upper  humerus.

Plain xray   showed   the humerus bone had been in  osteolysis.

Ultrasound  made sure that  cortical bone rupture of upper portion the left   humerus, without changing  periosteal  space, and arrounding muscle were intact.

CTscan with CE  reported  a suggestion  of BONE CYST ANEURYSM. Do you agree with this  suggestion or  not?

Biopsy  was  made  a diagnossis  as benign  fibromateous histiocytoma..

Operation  was  curettage  removing tumor and  filling  by  cement.

 

 

 

REF .case report.

 

CASE 203: ULTRASOUND FIRST DIAGNOSED ECTOPIC PREGNANCY, Dr PHAN THANH HẢI. MEDIC MEDICAL CENTER, HCMC, VIETNAM

Ultrasound first express: Women 41 yo acute abdomen pain 7 days ago cannot lay down decubitus by pain, came to MEDIC for ultrasound in emergency with patient sitting position.

Abdomen ultrasound scan showed free fluid intra abdomen like internal bleeding, uterus was big and one round mass nearby uterus with size of 4 cm. The mass with vessel central and doppler flow was looked like ECTOPIC PREGNANCY. Scanning time lasted only 5 minutes, and diagnosing is rupture ectopic pregnancy.

Emergency ambulance sent this patient to surgery hospital.

Laparotomy was done in 30 minutes to control bleeding and remove the mass of tubal ectopic pregnancy.

Conclusion: 5 minutes of ultrasound first can save the patient life.

CASE 202: BOWEL OBSTRUCTION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  88yo  suddenly got  epigastric pain and  vomitting. Ultrasound abdomen first  nothing abnormal detected. After 10 hours,  ultrasound in second time shows small intestine dilated and hyperperistalsis, colon no dilated (see 2 pictures of small bowel dilated) but cannot  make sure why small bowel in obstruction.

Chest X-ray  revealed air-water level at  right subdiaphagmatic, so suspected  a  subdiapragmatic abcess.

But  MSCT  detected  small intestin moving over the liver and fixed to right diaphragm and in strangulation (see CT pictures).

Summary: Ultrasound, X-ray, CT cannot make sure why small bowel in obstruction, but  surgery in emergency is done.

Emergency operation detected  small bowel fixed onto falciform ligamentum by one orifice of 2 cm diameter. It is an internal hernia due to defected falciform ligamentum. See picture of orifice of falciform ligamentum.

REFERENCE:

CASE 201: ULTRASOUND FIRST of R. HYDRONEPHROSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 37 yo in pregnancy for 7 weeks, onset acute pain at right kidney.
Ultrasound first at  FV hospital revealed  hydronephrosis of  right kidney in first degree, but cannot find out any stone. After 24 hours,  second ultrasound at MEDIC CENTER detected one small stone  intramural urinary bladder at right ureteral orifice (see  picture 1:  hydronephrosis of right kidney , picture 2:  uterus in gestation, picture 3: intramural stone).

Urologist  requests  MRI  for make sure the right ureteral stone (2 MRI pictures).

Cystoendoscopy in emergency for releasing pain by JJ stent in ureter.

Discussion: Ultrasound first or second time are better for patient by safety and cost-benefit.