CASE 286: HCC GOING TO HEART, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 46 yo, chronic hepatitis B, presented abdomen distension and dyspnea (photo).

Cardiac  ultrasound   showed  the  mass  intra  right  atrium  from  IVC (SEE  ECHO CARDIO 3D).

 ABDOMEN US FOUND OUT  LIVER TUMOR  WITH  BIG THROMBUS  INTRA IVC  EXTENSION TO RIGHT ATRIUM.

MSCT  WITH  CE   ALSO   DETECTED  THROMBUS  INTRA  CARDIAC  AND IVC.

BLOOD TESTS:   HBV POSITIVE  AND  AFP  1500 UI/ML.

CONCLUSION...HCC  FROM  THE  LIVER  GOES TO IVC  UP TO  RIGHT ATRIUM.

REFERENCE:

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CASE 285: SKIN TUMOR, Dr PHAN THANH HẢI - Dr LÊ THÔNG LƯU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  31 yo,  past  history 3 years  before went through an operation for removing one small  tumor at the neck. which was suspected a  sebaceous cyst. But now it was in recurrence with size of 2cm. Clinical palpation was not  painful, hard, subcutaneous tumor ( see  foto) due to  scar  by later operation.

Ultrasound found out a subcutaneous tumor, cystic formation, inhomogeneous structure, hypovascular in Doppler ultrasound scanning.

Elastoscan of this tumor is soft in central part, well-bordered, and the covered skin is in intact.

Preoperation  diagnosis  was  not  looked like  sebaceous cyst recurrence. 

Surgery  removed this tumor..

Surgeon reported  macroscopy of the  tumor being like  caverneous  hemangioma.

Microscopic result  confirmed  the  diagnosis for the case.

CASE 284: DIFFUSE LYMPHOMA, Dr PHAN THANH HẢI ,Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 76yo, swollen R. neck, axilla and supraclavicular area for ½  month, no pain nor fever.

Ultrasound detected  R. maxillary angle, carotid chains and supraclavicular nodes, size of 20-43mm. Round, poor liked cystic, vascular, noncalcified, lost-hilar nodes. Small nodes were homogenous, but  big one was inhomogenous, with necrotic areas and hyperechoic fibrous septa.

R. axillary node, big size od 50x40mm, lost-hilar node, inhomogenous with necrotic and vascular solid areas.

In epigastric region, sonologist  detected a poor node, size of 25mm.

No lymph node in groins and L.axillary area was found.

Thought about diffuse infiltrating lymphoma and different diagnosing of TB nodes.

Chest X-Rays and pharyngoscopy were  intact.

Pathologic immunohistology staining result: HMMD: CD 20 (+), CD 3 (-), CD 30 (-).  DIFFUSE LARGE B CELL LYMPHOMA.

DISCUSSIONS=

Ultrasound has the role of detection and diagnosing of lymphoma quite exactly based on liked cystic pattern of node.  Non edema surrounding fatty tissue helps ruling out acute inflamed node or infested TB node.

Ultrasound can approach multi area of body that evaluates staging so helping of treatment planning as fast as possible.

CASE 283: SCARPA TRIANGLE MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

WOMAN 28YO  DETECTED HERSEFT  AT THE  RIGHT GROIN (SCARPA'S TRIANGLE)  ONE MASS  GROWING BIGGER  FOR 3 MONTHS WITHOUT PAIN  NOR TRAUMA.

ULTRASOUND  FOUND IT OUT  FIRST  BEING  A MASS WHICH WAS MULTILOBULATED, INTRAMUSCULAR, HYPOVASCULAR AND  HARD  IN ELASTOGRAPHY ULTRASOUND ( SEE  4 IMAGES).

MRI WAS DONE  FOR MAKE  SURE DIAGNOSING OF  MUSCLE TUMOR THAT WAS EXTENDING  INTO  MEDIAN COMPARTMENT  OF THE RIGHT THIGH (see 2 MRI images).

MSCT  DETECTED THE  HEAD OF  FEMUR BONE AND ILIAC BONE IN  EROSION.

PET- CT  MADE POSITIVE  FDG  CAPTURE OF THIS TUMOR.

Operation  for  remove  this tumor was done. Microscopic report was  a  tenosynovial giant cell tumor,  low grade  tumor.

Suspected  local recurrence.

REFERENCE:

CASE 282: SUPRAPUBIC MASS, Dr PHAN THANH HẢI-Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 45 yo, 3 months after operation  for repairing left  inguinal  hernia,  pain in micturition and  polykiuria; clinical palpation  detected one mass  at suprapubic area.

Ultrasound  detected  this mass being a cyst, size of 10cm with many  bodies hyperechoic  intra cystic, which were looked like  foreign  bodies  ( see 4  US pictures). This  mass was  intra  abdominal  wall in  compression to urinary bladder.

MRI  of pelvis with gado reported  a  mass which was liked an abscess with  viscous fluid content  and cannot see  intracystic structure.

What is your suggestion for diagnosis of the suprapubic mass?

CASE 281: INSULINOMA, Dr PHAN THANH HẢI-Dr NGUYỄN THÀNH ĐĂNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 39yo  after  delivering her  second  baby, she  had  hypoglycemia  repeatedly  and  more  frequently.  But ultrasound  of pancreas  many time with many sonologists  cannot detect  abnormal in pancreas (see 3  ultrasound pictures  at Medic).

MRI  with gado detected  a small mass  of 1 cm in diameter  at the  head  of  pancreas ( see 3 MRI pictures)

Operation was done  for removing  this mass  and for  microscopic report.

After  removing  the mass of  pancreas,  the  sugar blood was getting  stable and returning to norma value.

Microscopic report was an insulinoma. 

TODAY PATIENT  DISCHARGED FROM HOSPITAL.

IN FASTING  INSULIN WAS  8.1 UI/ML  IN COMPARISON TO PRE-OP VALUE OF 50.9UI/ML.

CASE 280: FETUS ONE KIDNEY in HYDRONEPHROSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman in pregnancy  31 yo  PARA 2002. First time cesarian delivery, but  now  check for the second delivery. Prenatal ultrasound that  detected  oligoamniotic  and  but fetus having only one right hydronephrosis [see image US 1, US 2 ].

Urinary bladder was  normal and cannot find out the left fetal kidney (US 3 video  showed the facial fetus and  his nose and mouth  in normal respiration).

Fetal MRI  made sure that  only one abnormal  right fetal kidney, small and cannot find out the left fetal kidney [see MRI 1, frontal section  MRI 2  section, MRI 3, sagital section, MRI 4.)

Prenatal 36 weeks  detected  renal  malformation  with agenesis of kidney.

DISCUSSION:

In this case,  fetus has only one  kidney  in  hydronephrosis.

The mother  has to undergo a cesarian deliverying  and  strict  survey the neonate, and if  the  hydronephrosis is  still progressing, an emergency  endostent by JJ is method for  reduction of intrarenal pressure.

It is  look like  POTT SYNDROME, this  baby needs   DNA gene examination.