CASE 289: GRAPE'S SIGN in LIVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27yo, one  month  ago, suffered from pain at  liver  with  low grade  fever.

First visiting of MEDIC ultrasound, he was detected at  segment 7 of liver  multiple  spots,  hypoechoic, size of 1-2 cm  with  the round border,  no rising vessels on Doppler. Elastoscan of these lesions was soft  tissue  as abscess. 

 Blood tests presented  WBC rising and parasite tests were  normal.

One  week later, with  more pain at liver, CT scan with CE made image  like  grapefruit as an abscess.

Blood tests:  WBC rising  and  more eosinophil, CRP and IgE rising.

Discussion:

Based on clinical  signs  and  blood tests rising eosinophil ( 1.05 /n, <0.5 x10-9 ), CRP =  62.23 , IgE=670) and liver US  and  CT scanning with  multiple abscesses  like  grapefruit, we suggested parasite  abscesses  of liver, but  ELISA test not positive with any common parasite.

TREATMENT  IS  FOCUS  ANTI PARASITE LIVER ABSCESS.

After  2 days of ANTIPARASITE TREATMENT patient had  cough  and  pain at  right chest.

Chest Xrays  detected infiltration  lesion at  upper  pole  of right lung.

CT of lung  with  CE suspected  tuberculosis  with pleural effusion..

Puncture  aspiration of the pleural fluid that was clear yellow color.

Pleural fluid analysis : ADA was low value, NOT CORELATED WITH  TUBERCULOSIS.

Wait for  PCR result later.  

CASE 288: BLACK SKIN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 55 yo  worried about the  black skin spot at the left eyebrow  which was getting bigger and  itchy recenlty in this month ( see foto),  and one dermatologist made a caution that was to be a melanoma.

Ultrasound  of this skin tumor by 15MHz probe with Doppler showed that was a superficial skin tumor, size of 2 cm  and rich vessel supplying.

Elastoscan ultrasound  showed this tumor in blue code, not invasive to deep layer.

What is your diagnosis for it ?

Operation for resection this tumor and microscopic report was a pigmented papilloma with melanocyte (see  pathology report).

CASE 287: CAROTID PSEUDOANEURYSM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  57 yo  detected  one mass at right  neck in pulsation.

Ultrasound  first at one clinic reported that  was a pseudoaneurysm  of  right  common carotid with thrombus inside  ( because  it had color inside this mass on  doppler).( see us 1, us 2).

Ultrasound  review at MEDIC:   it is a cystic mass  of  right lobe  thyroid gland without   Doppler  flow inside)  See  ( image us2, us4)

Reference from doctor  requested  CT angio of carotid  artery to make  sure  diagnosis of normal  carotid artery.

FNAC  was done for this thyroid mass which was to be a colloidal cyst.

What is atefact on color Doppler to make the misdiagnosis at the first ultrasound?

What is setting  parameter of  ultrasound color Doppler for elimination  this atefact?

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: