CASE 308: PATELLA DISLOCATION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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CASE-308 PATELLA DISLOCATION

WOMAN 53 YO, CHIEF COMPLAINT  OF   SWELLING  AT HER LEFT KNEE, INSTABILITY AT WALKING. DIFFICULT SITTING AND STAN DING DUE TO  ONE MASS  MOVING  FROM  MEDIAN SITE  TO LATERAL SITE OF THE LEFT KNEE ( SEE FOTO THE LEFT KNEE SITTING  AND STANDING).

ULTRASOUND SCANNING  OF THIS  MASS  WAS FLUID COLLECTION  AND CANNOT DETECT  PATELLA BONE AT THE MIDDLE SITE OF THE JOINT (SEE 3 US PICTURES).

X-RAYS OF THE  LEFT KNEE  JOINT  MADE  DIAGNOSING  OF PATELLA  BONE DISLOCATION, MOVING  FROM  MEDIAN TO LATERAL  OF  MIDDLE LINE OF  THE KNEE JOINT ( SEE  3  X-RAY FILMS).

REFERENCES:

CASE 307: EXTRAPERITONEAL RUPTURE of URINARY BLADDER, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI

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CASE 307: extraperitoneal-rupture-of-urinary-bladder

A 38-year-old man has fallen motorcycle one month ago. About two weeks he had dysuria and bloody urination.

Abdominal ultrasound scans detect structure echo free with thickening border due to inflamed fat close to urinary bladder. After to rule out appendicitis, abscess and fluid collection of acute pancreatitis, color Doppler with grade-compressible technique was used and to reveal color flow of jet or stream from fluid-filled structure into urinary bladder. Therefore diagnosis of extra-peritoneal urinary bladder rupture was established.

Late phase contrast enhanced-MSCT showing urine sac close to urinary bladder.

There is urine accumulation adjacent urinary bladder at cystography. 

Patient has been operated promptly.

Key diagnosis of fluid sac due to extraperitoneal urinary bladder rupture: color Doppler flow of urine jet through gap from fluid sac into urinary bladder.   

CASE 306 : THYROID or PARATHYROID TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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Case-306-thyroid-or-parathyroid-tumor

 Lady 24 yo, 5 years  before  fracture of  left femoral head, and  now fractures of  2 bones of  right forearm by  falling trauma [see  photo].

X-rays  of  pelvis bone  made  pointed  osteoporosis of bone .

For screening, ultrasound of the neck  detected one ovoid mass, size  of  3-2cm,  hypoechoic  at the  lower pole of  the thyroid gland,  and  hypervascular on Doppler.

Sonologist suggested PTA for the case.

Osteogram BMD showed very lower bone  index.

Blood tests  =   PTH  very high and elevated  calcium.

Do you  make first choice of diagnosis of  PTA?

OPERATION  of  RIGHT  LOBECTOMY.THIS TUMOR WAS  WELL BORDERED, SOFT TISSUE.  ( see MACRO1,2).

MICROSCOPIC REPORT  WAS  PARATHYROID ADENOMA.

REFERENCE  

CASE 305: Presacral Tumor, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-305- PRESACRAL TUMOR

Man 65 yo in trouble  and difficult mictation, looked like in prostate disease.

Ultrasound of pelvis  detected  one presacral ovoid mass causes  deplacement  of rectum and  prostate (US picture 1).

Pelvis MSCT of this tumor presented solid, retrorectum, and presacral, well bordered, and not connected to rectum or  sacrum (see CT1, CT2).

MRI with gado of this  tumor is  central necrosis , well  enhanced  with gado contrast ( see  MRI 1, 2 ,3).

Blood tests detected normal everything.

ULTRASOUND GUIDED  CORE BIOPSY  REPORT WAS  GIST.
DISCUSSION :

CASE 304: HIP PAIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-304-hip pain

Man 43 yo, one week ago, pain at  his left  hip  while moving his thigh, no trauma history.

Ultrasound first saw  the  left hip joint  having a small amout of fluid collection  and  more  Power Doppler in muscles  around the hip ( see 4 US images).

MSCT was done but radiologist said nothing abnormal detected.

MRI detected abnormal head of left  femur  bone  looked like  aseptic necrotic femoral head.

Please compare  diagnostic values of 3 diagnostic modalities for this case:ultrasound, MSCT and MRI.

DISCUSSION:
In this case  ultrasound first  saw abnormal edema in the left hip joint. CT  scanning  cannot  detected  at the early stage  of  head femoral AVN disease ( AVN, avascular necrosis). MRI  was the best  imaging modality for  diagnosing  AVN  in this case. Early  diagnosing  may cause  good response  to medical treatment.

CASE 303: INGUINAL SCARPA TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-303 INGUINAL SCARPA TUMOR

Woman  61 yo  detected  at right inguinal  scarpa a  small tumor  slowly  growth, no  painful,  size of  about  one egg. Clinical palpation was  subcutaneous, hard nodule,  fixed  to  deep  layer.
Ultrasound scanned it was  a round mass , size of 5 cm in diameter,  well-bordered, inside  structure  was  solid and inhomogeneous  ( US picture 1).

 Doppler  scanning  detected  hypervascular  with  hilus,  vascular supplying  of a lymph node (US picture 2), and   Doppler spectrum  of  hilus artery  was  pulsatile , V1= 52 cm/s and  RI=0.6.
  

Elastography ultrasound  was a soft mass, inhomogeneous structure.

Sonologist  cannot  find another abnormal  lymph node at  another  side, and report  suspected  inflammation  lymph node.

Blood tests  WBC, CRP, beta2 microglubuline  were  normal.

Core biopsy with immunohisto staining report was lymphoma.

Reference ;

CASE 302 : OVARY TUMOR , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

case-302ovarian-tumor

Woman 50 yo, vaginal bleeding.

Pelvis ultrasound  detected  one mass  cystic, multiloculated   with  septation thickening and  solid part. No ascites (see  5 US pictures).

MRI  with  gado reported  with  enhanced  CE  suspected  ovary cancer.

Blood test :  CA-125  rising  125 U/mL
Pre operative  diagnosis  is  ovary cancer  stage II B. Microscopic  specimen report is  serous cystadenocarcinoma.

Discussion: With 3 modalities for diagnosing  this case ULTRASOUND, MRI  and BLOOD TEST MARKER, what  is  the excellent value?.