CASE 319: LINGUAL THYROID, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-319-lingual-thyroid

WOMAN  34 YO  HAD BEEN SUFFERED FROM RECURRENT SORE THROAT, COMING TO SEE  ULTRASOUND OF THE NECK MANY TIMES.

SONOLOGIST  REPORTED  THAT CANNOT FIND  OUT THYROID GLAND  AT THE NECK. ULTRASOUND   CANNOT  FIND  THYROID GLAND NOR THYROID ARTERY (SEE  US1, US2).

BLOOD TEST  =  TSH  6.19UI (N 0,3-5UI)  FREE T4 :1,3 N (0.7-1.8).

MSCT  OF THE  NECK  NON CE   DETECTED  2 HYPERDENSE MASSES  SIZE OF 2-3 CM   WITH HU  119 AT THE BASE OF LINGUAL  AND  BUCCAL PLANTAR ARE (CT1 ).

MSCT  CE OF  THIS MASS =  VERY  QUICK  ENHANCE  TO HU 176 ( CT2).

CT3: LATERAL  VIEW  3 MASSES, CT4   FRONTAL VIEW , CT 5   VASCULAR  OF CAROTID  NO DETECTED  THYROID ARTERY, CT6  3D VIEW OF 2 MASSES.

CONCLUSION :ECTOPIC THYROID GLAND  AT  LINGUAL  AREA.

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CASE 318 : DIFFUSE LYMPHADENOPATHY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-318diffuse-lymphadenopathy

Woman  56 yo,  low-grade fever for  one month, with swollen neck and left  supraclavicular area.

Ultrasound  the neck presented  normal thyroid and  many lymph nodes,  hypoechoic, without  hilus nodes (US image ).

Abdomen ultrasound scanning detected  aorta  elevated  by  hypoechoic mass, para-retro aortic  just  prolonged to pelvis (US 1, US 2) and sonologist  suggested  lymphoma.

MSCT  with CE  for  staging  the  mass  nodes,  left supreclavicular, mediastinal,  para- aortic   and  inguinal area ( CT 1, CT2, CT3) =  stage IV  LYMPHOMA.

Blood tests  =   high  beta microglobulin and  ferritin.

Biopsy of supraclavicular node  and  its histo- immuno chemistry stainning  report was  LYMPHOMA  diffuse  large B CELL.

CASE 317:CT FIRST U/S SECOND IN CAUTION OF THYROID FUNCTION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-317-ct-first-and-ultrasound-second-in-caution-thyroid-function

MAN 29YO  TRAUMA  AT THE HEAD AND NECK BY TRAFFIC ACCIDENT, NOW IN  PAIN  AND TACHYCARDIA.

CT  NON -CE WAS FIRST LINE, RADIOLOGIST  REPORTED    BIG AND  DARK THYROID GLAND , CT UNIT ARROUND   85 UI HOUSFIELD ( SEE  FOTO AND  CT1,CT2 ARE  ABNORMAL).

 ULTRASOUND  OF  THYROID  ALSO    REPORTED LARGE VOLUME WITH  HYPOECHOIC AND   VERY  HIGH  SIGNAL DOPPLER . SPECTRAL DOPPLER  OF  SUPERIOR THYROID ARTERY  WAS VERY  FAST PULSATILE, TYPICAL HYPERTHYROIDISM  AS  GRAVE  DISEASE (BASEDOW).

BLOOD TESTS  CONFIRMED  A  HYPERTHYROIDISM  WITH TSH  LOW  VALUE  AND VERY  HIGH T3 AND T4.

SUMMARY: CT  NON CE  IS  POTENTIAL IN CAUTION  THYROID FUNCTION.

CASE 316: RETROPERITONEAL CALCIFACATED TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-316-retropertoneal-calcifacated-tumor

WOMAN 45 YO, PAIN  AT  RIGHT  SUBCOSTAL REGION. PLAIN XRAY FILM  KUB DETECTED  CALCIFICATION  PUNCTIFORM   AT LIVER BORDER AND  RIGHT KIDNEY ( SEE XRAY PLAIN FILM).

ULTRASOUND  OF ABDOMEN  FIND OUT  THIS MASS  IN RETROPERITONEUM,  SIZE  OF 7X5 CM , WHICH PULL THE RIGHT KIDNEY DOWN. ITS STRUCTURE  IS  CYSTIC,  MULTILOCULATED WITH  FINE WALL  AND  CALCIFICATED. THE CONTENT OF THIS CYST IS  MIXED ECHOGENIC STRUCTURE ( SEE  4 US IMAGES ).

MSCT OF ABDOMEN  WITH CE=  THIS TUMOR IS  MULTICYSTIC  WITH  CALCIFICATION OF  THE WALL ( SEE 3  CT IMAGES).

BLOOD TESTS  AND  MARKERS = AFP,  BETA HCG ARE NORMAL

Preoperative  diagnosis  in  BD HOSPITAL IS retroperitoneal teratoma.

Operation  removed  this mass   hard  and clear bordered, specimen  is  white  structure  like  fibroma.

Microscopic result is fibroma in retroperitoneum.

REFERENCE:

CASE 315: SPONTANEOUS PORTO-SYSTEMIC SHUNT, Dr PHAN THANH HAI, Dr NGUYEN THI ANH HONG, Dr LE THONG NHAT, Dr TRAN LAM

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case 315

Woman  63 yo,  5 years ago  had been treated  diabetes  not  control blood  sugar. Patient  has  some  subcoma  crisii that had been treated in many  hospitals, now she  is in somnolence, easy in sleeping  after eating but cannot sleep at night.

MRI of  the brain, radiologist  detected  hyperintense  T1 at basal ganglion area, susgested  hepato-encepalopathy (image MRI).

Checking  the liver by blood tests, liver function is still good,  but ultrasound of  liver  detected  porta-systemic shunting  very high flow ( see US image 1 dilatation cystic  intrahepatic, US 2, color Doppler:  porta-systemic shunting and US video).

MSCT angio of  liver with  3 phases: arterial phase shows that not abnormal ; venous  phase : dilated  the  porta-systemic  anastomosis like snake. In 3D CT reconstruction  confirmed a  high flow porta-systemic shunting).

Bood test reports  this time  no ceton, high NH3 = 88.89 micromol/mL (normal  18-72).

Conclusion: It is  a high flow  spontaneous  porta-systemic  shunting appeared as hepatic encephalopathy in clinical examination.

REFERENCE:

CASE 314:CALCIFIED LIPOMA of CALCANEUS TENDON and SOLEUS MUSCLE - - Dr PHAN THANH HẢI- Dr LÊ THANH LIÊM- Dr Nguyễn Đức Duy Linh; Dr Nguyễn Ngọc Xuân Giang – BÌNH AN GENERAL HOSPITAL_KIÊN GIANG_VIỆT NAM.

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case-314-lipoma-calcification-of-calcaneus-tendon-and-soleus-muscle-

A 30 year-old woman with history of mass within the right heel region 2 year ago, no pain  and normal walking.

ULTRASOUND

Ultrasound found an echogenic mass in the calcaneus tendon and soleus muscle, hypovascular.

The surface of the mass was close to the Achilles tendon, well-defined with the capsule. Deep surface was very difficult to survey. Intra the mass there was an hyperechoic structure with strong shadowing, like bone. Ultrasound did not determine that there was continuity between the mass with calcaneus tendon or not.

Sonologist suggested a diagnosis of chondro-osteoma and organized synovial cysts of the ankle. Dx: Lipoma calcification.

CT SCAN

MSCT detected a lesion in the soleus muscle, density of fatty tissue, 10x4cm in size, around of achilles tendon, clear capsule, rounded border, with a very high-density nodule inside, looked like the bone. The lesion was not associated  with the calcaneus bone and the leg bone. Radiologist suggested a diagnosis of calcified lipoma.

OPERATION

Surgery was conducted in next day. Macroscopic image looks like the lipoma with calcified nodule inside.

Microscopic result is benign lipoma.

REFERENCE:

CASE 313: FISH BONE APPEARING in NECK, Dr PHAN THANH SƠN, Dr NGUYỄN ĐỨC DUY LINH, Dr NGUYỄN NGỌC XUÂN GIANG, BÌNH AN HOSPITAL, KIÊN GIANG

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case-313-fish-bone-appearing-in-NECK

Male patient 79 yo had foreign body on right neck (see pictures).

HISTORY

4 days before of hospitalization, during dinner with stingrays, in sneezing, a 79 yo patient took out and in some fish parts, and then feeling caught something in his throat but still eating.

Morning after he went to hospital as felt felt like a head of bone at his right neck.

ULTRASOUND

 Ultrasound at right neck revealed a fish bone in soft tissue, echogenic line in subcutaneous edema around the fish bone, but no vascular.

ENT ENDOSCOPY

 ENT endoscopy detected edema of right piriformis recess due to fish bone perforating outside from the throat.

CT SCAN

CT–Scan confirmed the fish bone in the right neck, not injured the right vessels of the neck.

The fish bone was removed out of the right neck, with 2.8 cm long of size.

Fish food is very interesting, but sometimes lead to dangerous situation like the case, specially for old patient. 

REFERENCE;