CASE 322: OVARY TWISTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

FOR PICTURES PLS CONNECT TO 3G / DOWNLOAD THE LINK
case-322-ovary-twisting-

WOMAN 36 YO, 3 DAYS  AGO PAIN AT  SUPRAPUBIS, AND POLYKYURIA.

ULTRASOUND  OF  PELVIS WAS NORMAL.

PAIN CONTINUING  AND  RISING  AND SHE  WAS IN ADMISSION  OF ONE  EMERGENCY HOSPITAL,   IN CLINICAL SUSPECTED  RENAL COLICKY PAIN.

ULTRASOUND  AGAIN   DETECTED  ONE SUPRAPUBIS MASS,  SIZE OF10CM,  CYSTIC WITH  CLOUDY  FLUID INSIDE (US 1).

CDI  REPORT  WAS SMALL UTERUS, CANNOT  DETECT VASCULAR  AT  RIGHT UTERUS CORNER (US 2).

THIS CYSTIC MASS  WITH  MASS INTRA CYST  LIKED  SEBUM THAT  SUSGESTED  RIGHT OVARY TERATOMA  IN TORSION.

NO STONE  INTRA URINARY SYSTEM.

MSCT  NON CE   PRESENTED  OVARY MASS  LOOK LIKED TORSION OF TERATOMA.

EMERGENT OPERATION BY LAPAROTOMY DETECTED THIS MASS BEING AN OVARIAN CYST   BLACK IN  COLOR DUE TO TORSION ( SEE FOTO)

OPEN  SURGERY  REMOVED  RIGHT  OVARY MASS  ISCHEMIA AND BLEEDING INSIDE OF A  TERATOMA TUMOR.

Discussion : Why the first ultrasound examination was  normal?  Looking  the first picture ultrasound of the uterus that was  clear view and  the fluid  over  look liked urinary bladder.

But  you can see the small urinary bladder  in the lower corner of the first ultrasound picture.

The mistake  was due to ultrasound  scanning  with  the urinary bladder  not full filling , the ovary cyst  was not  septation because scanning view in small window.

The ultrasound examination is better  view  with  lateral decubitus position, but in some cases cannot see well in decubitus position.

Pathology report was an ovarian teratoma.

CASE 321: MALE BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

FOR PICTURES PLS CONNECT TO 3G/ DOWNLOAD THE LINK
/case-321-male-breast-tumor

Male 58 yo  history of sefl  detected  right  breast tumor  slowly growing for 10 years [see FOTO],  its size of  6 cm and  changing color of covered skin.

On ultrasound   it was a solid tumor  with cystic formation, hypovascular, no  adherence to deep  muscle layer and small  axillary nodes ( US 1, US 2, US 3).

Mammography  showed well- bordered  round tumor,   no calcification ( mammo1, 2).

MSCT  with CE of this  tumor was  low CE enhanced,  very clear border (CT 1,2,3).

FNAC report  was  blood cell only and no tumor cell.

Operation  removed this tumor ( 2 specemen )

Pathology report  was  caverneous  hemangioma.

CASE 320: VENA PORTA THROMBOSIS BY HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

FOR PICTURES PLS CONNECT TO 3 G / DOWNLOAD THE LINK

case-320-portal-vein-thrombosis

Woman 58yo, history of  infected  HBV  and diabetes. One week ago  she was very  painful  in  liver region.

Chest x-ray showed elevated  right diaphragm ( see Xray chest film).

Ultrasound  reported that  no pleural effusion..but  liver  had  many tumors with  portal vein thrombosis  completly..( us1, us 2, us 3, us4 and video).

Blood tests = HBsAg  positive  with  AFP = 9.3 ng/mL.

Blood tests  again  with   HCC risk  on Wako machine resulted  very high  level of DCP, this test made thinking  portal vein  thrombosis  by HCC.

Discussion : History of  infected  chronic HBV,  and normal..AFP,  but  ultrasound suggested   VP THROMBOSIS due to HCC  that based on  WAKO  compiling  3 tests  AFP, AFP-L3%, DCP which confirmed  HCC.

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

FOR PICTURES PLS CONNECT TO 3 G / DOWNLOAD THE LINK

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.

Reference=

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

FOR PICTURES PLS CONNECT TO 3 G/ DOWNLOAD THE LINK

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

FOR PICTURES PLS CONNECT TO 3G/ DOWNLOAD THE LINK

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.