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Sunday, 9 August 2015

CASE 328: DISSECTING SUPERIOR MESENTERIC ARTERY, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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Male patient  50yo, old patient of Medic Center with history HTA and prolonged epigastric pain , HP infected.

Epigastric pain was getting worse for one month, he was admitted by province hospital for 10 days and had been treated as gastritis, but continued gastric pain out of hospital for 20 days. So coming back to Medic Center.






Ultrasound at Medic Center revealed dissecting SMA at its origin, d=12mm, raising diameter and flapping moving inside in TM mode, aliasing in color mode,  and confirmed it later by MSCT.




REFERENCES:



Saturday, 1 August 2015

CASE 327: INTRATHORACIC THYROID TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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Woman 37 yo with history of  sore throat and  changed  speaking.
Chest X-Ray detected  one  mass at upper pole of right lung (chest x-ray film).


Transthoracic ultrasound  of this mass revealed  a solid  hypovascular mass, size of 10 cm, no moving  with  respiration. Thyroid  ultrasound  scan  was normal  but the right lobe was  smaller  than left one.




MSCT  angio in  cervico-thoracic region showed mass in connecting with right  thyroid lobe.
Main vascular supplying for this mass was from branch of  inferior thyroid artery  (see CTA).



Operation for  removing of  one round mass connected with  right lobe of thyroid, its
structure was inhomogeneous  and pathology report was  colloidal  thyroid goiter.



Conclusion: this case  was  an intrathoracic goiter while on chest X-Ray film  looked like  lung tumor.
Reference:
Case from Mayo Clinics 



Sunday, 26 July 2015

CASE 326: INTUSSUSCEPTION of COLON INDUCED by POLYP, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

FOR PICTURES PLS CONNECT TO 3G /DOWNLOAD THE LINK

A 4 years-old boy presented to Medic Center with one year history of weakness, fatigue, lethargy, pale skin and less active. No recognition of other symptoms such as vomiting, abdominal pain or bloody stools. Patient was done blood test and abdominal ultrasound. 
Abdominal ultrasound detected colo-colonic intussusception in the right upper quadrant with concentric rings sign in transverse scan and "hay fork" sign in long axis scan. Located adjacent the intussusception show an isoechoic to hypoechoic solid mass, well defined oval, 30 mm in diameter, hypervascular in the hilus of the mass. Those blood vessels were continuing with the blood vessels from central portion of the intussusception. Sonologist suspected a intussusception of the ascending colon secondary to a  polyp. 


Laboratory investigations showed the reduction of Hemoglobin: 6.5 g / dl.


The patient was transferred to the hospital Nhi Dong 2. He had positive fecal occult blood test. Colonoscopy showed a polyp of ascending colon. 






A surgery was then obtained 2 weeks later.








 Surgical results confirmed polyp of the ascending colon which pathology result is tubular polyp.

Sunday, 19 July 2015

CASE 325: STRETCH MARKS SKIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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Boy 15 yo, history of  treated  high dosage  corticoid  due to uveitis;  2 years later  detected  many  scars  over  skin  at abdomen, leg, arm, back ( foto).

Ultrasound  of skin abdomen  shows  that  skin thin  and  hyperechoic, soft elasoscan ( see  US pictures 1,2,3,4).






Conclusion: It is  stretch marks skin due to  overuse  corticoid  which  destructed elastic fibers  in  derma layer of the skin.

REFERENCE:

Cases  of  skin stretch marks.




Friday, 17 July 2015

CASE 324: BREAST PSEUDOTUMOR, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM


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Woman 52 yo, history of hypertrophy of bilateral mammar gland. She had been in operation  for reduction of breast  size   10 years before. After operation she  detected  the  mass at the  site operation,  6- hour  position  at  2 breasts more and  more hard and no painful.
Ultrasound  check-up detected  at 2 breast,  masses  size  arround 5cm under  the skin incision at 6-hr position  of the breast,  hypoechoic  with  lateral shadowing.  At the left  breat mass  had  calcification,  soft elasto Q-score (see 5 ultrasound scan).






Mammography  cannot detected this mass.



MRI of breast without  gado, T1 ,T2 and fat subtraction, showed  fat  tissue with fibrosis  around and no axillary  lymph node.





Core biopsy of  this mass  and  reported  that  fatty tissue with  fibrosis, the border
was  fibrosis of scar  after operation  looked like a tumor. 


Tuesday, 14 July 2015

CASE 323: ELEPHANTIASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

FOR PICTURES PLS CONNECT TO 3 G / DOWNLOAD THE LINK
/case-323-


BOY 16 YO, HISTORY OF    ABNORMAL DETECTION OF HAND AND LEG IN THE CHILDHOOD, SLOW GROWTH ( FOTO).


2 HANDS  AND RIGHT LEG ARE ABNORMAL. PALPATION OF THE SKIN FEELS  EDEMA AND COMPRESSIBLE, NO PAINFUL.
ULTRASOUND  of  RIGHT LEG  REVEALED  SKIN AND SUBCUTANEOUS  LAYER THICKENING  TO 1,9CM, NO RAISED  VASCULAR STRUCTURE.





MSCT  NON CE SHOWS  SKIN AND  SUBCUTANOUS   FATTY EDEMA, LOCATED THE  2 HANDS AND  FOREARM, RIGHT  HALF BODY, AND RIGHT LEG WHILE   BONES AND MUSCLES ARE NORMAL.






WHAT IS  YOUR  DIAGNOSIS?.