CASE 341: THYROID TOXIC ADENOMA, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 41 yo male patient with chronic fatigue syndrome and  nervousness, irritability; sometimes  he feels muscle weakness and hand tremor  for three months and getting severe in ten days. Wants to check up his liver and nervous system. 

Abdominal ultrasound revealed nothing abnormal. Because of his symptoms, sonologist also perfomed a thyroid ultrasound.

Thyroid ultrasound showed that  right lobe and  upper portion of  left lobe were normal in size with smooth margin and homogeneous echotexture, normal blood flow in Doppler ultrasound.

But  lower portion of the left lobe had a 5 cm, mixed cystic-solid nodule with hypervascular, isoechoic in peripheric part and nonvascular cystic degeneration in center part of tumor.

On Doppler US,  inferior thyroid artery showed  peak systolic velocity in  left lobe is 122.7 cm/s, five times more than one of right lobe 24.3 cm/s. So,  sonologist suspected  nodule in  lower left lobe maybe a toxic thyroid adenoma, which is cause of  hyperthyroidism.

Blood tests were done and confirmed the diagnosis with low level of TSH and high level of Free T3, Free T4.

Measuring the peak systolic velocity of inferior thyroid artery in both side to diagnose toxic thyroid adenoma. Do you think we can diagnose toxic thyroid adenoma by ultrasound?

CASE 340 : UMBILICAL TUMOR, Dr PHAN THANH HẢI, Dr LÊ THÔNG LƯU, Dr NGUYỄN THị KIM UYÊN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-340-umbilical-tumor-

Woman 45 yo, PARA 2002, normal spontaneous vaginal deliveries,no cesarean operation  nor history of hormonal contraception. 

2 years ago  she  detected  her umbilicus swelling some days before her menses and continuous pain  during  the entire of her period in some times bleeding.

In clinical  examination  the umbilicus  deformed  by one mass which were bluish-black, hard and not  hot (see 2 photos).

Ultrasound findings of this mass=

US1: this mass was well bordered, localized in cavity of  navel. Structure of mass was solid, size of  2.68 cm.

US 2:  in CDI, vascular supplying from peripheral part of mass.

US 3:  in elastography:  hard mass in comparison to muscle.

US 4 : uterus and pelvis were not intact.

Preoperative diagnosis is primary endometriosis. Removed this tumor. See macroscopic specimen.

Microscopic report: ENDOMETRIOSIS.

CONCLUSION: This  is  a case of   PRIMARY  ENDOMETRIOSIS in umbilicus.

REFERENCE:

CASE 339: INTRAMUSCULAR TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-339-intramuscular-tumor-

Man 51 yo  detected  himself  swollen at  left  scapula region, no pain for 2 years (photo). 

The tumor  was  underskin and ovoid shape.

Ultrasound  of this mass was  localized   in  trapezius muscle, well bordered,  size of 10cm. CDI  no abnormal blood  flow. Elasto scan was  slow  kPa (7.7kPa) in  comparison to muscle 22.9 kPa.

MRI  scan= MRI 1,tumor  well bordered with  density as  fatty tissue, MRI 2, MRI 3).

Operation  was done  for removing of  the tumor.

Microscopic report of this tumor is LIPOMA.

CASE 338: THYROID CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-338-thyroid-cancer

Man 30yo, in general check-up,  ultrasound detected  thyroid tumor  at right and left  lobes.

US1 scan at   right lobe, small nodule 1cm diameter,  hyperechoic due to  calcification.

US 2 scan at  left  lobe,    round border tumor, 4 cm with many white calcification spots.

US 3 & US 4:  CDI of  left  thyroid tumor, hypervascular.

US 5  elasto scan of right  tumor was very hard.

US 6 elastoscan with Q box score,  tumor in comparison to  normal thyroid tissue.

No detection of  regional lymph nodes.

Report  by  sonologist   was suspected  thyroid carcinoma, THYRADS IV, and FNAC of  the left tumor was  PAPILLARY  CARCINOMA.

DISCUSSION: B MODE  SCAN  THYROID TUMOR   WITH MANY  WHITE SPOTS  WITHOUT  SHADOWING, IT IS   MICROCALCIFICATION NAMED   PSAMMOMA BODY..WHICH  IS  TYPICAL  OF  PAPILLARY THYROID CARCINOMA.

ELASTOSCAN THIS TUMOR   WITH  QUANTITATIVE Q-BOX  IS 99.5 kPa  IN COMPARISON WITH   NORMAL THYROID  GLAND IS  12.2 kPa.
ELASTOSCAN  IS NEW  TECHNOLOGY  FOR  DETECTION  THYROID  CANCER.

REFERENCE

CASE 337: BILATERAL BREAST TUMOR, Dr PHAN THANH HẢI, MEDIC, MEDICAL CENTER, HCMC, VIETNAM

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case-337bilateral-breast-tumor-

WOMAN  30 YO, FOR CHECK-UP MAMMOGRAPHY  DETECTED  CALCIFICATION MASS  IN RIGHT AND LEFT  BREAST AND RADIOLOGIST SUGGESTED  BIRADS 4 BREAST TUMORS ( SEE  XRAY MAMMO ).

ULTRASOUND  OF RIGHT BREAST DETECTED  ONE HARD MASS,  IRREGULAR BORDER   WITH VERY STRONG  POSTERIOR ATTENUATION  WITHOUT AXILLARY LYMPH NODE ( SEE  US 1, 2, 3).

ULTRASOUND SCANNING  OF LEFT BREAST  ALSO  HAD  SAME  TEXTURE  MASS WITH  IRREGULAR BORDER   WITH  HIGH  ATTENUATION.

SONOLOGIST    REPORT   WAS  ALSO BILATERAL BREAST  TUMOR IN SUGGESTION MALIGNANT  BIRADS 4.

ULTRASOUND GUIDED CORE  BIOPSY of RIGHT AND LEFT  BREAST TUMORS,   RESULT WERE FIBROADENOSIS CALCIFICATION.

REFERENCE:

CASE 336:02 year Abscess in Leg Muscle due to Missed Foreign Body, Dr LÊ THANH LIÊM, Dr LÊ THÔNG LƯU, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-336-leg-abscess-for-2-years-due-to-missed-foreign-body-

CASE 335: HEMOPERITONEUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-335-hemoperitoneum-

WOMAN 33 YO, ACUTE   LEFT PELVIC PAIN, ULTRASOUND  EMERGENCY  SHOWED NORMAL SIZE OF UTERUS, ENDOMETRIUM  IN MIDDLE OF MENSTRUAL CYCLE, AND HAVING A LOT OF FLUID AND  BLOOD ARROUND  UTERUS TO MORRISSON'S  SPACE  OF ABDOMEN.

IT WAS A CASE OF HEMOPERITONEUM.

ULTRASOUND  DETECTED  ONE ROUND  MASS  AT LEFT  PELVIS WHICH WAS  SUSPECTED AN  OVARY CYST WITH SIZE OF 4 CM.

PUNCTION OF ABDOMEN  AT  RIGHT ILIAC FOSSA  REMOVED OLD  BLOOD.

BLOOD TESTS  WERE NORMAL  BETA HCG,  Hct   21%, NORMAL AMYLASEMIA.

MSCT  WITH CE  DETECTED  2 MASSES  BOTH 2 SIDES RIGHT AND LEFT  UTERUS; THE LEFT ONE  WAS  VERY QUICK CE ENHANCED  IN COMPARISON TO THE RIGHT  ONE  NON-CE ENHANCE.

Patient was  in admission of emergency of  surgery hospital.
After receiving of  2 units of blood transfusion, the vital status was stable.
Follow- up by  ultrasound one week later  the  blood clot  in pelvis was not rising  but not dissolved. Laparoscopic surgery  for  washer  this blood  and  detected  right ovary was normal, while  left ovary  had  ruptured one cyst but  already  stop bleeding.

Report of surgeon was rupture  of luteinic corpus  with blood loss more than 2,000 ml-- a  severe case of internal bleeding.