CASE 347: APPENDICOLITH, Dr PHAN THANH HAI, Dr LY VAN PHAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 60 yo,  pain  at  RLAQ for one month and was treated with medicine but not  resolving her problem.

Ultrasound  scanning of  abdomen  detected  at  RLAQ  one mass with thickening of the wall  and  hypervascular ( see US images 1, 2,3,4)

WBC  is normal, CRP is raised of  16.55ng/mL.

MSCT with CE  detected one  mass  near  coecum area with   stone  ( CT images 1, 2).q

Operation for  removing of this mass.

It is  a retrocoecal  appendicitis with abssess  and stone in appendiceal lumen [ appendicolith].

REFERENCE

CASE 346: THYROID NODULE or PTC, Dr LE THANH LIEM-Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

CASE 345: LEFT RENAL VENOUS ANEURYSM, Dr NGUYỄN NGHIỆP VĂN-Dr VÕ NGUYỄN THÀNH NHÂN,MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-345-left-renal-venous-aneurysm-

Female 27yo from Baclieu province, suffered from left side lumbago, which was getting worse in effort

No history of trauma. Entered 121 hospital,  Cantho hospital but status not changing then went to Medic

Center

Sonologist said left kidney AVM which caused left renal vein dilatation of 48mm in diameter.

MSCT with CE was done that IVC appeared early with taken CE of aorta and presented a huge renal vein on left side.

DISCUSSIONS

•      Left renal vein aneurysm presented commonly on left side, and true renal vein aneurysm ( absence of media tunica) which was rare, from now on about 10 cases in literature.

•      Etiology of aneurysm of left renal vein : hypertrophy of the tunica media with fibrotic thickening) : AVM ( post trauma, RCC ), intrarenal AVM, AVM of aorta and renal vein (in case of renal vein behind AAA).

For prevention of lung venous embolism, rupture of aneuysm... patient was repaired in Cho Ray left renal AVM by coiling and getting well .

Left venous aneurysm disappeared totally post op.

CASE 344 :LEFT GROIN TUMOR, Dr PHAN THANH HẢI, Dr LÊ TỰ PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-344-left-groin-tumor-

Man 33 yo, detected  left groin  having  a mass  slow growth for 1 year, no pain ( see foto).

Ultrasound  scanning of this mass=

US1: more  calcification  and  very strong shadowing, but  femur bone was intact.

US 2:  tumor had  cystic part  and hypovascular

US 3  elasto scanning=  inhomogeneous  structure tumor

MSCT  without CE=

CT 1 structure  of tumor from  ischium bone extension to  muscle.

CT 2 ischium bone was destroyed  by tumor.

CT 3..3D view of this tumor.

Core biopsy  of this tumor  with report is  osteo-enchondroma.

CASE 343: TB AXILLARY NODES, Dr PHAN THANH HẢI, Dr JASMINE THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

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case-343-tb-axillary-nodes-

Woman 49 yo, on mammography screening detected  many  left axillary nodes and calcification, no  detected tumor in mammary gland (see mammogram).

Ultrasound  of left   axillary  found  many  lymph nodes,   sizes of 1-2 cm,  round

and  calcification  inside node ( US picture 1). 

CDI cannot  detect  hilus  of nodes, no vascular signal  in  nodes, ( US 2, US 3). Elastoscan  US of this  node was hard,    17.3 kPa ( US 4)

MRI  with  FAST SCAN   DWI..made sure  no tumor intra  left  breast and  

axillary nodes.

Biopsy   removed one  big node with  structure  inside  look liked  caseum.

Microscopy result was   tuberculosis  with  typical  big cell  LANGHANS.

CONCLUSION: Tuberculosis of axillary lymph nodes..

CASE 342 : FRONTAL LUMP, Dr PHAN THANH HẢI, Dr LÊ THỐNG NHẤT, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-342-frontal-lump

MAN 65 YO  ONE YEAR AGO  DETECTED  AT  RIGHT FRONTAL A SMALL MASS UNDER SCALP  SLOWLY GROWING WITHOUT PAIN.

ULTRASOUND FINDINGS=

US 1:TUMOR  DESTRUCTING   FRONTAL BONE, SIZE OF 2CM.

US 2:  HYPERVASCULAR TUMOR.

US 3:ELASTOSCAN OF TUMOR OF 36.3kPA.

US 4.  ULTRASOUND FINDINGS OF  LIVER TUMOR OF 5 CM.

US 5: ELASTOSCAN  OF LIVER TUMORS = HARD,  55.9 kPA

MSCT  BRAIN=  3  CT PICTURES SUSPECTED  METASTASIS TO FRONTAL BONE.

BLOOD TESTS=   HCV POSITIVE  AND WAKO TEST  WASE  STRONG POSITIVE WITH DCP. IT MEANS  HCC.

FNAC  OF THE  FRONTAL TUMOR WAS  HCC METASTASIS.

CONCLUSION:  HCC IN LIVER  METASTASIS TO  FRONTAL BONE.

REFERENCE

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?