CASE 436: SOLITARY KIDNEY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 32yo  with acute pain at  right renal fossa.

Emergency ultrasound:

US 1 = right kidney  hydronephrosis, no left kidney.

US 2 =  crossed section of  right kidney.

US 3 =  right  ureter dilated and stone of 1.5 cm in diameter.

US 4 = color Doppler  twinkling artifact  with stone.

US 5 = in  urinary bladder , urine jet only on right site.

US 6 =  cystic mass at the left wall of urinary bladder.

MSCT with CE=  

CT1:  fron tal view,  right  kidney  hydronephrosis no left kidney.

CT 2:  sagital view   the stone in right ureter.

CT 3:  3D view.
CT 4:  vascular malformation of agenesis of left kidney.

CASE 435: CERVICAL LYMPH NODES, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Female patient 23 yo detected  submandibilar nodes with history of recurrent sore throat. And some palpable  left cervical  nodes along  of SCM. No fever, nor pain.

US 1: hypoechoic, no hilus left submandibular nodes.

US 2: scanning  along  left site SCM, small hypoechoic nodes.

US 3: hypervascular  color Doppler .

US 4. high flow vascular  intranodes without defected area.

US 5: spectral Doppler  high RI and PI.

US 6: elastoscanning of  inhomogeneous nodes, central low kPa.

Biopsy of  the big submandibular node.

Blood tests=  normal WBC, CRP,  but high beta microglobuline 3200 UI, and  normal LDH, ferritine.

Microscopic report of this biopsy is tuberculosis  lymph nodes with LANGHANS  MACROPHAGE CELLS.

SUMMARY :TUBERCULOSIS CERVICAL LYMPH NODES.

CASE 434: TESTIS TUMOR, Dr PHAN THANH HẢI - Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man  36yo with right testis tense.

Ultrasound scanning of  right scrotum  detected big testis focal lesion,  round,  size of 3cm

US 1  color doppler  not  hypervascular, well bordered.

US 2 CDI: hypovascular tumor.

US 3  elastoscan of  this tumor is inhomogeneous with some parts very hard.

MRI  with gado: MRI 1, 2, 3: this tumor  very low gado enhanced.

Radiologist suggested epidermoid  cyst.

Blood tests =  normal   AFP  and   HCG.

Operation   resection of  right testis (see  macro 1, 2).

Microscopic report is epidermoid cyst.

CASE 433: GIANT RETROPERITONEUM LIPOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 44yo nullipareous, with abdomen  distention, and  clinical  suspected   ovary tumor.

US scanning of abdomen detected  all bowell loops in deplacement to left flank.

US 1: epigastric scanning detected  right kidney near left lobe liver.

US 2: big solid mass, hyperechoic  like  fatty tissue.

US 3, US 4  color Doppler  of this mass showed from  retroperitoneum which extended from the epigastric  to pelvis but  no deplacement of abdominal aorta.

MRI  with  gado:  This  big mass is in retroperitoneum deplaces right kidney to liver (MRI 1, MRI 2, MRI 3,  MRI 4 , MRI 5).  

Radiologist reports  that  retroperitoneal lipoma or retroperitoneal liposarcoma.

Operation removed this mass easily (see macro).

Microscopic report is lipoma.

Reference:

CASE 432: A K I by STONE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man  51 yo with acute  pain at  right flank, type colicky  pain. History of being treated  renal stone of  left kidney by operation and ESWL for 2 years.

Emergency  ultrasound  detected right and left kidney hydronephrosis (US 1, US 2).

CT scanning  with CE:  CT 1= kidneys no CE.

CT 2 with CE,  arterial phase.

CT 3,  venous phase.

CT 4,  delay phase.

CT 5,  frontal view.

 CT 7,  3D view.

Blood test: EGFR=  23mL/s.

Discussion: Ultrasound  scanning in acute renal colic crisis cannot make diagnosis of  A K I ( acute kidney insufficiency);   CT  non CE  with HU  low and CE phase in delay  secretion that suspected AKI.

 Emergent  operation was done  for removing  of the stuck stone in right ureter for this case.

CASE 431: BIG GASTRIC TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 44 yo with one month complaining of epigastric distention but normal gastroendoscopy.  

Ultrasound  detected  big epigastric mass,  looked like  left hepatic tumor with size of 15 cm,  central necrosis (US 1, US 2).

MSCT CE represented that this tumors is  nearby  left lobe of liver  and  deplaces  gastric fundus [CT1, CT 2,  CT 3] with central  necrosis.

   

Blood tests with all cancer markers are normal. Wako test is  negative.  

Operation  removed  this big tumor   which came from  gastric wall.

Microscopic is GIST with high malignant potential.  

Reference: