CASE 494: PRIMARY LIVER LYMPHOMA (PLL),Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman  62yo  with 5 months of history of epigastric  pain and  being  treated as gastritis  after gastroscopy. Ultrasound of liver  reported as inhomogeneous fatty liver.

Ultrasound liver  reviews  3 months later :  US 1  manny hypoechoic  focal lesions at peripheral area of liver with   size 2-3 cm  without  bending vascular sign.  (US 1 , US 2  CDI,  US 3   central  liver, US 4 liver elastography of this hypoechoic mass  is hard   41kPa, normal  liver is  18kPa) US 5 : big spleen .

MSCE with CE   detected hepato slenomegaly  with many  nodules  captured contrast in  arterial phases.

No  lymphadenomegalia  in abdomen.

MRI of  liver  with gado  Images with  many  hyperintense areas,  T1  captured  gado enhanced  peripheral   ( MRI 1, 2 ,3 ,4).

Blood tests =   HBV positive  EBV  IGG positive   Wako test negative   

Beta2 migroglobuline rised very high 8,341 UI/  IGG  rised to 2,188 UI   kappa IGG detected . 

Summary:  Based on  US imaging , CT with CE, MRI with CE and blood tests   diagnosis  is  PLL ( primary liver lymphoma ),   wait for  liver biopsy.

REFERENCE Case PLL.

CASE 493: THYROID SMALL PTC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 52 yo, thyroid ultrasound screening detected 2 small nodules of left thyroid gland  in  2015. But now in 2018,  sonologist reported back them being in TI-RADS 5, size=3.5mm. FNCA   made sure that PTC.

Operation is subtotal thyroidectomy.

   

See  macroscopic specimen pictures.

Microscopic report post op made sure again PTC.

Reference  :   medic ultrasound case  276 ptc ,  case 460 ptc,  case 475 ptc.

CASE 492 : APPENDICULAR MUCOCELE, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 65 yo with abdomen distention (photo). For 40 years he underwent a laparotomy in emergency by gunshot.

Ultrasound of abdomen detected at pelvis  one round bordered mass,  size of  20cm. Its structure looked like cyst with many ring layers as an onion skin sign.

US 1: crossed- section at middle abdomen;  US 2 : with CDI,  mass no vascular inside; US 3:  longitudinal scan over aorta; US 4:  multiple ring layers as onion skin sign; US 5 : with  linear probe.

MSCT  scan with  CE : CT 1: this mass is cystic formation from the coecum; CT 2 : frontal view.

Appendicular mucocele  was made for  diagnosing of the pelvic mass. Operation removed one mass with mucus content from appendix.
DISCUSSION:
http://www.ytetunhantphcm.com.vn/vi/hoat-dong/khoa-hoc-dao-tao/82-ban-luan-ve-benh-u-nhay-ruot-thua-mucocele-of-the-appendix

Microscopic report is  mucineous cystadenocarcinoma.

REFERENCE:

https://onlinelibrary.wiley.com/doi/pdf/10.7863/jum.2004.23.1.117

   .

CASE 491: TOOTHPICK MOVING TO RETROPERITONEUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 60 yo with  epigastric pain  one month ago; in  emergency CT of abdomen detected    a  foreign body ( FB) looked like a toothpick penetrating duodenum D2 wall.

But gastroscopy and colonoscopy cannot find  out this foreign body (FB). And  so  do laparoscopy later.

At Medic center,  ultrasound again detected this foreign body (FB) in retroperitoneum  near IVC and aorta (US 1. US 2), very strong shadowing , US 3: longitudinal  FB # 5 cm).

MSCT of abdomen  non CE   (CT1:  crossed section  this FB near aorta , CT 2 : frontal view , CT 3:  3 D view).

Gastroscopic laparoscopy again removed this  toothpick # 5 cm at the wall of D2.

Conclusion : Toothpick  can move to retroperitoneum.
REFERENCES:

In10 years at Medic it exists  5 published cases about toothpick , CASE  20 dec 2008  dr LY PHAI ,   MEDIC ULTRASOUND CASE 232,  CASE 229,  CASE 479 , CASE  491 and 7 other cases.

NHÂN 12 CA NUỐT TĂM XỈA RĂNG: VAI TRÒ SIÊU ÂM CHẨN ĐOÁN

CASE 490: ANECHOIC CRESCENT' S SIGN OF AORTA DISSECTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 34 yo, now  epigatric pain  with history of  operation for repairing aortic valve since 2008.

Ultrasound of abdomen detected abnormal aorta.          

US 1  crossed- section   aortic  size 3 cm   with anechoic crescent in lumen of aorta

US 2  longitudinal scan  with  Doppler dual gates=  aorta had double  flows in aorta in turbulence.

US 3  video

Ultrasound suspected   dissection of  abdominal aorta

MSCT angio: 

CT 1   crossed section near aortic valve.

CT 2  crossed section over cross aortic   also see “crescent sign" of the wall of aorta,  with double lumen.

CT 3  frontal view.

CT4   full aortic tree =aortic dissection.

Summary:   Anechoic crescent sign in ultrasound or CT of  aortic dissection.

REFERENCES:
1/

 2/

CASE 489: LOST OF CONTRACEPTIVE IMPLANT, Dr PHAN THANH HAI, Dr LE THONG NHAT, Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN  31 YO  HAD BEEN PUT ACONTRACEPTIVE IMPLANT AT THE LEFT BRACHIAL AREA 3 YEARS AGO, BUT NOW THE OB-GYN HOSPITAL CANNOT FIND OUT THE DEVICE FOR REMOVING IT.

 AT MEDIC CENTER, X-RAYS FOUND THIS IMPLANT STILL NEAR THIS PLACE (X-RAY FILM).

ULTRASOUND DETECTED  IT IN BICEPS MUSCLE  ( US 1, US 2 ).

OPERATION REMOVED THE INTRAMUSCLE DEVICE  (PHOTO).

CONCLUSION : CONTRACEPTIVE IMPLANT CAN MOVE  TO ANOTHER SITE POST IMPLANTATION.

REFERENCE   CONTRACEPTIVE IMPLANT MOVE TO THE LUNG.