CASE 549: RENAL CYSTIC TUMOR, Dr PHAN THANH HAI, Dr NGUYEN PHUOC TOAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 38 yo with annual health check up ; 3 years ago ultrasound detected  right renal cystic tumor growing bigger for year. 

NOW,   US 1: LONGITUDINAL SCANNING OF  RIGHT KIDNEY  NOTES THAT A CYSTIC TUMOR AT UPPER  POLE OF RIGHT KIDNEY.

US 2: CDI  IN CROSSED SECTION OF RIGHT KIDNEY.

US 3:  LONGITUDINAL SCANNING OF RIGHT KIDNEY WITH CDI.

MSCT CE    

CT1 : CROSSED SECTION OF RIGHT KIDNEY CYSTIC TUMOR  WITH FINE SEPTATION.

CT 2 : FRONTAL VIEW OF   RIGHT KIDNEY.

CT 3 : TUMOR  COVERS  UPPER POLE OF RIGHT KIDNEY TO  HILUS OF RIGHT KIDNEY.

CT4=  SAGITTAL VIEW OF RIGHT KIDNEY.

RADIOLOGIST  SAYS CYSTIC TUMOR OF RIGHT KIDNEY  TOO BIG  THAT COVERS MORE RIGHT KIDNEY in  BOSNIACK III  CLASSIFICATION.

THIS PATIENT PLANS TO  NEPHRECTOMY OPERATION.
MRI of THIS CASE  REPORTED   CYSTIC TUMOR OF RIGHT Kidney,  SIZE 5 CM, BOSNIACK IV.

OPERATION  BY ROBOT,   RETROPERITONEAL RESECTION OF RIGHT KIDNEY.   

SEE MACRO  

OP 1: SURFACE OF  R KID  NO INVASION OUT OF  KID BORDER

OP 2 : SAGITTAL SECTION, TUMOR IS CYSTIC NO SOLID PART INTRA TUMOR.

MICROSCOPIC REPORT IS BENIGN CYST.

REFERENCE =  BOSNIACK CLASSIFICATION  AND HISTORY.

CASE 548: APPENDICITIS in PREGNANCY, Dr PHAN THANH HAI, Dr DANG VINH PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 37YO IN GESTATION 16 WKS,  10 DAYS AGO PAIN IN RLAQ.

ULTRASOUND   

US1  PREGNANCY 16WKS  

US2  CROSSED SECTION AT RLAQ  SUSPECTED  APPENDICE RETROCOLON ASCENDING.

US3  LONGITUDINAL SCAN   APPENDICE  EDEMA.

BLOOD TESTS:  WBC  9,2K WITH 75% neutro. CRP  110ng/mL.

MRI  IS DONE.   

MRI1  CROSSED SECTION.

MRI2  CROSSED SECTION AT COLON ASCENDING.

MRI3  SAGITTAL VIEW.

 MRI4  FRONTAL VIEW.

RADIOLOGIST SAYS RETROCOLON APPENDICULAR ABSCESS.

EMERGENCY OPERATION   

OP1,2.

CONCLUSION=   IN PREGNANCY   US AND MRI  CAN DO DIAGNOSTIC  for RETROCECAL APPENDICITIS.

REFERENCE: AJOG DEC 2006, APPENDIITIS IN PREGNANT PATIENTS:  DIAGNOSTIC EFFICACY OF ULTRASOUND vs MRI.

CASE 547: MONDOR'S DISEASE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 60YO WITH PAIN AT RIGHT UPPER QUADRAN OF RIGHT BREAST. 

ULTRASOUND DETECTED  ONE MASS  NOT CLEAR BORDER  WITH ONE TUBULAR STRUCTURE  LOOKED LIKE  A  THROMBOSIS  OF VEIN .

PRESSURE OVER THERE IS PAINFUL.

(US1).

CROSSED SECTION  THIS STRUCTURE ( US 2) .

US 3 : WITH COLOR DOPPLER  THIS STRUCTURE IS NEARBY AN ARTERY.

US 4 : WITH PDI  THIS MASS IS NO FLOW IN COMPRESSION.

US 5 : ELASTOGRAPHY  THIS STRUCTURE IS HARD BORDER .

MAMMOGRAPHY XRAY   

M1   THE RIGHT BREAST VASCULAR STRUCTURE  HAD BEEN DILATED 

M2  ZOOM THIS MASS .

M3  ANOTHER VIEW 

SUMMARY = ONSET PAIN  NOT TRUE A MASS TUMOR  WITH   TUBULAR STRUCTURE  AS A VEIN THROMBOSIS. THE DIAGNOSTIC IS  MONDOR'S  DISEASE.

Image history of Dr Henri MONDOR.

CASE REPORT PDF.

CASE 546: LUNG CANCER, Dr PHAN THANH HAI, Dr HUYNH TRAC LUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 52 YO WITH  PROLONGED COUGH.     
CHEST X-RAYS DETECTED A  MEDIASTINUM TUMOR.

MSCT with CE  =
CT  LUNG 1:   FRONTAL VIEW:  LARGE NECK BY LYMPH NODES. MEDIASTINUM  ENLARGED BY MANY LYMPH NODES  AND LEFT LUNG TUMOR.

CT 2 :  CROSSED SECTION,  TUMOR OF LEFT LUNG WITH LYMPH NODES in MEDIASTINUM.

CT 3: LEFT LUNG TUMOR .

CT 4: SUPRACLAVICULAR LYMPH NODES  BOTH 2 SIDES.

ULTRASOUND OF THE NECK   

US 1=  BIG LYMPH NODES AT RIGHT SUPRACLAVICULAR AREA.

US 2 = AT LEFT SUPRACLAVICULAR  AREA , NODE SUSPECTED  METASTASIS.

BLOOD TESTS =CYFRA 21-1 : 3.05 ( N=  3.3)  PROGRP : >5000 pg/ml( N=65)

ACTH  282 pg/ml (N= 7-63)    CORTISOL  23 pg/ml (N=  6.2-19.4)

Biopsy of  right supraclavicular  lymph node.

HISTOLOGY REPORT WITH  IMMUNO STAINING IS  SCC.( NEUROGENIC ENDOCRINE TUMOR).

REFERENCE    Pro-GRP  [Pro-gastrin-releasing peptide] TEST for small cell carcinoma.

NOTA= VUD published 2 cases of SCC from 07 cases of lung tumor topic.

CASE 545: AORTIC DISSECTION, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 72 yo with epigastric pain and back pain.

Ultrasound of abdomen   detected   aortic  dissection.  

US 1 : longitudinal scan of aortic  epigastric area  having of septation intra aortic lumen, double lumen sign,  to lower division.

US 2 ,  US 3 : Doppler  flow.  

US 4 : crossed section,  Doppler flow  of

echocardiography detected dissection of aorta.

MSCT angio= CT 1   crossed section  of  aortic arch

CT 2= crossed section of aorta shows double lumen in  epigastric area.

CT 3 =longitudinal scan of aorta.   

CT 4 = 3D  view of  aortic  thoraco-abdomen.

Conclusion : ultrasound detected thoraco-abdomen aortic dissection.

Treatment :  Intervention of stenting graft for aortic arch.

NOTA= In a survey of AAA at Medic Center for 10 years (1990-2000), 246/987 cases of AAA dissecting were detected and documented by ultrasound and CT scanning confirmed, # 24.9%, that had been prothesis grafting later in Binh dan hospital.

CASE 544: GASTRIC PERFORATION DUE TO FISHBONE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 53 YO WITH EPIGASTRIC PAIN HAS BEEN  TREATED AS GASTRITIS BUT NO RESPONSE.

ULTRASOUND OF ABDOMEN  DETECTED ONE ECHOGENIC BODY AT ANTRUM. 

US1/US 2 LOOK LIKE  FOREIGN BODY.

MSCT of ABDOMEN  ALSO  DETECTED  FB(  FORGEINE BODY )  3 CM  AT ANTRUM  

CT 1 /CT2 :SAGITTAL  SHOW THAT PENETRATING THE WALL ofANTRUM TO PANCREAS.

CT3  3D VIEW.

EMERGENCY GASTROENDOSCOPY  REMOVE ONE FISHBONE 3 CM.

Nota= VUD published 18 cases of fishbone ingestion, including 4 cases of perforation of stomach that were removed endoscopically 2 cases.