CASE 568: SUBACUTE THYROIDITIS DE QUERVAIN, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 76 yo with past history of 10 years  partial nephrectomy for RCC of left kidney.

General check up in present time detected one mass in thyroid left lobe, size 4cm x 3 cm.  

US1: crossed section of left lobe  thyroid=  solid tumor with microcalcification, inhomogeneous structure.

US2 : one small lymph node near jugular vein.

US3 : CDI = hypervascular tumor.

US4 : elastostrain scanning =  mapping color of this tumor, hard with high kPa.

Ultrasound report  is TIRADS-4 . 

FNAC   REPORT IS  TUBULAR STRUCTURE  OF THYROID TISSUE.

OPERATION  FOR LEFT THYROIDECTOMY.
MACROSCOPIC  SPECIMENS.

Microscopic report is  SUBACUTE THYROIDITIS DE QUERVAIN.

REFERENCE CASE    SUBACUTE  THYROIDITIS DE QUERVAIN--GRANULOMATEOUS CELL  THYROIDITIS

CASE 567: TESTICULAR TORSION, Dr PHAN THANH HẢI, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

BOY 17 YO  PAIN AT LEFT TESTIS.  EMERGENCY DIAGNOSIS IS ORCHITIS . MEDICAL TREATMENT FOR 20 DAYS  BUT STILL PAIN  AT LEFT TESTIS.

ULTRASOUND  CHECKS SCROTUM  

US1 =  AT LEFT TESTIS   SIZE 4CM  HYPOECHOIC TESTIS,  HYPERECHOIC EPIDIDYME   WITH SMALL FLUID AROUND TESTIS.

US2 =  COLOR DOPPLER NO VASCULAR SIGN IN LEFT TESTIS   BUT HIGH  VASCULARIZATION  IN TESTICULAR CORD.

US3 = CROSSED SECTION VASCULARIZATION ONLY ONE PART OF EPIDIDYME

US4 = ELASTO US OF LEFT TESTIS  BY STRAIN TECHNIC  IS  VERY HARDENING  INHOMOGENOUS IN

COMPARISON TO RIGHT TESTIS  

US5  = CDI  POOR VASCULAR SIGN IN LEFT TESTIS  

US6 =  ELASTO OF RIGHT IS  SOFT TESTIS HOMOGENEOUS  STRAIN  SCORE

CTCE  OF TESTIS  HYPOPERFUSION AT LEFT TESTIS  

ULTRASOUND  REPORT IS  TORSION OF LEFT TESTIS AVASCULAR NECROSIS  

EMERGENCY OPERATION DETECTED AND REMOVED LEFT TESTIS NECROSIS IN BLACK.

MICROSCOPIC REPORT  IS TESTIS  NECROSIS.

CASE 566: PERIVASCULAR TUMOR, Dr PHAN THANH HAI, Dr HO CHI TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 36YO  DETECTED  ONE MASS AT THE LEFT THIGH,  PAINFUL  PALPATION.

ULTRASOUND OF  THIS MASS.

US1:  THE PERIVASCULAR TUMOR  OF LEFT FEMORAL ARTERY  HAD HYPOECHOIC PATTERN ,  SIZE 4 CM  AND THE FEMORAL ARTERY IS STILL IN THIS MASS.

US2 : THE LEFT FEMORAL VEIN  DILATED  BUT  FEMORAL ARTERY IS NOT STENOSIS

US3 : COMPRESSION OVER THIS TUMOR  THE FEMORAL VEIN IS COMPRESSIBLE  

US 4:  CROSSED SECTION THIS MASS  THE ARTERY LUMEN STILL HAD NORMAL FLOW.  

SONOLOGIST SUSPECTED  THAT TUMOR OF PERIVASCULAR FEMORAL ARTERY.

MRI  OF THIS MASS  SHOWED  THIS TUMOR FROM THE WALL OF ARTERY  ( MRI1) 

MRI2  VEIN DILATATION.

CT ANGIO: NORMAL  FLOW OF LEFT FEMORAL ARTERY.

Operation  removes the tumor covered around  left  femoral artery.

MICROSCOPIC REPORT OF THIS TUMOR IS  LEIOMYOMA  OF VASCULAR WALL  ( ANGIOLEIOMYOMA).

REFERENCE CASE  

For 9 months post op: only removing tumor, now pain and touchable  beneath scar, the perivascular tumor is in recurrence.

CASE 565: SUPRARENAL AORTIC ANEURYSM, Dr PHAN THANH HAI, Dr LE TU PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 72 yo with pain at RUAQ.

CHEST X-RAYS AND  SPINE  X-RAYS CANNOT DETECTED  ABNORMAL.

US SCANNING OF EPIGASTRIC AREA  DETECTED ONE MASS NEAR AORTA IN RETROPERITONEUM  # 4 CM   WITH DOPPLER  FLOW IN THIS MASS

US 1: PW DOPPLER SHOWS ARTERY FLOW PATTERN

US 2: THIS FLOW IS CONNECTED TO AORTA.

MSCT CE AORTA   

CT1 = CROSSED SECTION AND FRONTAL VIEW  THIS  MASS IS ANEURYSM WITH  BLOOD CLOT INSIDE  

CT2 = 3D VIEW  THIS SITUATION IS  CLOSE  BY SMA AND RENAL ARTERY 

EMERGENCY ADMITTED TO HOSPITAL FOR  TREATMENT PLANNING.
Operation for devascularization  SMA and renal artery  (DSA 1)AND  PUT STENT IN AORTIC ANEURYSM (DSA 2).

AFTER OPERATION  IN ICU  ULTRASOUND POCKET AT BEDSITE WITH BUTTERFLY IQ  MAKES SURE AORTIC FLOW.

CASE 564: VAGINAL CUP, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 35 yo  goes to general ultrasound check up .

Ultrasound scans at pelvis detected  uterus  had IUD T shape.

 U S 1  cervix deformation looks like tumor on longitudinal scan with   some echogenic things around the vagina.

U S 2  longitudinal scan  cervix  and vagina

U S 3:  crossed section scan  cannot see well  cervix by echogeneicity prothesis

 U S 4: scan at uterus  detected T shape IUD.

MSCT scan  detected a vaginal cup covered over cervix.

Conclusion:  we should know  some abnormal pictures due to vaginal cup.

CASE 563: ILEOCECAL TUBERCULOSIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

MAN 41 YO  with CLINICAL COMPLAINT about HYPERPERISTALTIS AT RLAQ due  to SUB-OCCLUSION OF BOWEL. 

ULTRASOUND  AT  RLAQ   

US1  SHOWS THICKENING of THE WALL OF ILEUM   

US2 COECUM WALL

US3  MANY LYMPH NODES AROUND ILEO-COECAL AREA

MSCT WITH CE    

CT1  CROSS SECTION THE COECUM , THICKENING OF THE WALL AND SOME LYMPH NODES  ENHANCED CE 

CT2  = FRONTAL VIEW OF  ILEO-COECUM

COLONO ENDOSCOPY   REPORTS  STENOSIS AT ILIO-COECAL JUNCTION ( PHOTO ENDOSC).

OPERATION OF  LAPAROSCOPY AT  FIRST   DETECTED COECUM  CHANGES SURFACE  NODULAR  ( IMAGE LAPARO)

SURGERY RESECTION of the USPSTF's COECUM AND 50CM OF ILIUM  ( FOTO MACRO)

MICROSCOPIC REPORT IS  TUBERCULOSIS OF  ILIO-COECUM AND  LYMPH NODES.