CASE 573: BILIARY HAMARTOMA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 51 YO FOR 5 YEARS CHOLECYSTECTOMY BY GALL BLADDER  STONE, NOW GETTING PAIN IN LIVER.

US SCANNING : GALL-BLADDER HAD BEEN REMOVED. CBD DILATED   OF 3CM IN DIAMETER   WITH DILATATION R/L BILIARY DUCTS IN LIVER  AND  THERE  ARE SOME  SMALL SPOTS LIKE CYST # 0.5 CM.  CBD  IS  STENOSIS AT ODDI AREA  AND NO TUMOR OF PANCREAS.

US1   BW US   US2 CDI 

MRI OF LIVER   

MRI 1  CROSSED SECTION OF LIVER   

MRI 2   CBD DILATED WITH MANY SPOTS  LIKE CYSTS IN LIVER   THAT  ARE HAMARTOMA OF BILIARY CANALS.

ERCP  CANNOT  ENTER THE CBD  (FOTO1, FOTO2)

OPERATION  REPORT   IS  CYST OF CBD AND STENOSIS  OF CBD AT ODDI SPHINTER.

 AND BIOPSY OF MANY SMALL NODULES AT SURFACE OF LIVER   (FOTO CBD).

PROCEDURE OF  ROUX- EN- Y  FOR  ANASTOMOSIS OF CBD AND  DUODENUM.

CONCLUSION = IT IS  HAMARTOMA OF BILIARY SYSTEM  WITH MANY SMALL LIKE -CYSTS OF BILIARY SYSTEM   AND STENOSIS OF CBD  DUE TO  STONE.

CASE 572: PROSTATE CANCER, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 45yo  with pain at sternum. SPECT bone scan detected multiple bone lesions (SPECT photo).

Ultrasound at sternum detects osteolytic lesions. 

Blood test=  PSA rises 92 ng/mL

Transabdominal Ultrasound of prostate  

US 1   section  prostate in small size 

US 2  sagital view also prostate in small size without abnormal focal lesions 

US 3 elastoscan detected abnormal zone inside prostate  

US 4 sagital elastography mapping one zone with kPa high,  #C50 kPa

Biopsy with TRUS elasto guiding;   report is prostate cancer, classified of Gleason core 7

Summary=  US elastoscanning of prostate guiding for biopsy is more accuracy than conventional TRUS guiding alone.

CASE 571: LUNG CYST, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 37YO  COUGH AND PAIN AT LEFT LUNG. 

CHEST X-RAY   DETECTED ONE MASS BILOBULATED ROUND  BORDER  # 3 cm.

TRANSTHORACIC ULTRASOUND SHOWED A CYST  WITH   CLEAR  FLUID.

MSCT  REPORT IS CYST WITH THE CALCIFIED WALL, SOLID STRUCTURE INSIDE CYST .

CT 1   CROSSED SECTION.  CT2  FRONTAL VIEW.   CT3  LUNG WINDOW .

OPERATION REPORT IS AN INFECTED CYST WITH PUS.

CASE 570: PTA, Dr PHAN THANH HAI, Dr LE THI THANH THAO, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 35 yo with small trauma and pain at right limb for one month  (photo).

X-rays show that fracture of the radius but the bone cortical abnormal very think
 (X ray 1, X ray 2). 

Ultrasound made sure that  fracture of the  humerus bone and mass arround the fracture  (US 1, US 2).

Ultrasound of thyroid gland detected one hypoechoic mass look like a cyst #3 cmx 4 cm  at  right lobe (US 3).

Abdomen ultrasound   shows  kidney nephrocalcinosis  and  big cyst at upper pole of left kidney (US 4,  US 5).

Blood tests = PTH very high  976pcg/mL  ( n=  16-65),  calcium =  3,1 mos 

Suspecting  PTA.

OPERATION was done. MICROSCOPIC REPORT IS PTA. 

CASE 569: RLAQ MASS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 44yo with pain and periodic hyperperitaltism at RLAQ for 6 months.

US1: ULTRASOUND  DETECTED AT RLAQ ONE MASS  HYPOECHOIC, MULTILOCULATED # 4 CM.   

US2: AROUND THIS MASS  NEAR CECUM SOME ANSES OF BOWEL DILATED.

US3: PW SHOWS THIS MASS IS LYMPH NODE WITH SANDWICH SIGN. 

US4: ONE ILEUM PORTION DILATED and THICKENING of THE WALL with MATERIALS INSIDE LOOK LIKE THE KIDNEY.

MSCT WITH  CE  :

CT1:  CROSSED SECTION OF  THE THICKENING WALL  OF ILIUM  

CT2 : CROSSED SECTION   THE  MASS  AT ANGLE ILIUM-COECUM  LOOK LIKE  MESENTERIC LYMPH NODES

CT3:  FRONTAL VIEW  IS  TUMOR AT ILUM WITH BIG LYMPH NODES 

GASTRO-COLONOSCOPY IS NORMAL

BLOOD TEST  TUBERCULOSIS WITH QRFERONE TEST IS NEGATIVE, BETA2 MICROGLOBULIN IS  NORMAL  

CONCLUSION: THE TUMOR OF ILEUM WITH BIG LYMPH NODES AROUND  LOOK LIKE MALT. 

OP REPORT IS RESECTION of THIS MASS of ILEUM AND COLON ASCENDING, END TO END ANASTOMOSIS.

MICROSCOPIC REPORT  IS LYMPHOMA.

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.