DISCUSSIONS
Case 1= Pneumomediastinum
Case 2= Fracture of left clavicule
Case 3 = Sealed - off right pleural effusion
Ultrasound could find out the abnormalities of 3 cases above but it need to confirm the diagnosing for them by other imaging modalities.
A 56 yo male patient undergoes hoarse voice for 6 months after screaming, now out of breath talking loud voice.
Laryngoscopy= Left apical arytenoid cartilage incompletely closed.
Cardiac ultrasound detected descending thoracic aneurysm witth aortic wall lesions.
MSCT confirmed atresia of left vocal cord and descending thoracic aneurysm in saccular form, non dissecting.
The recurrent laryngeal nerve RLN *from vagus nerve * supplies muscles of the larynx with the posterior and lateral cricoarytenoid.
In the case, descending thoracic aneurysm with aortic wall lesions may damaged the left RLN nearby which makes him the hoarse voice.
A 43 yo female patient found herself a mass of left thoracic wall for one month. It is painful when she palpates it and moves her left arm.
Mammography and breast US in Vietnam detected nothing abnormal. PET-CT in Singapore was normal.
Female patient 55yo loss of weight 7 kg for 4 months with bad feelings of contracting her muscle trying to empty her bowels. There was no blood stool, but existing abnormal uterine bleeding. Digital rectal exam revealed a rigid, mobile mass at posterior wall that suggested a rectum cancer which took part of 1/3 of lumen of the rectum.
MSCT whole body detected thickening of rectum wall that adhered uterus, captured contrast and blurred fatty tissue around. Results confirmed a rectum cancer invading around with some pelvic lymph nodes.
Ultrasound detected left kidney hydronephrosis grade 2 as a hyperechoic mass # 47x35mm inside renal pelvis that suggested a transitional cell cancer (TCC).
CT Scan: Soft tissue mass was in renal pelvis and ureter, d= 30 x 50 mm that highly captured contrast media while left kidney was in poor secretion of contrast. CT confirmed a left TCC.
It existed red and white blood cells and bacteria in urine analysis.
Endoscopic biopsy results was high malignancy uroendothelial carcinoma invaded the renal stroma.
Pathological results : Transitional cell carcinoma poorly differentiated invaded parenchymal kidney. Non existed malignant cell in lymph nodes.
Female patient 32 yo, loss of weight #10kg with epigastric pain and nausea for 2 months.
She herself took gastric drugs for a while but failed so went to Medic for a new examination.
Ultrasound of abdomen at Medic revealed many lymph nodes that were suspected metastatic nodes and mesenteric thickening; stomach walls infiltrated thickening and slight splenomegaly.
Gastric endoscopy showed gastric corpus roughly inflammed. Results of biopsy were inflammed submucosa layer of stomach and chronic inflammation of duodenum suspected due to TB infection.
MSCT confirmed that existed a lot of lymph nodes at hepatic hilus, lesser curvature of stomach, around celiac axis. These nodes maybe belong to TB nodes.
Result of biopsy of intraabdominal lymph nodes was TB inflammed nodes.
TB of stomach is still a rare entity, which is about 1-2% of GI tract tuberculosis and in 0.5% of patients contracted with TB. Usually it is secondary after the pulmonary TB infection.
Our patient is now getting better status, gained more 2 kg of weight while being taken TB drugs for 2 months of 6 month-regimen of therapy.
