CASE 698: HTA YOUNG PATIENT with 2 RENAL ARTERIES each side, Dr PHAN THANH HẢI, Dr PHAN THANH HẢI PHƯỢNG, Dr HỒ KHÁNH ĐỨC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 47 year-old HTA male patient with feelings of his heavy chest. His history notes 2 times of syncope and suffering from HTA since his ages of seventeen.

Ultrasound feels uncertainly about a  50% stenosis of renal artery which its diameter is # 7.5 milimeter.

Renal structures and sizes seem being in normal limits.

Chest X-RAY film is normal and his EKG results ischemic heart disease.

Lab data shows renal insufficiency: eGFR 37mL/min/1.73m2; creatinin 2.2mg/dL;  and hyperuricemia with serum urea 65.84mg/dL

At last, DSA detects 2 renal arteries each side that belongs to a renal artery malformation (bilateral duplication of renal artery).

So the male patient with renal duplicated arteries might be suffering from parenchymal nephropathy /and due to gout.

REFERENCE

Renal arteries are a pair of lateral branches from abdominal aorta. Normally each kidney receives one renal artery. However, accessory renal arteries can also exist. The normal renal arteries enter the kidney through its hilum where as the accessory renal arteries might enter the renal artery through the hilum or through the surfaces of the kidney. Knowledge of the variations in the renal arteries is important for urologists, radiologists and surgeons in general.

Accessory renal arteries are common in 20–30% of individuals, usually arising from the aorta above or below the main renal artery. The variation in the number of arteries is because of persistence of lateral splanchnic arteries or due to the persistence of blood supply from lower level than normal.

CASE 697: STOMACH GIST, Dr PHAN THANH HẢI, Dr PHAN THỊ HƯỜNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 47 year-old female patient with a gastric tumor at lesser curvature which was incidentally revealed by ultrasound.

But gastroendoscopy result was only a gastritis.

Later MSCT confirmed a 50x58 mm gastric wall tumor maybe a stomach GIST. The tumor captured CE inhomogeneously and grew out of its way to compress the other organs around in abdominal cavity.

Robot surgery removed entirely the gastric tumor and recreated the cardia. The histopathological result is gastric GIST.

REFERENCE:

A 53 yearale patient with a gastric tumor which is spontaneously evealed 

CASE 696: PRIMARY CLEAR CELL HCC, Dr PHAN THANH HẢI, Dr NGÔ THỊ HUYỀN TRANG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

  

A male patient 53 year-old with tumor in right lobe of liver and negative WAKO tests.

A 55 x 42 mm liver tumor is observed on ultrasound in segment 7. It is almost uniform, well-limited, weakly vascularized, and exhibits elastography ultrasonography SWE that is five times harder than hepatic parenchyma, measuring 29 kPa as opposed to 6.3 kPa. HCC risk testing is negative with WAKO.

MRI with Primovist confirms a 50 milimeter clear cell HCC (CC-HCC). T2 CE captured signals are higher than liver parenchyma and  lower than on T1. 

Biopsy results of tumor is an HCC well differentiazed.

REFERENCE:

Hepatocellular carcinoma (HCC) is a common cancer world-wide with a higher incidence in Asia. Clear cell variant of HCC (CC-HCC) has a frequency ranging from 0.4% to 37%. The presence of 90-100% clear cells is rare.

CASE 695: Fasciola sp, UNUSUAL CAUSE of THICKENING of G I TRACT, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, Dr LÊ ĐÌNH VĨNH PHÚC, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

  

Two cases of infected Fasciola sp whose larva migrants having in the same time some hepatic lesions and thickening of duodenum (2023) and right colon wall (2017) that are noted at Medic Center. 

CASE ONE:  A male patient 45 year-old, with history of thyroid cancer in 2013, enters a hospital as nausea, abdominal pain without fever after a ceremony buffet one day before.  Ultrasound detects hepatic lesions, and MRI  later reveals lesions in caudate lobe of liver and duodenum D3 wall thickening that is thought a case of infiltration of lymphoma on GI tract and liver.

But lab data notes raised highly the eosinophil proportion (48%) and positive Elisa tests for Fasciola sp and Gnathostoma.

Ultrasound of Medic Center confirmes liver lesions  and  duodenum D3 wall thickening  that maybe concludes due to infected parasites.

After 6 weeks managed by medical parasite drugs for Fasciola sp the male patient remains well; liver lesions reduce its sizes and duodenum wall gets normal on ultrasound and abdominal MSCT , and getting downed the eosinophil proportion.

CASE TWO: 

A female patient with Fascioliasis lesions in her liver and her right colon wall thickening in the same time which were detected by ultrasound and MSCT. 

Endoscopic biopsy of colon result was epithelial inflammation with eosinophil white blood cells.

She was managed successfully as Fasciola visceral larva migrants.

Larva migrants, especially for Fasciola sp, have a classic site in liver and biliary tree in acute phase and chronic phase. 

It exists two cases of larva migrants going outside the liver and biliary tree, to GI tract. If having lesions of it in liver or biliary tree one should not forget to find out larva migrants in another place.

REFERENCES:

https://www.nguyenthienhung.com/2008/10/c-im-siu-m-tn-thng-gan-do-sn-l-gan-ln.html?m=1

Ultrasound and Fascioliasis at MEDIC CENTER, Vietnam (slideshare.net) Oct, 21, 2013

CASE 694: SPONTANEOUS SPLEEN LACERATION, Dr PHAN THANH HẢI, Dr NGUYỄN NGHIỆP VĂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A male patient 56 year-old  with one day of pain at left side of abdomen, obesity, and five-year chronic leukemia.  His history is noted splenohepatomegaly and cirrhosis and controlled type 2 diabetes. 

At Medic Center ultrasound detects free fluid in abdomen and big spleen with hematoma inside which makes thought about a spontaneous spleen laceration without any injured causes in spite of spleen infarction.

MSCT  with CE confirmes a spleen rupture with subcapsular hematoma and free fluid in the abdomen.

Surgery in emergency is done to remove the # 180x120x80 mm spleen and hemostasis procedure.

At the middle of anteromedial face of spleen it exists a #50 mm long  and 30 mm deep laceration line. Bloody fluid in abdominal cavity is an amount of 1.8 liter.

The patient goes through successfully the operation  but comes back with an 80x89 mm spleen bed abscess which is solved by medical management.

 

Chronic leukemia and obesity and DM may induce a spontaneous spleen laceration.