A 43 year-old woman with right upper abdominal pain for 3 months but failed with unknown treatments.
Ultrasound at Medic Can tho detected a 78×100 mm solid hypoechoic mass with Doppler signals inside and noted a mesenteric tumor.
MSCT confirmed a # 98x76x91 mm mass in soft tissue density which adhered to stomach wall maybe an exophytic gastric GIST.
Endoscopic surgery removed the tumor and microscopic result is a gastrointestinal GIST.
A 15 15 year-old male child with dysuria and had been failed in treatment for urinary infections many times in history.
Ultrasound detected a # 4x5 cm solid mass at right anterior face of urinary bladder with a calcified spot inside.
MSCT noted an urachal remnant adhesive to bladder or bladder tumor.
Bladder endoscopy removed the bladder tumor, and microscopic result is glandular cystitis.
A 40 year-old man in check-up was detected a # 39x45 mm mass nearby the head of pancreas by ultrasound. Sonologist noted a mesenteric tumor or GIST.
A 64 year-old woman with fatigability in general check-up.
Neck ultrasound incidentally detects a right 16×11mm parathyroid tumor in right posteroinferior face of thyroid.
Laboratory findings note PTH value highly raised but not raised calcemia value. Osteogram notes her osteoporosis status with the bone fracture risk 6 times more.
Parathyroid Scan BIMI-99 Tc confirms a right parathyroid tumor.
Summary
Normocalcemic hyperparathyroidism is a newly described variant of hyperparathyroidism.
It is defined as persistently low or normal corrected or ionized serum calcium levels taken at least six months apart in the presence of elevated parathyroid hormone levels.
It may be primary or secondary. Normocalcemic secondary hyperparathyroidism is treated medically, while primary may need surgery.
….
The initial diagnostic approach for the patient is to rule out all secondary causes of hyperparathyroidism.
Normocalcemic primary hyperparathyroidism may be present in up to 17% of all cases of elevated PTH.
While usually asymptomatic, over one-third of nPHPT will progress to symptomatic bone disease or nephrolithiasis.
Familial hypocalciuric hypercalcemia needs to be ruled out. This can generally be done via a low calcium/creatinine clearance ratio.
Cerebral ischemic diagnosing bases on spontaneity of decreasing and loss memory and vision. And Face Arm Speech Time [FAST] scale. Roles of diagnostic imaging in cerebral ischemia are exactly detecting and rapidly in time (less than one hour).
CASE 01:
A male patient 55 year-old with left eye blurred vision and left dull headache for 2 days. 8 months ago his right arm was in weakness in 2 hours. History notes no FAST, without HTA, DM, except smoking for 30 years.
Brain MRI notes left brain ischemia at occipital region in small area and leukoaraiosis.
CTA notes the left ICA occlusion and the left middle cerebral artery is enhanced from the left anterior cerebral artery.
CASE 2:
A HTA male patient 63 year-old with spontaneous loss memory after a critical headache for 6 days. His history is smoking and alcohol beverage for 40 years. No FAST. No loss vision.
Vascular ultrasound notes plaque at the right ICA origin which narrows up 90% lumen and total left ICA occlusion (NASCET), ICA/CCA ratio> 2.
Brain MRI shows large cerebral ischemia, occlusion of the left middle cerebral artery and the left ICA.
REFERENCES: [for vascular ultrasound]
A HTA 65 year-old female with chest pain, mild apsnea and without gastroenterological symptom.
Ultrasound incidentally detects a 37x29 mm hypervascular hypoechoic mass which seems to be from the small bowel at her left abdomen.
Because of the rare incidence of small intestine (SI) tumor and in SI GIST, sonologists choose a SI polyp in differentiaziting a SI GIST.
MSCT confirms a 30x40 mm non invasive bowel wall tumor of GIST, strongly captures CE.
Endoscopic examination notes an exophytic jejunum tumor and open surgery removes a small intestine loop which is an adequate clearance of 5 cm upper and lower of the tumor, and performs an end-to-end anastomosis.
Gross specimen is a 5cm bowel intestine that exists at submucosa layer. The tumor section surface is solid, whitish with hemorrhagic ulceronecrosis.
Microscopic studies reveales spindle cells type of GIST with low mitose index.
A 30 year-old female patient with a 13x17 mm right breast tumor goes through breast ultrasound 3 times.
In the first time, results are tumor BI-RADS 4A, FNAC : Fibrocystic changes.
