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Thursday, 13 March 2025

CASE 818: BREAST TB NODE, Dr PHAN THANH HẢI, Dr LÂM CẨM THÙY, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 28 year-old woman with fever and pain her left breast for one week.

Ultrasound detected  a  #12x6.6 mm well-border mass  at 3h o'clock with mixed echo, hypovascular and no fistula nor skin red.


FNAC result was chronic inflammed node maybe a TB mastitis.


Microscopic specimen was a tuberculous mastitis with Langhan cells.



TB regimen for 6 months and TB node became a 9x7 mm inflammed node.



CASE 817: BOWEL VOLVULUS due to MESENTERIC LYMPHATIC TUMOR, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 15 year-old asthenic thin boy with crisii of nausea and colicky pain for ( 3 ? ) years. Failed in management of gastritis HP infected.


Ultrasound detected a malrotated mass with mesenteric vessels inside going to the clockwise.


Beside there was a hyperechoic mass in the pelvis with vessels in the mass.


MSCT confirmed the bowel malrotation and a lipoma in the pelvis.





Surgery was done to remove the #12,5x11mm pelvic mass which was a microcystic lymphatic malformation of the mesentery. It adhered the bowel and caused the bowel volvulus.

The boy gained 10 kilogram and had no pain nor nausea postop.



CASE 816 : PROSTATE CANCER RISK and Low Free PSA, Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM


A 62 year-old man with  low PSA value which is in risk of prostate cancer.


But ultrasound and MRI detected only calcification of prostate.


 The patient belongs the high risk group of prostate cancer in our report 2011 although the normal results of diagnostic imaging.





Tuesday, 11 March 2025

CASE 815: ACUTE CHOLECYSTITIS and CHOLECYSTILOSIS, Dr PHAN THANH HẢI, Dr LÊ THANH TÙNG, Dr VÕ THỊ PHƯƠNG TRINH, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A  78 year-old diabetic man with a colicky pain at RUQ  and nausea in night. Coughing for one month he has been managed antibiotics in time.




Ultrasound detected  a #94x39 mm dilated gallbladder with an impacted biliary stone at the neck of GB and some 8-13 mm other stones in the inflammed GB (# 6mm thickening of the GB wall, anterior wall partial hypoechoic). It existed an amount of fluid around the inflammed gallbladder.










MSCT confirmed an impacted #14 mm GB stone at the neck of the GB.


Emergency endoscopic surgery was done after 8 hours entering the surgical ICU to remove the inflammed GB and peritoneal pseudomembranes.






REFERENCE:








Thursday, 6 March 2025

CASE 814: COMPLICATED DIVERTICULITIS, Dr PHAN THANH HẢI, Dr PHAN THANH VIỆT BÌNH , MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 65 year-old diabetic man with LLQ pain and lose stool for weeks.

Ultrasound detected some diverticula 7-9mm and a mass of sigmoid colon leading to an colo-colonic intussussception ?.


Colonoscopy noted some sigmoid diveticula and a  tumor caused narrowing 70% the lumen of the sigmoid colon.


MSCT confirmed an abscess of sigmoid colon maybe from an acute inflammation.


Surgery removed the sigmoid colon which had some diverticuls and a perforated diverticulum. It existed no tumoral mass of the sigmoid colon.


Microscopic result was  an acute sigmoid colitis having diverticula with a perforated abscess of a diverticulum.


Complicated diverticulitis : perforation, abscess are still rare conditions for MSCT and abdominal ultrasound (POCUS).

REFERENCE:






Friday, 28 February 2025

CASE 813: SPINE TUBERCULOSIS, Dr PHAN THANH HẢI, Dr PHÙ DUNG THÁI BIỂU, Dr TRẦN THỊ HỒNG VÂN, Dr TRẦN VĂN NAM, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

 A 44 year-old man with lumbago to the buttock for months, lumbar pain progressing in coughing and changing body position which failed in analgesics management. 

Ultrasound detected the #85x32mm left psoas muscle abscess with many hypoechoic foci in the upper of left psoas muscle maybe due to TB infection, and hypoechoic lesions in spinal thoracic and lumbar column.








MRI confirmed the vertebral lumbar column lesions from L2-S2 and the soft tissue inflammation of the left psoas muscle [L5-S1].


Lab data was only positive HCV. But positive with QuantiFERON-TB.


TB management of the spine has been done for 9 months. And treatment of HCV infection for 3 months. Lumbago reduced in the first month of treatment. HCV negative after 3 months. And at the 9th month, the spine lesions in recovery phase of TB treatment on Spine MRI.


QuantiFERON-TB in vitro, a ELISA technic (IGRAs) measures the adaptive immunity of T cell CD 4 and T CD 8 in releasing interferon gamma while in contact peptid of TB bacteria [sens 95.3%, spec 97.6%].

Thursday, 27 February 2025

CASE 812: RENAL ARTERIAL STENOSIS, Dr PHAN THANH HẢI, Dr LƯƠNG THANH BỬU, Dr TRẦN THỊ THANH NGA, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 48 year-old diabetic woman with arterial hypertension for 6 years. BP: 211/116mmHg, HB: 89b/min





Lab data was still in normal values, but Doppler ultrasound detected stenosis 70% of the proximal part of the left renal artery and 30% of the right one due to atheroma.



MSCT Agio confirmed the stenosis of renal arteries due to atheromatous plaques.


Stenting successful of the left renal artery and the woman remains well, managed only Amlor per os 01c/day.


The arterial hypertension patient needs a Doppler ultrasound examination of the kidney and vessels to detect the stenosis of renal vessels.