CASE 184:MEDIC RADIOLOGY CASE 02: MEDIASTINAL LIPOMATOSIS, Dr NGUYỄN VĂN CÔNG - Dr HỒ CHÍ TRUNG , MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male patient 54 yo takes CXR for heath check at Medic Center.

Surprisingly we found a very enlarged heart shadow which oblitrated ½ lower chest on both PA and lateral chest XR.

On cardiac ultrasonography, the heart is within normal limits, but there are abnormal structures surrounding the heart with hyperechogeneicity.

We decided to do a thoracic CT scan to clarify the problem.

The result of CT scan shows a very large structure of  fat density occupied all lower half of the chest and confirmed by surgery and pathology: about 2 kg of fat was removed from lower mediastinum due to mediastinal lipomatosis.

CASE 183: LEFT ARM MASS, Dr PHAN THANH HẢI - Dr LÂM CẨM TÚ, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27 yo,  3 months  ago  detected  mass  at  left  arm  ( foto)  no pain  no trauma  history and slowly  growth.

Ultrasound first  seeing  this mass  is  hypoechoic,  intramuscular, well  bordered  with  very  high  pattern color Doppler.

MSCT  with CE  of  this  mass  filling rapidly contrast  agent  that  looked  like  an A-V  MALFORMATION.

OPERATION REMOVES  EN BLOC TUMOR, WELL BORDERED WITH  OPENED SURFACE   IS CONVEX, LOOKED LIKE BENIGN TUMOR.

MICROSCOPIC WITH IMMUNOHISTOLOGIC STAINING REPORT: Hemangioendothelioma, it is  very rare soft tissue tumor.

CASE 182: Malignant Melanoma of Choroid, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 53 yo,  Binh duong province, loss of right vision for 3 months,  ultrasound and OCT of  Eye Hospital think about melanoma of ciliary body.

At  Medic Center, ultrasound detects a right intraocular tumor, size of 12x10mm, at anterior and internal location, echo rich, round border, no calcification, vegetation and nor posterior shadowing.  It is a hypovascular tumor.  There is a right retinal detachment.

 On elastographic ultrasound with eSie Touch and ARFI techniques ( Acuson S2000, Siemens) velocity of VTI is hard in moderate grade, homogenous, in grey color meanwhile tumor is hard and homogenous in eSie Touch ( black and blue).

MRI reveals an intraocular tumor on right eye, which is from ciliary body, size of 12x11mm, low signal on T2W1, and high signal on T1W1 and T1GRE,  lightly catched Gado, and no extraocular invasion. Follow-up  a Choroidal-Ciliary Melanoma.

Surgery was done on 15-4-2013,  microscopic result :malignant melanoma of the choroid.

 

CASE 181: APPENDICULAR MUCINEOUS CARCINOMA and INTUSSUSCEPTION, Dr PHAN THANH HẢI - Dr VÕ NGUYỄN THÀNH NHÂN , MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 73 yo has  pain at  right pelvis for 6 days, crisis, hyperperistalsis. Ultrasound  shows  one cystic mass  nearby  urinary bladder, with size of 4 cm, round  border with the neck connecting to lumen of  intestine.

See 3  ultrasound pictures with 3.5 MHz curve probe, and with  linear probes 12 MHz; this cystic mass has multilayer wall, calcification of the border, the fluid is cloudy. This cystic mass  is  moving  with  hyperperistalsis due to intussusception (3 images).

On MDCT this  mass is cystic,  intra  intestine lumen,  portion of  terminal ilium.

This case has emergent onset. Ultrasound first says that intussusception, but don't know what  the cyst is; MDCT  suggests an appendicular mucocele. Do you agree with the idea ?

Operation is laparotomy which detects  right colon very mobile with one mass at appendix site.

Procedure is right hemicolectomy. In macroscopic dissection, specimen is an appendicular mucocele.  Wait for confirmation of microscopy.

The  clinical  case  of  intussusceptions  in  old  woman  has  the cause. Ultrasound   detects  cystic  mass  close to urinary bladder  which  is  not common cause  for  ileo-colic  intussusception.

 MCDT  reveals   cyctic mass  intra intestinal  lumen with  mural calcification is  the key point  for   diagnosing  this case.

Microscopic report  is mucinous carcinoma of appendix.

REF  : Appendicular Mucocele as Cause of Intestinal Intussusception

CASE 180: AV FISTULA POST OP MIDDLE EAR SURGERY for 10 YEARS, Dr LÊ THANH LIÊM, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 Male patient 30 yo underwent a middle ear surgery for  10 years. After  surgery about  2 years, a posterior ear mass appeared and getting its size bigger .

 There are thrills in the mass, and it is collapsed with palpation.

 Ultrasound detects tortuous dilatation of subcutaneous vasculature at temporoparietal area on right side and around right auricular area, Doppler shows continuous  flow pattern which is thought to be an AV fistula post op.

  MDCT confirms an AV fistula on 1/2 right head which is supplied by superficial temporal artery and drains away by facial and right jugular veins.

CASE 179: CHRONIC DIARRHEA and CAPSULE ENDOSCOPY, Dr PHẠM CHÍ TOÀN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Clinical history=

Female, 91 years old, Nha be district. For 3 months: watery diarrhea without blood (over 10 times/day), no abdominal pain. Treated by many doctors and medical centers, but diarrhea did not stop.

Tropical disease hospital admission: failed treatment after a month and transmitted to Binh dan hospital.

v  Lab test: normal, Abdominal US,  CT scan: normal, UGE : normal, Rectosigmoid endoscopy: normal. Stool test: negative, suggestion : capsule endoscopy.

v  Capsule Endoscopy= Many worms with the appearance of Ankylostoma in jejunum and ileum and inflammed mucosa of small bowel.

Diagnosis=Enteritis due to parasite (maybe Ankylostoma duodenale).  Internet : some case reports like this.

Treatment=

Suggestion : stop using all kinds of drugs including antibiotics, start with Zentel 2 tablets a day/ 3 days. Diarrhea improves in getting down : 10 times and 6 times and 4 times and 2 times. Discharge. Suggestion: repeated Zentel after a week, now normal stool.

Conclusion=

Few case reports, besides anemia, acute or chronic diarrhea sometimes happens. Easy and simple treatment.

But the worm name should be proved by ELISA test for Ankylostoma.

CASE 178: CHORDOMA, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

56-year-old female patient from Tra Vinh province. She's undergoing  low back pain  more than 1 year, recently appeared constipation. Spinal x-ray shows destruction of the sacrococcygeal bone. 

 

Ultrasound shows lesion that is a  heterogeneous hypoechoic solid tumor, size 72 x42 x 62 mm, inner tumor to be calcified.

 

 

MRI shows tumor from sacrococcygeal bone, dimension = 5 x 6.5 x 7cm, high density on T2W1 and low on T1W1.

 

Patient underwent surgery at Cho Ray hospital. Histopathologic report is  chordoma.