CASE 543: PELVIC WALL ABSCESS, Dr PHAN THANH HAI, Dr HO CHI TRUNG, Dr VO NGUYEN THANH NHAN, Dr NGUYEN THANH DANG, Dr LE THONG LUU, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Male patient 31yo with right pelvic pain for some weeks in deep palpation.

X- Rays : Normal chest and vertebral column.

Blood tests : WBC , hs CRP : normal.

Ultrasound of pelvis:

Mass with mixed pattern of structure presses on urinary bladder that connects retroperitoneum and covers right poas muscle.

 Mass goes forward under right pelvic wall and presses on peritoneum.

And enters muscle layers of right pelvic wall.

A diagnosis of pelvic abscess is made by sonologist.

MSCT : Lesion in right pelvic wall#5x8cm, cystic , multicrescent, thick capsule with septation which takes contrast and presses urinary bladder and goes down to right inguinal canal. Radiologist thinks about a pelvic wall abscess.

MRI : Right pelvic abscess in retroperitoneum goes forward that presses on urinary bladder then goes upward to right pelvic wall muscles.

FNAC withdraws some milky fluid, like abscess fluid.

Core biopsy  results TB pelvic abscess.

A 6 month TB planning is done for this patient.

CASE 542: NECK TUMOR LIPOMA, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 65 yo with  history of 5 years ago having a tumor at right neck that  was in growth slowly and no pain nor voice change (photo).

In examination, this mass is soft and mobile.  

Ultrasound,   

US 1 :  crossed section of this mass is subcutaneous  structure as fatty tissue,  size of 5

x 4 cm.

US 2 : this tumor  deplaces SCM and  not  connected to  normal thyroid gland.

US 3 : this tumor is nearby right CCA.

MSCT of the neck,    

CT 1=  crossed section, this tumor is subcutaneous, hypodensity,   out of thyroid gland.

CT 2=  frontal view,   this tumor  has CT density HU  IT  FROM SUB MENTAL AREA TO THE CLAVICULAR AREA.

CT3 = FRONTAL VIEW, THIS TUMOS HAD SEPTATION.

CT4 = CROSSED SECTION  TUMOR.

RADIOLOGIST DIAGNOSIS IS SUBCUTANEOUS LIPOMA.

OPERATION FOR REMOVE THIS TUMOR.

Operation removed this tumor and some cervical lymph nodes.

Microscopic report is lipoma.

Reference of case report.

CASE 541: RIB TUMOR, Dr PHAN THANH HAI, Dr HO CHI TRUNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman 45 yo  with pain at left thorax.   
Chest X-rays detected one mass at left  lower lung.

Ultrasound detected this mass from thorax wall.  US 1 :  solid mass  hypovascular.

US 2:  crossed section of this mass is round border freely with pleural space.

US 3 : longitudinal scan of this tumor is  hypovascular.

MSCT with CE of thorax,  this tumos is from 9th  rib, size 9cmx5 cm   ( CT 1  cross section,  C T 2   sagittal  section,   CT 3  3 D  view).

Biopsy of this mass is cavernous hemangioma.  

Operation for resection this tumor is done.
See tumor specimen.

Microscopic report is metastasis from thyroid cancer.

Review MSCT total body of this patient we see the thyroid tumor and liver focal which suspected metastasis from thyroid cancer.

Notes: This case is one of 18 thyroid cancer cases  and one of 4 cases bone metastasis published on VUD.

CASE 540: URINARY BLADDER TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 32 YO  with HEMATURIA.  

ULTRASOUND of ABDOMEN.  

US 1 : LONGITUDINAL SCAN AT HYPOGASTRIC  REGION DETECTED  ONE CYSTIC MASS INTRA URINARY BLADDER WALL.  

US 2  : THIS MASS IS  FIXED TO ABDOMEN WALL .

US 3 : CROSSED-SECTION OF  CYSTIC MASS  IN URACHUS AREA.

CYSTO-ENDOSCOPY  DETECTED  ROUND TUMOR  MUCOSA OF UB INTACT.

MRI OF   URINARY BLADDER .

MRI 1, MRI 2  =  TUMOR 3 CM  INTRA UB WALL  CYSTIC 

MRI 3  DWI,   MRI 4 =  TUMOR IS  LOCATED AT URACHUS REMNANT.

OPERATION  FOR PARTIAL CYSTECTOMY.

OPE 1= AFTER  INCISION  THE TUMOR IS CYSTIC FILLED WITH MUCUS.
OPE 2 = FLUID CLEAR AND MUCUS GOES OUT.

MICROSCOPIC REPORT  is urachus cyst .

CASE 539: DENGUE FEVER and ASCITES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 25 YO WITH 3 DAYS  FEVER  AND EPIGASTRIC DISTENTION.

ULTRASOUND  FIRST :  

US 1: HEPATOMEGALY.  

US 2: GALL BLADDER WALL IS THICKENING 3 MM  NO STONE.

US 3:  FLUID IN MORRISON SPACE ( LIVER KIDNEY SPACE).

US 4: FLUID AROUND RIGHT KIDNEY.

US 5: IN PELVIS  BIG VOLUME OF ASCITES.

US 6: NORMAL SPLEEN WITH FLUID IN HILUS.

CHEST X-RAYS SHOWS  SMALL FLUID IN COSTO-PLEURAL SPACE.

BLOOD TESTS  SHOW   WBC HIGH, CRP HIGH  PLATTELETS  DROPPED TO 19K.          

ELISA  DENGUE FEVER TESTS  POSITIVE FOR IgG  AND IgM.

EMERGENCY ADMISSION IN INFECTIOUS TROPICAL HOSPITAL.

REFERENCES:

Role of ultrasound in Dengue hemorrhagic fever in Vietnam

http://www.vusta.vn/vi/news/Thong-tin-Su-kien-Thanh-tuu-KH-CN/Gia-tri-cua-sieu-am-bung-trong-sot-xuat-huyet-Dengue-21155.html
Ultrasound Findings in Dengue Hemorrhagic Fever