CASE 547: MONDOR'S DISEASE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

WOMAN 60YO WITH PAIN AT RIGHT UPPER QUADRAN OF RIGHT BREAST. 

ULTRASOUND DETECTED  ONE MASS  NOT CLEAR BORDER  WITH ONE TUBULAR STRUCTURE  LOOKED LIKE  A  THROMBOSIS  OF VEIN .

PRESSURE OVER THERE IS PAINFUL.

(US1).

CROSSED SECTION  THIS STRUCTURE ( US 2) .

US 3 : WITH COLOR DOPPLER  THIS STRUCTURE IS NEARBY AN ARTERY.

US 4 : WITH PDI  THIS MASS IS NO FLOW IN COMPRESSION.

US 5 : ELASTOGRAPHY  THIS STRUCTURE IS HARD BORDER .

MAMMOGRAPHY XRAY   

M1   THE RIGHT BREAST VASCULAR STRUCTURE  HAD BEEN DILATED 

M2  ZOOM THIS MASS .

M3  ANOTHER VIEW 

SUMMARY = ONSET PAIN  NOT TRUE A MASS TUMOR  WITH   TUBULAR STRUCTURE  AS A VEIN THROMBOSIS. THE DIAGNOSTIC IS  MONDOR'S  DISEASE.

Image history of Dr Henri MONDOR.

CASE REPORT PDF.

CASE 546: LUNG CANCER, Dr PHAN THANH HAI, Dr HUYNH TRAC LUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 52 YO WITH  PROLONGED COUGH.     
CHEST X-RAYS DETECTED A  MEDIASTINUM TUMOR.

MSCT with CE  =
CT  LUNG 1:   FRONTAL VIEW:  LARGE NECK BY LYMPH NODES. MEDIASTINUM  ENLARGED BY MANY LYMPH NODES  AND LEFT LUNG TUMOR.

CT 2 :  CROSSED SECTION,  TUMOR OF LEFT LUNG WITH LYMPH NODES in MEDIASTINUM.

CT 3: LEFT LUNG TUMOR .

CT 4: SUPRACLAVICULAR LYMPH NODES  BOTH 2 SIDES.

ULTRASOUND OF THE NECK   

US 1=  BIG LYMPH NODES AT RIGHT SUPRACLAVICULAR AREA.

US 2 = AT LEFT SUPRACLAVICULAR  AREA , NODE SUSPECTED  METASTASIS.

BLOOD TESTS =CYFRA 21-1 : 3.05 ( N=  3.3)  PROGRP : >5000 pg/ml( N=65)

ACTH  282 pg/ml (N= 7-63)    CORTISOL  23 pg/ml (N=  6.2-19.4)

Biopsy of  right supraclavicular  lymph node.

HISTOLOGY REPORT WITH  IMMUNO STAINING IS  SCC.( NEUROGENIC ENDOCRINE TUMOR).

REFERENCE    Pro-GRP  [Pro-gastrin-releasing peptide] TEST for small cell carcinoma.

NOTA= VUD published 2 cases of SCC from 07 cases of lung tumor topic.

CASE 545: AORTIC DISSECTION, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 72 yo with epigastric pain and back pain.

Ultrasound of abdomen   detected   aortic  dissection.  

US 1 : longitudinal scan of aortic  epigastric area  having of septation intra aortic lumen, double lumen sign,  to lower division.

US 2 ,  US 3 : Doppler  flow.  

US 4 : crossed section,  Doppler flow  of

echocardiography detected dissection of aorta.

MSCT angio= CT 1   crossed section  of  aortic arch

CT 2= crossed section of aorta shows double lumen in  epigastric area.

CT 3 =longitudinal scan of aorta.   

CT 4 = 3D  view of  aortic  thoraco-abdomen.

Conclusion : ultrasound detected thoraco-abdomen aortic dissection.

Treatment :  Intervention of stenting graft for aortic arch.

NOTA= In a survey of AAA at Medic Center for 10 years (1990-2000), 246/987 cases of AAA dissecting were detected and documented by ultrasound and CT scanning confirmed, # 24.9%, that had been prothesis grafting later in Binh dan hospital.

CASE 544: GASTRIC PERFORATION DUE TO FISHBONE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

MAN 53 YO WITH EPIGASTRIC PAIN HAS BEEN  TREATED AS GASTRITIS BUT NO RESPONSE.

ULTRASOUND OF ABDOMEN  DETECTED ONE ECHOGENIC BODY AT ANTRUM. 

US1/US 2 LOOK LIKE  FOREIGN BODY.

MSCT of ABDOMEN  ALSO  DETECTED  FB(  FORGEINE BODY )  3 CM  AT ANTRUM  

CT 1 /CT2 :SAGITTAL  SHOW THAT PENETRATING THE WALL ofANTRUM TO PANCREAS.

CT3  3D VIEW.

EMERGENCY GASTROENDOSCOPY  REMOVE ONE FISHBONE 3 CM.

Nota= VUD published 18 cases of fishbone ingestion, including 4 cases of perforation of stomach that were removed endoscopically 2 cases.

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.