CASE 111: MASS in FEMORAL TRIANGLE POST PROSTATECTOMY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Man 80 yo suffered from prostatectomy as cancer for 2 years. Now he has got a big mass of 6 cm at left Scarpa triangle. On ultrasound examination this mass is round, well bordered limit, hypoechoic, look like a cyst. Doppler spectrum is in high PSV.

There were 3 reports of ultrasound of the mass from 3 doctors as abscess,  metastasis from prostate cancer or lymphoproliferative syndrome.

His PET-CT scan report is very high isotope uptake.

Prostate and  the inguinal mass core biopsy were done.  The result  were  prostate cancer recurrence and metastase of inguinal lymph node (see first report biopsy)

In clinical examination this inguinal mass is big of 6 cm and in not common site of metastase from prostate cancer. Color doppler this mass  reveale look like a  big lymph node, with hilus present, no filling defect  area inside this mass, and it is in black like a cyst with strong posterior enhancement.

After one month treatment as prostate cancer, this mass was growing up bigger and able to compress the venous return. DVT of the left leg appeared. FRAXIPARINE is  in use  in short time and surgery  for removing this mass.(image below: the mass after one month).

Microscopic report this mas is lymphoma B-CELL type.

DISCUSSION

                     1-  It is a case of 2 kinds of cancer on one patient.
                     2-  Ultrasound this mass was not correct with first diagnosis as metastase from prostate cancer.
                     3- This mass is look like lymphoma as having very black echostructure.

CA 110: HEPATIC VEIN and PORTAL VEIN SHUNTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Woman 49 yo, anemia and big liver. Ultrasound liver detected hypoechoic area at segment 7,  the hepatic vein dilatedand shunt to vena porta. PW Doppler of hepatic vein showed that high hepapedal  flow

It is vascular malformation or patholgy (see 4 us images )?

MSCT ANGIO of LIVER find out that righ lobe of liver lesion having  hypodense pattern and high contrast enhance at arterial phase. It looks like HEPATIC HEMANGIOMA.

All blood tests have no evidence of viral infections. AFP, CEA values are negative.

SUMMARY: Ultrasound of liver with B mode has limit in characterization of hepatic lesion.

CASE 109: WHY DOES STONE KEEP MOVING in CBD ?, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Male 72 yo, past  history cholecystectomy and  remove stone in CBD. Now  pain at RUQ  and  fever. Ultrasound emergency  shows a round  spot  moving in CBD. See video, what is this?

Looking the video, this round spot had posterior shadowing and  moving.  ERCP removed the biliary stone. But why does it move in CBD.?