VIETNAMESE MEDIC ULTRASOUND DIAGNOSIS

ASCITES due to PANCREATITIS with HIGHLY ELEVATED CA-125 , Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2012-01-02T20:50:00.005+07:00

BOY 15 YO WITH ABDOMEN DISTENTION FOR 01 MONTH. DISCHARGED FROM A LOCAL HOSPITAL WITH SUSPICION OF PERITONEUM CANCER.

ULTRASOUND AT MEDIC DETECTS A BIG AMOUNT OF ASCITES, NO CARDIO- PLEURAL EFFUSION, LIVER, KIDNEY ARE NORMAL AND NO ABDOMINAL MASS. ASCITES IS IN CLOUDY APPEARANCE.

It is free ascites no septation, mesentery moving freely in the fluid.

ABDOMEN TAP: ASCITES IS YELLOW IN COLOR. ANALYSIS IS.. POSITIVE RIVALTA, ADA=16,3 UI/L, CA-125 MORE >1000U/mL.

BLOOD TESTS: ANA, LE-CELL NEGATIVE, BLOOD CA-125=583 UI/mL.

THIS CASE WAS ADMITED IN EMERGENCY BY CHILDREN n0.1 HOSPITAL.

CT SCAN OF ABDOMEN SHOWED DILATATION OF WIRSUNG DUCT, SUSPECTING
PANCREATITIS, AND CONFIRMED BY VERY HIGH BLOOD AMYLASE TEST.

SUMMARY: DIAGNOSING OF ASCITES MUST FOLLOW THE GUIDING CHART OF CHECK
LIST. A RARE CAUSE OF ASCITES LOOKS LIKE CHRONIC PANCREATITIS IS EASILY DIAGNOSIS IF AMYLASE IN LIST FOR ANALYSING.

A LIVER MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-12-29T11:54:00.002+07:00

Case 106 in the end of year 2011.

Man 47 yo, healthy. US check up screening detected a right lobe of liver mass, ellipsoid of 4-5cm in diameter, well-bordered, mixed cystic structure and solid parts, hypovascular with bending sign ( 3 US images with 3.5 MHz and 12 MHz probes)

It is not infected liver due to virus in the past, all cancer markers are negative (AFP, CEA, CA 19-9.)

MRI with gado, looking this tumor likes the white apricot flower, but radiologist susgested that is a HCC.

The result of operation yesterday with macroscopic specimen tumor are clear bordered tumor, in that mixed structure including blood clots and yellow tisue.

The microscopic report is HCC.

SUMMARY: ULTRASOUND IS THE BEST SCREENING TOOL FOR LIVER DISEASE. HCC IS THE FIRST LINE of CHOICE FOR DIAGNOSIS EVEN IF AFP value is NEGATIVE.

SUBCUTANEOUS NODE of SARCOIDOSIS with a 6 YEAR HISTORY of LUNG TUBERCULOSIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-12-21T20:04:00.001+07:00

A 33 yo male patient, with a long history of 6 years ago including fever, cough, and his chest xray and lung CT suspected tuberculosis of the lung and hilar lymph nodes.

After being received antituberculosis drugs for one year, he detected himself many small subcutaneous nodules which are hard, painless at the neck, thorax, and arms.

Ultrasound shows that are hypoechoic nodules of 2-3 cm, ellipsoid. On Doppler color, it is like the vascular hilus of the big lymp node.

Blood tests only have eosinophil elevating.

The first biopsy of neck lymph node in 2006 was tuberculosis ; the second biopsy of submandibular node was chronic inflamation . And the third biopsy at the left arm subcutaneous nodule with previous ultrasound image is SARCOIDOSIS (BBS)..with histoimmunostaining.

Summary:
THE CASE of FEVER, LYMPHADENOPATHY, SUBCUTANEOUS NODULE for 6 year progressing is SARCOIDOSIS. IT IS A MISDIAGNOSING AS TUBERCULOSIS OR LYMPHOMA.

CECAL TUBERCULOSIS MIMICKING TERMINAL ILEUM INTUSSUSCEPTION, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-12-05T19:56:00.001+07:00

MAN 50YO FROM BD HOSPITAL REQUESTS URGENCY CT OF ABDOMEN AS ABDOMINAL PAIN AT RLAQ 3 DAYS AGO.

US SCAN BEFORE CT SHOWED ONE ROUND BLACK MASS OF 3CM

CROSS-SECTIONAL SCAN

LONGITUDINAL SCAN

LOOK LIKE CERVIX OF UTERUS, BUT IT WAS SEEN AT RLAQ.

RULE OUT APPENDICITIS.

CT SCAN REPORTED THAT WAS A TERMINAL ILEUM INTUSSUSCEPTION.

As preparing for operation intestinal tumor, the chestxray is abnormal look like tuberculosis, but no BK detection.

Surgery report showed that tumor at coecum with some small mesenteric lymph nodes. Microscopic results is tuberculosis with typical geant cells.

DISCUSSION: We cannot make sure diagnosis before surgery with ultrasound, CT, blood tests. Chest xray can tell the past history of TB lung; but now the tumor is in RLAQ which belongs another stage of the process of TB diseases.

PROLONGED FEVER AND ULTRASOUND, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-11-18T12:18:00.001+07:00

MAN 36 YO FEVER FOR 40 DAYS # 39 Celsus DEGREE AND SORE THROAT
NO RESPONSE WITH ANTIBIOTIC TREATMENT.

FIRST ULTRASOUND OF THE ABDOMEN DETECTED BIG LIVER AND SPLEEN, SUSGESTED MALARIA. BUT BLOOD TEST RULES OUT.

MSCT ABDOMEN, SUSGESTED BIG SPLEEN LIKE INFECTED SPLEEN OR LYMPHOMA.

THE SECOND ULTRASOUND DETECTED MANY LYMPH NODES AT THE NECK , SIZE
1-3 CM, ECHO POOR, NO MORE VASCULATURE.

BIOPSY THIS LYMPH NODE FOR MAKING SURE THE DIAGNOSIS.

Waiting long time for immuno-histo staining the lymph node biopsy, the result is look like true-lymphoma, but the bone marrow biopsy show that it is HLH (hemophagocytic-lymphohistiocytic) and blood test also EBV positive.

Summary:
This prolonged fever case with sore throat, cervical lymphoadenopathy, blood test is leukopenia, with EBV Elisa test positve. Ultrasound and CT say HEPATO-SPLENOMEGALIA. BONE MARROW biopsy confirmed that HLH.

THE DIAGNOSIS IS MADE AFTER 50 DAYS FEVER.

LEFT URINOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-10-24T05:36:00.003+07:00

WOMAN 42YO, LEFT ABDOMEN TUMOR
U/S SCAN CANNOT FIND OUT THE L KID. IT TAKES PLACE BY A BIG CYSTIC MASS WITH SEPTATION.

THE VASCULAR STRUCTURE IS DISTORTION ON POWER DOPPLER

IVP CANNOT FIND OUT L KID.

ABDOMINAL MDCT WITH CONTRAST SHOWED THE LEFT KIDEY PULLED UP
AND RUPTURE. THE CONTRAST URINE IS LEAKED OUT THIS MASS.

PUNCTURE THE MASS FOR ASPIRATION GETTING SOME OF YELLOWISH FLUID LIKE URINE.

IT IS AN URINOMA DUE TO RUPTURE OF LEFT KIDNEY.

SUMMARY= IVP IS NOT SENSITIVE IN COMPARISON TO CT. ULTRASOUND IS FAST IN PERFORMANCE BUT DIFFICULT IN CASE OF BIG VOLUME TUMOR.

RETROPERITONEAL DESMOID TUMOR and RIGHT HYDRONEPHROSIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-10-14T16:27:00.000+07:00

16YO MALE, PAIN AT RIGHT LUMBAR FOSSA. NO G.I. TROUBLE NOR FEVER.

ABDOMINAL ULTRASOUND DETECTED RIGHT KIDNEY HYDRONEPROSIS 2 nd DEGREE DUE TO ONE BIG RETROPERITONEAL MASS AT RIGHT ILIAC FOSSA.

THIS TUMOR WAS HYPOVASCULAR, SOLID WITH SIZE OF 12CM, WHICH COMPRESSED COMPLETELY URETER .

IT IS BIG SOLID TUMOR RETROPERITONEUM WITH URETERIC OBSTRUCTION. THE MOST COMMON IS SARCOMA.

LAPAROTOMY SHOWED TUMOR OCCUPYING THE RIGHT ILIAC FOSSA, VERY HARD MASS WHICH WAS DIFFICULTLY REMOVED IN COMPLETE.

MACROSCOPIC SECTION OF TUMOR WAS SMOOTH AND HARD.

AND MICROSCOPIC RESULT IS A RETROPERTONEAL DESMOID TUMOR.

LEFT LUNG MASS METASTASES to RIGHT ADENAL, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-09-29T13:22:00.000+07:00

MAN 70YO, COUGH AND PAIN AT R THORAX.
ABDOMINAL US =
LIVER INTERROGATION
IMAGE 1: CROSS SECTION, WELL LIMITED MASS BELOW THE LIVER.

IMAGE 2: LONGITIDINAL SCAN, THIS MASS IS MOVING BY RESPIRATION, TAKES PLACE ABOVE R KID, HYPOVASCULAR AND HYPOECHOIC PATTERN.

IT IS NOT LIVER MASS NOR KIDNEY TUMOR. THIS POSITION IS OF ADRENAL

GLAND, IN COMPARING TO LEFT SITE IS NORMAL.
MDCT SHOWED A LEFT LUNG TUMOR AND SUSPECTED METASTASE TO RIGHT

ADRENAL GLAND.

WAIT FOR BIOPSY CONFIRM DIAGNOSTIC.

IMAGE CT LUNG-ABDOMEN

IMAGE US OF LUNG TUMOR

MULTIPLE NODULES OF LIVER TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-09-15T18:14:00.002+07:00

ONE MAN 54YO WITH GI TROUBLE, ABDOMINAL ULTRASOUND DETECTED MULTIPLE NODULES OF LIVER TUMOR, WELL BORDERED, HYPERECHOIC AND INTRATUMORAL MICROCALCIFICATION.

SONOLOGIST SUGGESTED THAT HCC, AND WAITING FOR BLOOD TEST AND CT SCAN OF LIVER.

But we don't thing it is HCC. It is like metastasis from GI LOWER TRACT. We try again with ultrasound, and find that lesion of thickening the wall of rectum.

Endoscopy and biopsy confirm that an adenocarcinoma of rectum.

Summary: Ultrasound oriented quickly diagnostic technique but not in wrong way.

GB STONE like TARGET SIGN at the BORDER of LIVER with the PARALLE SIGN of INTRAHEPATIC BILIARY TREE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-09-12T20:20:00.011+07:00

AN 82 YO MALE PATIENT WITH EPIGASTRIC PAIN. ABDOMINAL ULTRASOUND DETECTED ONE OVOID MASS LIKE TARGET SIGN AT THE BORDER OF LIVER WITH THE PARALLE SIGN OF INTRAHEPATIC BILIARY TREE. SONOLOGIST SUSGESTED A COLON TUMOR AND PREFER COLONOSCOPY.

MSCT OF ABDOMEN: THE BILIARY SYSTEM IS DILATED AND A GALLBLADDER STONE. NO COLON TUMOR.

ERCP CONFIRMED ODDIE SPHINCTER STENOSIS AND STONE IN CBD WHICH WAS REMOVED VIA ENDOSCOPY.

SUMMARY: SOMETIMES STONE IN GALLBLADER LOOKS LIKE A TARGET, MIMICKING A COLON CANCER. MSCT IS IMAGING MODALITY OF CHOICE AND, FOR THIS CASE , ERCP PLAYED A BEST ROLE IN DIAGNOSIS AND RESOLVING THE PATIENT COMPLAINT.

COLONIC INTUSSUSCEPTION DUE TO LYMPHOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-08-08T21:36:00.005+07:00

A 57yo male patient sufferes from periodic abdominal pain crisis at the RLQ without fever nor diarrhea.

US emergency of the abdomen shows one mass like TARGET over the right kidney.

Fig. 1 : CROSS SECTION of the mass.

Fig.2 : LONGITUDINAL SECTION of the mass.

VIDEO of SCANNING THE MASS

ULTRASOUND REPORT SUSPECTED A COLO-COLIC INTUSSUSCEPTION.

MSCT WAS DONE...WITH 2 PICTURES.

THIS CASE HAD A COLONOSCOPY FOR TEMPORALY REDUCTION OF INVAGINATION.

A RIGHT HEMICOLECTOMY WAS DONE. THE RESULT OF MICROSCOPY IS LYMPHOMA.

SUMMARY= 90% OF CASE OF INTUSSUSCEPTION IN ADULT IS DUE TO TUMOR.

ULTRASOUND IS A VERY SENSITIVE TOOL FOR DETECTION OF INTUSSUSCEPTION.

A JEJUNUM TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-07-26T21:03:00.002+07:00

A 65YO MALE PATIENT HAS GOT PAIN AT LEFT SITE OF UMBILICUS, PERIODIC CRISIS WITHOUT FEVER.
ABDOMINAL ULTRASOUND DETECTED A MASS WITH SIZE OF 10CM PLUS 6CM AT THE LEFT FLANK. THE MASS SEEMED TO BE LOOK LIKE THE KIDNEY, BUT CDI SHOWED ITS CENTRAL PORTION IN MOTION LOOK LIKE THE FLUID.

This patient had gone through a laparotomy procedure but cannot remove this tumor..
MDCT abdomen at one month after ope( POSTOP) SUSPECTED A TUMOR OF JEJUNUM.

This patient wait for a reoperation to try removing this tumor.

WHAT IS YOUR SUGGESTION ?

BUDD-CHIARI SYNDROME or NOT ? Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-07-01T07:14:00.013+07:00

A 25 YO WOMAN CAME FROM TU DU HOSPITAL FOR INFERTILITY. SHE HAD BIG
LIVER AND SPLEEN, WITH THE SUSPICION FROM 3 HOSPITALS OF BEING OF liver CIRRHOSIS WITHOUT INFECTION FROM HBV or HCV.

ULTRASOUND LIVER AT MEDIC= BIG LIVER AND SPLEEN, AND WE DETECTED THE PORTAL FLOW IS STILL NORMAL, BUT IVC IS TOO BIG AND VERY LOW FLOW.

IMAGE H=US LONGITUDINAL SCAN OF IVC. THE FLOW IS STOPPED AT THE UPPER PORTION OF LIVER BUT THE HEPATIC VEINS HAVE THE LOW FLOW.
NO ASCITIS.

UPDATING=

MSCT ANGIO= IVC IS TOO BIG AND VERY LATE CONTRAST FILLING, STENOSIS SUPRAHEPATIC WITH SMALL CALCIFICATION.

MANY COLLATERAL ANASTOMOSIS AT PELVIS, PERIUMBILICAL, AZYGOS, AND LIVER SCAN IS ABNORMAL DUE TO INTRA LIVER VASCULAR HEMODYNAMICS.

IS IT BUDD-CHIARI SYNDROME OR NOT? AND WHAT IS YOUR IDEA?

AFTER MEDIC CONFIRMED BUDD-CHIARI SYNDROME, THIS PATIENT WENT TO CHORAY HOSPITAL FOR TREAT MENT WITH THE SUGGESTION

OPEN BY PASS SURGERY OR ENDO IVC DILATION IF THIS IS A CAUSE OF MOVC (Membraneous obstructive of the vena cava..)...See attache file case reference. Obstruction of the Inferior Vena Cava With Vertebral Collaterals Color Doppler Findings, S. Boopathy Vijayaraghavan, MD, DMRD, Parasuram Ramchandran, MD and Mathew Cherian, MD
http://www.jultrasoundmed.org/content/22/2/233.full?sid=ac4b4777-28a4-4d0d-ba89-28974903c5db

TB ABSCESS of THORACIC WALL , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-06-22T13:56:00.002+07:00

AFTER ONE YEAR BEING TREATED BY LUNG TUBERCULOSIS, A 75 YO WOMAN DETECTED BY HERSELF ONE MASS AT RIGHT LOWER THORACIC WALL FOR ONE MONTH.

ON ULTRASOUND THIS MASS COMPOSES 2 CYSTIC MASSES IN CONNECTION TOGETHER LOOK LIKE A HOUR- GLASS SHAPE ABSCESS .

CDI AND PDI SHOWED HYPERVASCULAR PATTERN AROUND THE WALL LESION

1. WE DID A PUNCTION AND WITHDRAW SOME FLUID WHICH WAS PUS AS CASEUM

2. LAB ANALYSIS: CYTO SMEAR AND PCR FOR TB WERE POSITIVE

3. START TO TREAT ANTI TB AGAIN AND OPEN THE WALL ABSCESS FOR DRAINAGE.

CONCLUSION= A HOURGLASS ABCESS OF THORACIC WALL BELONGS COMMONLY TB ABSCESS WITH TB LUNG HISTORY.

PSEUDOANEURYSM to BILIARY TREE POST CHOLECYSTECTOMY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-06-10T20:21:00.002+07:00

A 44 YO WOMAN, ONE MONTH AFTER ENDOSCOPIC CHOLECYSTECTOMY BY STONE GALLBLADDER, GOT EPIGASTRIC PAIN AND HEMATEMESIS.

ULTRASOUND LIVER SHOWED AN ECHOGENIC DILATATION OF CBD AND LOOK LIKE STONE, OR BLOOD CLOT (FIG. 1)

FIG 2: ONE MASS OF 1 cm WITH YINYANG SIGN IN COLOR DOPPLER IMAGING

FIG.3: ARTERIAL SPECTRAL PATTERN FLOW.

RECORDING OF A-V FLOW REVEALED A PSEUDOANEURYSM POST CHOLECYSTECTOMY.

MSCT Angio : CONFIRMING A PSEUDOANEURYSM to BILIARY TREE

A LEFT KIDNEY MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-05-21T12:22:00.002+07:00

A 23yo female patient got pain at her left flanc and fever for 01 week.
Abdomen ultrasound revealed a left kid mass of 4cm, echo poor, hypovascular with the border edema (4 images B/W, CDI, PDI).

MSCT with CE (2 images).

WBC 16K, NEUTRO 80%.

This case had been treated as a kidney abscess case by antibiotic. Patient checked out hospital and review after one week.

A MESENTERIC TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-05-16T16:11:00.005+07:00

OF A 35YO MALE PATIENT, ROUTINE ABDOMINAL ULTRASOUND DETECTED ONE HYPOECHOIC MASS WITH SIZE OF 7,5 CM, LOOK LIKE AN AVOCADOS AT THE LEFT SITE OF UMBILICAL AREA.

IN DOPPLER CDI THIS MASS HAD A VASCULAR PEDICULE FROM SMA, BUT IT IS HYPOVASCULAR AND NOT RELATED WITH GI TRACT.

IT IS A MESENTERIC TUMOR. POWER DOPPLER (PDI) ALSO SHOWED THAT HYPO VASCULAR INHOMOGENOUS MASS, NOT LOOK LIKE THE LYMPH NODE.

NOTHING ABNORMAL DETECTED IN THE REMAIN OF EXAMINATION.

MSCT WITH CE : THIS MASS IS WELL LIMITED BORDER WITH A PEDICULATED VASCULAR SUPPLY FROM SMA.

THE BLOOD TESTS WERE NEGATIVE OF ALL CANCER MARKERS.

THIS CASE HAD BEEN OPERATED. THE SURGEON REMOVED THE ROUND TUMOR WHICH BELONGS INTRAMESENTERIC PART OF TREITZ AREA, NO RELATED TO GI TRACT. THE CUTTING SURFACE OF SPECIMEN LOOK LIKE A MANGO FRUIT.

WAIT FOR THE PATHOLOGY REPORT TODAY (17/MAY).

THE MICROSCOPIC REPORT IS MALIGNANT SARCOMA, BUT RESULT OF IMMUNO-HISTO STAINING IS A GIST (GASTROINTESTINAL STROMAL TUMOR).

A CYSTIC STRUCTURE IN CONNECTION TO PORTAL VEIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-05-07T19:53:00.002+07:00

A 24 YO LADY PATIENT IN ROUTINE ABDOMINAL ULTRASOUND SCANNING.

IN EPIGASTRIC LONGITUDINAL, US SCAN DETECTED A CYSTIC STRUCTURE ALONG ABDOMINAL AORTA.

THIS CYST IS CONNECTED TO PORTAL VEIN.

SPECTRAL FLOW ANALYSIS IS A VENOUS FLOW PATTERN.

MSCT WITH CE= CROSS SECTION AND MIP PICTURE.

WHAT IS YOUR EXPLANATION AND TREATMENT PROPOSAL FOR HER?
UPDATE=
IN 3d reconstruction MSCT ANGIO WITH MIP= the left ovary vein is too big and connected to SMV. IT CAUSES DILATATION SMV.

IT IS A CONGENITAL PORTO-CAVA SHUNT WITHOUT CLINICAL SYMPTOM AND NO NEED INTERVENTION..

CAUTION = DURING SCANNING ABDOMEN, SONOLOGIST MUST KNOW SOME VARIATIONS AND TRY MAKING THAT CLEAR BY MSCT.

A BREAST MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-04-21T09:43:00.006+07:00

WOMAN 45YO, BY BREAST PALPATION, DETECTED HERSELF A MASS INSIDE HER RIGHT BREAST.

MAMMOGRAPHY IS NORMAL.

BUT BREAST ULTRASOUND DETECTED A MASS OF 2,5 CM AT INTERNAL LOWER QUADRANT, HYPOECHOIC, IRREGULAR BORDER, WITHOUT POSTERIOR ENHANCEMENT. COLOR DOPPLER SHOWED ARTERIAL FEEDING WITH ABNORMAL DOPPLER SPECTRAL PATTERN AS HIGH PEAK SYSTOLIC VELOCITY.

QUESTIONS:

1. WHAT IS YOUR SUSGESTION?
2. WHAT IS THE MEANING OF DOPPLER SPECTRAL PATTERN IN THIS CASE?

UPDATING=

A CORE BIOPSY HAD DONE FOR THIS CASE AND IT IS A BREAST CANCER.

ANSWERS

1. Basic B mode ultrasound diagnostic breast cancer is more sensitive than mammography.

2. COLOR DOPPLER with spectral waveform detected high flow is high malignancy. Vmax is prognostic factor. With Vmax more than 25cm/s, 5 year survival is low ( 36,6%) in comparison to lower Vmax (82,3% ).

SPLEEN HAMARTOMA with THROMBOCYTOPENIA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-04-07T12:33:00.006+07:00

A 50YO MALE PATIENT HAS GOT PAIN AT HIS LEFT THORAX.

ULTRASOUND DETECTS A BIG SPLEEN EMBEDDING A TUMOR IN LOWER POLE WITH SIZE of 10CM. THERE ARE BENDING SIGN and HYPOVASCULAR SUPPLY of THE TUMOR, WHILE THE HEART HAS NOTHING ABNORMAL DETECTED.

CT SCAN WITH CE FIND OUT A HYPODENSE and HYPOVASCULAR TUMOR IN LOWER POLE OF THE SPLEEN.

PLATELET COUNTS ARE VERY LOW IN VALUE =40K/mL.

THIS CASE HAD OPERATION ON APRIL,7, AS A PLATELET TRANSFUSION UP TO 87K/mL. FIRST BY LAPAROSCOPY, VIEWING THE SPLEEN IS SMOOTH BORDER, AND SPLENECTOMY IS DONE.
IN MACROSCOPIC SECTION, THE TUMOR IS WELL BORDERED, HOMOGENEOUS, CHOCOLATE-LIKE STRUCTURE.
THE MICROSCOPY RESULT IS A SPLENIC HAMARTOMA.

WAIT FOR PLATELETS GET RISING UP BACK TO NORMAL WHEN THE SPLEEN TUMOR BEING REMOVED.
IT IS A RARE CASE IN THE WORLD.
SEE REFERENCES ON INTERNET.

HONEYCOMB LIVER METASTASIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-03-26T16:45:00.004+07:00

A 47YO WOMAN FROM HOSPITAL OF TROPICAL INFECTIOUS DISEASE SUFFERED FROM A BIG LIVER FOR 3 MONTHS, WITHOUT FEVER. BLOOD TESTS WERE FREE FROM HBV, HCV. ALPHA FP WAS IN NORMAL VALUE.
ENDOGASTROSCOPY WAS ALSO NEGATIVE.

ULTRASOUND : LIVER IS TOO BIG WITH MANY HYPOECHOIC SPOTS, AVERAGE OF SIZE 1CM WHICH DIFFUSE OVER LIVER.

MSCT LIVER WITH CE IS LOOK LIKE A HONEYCOMB.

ULTRASOUND AND MSCT LIVER ARE LOOK LIKE HONEYCOMB WITH THE MOST COMMON CAUSE IS METASTASIS.

AND WE FIND OUT IN HER RIGHT BREAST A MASS BY ULTRASOUND.

MSCT ALSO DETECTS BREAST CANCER, BUT THE LUNG AND SPINAL ARE
INTACT.

BIOPSY CONFIRMS THAT IS A CASE OF LIVER CANCER METASTASIS FROM BREAST TUMOR.

Some questions for this case:

1/ Have you ever seen the case like that by ultrasound or CT?

2/ Why does breast cancer metastase to liver only by the way?

3/ Can ultrasound liver predict the primary site of cancer?

THROMBOSIS OF RIGHT INTERNAL JUGULAR VEIN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-03-13T12:51:00.003+07:00

A 45 YO MALE PATIENT SUFFERED FROM FEVER AND PAIN AT HIS RIGHT NECK FOR ONE WEEK. HIS NECK WAS IN DISTENTION.

ULTRASOUND DETECTED A THROMBOSIS OF RIGHT INTERNAL JUGULAR VEIN.

2 PICTURES SCANNING AT THE RIGHT COMMON CAROTID ARTERY.

AFTER THAT A MSCT ANGIO OF CAROTID WAS PERFORMED.

THE RESULTS FROM MSCT REPORTED THAT A LUNG TUMOR IN RIGHT APEX GOING UP TO BLOCK HIS RIGHT INTERNAL JUGULAR VEIN. IT IS A CASE OF PAGET-SCHROETTER SYNDROME.
HAVE YOU EVER HEARD THIS NAME?

BREAST CYSTIC MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-03-04T15:50:00.005+07:00

A 45 YO WOMAN DETECTED HERSELF A LUMP IN PALPATION HER LEFT BREAST.

ULTRASOUND:
1. IMAGE 1=HYPOECHO MASS LIKE CYST.

2. CDI DETECTED COLOR SIGNAL INSIDE THIS MASS (IMAGE 002)

3.CROSS SECTION ALSO CAN SEE COLOR SPOTS.

4. VIDEO MOTION

IS IT SOLID OR CYST, WITH OR WITHOUT BLOOD SUPPLYING INSIDE THIS MASS?

VIEW VIDEO: THE CDI IS MIROR EFFECT ARTEFACT.

THIS CASE HAD BEEN IN PUNCTURE AND COMPLET ASPIRATION BREAST CYSTIC MASS.

CELL BLOCK COMPOSES ALL NORMAL CELLS.

SPONTANEOUS ECHO CONTRAST, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-02-28T08:10:00.005+07:00

MALE 56YO, HEADACHE, ULTRASOUND CCA FOR DETECTION CAROTID INTIMA-MEDIA THICKNESS (IMT).

FINDINGS=
LEFT INTERNAL JUGULAR VEIN IS BIG AND FILLING MORE ECHO IN ITS LUMEN THAN THAT OF COMMON CAROTID ARTERY (VIEW IMAGE IN CROSS- SECTION) . IN LONGITUDINAL VIEW , THE BLOOD FLOW OF LEFT JUGULAR VEIN IS SLOW, WITH SMOKE LIKE ECHO (VIEW VIDEO).
.

IT IS S.E.C. (SPONTANEOUS ECHO CONTRAST) OF LEFT INTERNAL JUGULAR VEIN.

1 / WHAT SITUATION HAD YOU EVER SEEN BEFORE?
2./ DO YOU TRY TO FIND WHAT, AND HOW ABOUT THE LAB YOU' RE LOOKING FOR?

Update=

1.STATUS THIS CASE = HYPERCOAGULATION..OR HYPOPROTIDEMIA..

2.LAB REQUEST IS D-DIMER, PROTIDE IN BLOOD.

ASCARIS into COMMON BILE DUCT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-02-17T19:53:00.006+07:00

A 38YO WOMAN WENT THROUGH AN ACUTE EPIGASTRIC PAIN AND VOMITTING FOR 4 DAYS.
ABDOMINAL ULTRASOUND DETECTED A BIG GALL-BLADDER WITHOUT STONE, AND COMMON BILE DUCT DILATED OF 1,5CM, WITH TUBULAR ECHOGENIC STRUCTURE INSIDE, NO SHADOWING.

WHAT IS YOUR PROPOSAL?

ULTRASOUND EASILY DIAGNOSES THAT AN ASCARIS IS MOVING UP TO CBD, BUT IT IS MALE OR FEMALE ASCARIS, CAN YOU EXPLAIN?.

AND VIDEO CLIP OF ULTRASOUND, BEFORE ERCP TO REMOVE ASCARIS.

ERCP XRAY: ASCARIS INTO CBD

VIDEO CLIP OF AN ASCARIS AFTER REMOVING FROM CBD BY ERCP.

RECURRENT ABDOMINAL PAIN DUE TO STONE in DUCT of PANCREAS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2011-02-10T18:27:00.003+07:00

A 60YO WOMAN FROM CAN THO HOSPTAL SUFFERED FROM A 3 TIME OF ABDOMINAL PAIN CRISIS IN LAST MONTH. PAIN IS IN EPIGASTRIC AREA, AND SHE HAS LOSS OF EATING.

SHE WAS TREATED AS A PEPTIC ULCER BUT ABDOMINAL PAIN CRISIS STILL CONTINUES.
ULTRASOUND AT MEDIC:

Fig. 1:TRANSVERSE SECTION AT EPIGASTRIC AREA SHOWS AN ABNORMAL FOCAL AT THE HEAD OF PANCREAS.

Fig.2: LONGITUDINAL SCANNING

Fig. 3: LIVER AND BILIARY SYSTEM ARE NORMAL

Fig.4: CDI AT THE PANCREAS HEAD

BLOOD TEST=WBC : 12,8K WITH 81,4% NEUTRO, CRP: 276mg/l.
Blood Amylase= 167U/ L. Amylase in urine.2509U/L

MSCT OF ABDOMEN INFORMS THAT PANCREAS DUCT IS DILATED BY A STONE
AT THE HEAD OF PANCREAS.

THIS IS THE STONE IN PANCREAS DUCT CASE.

CYSTIC MASS INTO LIVER POST TRAUMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-02-07T14:08:00.006+07:00

A 19 YO FEMALE PATIENT TO MEDIC IN SHOCK, BP=10/5cmHg, P: 120/min

7 DAYS BEFORE SHE HAD BEEN IN TRAFFIC ACCIDENT, WENT THROUGH ONE
DAY IN HOSPITAL, AND DISCHARGED GOING HOME LATER.

ULTRASOUND FOR ROUTINE CHECK.

SCANNING ABDOMEN AT PELVIC REGION DETECTED A CYSTIC MASS INTO LIVER.

ULTRASOUND SCANNING WITH LINEAR PROBE

AND DOPPLER VIDEO AT LIVER.

CT ABDOMEN IN THE Binh Dan HOSPITAL SHOWED A LARGE AMOUNT OF HEMOPERITONEUM WITH THE MASS INTO RIGHT LOBE AND CONNECTING TO THE SURFACE OF LIVER.

CT NON CE

CT WITH CE

THIS PATIENT IS WAITING FOR OPERATION, AND HAS BEEN IN BLOOD TRANSFUSION.
IN COMPARISON CT TO CDI AND DOPPLER VIDEO, ULTRASOUND IS THE BEST FOR EMERGENCY CASE.

After 2 days in follow up with blood transfusion, this patient is getting in stability and check out ICU today, no need emergency operation.

IT IS A HEMATOMA INSIDE THE LIVER DUE TO TRAUMA AND IT BLOWS OUT OF
THE LIVER IN FORMATION HEMOPERITONEUM, BUT ITSELF LIMITED AND STOP BLEEDING NOW.

POST-TRAUMATIC ANEURYSM of LEFT THIGH, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2011-02-03T00:55:00.002+07:00

A 45 yo male patient had tap wound for one month at the left thigh. Today he got pain and cramp.

On examination it is a tumor of the left thigh.

MSCT ANGIO suspected a hematoma or muscular tumor.

Ultrasound for second look.

THIS CASE HAD BEEN OPERATED, SURGERY REPORTS AN ANEURYSM OF QUADRICEP MUSCLE ARTERY. IN THIS CASE, DOPPLER ULTRASOUND MADE A BETTER DIAGNOSIS. ANEURYSM DISPLAYS A COLOR YINYANG SIGN IN REALTIME.

ULTRASOUND MEDIC'S ACTIVITIES in 2010 and in 10 YEARS from 2001 to 2010

2011-01-19T20:12:00.002+07:00

NOTA: February is the month of Lunar New Year in Vietnam, so the number of ultrasound examination is always lower than the other months of year.

5,228,780 is the sum of number of ultrasound examination in 10 years,

from 2001 to 2010, at MEDIC MEDICAL CENTER, HCMC, VIETNAM.

EMBRYONIC RHABDOMYOSARCOMA of RIGHT LEG, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2010-12-22T20:46:00.009+07:00

A 3yo male child had no pain no fever, got swollen his posterior lower right leg, without history of trauma.

Ultrasound this area

Fig. 1: Cross-section: Hypoechoic tumor belonged to the soleus muscle.

Fig. 2: Longitudinal scan this tumor: size 6x4 cm, straitified structure like muscle, well limited in the muscular aponevrosis.

Fig. 3-4: In Doppler, a hypervascular tumor.

MRI with CE: Very high and rapid enhance tumor with gado.

OPENED BIOPSY was done in CHILDREN HOSPITAL N0 2 on December 31 = THE MICROSCOPIC RESULT IS AN EMBRYONIC RHABDOMYOSARCOMA WITH SPECIFIC HISTO-IMUNOLOGIC STAINING, A VERY HIGH MALIGNANT TUMOR.

A SCHWANNOMA at INNER SITE of LEFT CAROTID ARTERY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2010-11-30T20:02:00.002+07:00

A 56 yo male patient detected himself a deformation of left site of his face, no pain no fever.
Ultrasound this area disclosed a solid mass, size 3cm-4 cm which located at the inner site of left carotid artery with calcification and low vascular structure.

MSCT with CE showed clearly the relation of the tumor and carotid artery, no lymph node arround.

Operation removed a round tumor, well-limited, size of 3cm in diameter, hard tissue. Microscopic result was a schwannoma. Ultrasound and CT findings were well correlated with its pathology.

CASTLEMAN DISEASE in RETROPERITONEAL SPACE, Dr PHAN THANH HẢI, MEDIC MEDICAL CETER, HCMC, VIETNAM.

2010-11-22T18:37:00.005+07:00

A 21 YO FEMALE PATIENT HAVING A MASS AT L L Q, NO PAIN NO FEVER.

ABDOMINAL ULTRASOUND SHOWED AN OVOID MASS SIZE 6CM NEAR AORTIC

BIFURCATION, CLOSE BY INNER BORDER OF LEFT PSOAS MUSCLE.

THE MASS HAS HYPOECHOIC STRUCTURE WITH LOW VASCULATURE SUPPLY.

FIGURE 1: AN OVOID HYPOECHOIC MASS TUMOR , LEFT SIDE OF THE AORTA.

F.2: THE VASCULAR SUPPLY IS ARROUND THIS MASS

F.3: DOPPLER: VERY LOW VASCULAR SUPPLY.

MSCT WITH CONTRAST ENHANCEMENT: VERY QUICK ENHANCE.

RETROPERITONEAL TUMOR HAVING HYPOECHOIC STRUCTURE WITH QUICK CE BY CT.

OPERATION AT CANCER CENTER REMOVED THE WELL-BORDERED MASS.
MICROSCOPIC RESULTS WAS A TYPICAL CASTLEMAN DISEASE OF LYMPH NODE.

Castleman disease is a benign hyperplasia of the lymph node. Commonly manifest as a solitary mediastinal mass. There are two variants: hyalin vascular type and plasma cell type. The hyalin vascular type is commonly unicentric, the other is multicentric disease.

We report a 21yo patient with retroperitoneal Castleman disease of the hyalin vascular type. Histological findings show "lopilop" structure and the "target" appearances of lymphoid follicles. She underwent a surgery for excision of the tumor and remains well.

BIG R/CCA with ABNORMAL PATTERN DOPPLER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2010-11-13T20:15:00.020+07:00

A 67 YO WOMAN FREQUENTLY IN SYNCOPE.

ULTRASOUND ROUTINE CAROTID ARTERY DETECTED A BIG RIGHT COMMON CAROTID ARTERY

AND ABNORMAL PATTERN DOPPLER WITH YIN -YANG SIGN AT THE CROSS
SECTION IN WHICH THERE WERE 2 FLOWS INVERTED WITH COLOR RED AND BLUE.

MSCT ANGIO CAROTID SHOWED A DISSECTION OF CCA.

WHAT CAUSE IS THIS CAROTID DISSECTION HAVING AN ABNORMAL INVERTED FLOW PATTERN.
THIS CASE WAS INTERESTING BY THE COLOR DOPPLER IN SCREENING ULTRASOUND THE ABNORMAL VESSELS.

COMET TAIL SIGN in the LUNG, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC. VIETNAM.

2010-10-24T10:46:00.005+07:00

A 52 YO WOMAN HAD VAGINAL DISCHARGE.

ULTRASOUND DETECTED MANY SMALL NODULES INTO THE LIVER WHICH WERE THE BULL EYE SIGN.

IN THE LUNG, WE SAW MANY COMET TAIL SIGNS, LOOKED LIKE THE LIGHTHOUSE IMAGE AT NIGHT.

MRI LIVER SHOWED THE LUNG WITH MULTIPLE METASTASIS.

THE COMET TAIL IMAGE OF THE LUNG BY ULTRASOUND DUE TO THE
METASTASIS NODULES IN THE LUNG AND PLEURA.
WE CAN CHECK UP THE LUNG BY ULTRASOUND WHENEVER SEEING THE LIVER WHICH WAS SUSPECTED MULTIPLE METASTASIS.

A THYROID with A-V SHUNTING, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-09-25T15:39:00.020+07:00

A 45yo male patient presented an insomnia and a weakeness of his 2 legs for one year in the afternoon after sleeping some times in a month. But it was getting more and more.
MRI spinal was normal. No lymph node at the neck.

Ultrasound of the thyroid was abnormal, enlarged volume and changing of the echostructure.

Fig.1=Cross-section of the left lobe thyroid gland, the echostructure was hyperechoic with many black spots in comparison to the SCM muscles.

Fig. 2= Cross-section the right lobe of thyroid.

Fig.3= Longitudinal section of the left lobe.

Fig 4 = CDI showed hypervascular pattern like a flamboyant flower.

Fig 5 = PDI with hypervascular appearance.

Fig 6: Pulse wave Doppler pattern = A-V shunting flow.

Blood tests showed the abnormal thyroid regulation as a hyperthyroid function.

This case had a clinical onset symptom which was weakness of 2 legs; thyroid ultrasound was a special case. The blood tests confirmed the disease.
We compare the PDI of hyperthyroidism as a flamboyant flower in Vietnam.

TUBERCULOSIS of CALF MUSCLE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-09-14T21:31:00.007+07:00

A 37YO WOMAN BY HERSELF DETECTED A LUMP AT HER LEFT CALF FOR ONE MONTH, NO PAIN NOR FEVER.

IN CLINICAL EXAMINATION THIS FIRM MASS WAS 10CM IN SIZE, ELLIPTICAL SHAPE AND BELONGED TO THE LEFT GASTROCNEMIUS MUSCLE.

SMALL PART ULTRASOUND=

IT WAS A HYPOECHOIC INTRAMUSCULAR MASS, WELL BORDERED WITH MORE POSTERIOR ENHANCEMENT (IMAGE 1).

IN CROSS-SECTION, THE MASS HAD NO LACK OF DEFINITION OF MUSCLE ARCHITECTURE, BUT SOME AREAS CHANGED TO HYPOECHOIC PATTERN LOOK LIKE FLUID (IMAGE 2).

IMAGE 3 : IN COLOR DOPPLER, THE MASS HAD HYPERVASCULAR PATTERN WHICH WAS SUPPLIED FROM OUTSIDE.

IMAGE 4: SPECTRAL PULSE WAVE PATTERN WITH LOW RI VALUE= 0,5.

IMAGE 5: B MODE SUPERSONIC WAS A HYPOECHOIC MASS.

IMAGE 6: QUANTITATIVE ELASTOGRAPHY SHOWED LOW ELASTIC SCORE #30kPa (EQUIVALENT ELASTOGRAPHIC VELOCITY = 3m/s) IN COMPARISON TO SURROUNDING MUSCLE.

BIOPSY WAS DONE WITH SUSGESTION OF AN INFLAMATION MASS AS MYOSITIS FOCAL LESION.

HISTOPATHOLOGIC RESULTS= SOME TUBERCULAR VESICLES OF MUSCLE AND SOFT TISSUES INCLUDED CASEUM IN THE CENTRAL AND SURROUNDING WITH DEGENERATIVE CELLS, LYMPHOCYTES AND LANGHANS GIANT CELLS.
CONCLUSIONS= A TUBERCULAR MYOSITIS.

SO THE PRESENT CASE ILLUSTRATES A TUBERCULOSIS OF SOLEUS MUSCLE WHICH INCLUDES THE HISTOLOGIC RESULT AND SOME INTERESTING ULTRASOUND FINDINGS, ESPECIALLY THE SHEARWAVE ELASTOGRAPHY CHARACTERS.

AN UTERINE AVM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC

2010-08-31T07:36:00.008+07:00

A 42YO WOMAN HAD BEEN TREATED FOR 20 YRS AS HYDATIDIFORM MOLE.

3 MONTHS AGO SHE SUFFERED FROM A VAGINAL BLEEDING.
US PELVIS = UTERUS WAS BIG IN SIZE WITH SOME INTRAMURAL MASSES WHICH WERE SUSPECTED FIBROMA, AND A MASS WAS ON THE LEFT LATERAL OF UTERUS IN CYSTIC APPEARANCE LOOK LIKE AN OVARY CYST.

(4 US IMAGES = IMAGE 1=LONGITUDINAL SECTION UTERUS, IMAGE 2= CROSS SECTION UTERUS, IMAGE 3+IMAGE 4= L. UTERUS MASS WITH DOPPLER MODE )

IT WAS HYPERVASCULAR A-V SHUNT UTERUS ARTERY.

MRI PELVIS=3 IMAGES SUSPECTED THE MASS BEING A BLEEDING CYST AND A-V SHUNT INTRA UTERUS.

BLOODTEST HCG=NORMAL.

A HYSTERECTOMY OPERATION WAS DONE AT TU DU HOSPITAL. THE MACROSECTION WAS AN AVM UTERINE VASCULATURE DUE TO A SEQUEL OF TROPHOBLASTIC DISEASE.

A HUGE RETROPERITONEAL XANTHOGRANULOMA, Dr PHAN THANH HẢI-Dr TRẦN THỊ BẢO CHÂU

2010-08-25T22:58:00.013+07:00

A 37YO WOMAN CAME TO MEDIC AS ABDOMINAL PAIN AND DISTENTION.

ULTRASOUND DETECTED A BIG RETROPERITONEAL MASS FROM THE EPIGASTRIC AREA TO HER LEFT PELVIS. IT WAS SOLID, ECHO RICH. THE MASS PUSHED THE LEFT KIDNEY TO THE RIGHT SIDE NEAR THE RIGHT KIDNEY, BUT THE AORTA WAS IN NO DISPLACEMENT.

IMAGE 01: THE RETROPERITONEAL MASS ON THE LEFT SIDE.

IMAGE 02: THE LEFT KIDNEY MOVED TO THE RIGHT SIDE AND OVER THE RIGHT KIDNEY.

IMAGE 03: ON THE RIGHT SIDE, THE LEFT KIDNEY WAS NEAR THE ANTRUM OF STOMACH BY DISPLACED POSITION.

MSCT WITH CE SHOWED THAT TUMOR WAS VERY BIG. CT.HU UNIT VALUES BELONGED TO FATTY TISSUE.

THIS PATIENT WAS ADMITTED IN BINH DAN HOSPITAL FOR OPERATION TO REMOVE THE RETROPERITONEAL TUMOR.

OPERATION HAD BEEN DONE AT BINH DAN HOSPITAL. THE WHOLE TUMOR WAS NEARLY REMOVED, BUT WHILE WAS LEFT THE LEFT KIDNEY. MICROSCOPIC REPORT WAS A RETROPERITONEAL XANTHOGRANULOMA. IT IS A BENIGN TUMOR.

A LEFT RETROPERITONEAL SCHWANNOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-07-13T22:36:00.003+07:00

A 38YO WOMAN WITH PAIN AT HER LEFT LUMBAR FOSSA.

ULTRASOUND DETECTED A 3CM ROUND MASS, WELL BORDERED, ECHO POOR AND LOW SUPPLYING VASCULATURE, WITH HIGHT POSTERIOR ENHANCEMENT.

IT WAS A RETROPERITONEAL MASS CLOSE BY THE AORTIC BIFURCATION.

MSCT SHOWED THIS MASS IN THE RELATION WITH ABDOMINAL AORTA.

ALL BLOOD TESTS WERE IN NORMAL VALUES.

THIS PATIENT RETURNED MEDIC CENTER ONE MONTH LATER.
ULTRASOUND REVIEWED THIS TUMOR BEING THE SAME APPEARANCE.

AN OPERATION REMOVED THE TUMOR WHICH WAS ROUND AND SOFT.

MICROSCOPIC RESULT WAS A RETROPERITONEAL SCHWANOMA.

WHY WE CANNOT MAKE SURE PREOP THE CARACTER OF THIS TUMOR, THAT
WERE SOME LIMITED VALUES OF ULTRASOUND, MSCT AND BLOOD TESTS
OF THIS CASE.

A CALCIFIED BLEEDING CARDIAC TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC VIETNAM

2010-07-08T20:25:00.003+07:00

A 36YO MALE PATIENT HAS BEEN IN FREQUENT SYNCOPE.

CHEST XRAY: THE LEFT HEART HAD A CONTOUR DEFORMATION AND A RING OF CALCIFICATION.

CARDIAC AUSCULTATION: CONTINUOUS MURMURE.

ECHOCARDIO= A CALCIFIED MASS IN THE LEFT VENTRICULAR CHAMBER.

MRI CARDIAC REPORTED A CARDIAC TUMOR WITH BLEEDING INSIDE.

MSCT ANGIO: THE MASS WITH RING CALCIFICATION WITHOUT CONTRAST ENHANCEMENT.

SUMMARY= A 36YO MALE PATIENT WITH CLINICAL SIGN OF FREQUENT SYNCOPE. ALL IMAGING MODALITIES OF HIS HEART AS ECHOCARDIO, XRAY, CT , MRI SHOW A CALCIFIED BLEEDING CARDIAC TUMOR.
NOW HE IS WAITING FOR A SURGICAL PROCEDURE.

WHAT IS YOUR SUGGESTION?

A RLQ OVARIAN CYST, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-06-28T07:21:00.003+07:00

NG TH TH. 17YO, 5 YRS BEFORE SHE HAD BEEN IN AN OPERATION BY PERSISTENT DUCTUS ARTERIOSUS.

ABDOMEN ULTRASOUND IN A PROVENCE HOSPITAL SUSPECTED APPENDICULAR
ABSCESS, WITH CLINICAL SIGNS OF NO PAIN NOR FEVER.

ULTRASOUND AT MEDIC= ELLIPTIC MASS AT RLQ, 4CMX3CM. HYPOECHOIC STRUCTURE, NON COMPRESSIBLE, NO PAIN, NO CHANGING LOCATION BY POSITION OF EXAMINATION.

SONOLOGIST SUSGESTED AN APPENDICULAR MUCOCELE.

MSCT SUSPECTED AN OVARIAN CYSTIC TUMOR.

BLOOD TEST IS NORMAL, NO INTECTED. CA125 IS NORMAL.

THIS PATIENT RETURNED TO MEDIC AFTER 10 DAYS.

ULTRASOUND REEXAMINED THIS CYSTIC TUMOR GETTING SMALLER #3CM, IN COMPARISON TO 5.3CM ONE BEFORE

OPERATION WAS DONE ON 28/6 SHOWED THAT THE APPENDIX WAS NORMAL AND THE RIGHT OVARY CYSTIC STRUCTURE ADHERENT TO RLQ FOSSA.

IMAGE 5: NORMAL APPENDIX

IMAGE 6: RIGHT OVARIAN CYST .

DISCUSSION: ABNORMAL LOCALISATION OF THE RIGHT OVARY IS THE CAUSE OF THE MISTAKE.

BUT THE SECOND TIME REVIEWING ULTRASOUND EXAMINATION WAS VERY IMPORTANT FOR A DECISION TO STOP THE OPERATION.

A PSEUDOTUMOR of LIVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-05-23T20:23:00.003+07:00

A 25 YO WOMAN WAS DETECTED A LIVER MASS BY ULTRASOUND CHECK UP WITH NO CLINICAL SYMPTOM. SO SHE CAME TO MEDIC FOR VERIFICATION.

ULTRASOUND AT MEDIC: A 6cm MASS AT THE 6th SEGMENT OF LIVER, HYPOECHOIC WITHOUT POSTERIOR ENHANCEMENT, INHOMOGENEOUS ECHO STRUCTURE WITH SEPTATION AND HYPOVASCULAR. BLOOD TEST = NO HEPATITIS B OR C, AFP = 2ng/mL.

MSCT LIVER NON CE AND CE BY ONE RADIOLOGIST SUSGESTS THIS MASS BEING A PSEUDOTUMOR BY NON FATTY ZONE OF THE LIVER.

WHAT DO YOU THINK?

UPDATE CASE PUBLISHED ON 23/5: THIS PATIENT IS WAITING FOR OPERATION.
AFTER REVIEWING 3 TIMES THIS TUMOR IS GETTING BIGGER.

HYPERVASCULAR INFLAMED AXILLARY NODE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-05-15T16:09:00.001+07:00

WOMEN 22YO. 01 WEEK AGO PAIN AT RIGHT AXILLARY AND A SWOLLEN MASS. ULTRASOUND SHOWED THAT THE BIG LYMPH NODE..

Fig 1: IMAGE B MODE.. STRUCTURE AND HILUS..RATIO INDEX...

Fig 2: CDI MORE VASCULAR SUPPLYING FOR THE MASS.

Fig.3 : SPECTRAL DOPPLER PATTERN OF THE MASS

THIS HYPERTROPHIC LYMPH NODE IS LIKELY BENIGN DUE TO INFLAMATION.
CORE BIOPSY WITH RESULT IS LYMPHADENITIS.

WE TREAT BY CORTICOID.
IMAGES ONE WEEK AFTER TREATMENT.

AN EPITHELIAL CYST of ABDOMINAL WALL, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-05-09T14:44:00.004+07:00

A 55 YO WOMAN FOR 10 YEARS SHE HAD GOT PAIN AT THE RIGHT ABDOMEN AFTER SPORT EXCERCISE.

5 YEARS AGO, A DOCTOR HAD DETECTED THE TUMOR AT THE RIGHT ABDOMEN WALL AND PERFORMED A PUNCTION IN WHICH ASPIRATED SOME ROSE COLORED FLUID.

NOW SHE FELT PAIN AND SWELLING AGAIN.

ULTRASOUND IMAGE 1= CROSS SECTION THE ABDOMEN WALL, A CYSTIC TUMOR FREE FLUID INTRA MUSCULAR.

IMAGE 2= LONGITUDINAL SECTION: THE TUMOR PROLONGED TO THE PELVIS.

CT IMAGE with CE: CROSS SECTION THE TUMOR DID NOT CAPTURE THE CE.

CT IMAGE : LONGITUDINAL SECTION, THE CYSTIC MASS WAS INTRAMUSCULAR.

THIS PATIENT HAD OPERATED. IN REMOVING A CYSTIC TUMOR INTRA ABDOMINAL WALL, MICROSCOPIC RESULT IS AN EPITHELIAL CYST.

RIGHT LOBE of LIVER SEPTATED MASS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-05-01T13:59:00.004+07:00

A 27YO MALE GOT SUDDEN PAIN IN HIS RIGHT LIVER AND CANNOT BREATH. URGENT ULTRASOUND EXAMINATION at MEDIC.

Fig.1: RIGHT LIVER INTERCOSTAL VIEW: ELLIPTIC ZONE OF ECHO-POOR AT THE BORDER OF LIVER, NO BLOOD VESSEL INSIDE.

Fig.2: LEFT LOBE OF LIVER.

Fig. 3: THIS STRUCTURE IS IN SEPTATION.

Fig.5: CT LIVER NO CE, SAGITAL VIEW.

Fig.6: TRANSVERSAL SECTION VIEW CT LIVER NO CE.

WHAT IS YOUR SUGGESTION?
MSCT CE ONE WEEK LATER: CT IMAGE SHOWS THAT A HEMATOMA INSIDE THE BORD OF THE LIVER ON THE WAY OF REABSORPTION.

INTRAHEPATIC TUBULAR STRUCTURE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-04-25T11:35:00.002+07:00

BEEING ABLE NOT SEEN BY ULTRASOUND.

A 57YO MAN 5 YEARS BEFORE HE HAD BEEN IN AN OPERATION FOR GASTRIC CANCER.

2 YEARS LATER HE HAD GOT ICTERUS AND BEEN TREATED BY ENDOSCOPY IN KOREA.

NOW HE HAD ICTERUS AGAIN AND BEEING EXAMINED BY ULTRASOUND AT MEDIC.

IMAGE 1= GALL BLADDER TOO BIG.

IMAGE 2: PANCREATIC DUCT IN DILATATION.

IMAGE 3: TUBULAR STRUCTURE INTRA HEPATIC WITH NO FLOW INSIDE

IMAGE 4: IN DOPPLER, IT WAS NOT A VESSEL, NO FLOW, MANY SHUNTING VESSELS BUT NOT INSIDE

IMAGE 5: MRI CROSS SECTION THIS TUBE.

WHAT IS THIS? SOME DOCTORS PERFORMED ULTRASOUND SCANNING BEFORE DID NOT SEE NOR DETECTED THIS TUBE.

It is CBD stent obstructed by tumor invation.

A GOSSYPIBOMA POST CESAREAN OPERATION FOR 5 MONTHS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-04-05T20:58:00.006+07:00

LOOK LIKE A SECOND PREGNANT UTERUS.

A 38YO WOMAN, FOR 5 MONTHS AFTER GOING THROUGH A CESAREAN OPERATION BY DELAYED DELIVERY, DETECTED HERSELF A MASS AT THE RIGHT UPPER ABDOMEN WHICH LIKED AN UTERUS WITH BABY INSIDE.

ULTRASOUND DISCLOSED THIS MASS AS AN OVALE TUMOR, SIZE 20CM X 12 CM CONTAINING FLUID WITH NO VASCULAR DOPPLER SIGNAL NOR AIR INSIDE THE MASS.

MSCT WITH CE SUGGESTED THE MASS NO CONTRAST ENHANCEMENT, NO RELATION WITH GI TRACT OR URINARY TRACT.

THE FEMALE PATIENT HAD NO PAIN, NO FEVER, AND BLOOD TESTS WERE NORMAL INCLUDING ALL CANCER MARKERS IN NEGATIVE VALUES.

SHE IS WAITING FOR AN OTHER OPERATION AT BINH DAN HOSPITAL.

TODAY APRIL,9 AN OPERATION WAS PERFORMED AT Binh Dan HOSPITAL, REMOVING A BIG TUMOR WITH RESECTION OF 25 CM SMALL INTESTINE. IT WAS AN ABSCESS DUE TO ONE COMPRESS FORGOTTING FOR 5 MONTHS.

SHEAR WAVE ELASTOGRAPHY of a LIVER LYMPHOMA MIMICKING a LIVER ABSCESS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-03-31T22:58:00.003+07:00

A 7yo male child suffered from an epigastric pain without fever.
Abdominal ultrasound results from 4 other doctors noted a 2.7cm liver abscess at the left lobe or a form of cystic bleeding into the liver.
At MEDIC, on CDI it was an inhomogenous well round mass of 3cm in diameter in the left lobe of liver. But the echostructure of the mass was very poor look like a cyst without posterior enhancement. No vascular structure detected inside the mass.
Shear wave elastography with Supersonic Imagine disclosed the tumor with elastic score of 0.17 kPa.
All blood tests were normal. No marker of parasite infection.
MSCT liver with CE suggested a focal nodular hyperplasia (FNH).
Operation was performed in Children Hospital 1; the tumor was removed and the microscopic result was a liver lymphoma.
Conclusion: A mass with echo poor like a cyst is lymphoma.

A HUGE PELVIC ABSCESS due to RUPTURE of an APPENDICITIS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-03-28T20:11:00.003+07:00

A 17 yo male patient suffered from a trouble micturition for 1 week and had a urinary bladder catheter.
Then he was treated as urinary infection by antibiotics, but now he cannot pass out of urine.

At MEDIC, ultrasound detected a 25cm hypogastric mass in which there was viscous fluid with many white spots like snowfall, and a gas-fluid level. It was misthought as a urinary bladder.

Fig.1: Fluid with many white spots like snowfall.

Fig.2: Both 2 kidneys in hydronephrosis.

This patient came to see an urologist with a KUB film without stone (Fig.3), and the mass localized at the location of urinary bladder.

MSCT UROLOGY with CE detected a small urinary bladder which was covered by this mass. And the mass looked like an ovary cystic tumor, but in a male patient.

This patient was sent in urgency to BINH DAN hospital.
In the operation a diagnosis was made. It was an huge abscess due to rupture of an appendicitis for a long time.

CONCLUSION = IT IS A HUGE ABSCESS DUE TO RUPTURE OF AN APPENDICITIS AND COLLECTS AT PELVIS LIKE AN OVARY CYSTIC TUMOR IN THE MALE PATIENT.

TWINKLING ARTIFACT of an URETERAL STONE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-03-24T21:53:00.000+07:00

A 72 YO WOMEN SUFFERED FROM A COLICKY PAIN AT LEFT LOWER ABDOMEN. ULTRASOUND DETECTED LEFT KIDNEY HYDRONEPHROSIS IN SECOND DEGREE, AND LEFT URETER IN DILATATION JUST TO PELVIC REGION.

AT THE PELVIC PORTION OF LEFT URETER, ULTRASOUND CANNOT MAKE SURE A WHITE SPOT WITHOUT SHADOWING BEING A STONE OR NOT.

CDI DISCLOSES A TWINKLING ARTIFACT THAT MEANS AN URETERAL STONE.

MSCT CONFIRMES THAT THE STONE LATER.

A STONE ENDOSCOPIC REMOVING IS PERFORMED FOR THE PATIENT IN THE SAME DAY.

SUMMARY: THE TWINKLING ARTIFACT IS A GOOD SIGN TO HELP LOCALIZING STONE IN THE DIFFICULT AREA TO REALIZE THE STONE OR A CALCIFICATION.

SHEAR WAVE ELASTOGRAPHY of a 5 YEAR TRANSPLANTED KIDNEY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-03-03T20:52:00.003+07:00

A 65 YO MALE PATIENT HAD BEEN TRANSPLANTED A RIGHT PELVIC KIDNEY FOR 5 YEARS.

ULTRASOUND AS A ROUTINE CHECK UP THE STATUS of KIDNEY TRANSPLANT WITH
3 IMAGES=

FIG. 1 : CDI OF TRANSPLANTED KIDNEY SHOWED THE STRUCTURE AND VASCULATURE IN NORMAL APPEARANCE.

FIG.2: SPECTRAL DOPPLER SHOWS THE GRAFTED KIDNEY IN GOOD PERFUSION.

FIG. 3: SHEAR WAVE ELASTOGRAPHY WITH SUPERSONIC IMAGINE PRESENTS THE Q-BOX WITH VALUES FROM 5-25 kPA. IT IS NORMAL OR NOT, NO FOUND REFERENCE SO FAR.

.

PLEASE TRY TO FIND ANY REPORT ABOUT SWE TRANSPLANTED KIDNEY ON INTERNET OR MEDICAL LITERATURE.

ASTEROID HYALOSIS with TWINKLING ARTIFACTS, Dr PHAN THANH HẢI-Dr LỮ MINH TÂN, MEDIC MEDICAL CENTER, HCMC VIETNAM.

2010-03-01T15:36:00.007+07:00

A 13yo girl who suffered from a visual acuity loss on the left with a suspicion of Ophthamic Hospital HCMC about troubled vitreous humor, came to Medic Center for a reviewing her left eye.

Ulltrasound at Medic detected a persistent hyperplastic primary vitreous (persistent Cloquet's canal) and a lot of white spots in the vitreous humor. But with CDI in the vitreous humor there were many Doppler color signals without flow spectral pattern.

Have you ever seen the twinkling artifacts in the eye globe like that ?

PERIAORTIC LYMPHOMA MIMICKING ABDOMINAL AORTIC ANEURYSM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-02-07T22:55:00.003+07:00

CASE BLOG Feb, 2010: CASE AAA MISTAKE.

A 79 YO PATIENT SUFFERED FROM EPIGASTRIC PAIN AND OLIGOURIA. ULTRASOUND IN ONE HOSPITAL SUSGESTED AN AAA WITH THROMBOSIS OF RENAL ARTERY. THIS CASE CAME TO MEDIC FOR REVIEWING ULTRASOUND AND MSCT OF THE AORTA.

ULTRASOUND IMAGES= ABDOMINAL AORTA WAS IN BIG DIAMETER WITH ECHO POOR ARROUND THE LUMEN JUST TO ITS BIFURCATION. CDI SHOWED NO FLOW IN THE LUMEN OF THE AORTA.

MSCT AORTA : 2 HYDRONEPHROSIS KIDNEY HAD BEEN COMPRESSED BY LYMPH NODES ARROUND THE AORTA, SUGGESTING A PERIAORTIC LYMPHOMA.

DISCUSSION= ULTRASOUND BLACK AND WHITE SOMETIMES MAKES MISTAKE LIKE THIS CASE. THE LYMPHOMA TISSUE HAS A POOR ECHOGENICITY WHICH IS THE SAME OF HEMATOMA OR SOME CYSTIC PATTERNS. WE NEED COLOR DOPPLER ANYTIME TO GET A DIFFERENT DIAGNOSIS.

SHEAR WAVE ELASTOGRAPHY of an UTERINE FIBROID DISAPPEARING POST UTERINE ARTERIAL EMBOLIZATION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-01-27T15:58:00.003+07:00

CASE OB-GY IN SHEAR WAVE ELASTOGRAPHY

A 36YO WOMAN SUFFERED FROM A VAGINAL BLEEDING DUE TO UTERINE FIBROID.

ULTRASOUND ELASTOGRAPHY SHOWED A 4 CM IN DIAMETER FIBROID NODULE IN SUBMUCOSAL LAYER.

PROCEDURE UAE WAS DONE TO CONTROL BLEEDING AND STOP VASCULAR FEEDING TO THE FIBROMA TUMOR.

IMAGE SCANNING 24 HRS AFTER UAE PROCEDURE = THE FIBROID TUMOR WAS IN WHITE SPOT LIKE PEPPER-SALT PATTERN.

10 DAYS AFTER UAE, SHE CAME TO EMERGENCY HOSPITAL BY PAIN AND VAGINAL DELIVERY THE FIBROID TUMOR.

IMAGE REVIEWS THIS TUMOR IN DISAPPEARANCE COMPLETELY.

HAVE YOU EVER SEEN THE SPECTACULAR CASE RESPONDING FROM UAE PROCEDURE FOR UTERINE FIBROMA, BUT NO NEED SURGERY.

SHEAR WAVE ELASTOGRAPHY of an INTRAOCULAR TUMOR, Dr PHAN THANH HAI, Dr NGUYEN THANH ĐANG, Dr LE DINH VINH PHUC, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-01-14T22:09:00.011+07:00

A 14 yo girl who suffered from a visual acuity loss on her right eye from Can tho province went to Medic Center for MRI and ultrasound examination.

MRI with Gado showed a choroidal hemangioma of the right eye and retinal detachment.

Ultrasound with supersonic probe 15 MHz presented an 9x10x11mm ovale right eye hypervascular tumor which was in rich echogenicity, and retinal detachment.

With shear wave elastography the tumor appeared in blue code (soft), with elastic score in range 10-14 kPa and shear wave velocity = 1,4m/sec.

It meant a benign vascular tumor, and a suspicion of choroidal hemangioma was thought to be. Hyperechoic intraocular tumor is a characteristic finding of a choroidal hemangioma. The last diagnosis is waiting for a result of surgical procedure in some day.
Those are some first pictures with shear wave elastography about an intraocular tumor which suggest highly a circumscribed choroidal hemangioma. Would you like give us your idea about this case?

SKIN TUMOR with SUPERSONIC PROBE 15MHz, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2010-01-12T20:36:00.002+07:00

IMAGES NEVER SEEN BEFORE

CASE No 2 IN JAN 2010.

SMALL NODULE APPEARED 7 WEEKS AGO ON THE NECK OF A 25 YO FEMALE PATIENT : RED, HOT, PAINFUL. ULTRASOUND BY SUPERSONIC PROBE 15 MHz SHOWED IMAGES B MODE AND COLOR DOPPLER.
HAVE YOU EVER SEEN A HYPERVASCULAR SURINFECTED SEBACEOUS CYST LIKE THIS ?

KIDNEY in SHEAR WAVE ELASTOGRAPHY by SUPERSONIC IMAGINE at MEDIC MEDICAL CENTER, HCMC, VIETNAM, Dr PHAN THANH HẢI.

2010-01-10T21:46:00.001+07:00

PICTURE OF REAL TIME KIDNEY ELASTOGRAPHY AT MEDIC BY SUPERSONIC IMAGINE SHOWED THE NORMAL CENTRAL REFLEX IN RED AND THE PARENCHYMA IN BLUE. SURPRISE ?.

BIG GALLBLADER without STONE on a DIABETIC PATIENT in FEVER and ICTERUS, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2010-01-08T17:59:00.006+07:00

CASE No 1 NEW YEAR JAN 2010
A 66 YO MALE PATIENT, DIABETIC TYPE 2, WELL CONTROLLED FOR A LONG TIME; 5 DAYS AGO HE SUFFERED FROM A RIGHT UPPER QUADRANT PAIN, ICTERUS AND FEVER, WBC 15K.
ULTRASOUND LIVER SEEMED TO BE NORMAL, NO BILIARY STONE, BUT THE GALL BLADDER WAS IN BIG SIZE WITH A SLUDGE LEVEL. THE GALLBLADDER WALL WAS THICK AND COLLECTING AN AMOUNT OF FLUID AROUND THE GALLBLADDER (SEE 3 IMAGES).

MRI.BILIARY- LIVER ALSO SHOWED THE BIG GALLBLADDER WITHOUT STONE.

THE CBD WAS IN NORMAL SIZE.
WHAT IS YOUR PROPOSAL?
Dr HAI MEDIC.

A GOSSYPIBOMA of RIGHT KIDNEY after REMOVING STONES for 13 YEARS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-12-25T21:32:00.005+07:00

CASE ULTRASOUND at the END OF THIS YEAR 2009.

A 50YO FEMALE PATIENT HAD BEEN IN AN OPERATION 13 YEARS BEFORE AT THE RIGHT KIDNEY BED FOR REMOVING THE KIDNEY STONE.
A SECOND OPERATION AT THE SAME SITE FOR A NEPHRECTOMY BY THE SILENT KIDNEY 3 YEARS BEFORE, BUT NOT IN SUCCESS BECAUSE OF AN ARTERIAL HYPERTENSIVE CRISIS. NOW SHE GOT PAIN AT THIS SITE.

ULTRASOUND ABDOMEN =

1.PICTURE 1 : LIVER AND GALLBLADER WERE NORMAL.

2. PICTURE 2: AT THE RIGHT KIDNEY FOSSA, THERE WERE A CYSTIC MASS AND MANY THINGS LIKE STONE WITH POSTERIOR SHADOWING.

3. CDI AT THE SAME SITE. (ALL 4 PICTURES WERE IN THE SAME SITE).

AFTER ULTRASOUND EXAMINATION WITH ANY CLEAR DISCLOSURE, MSCT UROLOGY WAS DONE WITH CE.
   CT   NUMBER 395 = SECTION NON CE
                              393 = WITH CE
                              392 = CE FRONTAL VIEW

MSCT 3D at MEDIC SHOWED A FOREIGN BODY WHICH WAS A TAPE SPONGE FOR HEMOSTASIS OF AN OPERATION IN THE PAST.

SUMMARY= ULTRASOUND 2D AND MULTISLICE CT SOMETIMES COULD NOT MAKE SURE A DIAGNOSIS, AND MSCT 3D IMAGES ARE THE BEST EVIDENCE OF A GOSSYPIBOMA FOR THIS CASE.

KELOID with SUPERSONIC IMAGINE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-12-16T18:13:00.004+07:00

A 4 yo child had been burnt for one year and now getting a keloid on the thigh, very itching.

Skin ultrasound with 15MHz probe showed blood supplying for keloid area.
SSI keloid had an elastic score = 29 kPa, and the thickness of lesion= 3.9-5.8 mm.
How to treat a keloid ?

BREAST CANCER with SUPERSONIC IMAGINE, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-12-16T06:37:00.007+07:00

A 30 yo female patient from BINH AN hospital (Kien Giang Province). She knew having left breast tumors in a check-up before giving birth.
10 months after her delivery, she came to BINH AN hospital for a treatment.

Ultrasound at MEDIC with Supersonic Imagine (SSI) showed 3 nodules inside her left breast. The central area was in blue black code and border in red code due to hardening with the score=156kPa.

Axillary lymph node was in size 3cm, in comparison to B-mode ultrasound which suspected this mass having a central necrosis meaning a soft one.

Mammography reported that the breast tumor in BI-RAD 4.

Core biopsy confirmed an ADENOCARCINOMA. IHC and FISH LAB for HER-2NEU were on the way.

A scheduled plan for her was done : operation first and chemo-radiation later.

SHEARWAVE ELASTOGRAPHY=SOME PRELIMINARY PICTURES , Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-12-10T23:09:00.007+07:00

A YINYANG MASS at PANCREATIC AREA due to MESENTERIC MALROTATION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC. VIETNAM

2009-11-07T16:13:00.011+07:00

ONE MONTH BEFORE, A 24 YO MALE PATIENT WENT THROUGH AN ENDOSCOPIC SURGERY FOR SUSPECTED ACUTE APPENDICITIS. DURING THE OPERATION, THE SURGEON found out many big tortuous vessels inside the abdomen.

ULTRASOUND ALSO REVEALED THE SAME THING: MASS WITH YINYANG SIGN AT THE PANCREATIC AREA, SIZE #2 CM.

INSIDE THE MASS THERE WAS A BIPHASIC SPECTRAL WAVEFORM PATTERN IN TURBULENCE.

THIS MASS WAS IN COMPARISON TO ABDOMINAL AORTA .

THERE WAS A BIG VEIN INTO THE MESENTERIC SPACE.

THIS PATIENT HAD A CLINICAL INTERMITTENT ABDOMINAL PAIN.

UPDATE CASE YINYANG MASS=

MSCT ANGIO REPRESENTED A MESENTERIC MALROTATION.

AS A RESULT, THE MESENTERIC VEINS DILATED IN TORTUOUS WAY DUE TO CLOCKWISE ROTATION AS WHIRPOOL SIGN.

CONCLUSION: DOPPLER ULTRASOUND COULD MAKE A MISTAKE FOR THIS CASE WHILE CT ANGIO HAD THE BEST ROLE IN SHOWING A MESENTERIC MALROTATION.

RIGHT PORTAL VEIN THROMBOSIS due to PROTEIN C DEFICIENCY , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-11-03T13:48:00.005+07:00

MALE 26 YO SUFFERED FROM AN EPIGASTRIC PAIN FOR 5 DAYS, FEVER AND NO GI TROUBLE.

US DETECTION= RIGHT PORTAL VEIN THROMBOSIS.

MSCT CONFIRMED A THROMBOSIS OF THE RIGHT BRANCH OF PORTAL VEIN WITHOUT TUMOR AND LIVER PARENCHYMA LIKE NORMAL.

BLOOD TESTS : WBC NORMAL, PLATELETS= 120K, SGOT =42, SGPT= 59 U/L. NO INFECTED HBV OR HCV. CRP=59,36 AND ESR = 51 AND 81 MM.

UPDATE PVT CASE=

ONCOLOGIST SUGGESTED PERFORMING MSCT TOTAL BODY AND BLOOD TESTS TO DETECT CANCER SOMEWHERE. RESULTS = NAD (NOTHING ABNORMAL DETECTED).

HEMATOLOGIST PROPOSED MORE BLOOD TESTS=

D-DIMER, very high PROTEINE C/ S. LEIDEN FACTOR ANTIPROTHROMBINE. THE RESULT OF C PROTEINE IS IN DEFICIENCY, ONLY 26%.

THE CASE WAS CONFIRMED THAT PORTAL VEIN THROMBOSIS BY C-PROTEINE DEFICIENCY. PROMPTLY PROCEED AN ANTICOAGULATION TREATMENT.

A WALL-OFF ABSCESS of LYMPH NODE in the MESENTERY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-10-21T23:18:00.009+07:00

A 17 yo MALE PATIENT WITH HISTORY OF PERIUMBILICAL PAIN FOR 1 MONTH, NO FEVER NO DIARRHEA, NO GASTROINTESTINAL TROUBLE. WBC=13K WITH 65% NEUTROPHIL. IN CLINICAL, THE MASS WAS REVEALED BY PALPATION AND LOCATED BELOW THE UMBILICUS.

ULTRASOUND =IT WAS A ROUND MASS , SIZE 10CM IN DIAMETER, CYSTIC FORMATION WITH AN AIR-FLUID LEVEL, AND VASCULAR BRIDGING INSIDE THE MASS.

MSCT WITH CE CANNOT FIND OUT THE APPENDIX, BUT THIS MASS CONTAINED AIR, FLUID, SOLID STRUCTURE AND VASCULAR STRUCTURE INSIDE, THE SAME AS FINDINGS OF ULTRASOUND. THE MASS WAS OVER THE AORTA FROM ABDOMEN TO THE PELVIS, THOUGHT TO BE IN THE MESENTERIC SPACE.

THIS CASE WAS SENT TO BINH DAN HOSPITAL FOR TREATMENT.

OPERATION IN URGENCY PERFORMED AT BINH DAN HOSPITAL. IT IS A WALL-OFF ABSCESS IN THE MESENTERY, SUSPECTING A TUBERCULOUS LYMPH NODE NECROSIS.

12 FOSSIL- LIKE PILLS inside a MASS of OLD COPROSTASIS in TERMINAL ILEAL DIVERTICULUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-10-04T13:01:00.030+07:00

A 31yo FEMALE PATIENT SUFFERED FROM ABDOMINAL DISTENSION AND PAIN.

FOR 20 YEARS SHE HAD GONE THROUGH AN OPENED OPERATION FOR APPENDICECTOMY AND THEN AN ANTI-TUBERCULOSIS TREATMENT HAD BEEN DONE.

ULTRASOUND IMAGES= ONE BIG MASS FROM PELVIS TO MIDDLE ABDOMEN, SIZE 25CM WITH "UMBRELLA SIGN " BY THE STRONG ATTENUATION.

ON A PLAIN ABDOMINAL X-RAY FILM THERE WERE MANY OSTEOGENIC RINGS INSIDE THE MASS.

MSCT SHOWED THAT THE MASS WAS WELL BORDERED, WITH GAS INSIDE AND 12 OSTEOGENIC RINGS .

Operation detected a diverticulum of the terminal ilium which was made by fecalith located at the iliocecal angle, and the outside walls were in adhesion and inflamation. The diverticulum contained an old coprostatic mass including 12 stone-like very hard structures, each one about 25mm in diameter. By breaking the stone-like hard structure it existed surprisingly the "fossil" of morrhuae oil (cod liver oil) pill.

HYPERECHOIC MEDULLA of the KIDNEY in a CASE of CORTICAL ADRENAL ADENOMA , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER

2009-09-29T22:22:00.023+07:00

FOR 3 YEARS, A 34yo WOMAN SUFFERED FROM A PERIODIC PARALYSIS WITH HYPOKALEMIA AND ARTERIAL HYPERTENSION 200/100mmHg.
ABDOMINAL ULTRASOUND SHOWED THAT 2 KIDNEYS HAD HYPERECHOIC MEDULLA AND VASCULAR RENAL DOPPLER WERE NORMAL.

Fig.1: RIGHT KIDNEY WITH HYPERECHOIC MEDULLA.

Fig.2: RENAL VASCULAR DOPPLER WERE NORMAL.

Fig.3: IN COMPARISON RIGHT TO LEFT RENAL STRUCTURE.

HYPERALDOSTERONEMIA = 420pg/mL ( N 20-210). MSCT DETECTED A SMALL# 1.2 CM TUMOR AT ADRENAL FOSSA.

THE MEDULLA OF KIDNEY HAD NO CALCIFIED.
NOTES = ADRENAL TUMOR WITH HYPERALDOSTERONEMIA. THE KEY POINT OF THIS CASE ARE: HIGHT BLOOD PRESSURE, HYPOKALEMIA, HYPER-ECHOIC MEDULLA OF THE KIDNEY.
REFERENCE= HYPERECHOIC MEDULLA of the KIDNEY, KEIKO TOYODA et all, RADIOLOGY, 1989, 173;431-4

OPERATION BY ENDOSCOPY REMOVED A SMALL 1.6 cm TUMOR WHICH WAS SOFT AND YELLOW IN MACROSCOPIC EXAMINATION.

MICROSCOPIC RESULT SAID THAT WAS A CORTICAL ADRENAL ADENOMA.

THE ARTERIAL BLOOD PRESSURE RETURNED NORMAL POST OP.

A RETROPERITONEAL CALCIFIED SCHWANNOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-09-23T19:49:00.013+07:00

A 52 yo man suffered from a pain at his right abdominal fossa which irradiated to his right leg.

Abdominal ultrasound detected one 3cm long ovoid mass, well bordered, hypoechoic, painfull due to press over it.

In comparison with the right kidney, this mass which was like a pseudokidney, but had no motion like the kidney. And there were some microcalcified spots inside the mass.

CT SCAN: THIS MASS was in RETROPERITONEUM, WITH CALCIFICATION INSIDE and NO RELATION WITH the APPENDIX.

THE MSCT REPORT SUSPECTED A RETROPERITONEAL TERATOMA.

IN SURGERY THE 8x5x3CM TUMOR WAS REMOVED EASILY. THAT WAS A WELL BORDERED TUMOR WITH CENTRAL CALCIFIED SEPTATION.

THE MICROSCOPIC STRUCTURE OF THE MASS WAS A RETROPERITONEAL SCHWANNOMA. The mass concludes some Schwann cells which have lozenge shape, flat and small nuclei in Antoni A classification: nerve sheath tumor, Schwann cells gather together in bundle, spiral or hedge.

HOW CAN WE MAKE A DIAGNOSIS ABOUT A RETROPERITONEAL SCHWANNOMA?.

2 MASSES in A CASE of ECTOPIC PREGNANCY, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-09-16T20:18:00.023+07:00

A 24 YO FEMALE PATIENT WAS IN HER FIRST TIME OF AMENORRHEA AND VAGINAL BLEEDING. THE VALUE OF HER BLOOD TEST beta hCG WAS 300 UI/L.
ULTRASOUND SCANNED IN THE PELVIC REGION DETECTING A 4cm MASS WHICH WAS NEAR THE RIGHT KIDNEY WITH ECHO POOR AND NO VASCULAR SUPPLIES TO THIS MASS. IT HAD MOTION WITH RESPIRATION LIKE AN INTRA-ABDOMEN STRUCTURE.

UTERUS WAS NORMAL IN SIZE AND NO INTRAUTERINE GESTATIONAL SAC. THERE WAS AN AMOUNT OF FREE FLUID LIKE BLOOD IN THE CUL-DE-SAC. ANOTHER 2 cm MASS APPEARED ON THE RIGHT SIDE OF THE UTERUS THAT HAD HYPOECHOIC STRUCTURE LIKE AN ECTOPIC PREGNANCY SAC.

THIS PATIENT CAME TO MEDIC FOR MRI. T1 AND T2 IMAGES SHOWED THE ABDOMINAL MASS WAS A COAGULATED BLOOD MASS.

AND ONE MASS ON THE RIGHT SIDE OF THE UTERUS WAS A GESTATIONAL SAC IN BLEEDING.

Follow up case= no more vaginal bleeding, no abdominal pain, beta hCG drops down to 30UI/L. This patient goes home with the diagnosis of E.P. REABSORPTION.

INTRAMYOMETRIUM PREGNANCY OF A YOUNG FEMALE PATIENT, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-08-26T18:34:00.014+07:00

18YO FEMALE PATIENT, FIRST GESTATION. ULTRASOUND DETECTED NO GESTATIONAL SAC IN HER UTERINE CAVITY. BUT SHE HAD A RIGHT ANNEXAL MASS WHICH WAS SUSPECTED AN ECTOPIC PREGNANCY .

BLOOD TEST (BLOOD beta hCG) = 65.000 UI/L. BUT LAPAROSCOPY WAS NORMAL.

AT MEDIC ULTRASOUND=

IMAGE 1=A 3CM MASS WAS IN THE RIGHT SIDE OF THE UTERUS, AND THE ENDOMETRIUM WAS IN THICKNESS.

IMAGE 2=CDI VASCULAR STRUCTURE OF THE MASS.

IMAGE 3= PULSED DOPPLER SPECTRUM WITH RI=0,5.

With a pelvic MRI this picture showed a nidus of intramyometrium pregnancy with hematoma. Blood test betaHCG dropped down to 300 unit/mL and no vaginal bleeding. By the MRI and blood test results with the progress of clinical status, we susgested it was an intramyometrium pregnancy in reabsorption.

NO LEFT KIDNEY BUT MASS MIMICKING SPLEEN, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-08-12T15:58:00.017+07:00

FEMALE PATIENT 29YO HAD NO THE LEFT KIDNEY BY ULTRASOUND, BUT IT HAD A MASS AT LEFT RENAL BED, AND THE MASS STRUCTURE WAS NOT LIKE THE KIDNEY .

IMAGE 1: RIGHT KIDNEY WAS NORMAL.

IMAGE 2: SCAN AT THE LEFT RENAL FOSSA, SPLEEN WAS IN UPPER AND A MASS IN THE POSITION OF THE LEFT KIDNEY.

IMAGE 3 : CROSS SECTION AT THE LEVEL OF PANCREAS: THIS MASS HAD A HYPOECHOIC PATTERN.

IMAGE 4: ON CDI, THIS MASS WITH ECHO STRUCTURE WAS LIKE THE SPLEEN.

This patient had a renal isotopic scan which showed that not having the left kidney ( image 5) .

MSCT 64 AT MEDIC =

IMAGE 6= LEFT MASS WAS NOT LIKE A KIDNEY.

IMAGE 7= THIS MASS WAS PROLONGED FROM THE SPLEEN.

MSCTA SHOWED THAT THE MASS WAS THE SPLEEN (image 8).

IT IS AN ATYPICAL SPLEEN in THE LEFT KIDNEY FOSSA.

INSTEAD OF 5 YEAR HYDRONEPHROSIS by US B-Mode, COLOR DOPPLER DETECTED ARTERIOVENOUS MALFORMATION, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, VIETNAM

2009-07-26T13:04:00.021+07:00

Mme DO THI SAU, 64 YO FEMALE PATIENT FROM GO CONG PROVINCE HOSPITAL, SUFFERED FROM A RIGHT KIDNEY HYDRONEPROSIS DETECTED BY A LOCAL ULTRASOUND UNIT. SHE WAS TRANSFERRED TO UROLOGY DEPARTMENT OF BINH DAN HOSPITAL THEN.

PAST HISTORY : SHE HAD BEEN TREATED IN BINH DAN HOSPITAL FOR 5 YEARS BY RIGHT HYDRONEPROSIS. THE MEDICAL RECORDS NOTED THAT WAS A STENOSIS OF RIGHT PELVIC URETER. DOCTOR HAD DILATED IT AND PUT A INTRAURETERAL STENT BY ENDOSCOPY. BUT THE HYDRONEPHROSIS WAS NOT IN RESORPTION.

AT THIS TIME ULTRASOUND BLACK AND WHITE (B-Mode) SAID THAT HYDRONEPROSIS IN SECOND DEGREE. INTRAVENOUS PYELOGRAPHY (IVP) WAS NOT CLEAR. BUT RIGHT KIDNEY WAS STILL IN ITS FUNCTION. AND SAME AS IN SPECT GAMMA SCAN.

AT MEDIC CENTER NOW ULTRASOUND NOTED HER RIGHT KIDNEY IN DILATATION LIKE HYDRONEPROSIS BUT CDI AND PDI REVEALED AN ARTERIOVENOUS MALFORMATION (AVM).

MSCT ANGIO CONFIRMED THAT WAS AN AVM OF THE RIGHT KIDNEY.

A NEPHRECTOMY OPERATION WAS DONE ON JULY 24 BY PROF VAN TAN PRESENTING AN AVM INTO THE RIGHT KIDNEY.

CONCLUSION= THE COLOR DOPPLER SHOWED A 5 -YEAR -MISTAKE OF BLACK AND WHITE ULTRASOUND .

ZENKER'S DIVERTICULUM, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-07-23T18:03:00.019+07:00

Mr DO VAN L.,75YM PAIN AT THE LEFT SIDE OF HIS NECK, DIFFICULT IN SWALLOWING. ULTRASOUND OF THE NECK REVEALED A NORMAL ECHOGENICITY OF THYROID AND THERE WAS A MASS IN THE LEFT LOBE, ROUND AND BRIGHT IN 2 CM DIAMETER WITH STRONG SHADOWING BELOW AND FLASH ECHO.

IMAGE 1= CROSS SECTION AT THE LEFT LOBE OF THYROID.

IMAGE 2 COLOR DOPPLER OF THE THYROID MASS

IMAGE 3 = LONGITUDINAL SECTION OF THE LEFT LOBE OF THYROID.

IMAGE 4 = CDI IMAGE OF A LONGITUDINALE SECTION OF THE LEFT LOBE OF THYROID.

THIS PATIENT DID NOT SPEND ANY PUNCTION PROCEDURE BEFORE.

UPDATING=

This patient had been done an endoscopic examination for looking larynx that was normal.

Reexamination ultrasound at MEDIC... when we scanned the thyroid with dynamic motion of the thyroid by deglutition of saliva there was the air inside this nodule.

MSCT CONFIRMED THAT WAS AN ESOPHAGEAL DIVERTICULA OF ZENKER.

LITTORAL CELL ANGIOMA of the SPLEEN in a BOY, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, VIETNAM

2009-07-02T16:47:00.021+07:00

14 YO BOY LIVING IN CAN THO. HE CAME TO CHECK FOR ABDOMINAL PAIN. ABDOMINAL ULTRASOUND AT MEDIC DISCLOSED A HYPERVASCULAR SPLENIC TUMOR, IN SUSPICION A HEMANGIOMA OF THE SPLEEN.

BUT HIS FATHER BROUGHT HIM FOR REEXAMINATION IN OTHER 4 ULTRASOUND CENTERS WITH MANY DIAGNOSTIC THINGKINGS INCLUDING= SPLEEN ABSCESS, SPLEEN TUMOR, LYMPHOMA OR NORMAL EXAMINATION.

AFTER 10 DAYS HE RETURNED TO MEDIC AGAIN FOR BLOOD TESTS. LDH =520 , BETA2 MICROGLOBULIN 1326ng/mL .

AND MSCT OF ABDOMEN WITH CE SHOWED THAT WAS A HYPERVASCULAR SPLEEN TUMOR , SIZE 4CM -5 CM WITHOUT LYMPHATIC NODE INTRA ABDOMEN.

SPLEEN TUMOR UPDATED (July 15, 2009)
OPERATION PERFORMED AT CHO RAY HOSPITAL TO REMOVE THE SPLEEN.

MACROSCOPIC SPECIMEN WAS A SOFT GREY-BROWNISH TUMOR, WELL-DELINEATED. MICROSCOPIC RESULT WAS A SPLENIC ANGIOMA IN SUSPICION LITTORAL CELL ANGIOMA OF THE SPLEEN. WAITING FOR IMMUNOHISTOCHEMISTRY STAINING TO IDENTIFY THE TUMORAL NATURE.

LEFT PSOAS MUSCLE HEMATOMA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-06-10T17:21:00.013+07:00

A 30 yo male patient from Orthopedic Hospital for emergency abdominal ultrasound examination. He has got pain and distension at his left iliac fossa. Ultrasound showed his left kidney displacing the psoas muscle which had cystic formation (Fig. 1) in comparison with the normal right psoas muscle (Fig.2).

Ultrasound in cross section at his left pelvic region revealed arround the iliac artery a mass like abscess or hematoma.

He had suffered from a spinal fracture operation 14 years ago, and being in paralysis since then, and lost of ability of working for a long time .

THIS PATIENT HAD BEEN PUNCTURED AND WITHDRAWN FREE BLOOD INTRA ABDOMEN. LAPAROTOMY WAS DONE AT BINH DAN HOSPITAL BUT THE SURGEON CANNOT FIND OUT THE SITE AND CAUSE OF BLEEDING.

MSCT ANGIO IN MEDIC CENTER AFTER OPERATION 4 HOURS = 4 IMAGES.

IMAGE 452 = GAUZE BULKING INTRA ABDOMEN FOR COMPRESSION.

IMAGE 459 = IMAGE OF HONEYCOOM DUE TO SURGICAL GAUZE.

IMAGE 453 = CONTRAST FILLING MASS NEAR THE HILUS OF LEFT KIDNEY. IT WAS LIKE AN ANEURYSM AT THE SITE HAVING METALLIC FIXATION BEFORE.

IMAGE 454 = 3D VASCULAR RECONSTRUCTION SHOWED THAT BLEEDING FROM AORTA NEAR THE LEFT KIDNEY FROM A METALLIC FIXATION SCAR.

OPERATION SURELY PROVED THE CAUSE OF BLEEDING.

SO WE HAVE A CASE OF PSEUDOANEURYSM OF ABDOMINAL AORTA WHICH RUPTURED INTO THE LEFT PSOAS MUSCLE DUE TO A METALLIC FIXATION AFTER 14 YEARS.

SOLITARY NODULE of LUNG, Dr LÊ HỮU LINH, Dr NGUYỄN THIỆN HÙNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-05-28T12:30:00.008+07:00

A 85yo female arterial hypertension patient had got pain of a swelling area of her left chest for 5 days due to a slight fall.
Ultrasound detected a small crash on the anterior arc of the left fourth rib and a small hypoechoic lesion with posterior enhancement on the surface of the left lung, 10 x 11mm in diameter, without Doppler signal. No pleural effusion nor oppressive status were noted.

MSCT 64 with contrast confirmed a 4th rib crash on the left and defined a small solitary nodule of the lingula of the left lung which still was in an uncertain nature.

What is your diagnosis and what should we do ?

Dr Lê Thanh Thảo had an exact comment about the C line for this case : distal alveolar syndrome.
We have a reference of the distal alveolar syndrome in the book General Ultrasound in the Critical Ill, 2002, p.119.

HUGE MASS INTO LIVER WITH PAIN AND FEVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-05-18T20:44:00.011+07:00

A 63 YO FEMALE PATIENT FROM 115 HOSPITAL WITH FEVER AND PAIN AT HER HEPATIC REGION.
PAST HISTORY : REMOVING STONE COMMON BILE DUCT BY ERCP IN 2005. CHOLECYSTECTOMY DUE TO STONE IN 2006.
ULTRASOUND MEDIC IN EMERGENCY= 3 IMAGES;

IMAGE 1: COMMON BILE DUCT NO DILATATION.

IMAGE 2: A HYPERECHOIC MASS INSIDE THE LEFT LOBE OF LIVER, TOO BIG, EXTENDING FROM THE RIGHT LOBE TO THE LEFT LOBE OF LIVER, WITHOUT POSTERIOR ATTENUATION.

MAGE 3: BIPLAN SECTION

MSCT NO CE: STONE INTO THE COMMON HEPATIC DUCT AND A HYPODENSE MASS, SIZE #12 CM, BEING LIKE THE PANCREAS, WITH A CANAL INSIDE THE MASS.

BLOOD TEST : WHITE BLOOD CELLS (WBC) RAISE 15K.
WHAT IS YOUR DIAGNOSIS ?

FALSE RUPTURE of the SPLEEN, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-05-11T16:17:00.031+07:00

A 18 y-o MALE PATIENT SUFFERED FROM AN ACUTE PAIN ON HIS LEFT UPPER ABDOMEN WHICH WAS GETTING WORSE AND WORSE. PAIN WITHOUT FEVER AND NOT ANY TRAUMATIC EVENT WAS NOTED.

ULTRASOUND IN EMERGENCY AT MEDIC AT 10 AM=
IMAGE 1= HEMOPERITONEUM IN LARGE VOLUME, MORE THAN 2 LITRES OF BLOOD AND REVEALED THE SPLEEN BLOOD CLOTS AT THE HILUS OF SPLEEN WITH AN ECHO POOR LINE WHICH WAS THOUGHT TO BE A SPLEEN RUPTURE (IMAGE 2).
IMAGE 3 WITH COLOR DOPPLER REPRESENTED A VASCULAR TREE OF THE SPLEEN WHICH WAS NORMAL.
CT SCAN WITH CE= SUSPECTED A RUPTURE OF THE PLEEN.
BLOOD TESTS= Hct: 34%, TOTAL BLOOD COUNTS WERE IN NORMAL VALUES.
THIS PATIENT WAS SENT TO BD HOSPITAL FOR EMERGENCY MANAGEMENT.
NOW WAITING FOR THE LAST REPORT.
DO YOU THING IT IS A CASE OF SPONTANEOUS RUPTURE OF THE SPLEEN.

Report from surgeons: operation was performed after 5 hours of admission when trying of a conservative treatment was failed as Hct still dropped down. 2 litres of blood were withdrawn. There were blood clots arround the hilus of the spleen, but the spleen had no signs of rupture.

The black line on US and CT images was a scissure of the one lobe of the spleen and find out nowhere did bleed.
This case was strictly under a survey post op for 24 hrs, still in stable condition and now was discharged after one week in hospital. Cause and site of bleeding were still unknown.

CONCLUSION=

CT and US detected sensitively an intra-abdominal bleeding, but some times the spleen morphology is very different in its anatomical variations. That is the cause of the mistake.

SPLEEN TUBERCULOSIS MIMICKING A SPLEEN TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-04-26T11:42:00.021+07:00

37 year-old male patient suffered from 39 Celsius degree fever in the afternoon for one month without peripheral pathologic node enlargement. Gastro and colonoendoscopies detected nothing abnormal. Chest X-rays, blood tests were in normal values and all cancer markers were negative.
Ultrasound of the spleen revealed some 1-2 cm in diameter hypoechoic multifocal with slight posterior enhancement. MSCT with CE confirmed multiple focal lesions in the spleen.

UPDATING CASE SPLEEN .. PHUNG MINH PHUC...

SPLENECTOMY AT CHO RAY HOSPITAL. MICROSCOPIC REPORT IS TUBERCULOSIS. THIS PATIENT HAS NO FEVER AFTER OPERATION UNTIL NOW .

HE HAD 4 MONTHS FEVER.

RETROPERITONEAL PARA-AORTIC PARAGANGLIOMA , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-04-13T18:56:00.021+07:00

42 year-old female patient suffered from an epigastric pain. Ultrasound detected =

Fig 1: Longitudinal section of the left lobe of the liver over the inferior vena cava (IVC). Tumor blocked the IVC (under the left lobe of the liver there was echo mixed and cystic mass).

Fig.2: Cross section= Tumor was bending the IVC from outside.

MSCT from an other hospital showed a retrohepatic tumor which seemed to be like from the caudate lobe of the liver but the IVC was not clear.

A surgical (retroperitoneal laparoscopic excision) removing the tumor was performed by Dr Tran Ngoc Sinh at Cho Ray Hospital.

It was a rare tumor of chromaffin tissue outside the adrenal gland (pheochromocytoma was a chromaffin tissue tumor inside the adrenal medulla); a paraaortic tumor belonged to organ of Zuckerkandl (paraganglioma). In Vietnam it was the third'case of retroperitoneal paraganglioma that we had ever known.

RENAL STONES and PARATHYROID TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-04-10T07:35:00.017+07:00

A 37 yo male soldier had been removed kidney stones 3 times for 2 years and in that time had got a broken arm in a slight fall.

Ultrasound revealed many stones in his kidney (Fig.1) and a hypoechoic mass on the left side of his neck (Fig.2-3).

In E-mode (elastography mode) of ultrasound, the tumor belonged to a blue score of soft tumor (Fig.4) that meant a benign tumor. With the increasing parathormone level more than 3,000 times, this mass was thought to be a parathyroid tumor in a status of hyperparathyroidism.

The purpose is not forgetting to look for a parathyroid tumor in a kidney stone patient who has a tendency of bone fracture.

BIG BLACK AORTA, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER HCMC, VIETNAM

2009-03-30T14:50:00.017+07:00

68 YO MALE PATIENT SUFFERED FROM EPIGASTRIC PAIN AS GASTRITIS AND ARTERIAL HYPERTENTION, BP = 22/10cmHg.

ULTRASOUND EXAMINING HIS ABDOMEN REVEALED A LEFT LOBE OF LIVER CYST AND A 4cm DIAMETER BIG AORTA.

WITH CDI, AORTA APPEARED IN BLACK WITH VERY SMALL FLOW, MEANWHILE THE SUPERIOR MESENTERIC AND COELIAC ARTERIES WERE WELL VISIBLE.

A CHEST X-RAYS WAS DONE WITH BIG THORACIC AORTA.

MSCT ANGIO BLACK AORTA SHOWED THAT WAS A THORACO-ABDOMINAL AORTIC DISSECTION, ITS TRUE LUMEN VERY SMALL. AND ULTRASOUND DOPPLER THE AORTA COULD NOT SEE THE FLOW.

SUMMARY: SEEING AN ABDOMINAL AORTA IN BLACK YOU OUGHT TO MAKE SURE NO FLOW IN IT AND FIND OUT THE CAUSES OF NO COLOR PATTERN IN THE VESSEL .

ANGIOMYOLIPOMA (AML) of the LIVER , Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-03-17T18:41:00.016+07:00

25 year-old female patient has got a suspected spleen tumor at her left subcostal region before giving birth. After her delivery 2 months the tumor became growing up. Ultrasound at Medic revealed the normal right lobe of liver (Fig.1) and the big tumor of left lobe which was in connection to the right lobe by a vascular pedicule (Fig.2). Fig.3 represented 3 level sections: upper, hypoechoic structure of tumor; middle, spleen parenchyma; and lower, hypoechoic parenchyma of the left kidney.

MSCT 64 with CE showed right lobe of liver and left lobe of liver tumor with hypervasculature.

MSCT Angio represented the vascular supply of the tumor from celiac truncus.

A surgical procedure was performed at Binh Dan hospital on March 23, removing the 1.7 kg left lobe of liver tumor. But it was difficult to determine the tumoral origine in microscopic studies.

The immunohistochemistry (positive cytoplasmic staining of HMB 45) and histopathologic results confirmed an Angiomyolipoma (AML) of the liver for the final diagnosis of the huge left lobe of liver tumor.

GALLBLADER WALL THICKENING, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-03-14T16:14:00.008+07:00

32 year-old female patient from Tu Du Hospital, 2 days after her delivery, liver enzymes increasing= GOT >540U/l, GPT=620U/l, gammaGT =420U/l. She had been a HBV carrier and did not suffer from abdominal pain nor fever.

Ultrasound findings= Homogenous structure of liver with normal size, no sign of cirrhosis. Gallblader wall was in thickness at 0.5cm, hypoechoic and no hyperemia. Common bile duct was not in dilatation.

Ultrasound reexamination after 10 days revealed gallblader in the normal appearance and liver enzyme levels returned to the normal values.
Conclusion: Gallblader aspect was like an avocado that really meant its reaction to acute hepatitis.

INTERNAL JUGULAR VEIN CASE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-03-05T07:21:00.001+07:00

A 83 year-old male patient post stroke went to vascular ultrasound examination with the normal right and left ICA.

He has got on his left lateral neck a round hypoechoic mass which was like an egg.

This mass was close to the ICA and lateral of left lobe of the thyroid gland. In longitudinal section it was suspected a big left internal jugular vein in B-mode and CD Imaging.

In comparison with the right side , the left one was bigger and no flow inside its lumen.

MSCT the lung detected a left apical lung tumor which invaded the subclavian vein.
In reviewing this case= If the size of the right and left IJV were different we ought to find out the causes of this phenomenon(thrombosis, compression or obstruction) and IJV diameters which were connected with CVP (central venous pressure)

MULTIPLE SKIN NODULES, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-03-01T11:35:00.001+07:00

A 60-year-old slightly anemic female patient had multiple nodules spreading on her thoracic skin for 3 months. They were red spots in size 1-2cm, no itching, no hot.
Skin Ultrasound was performed with a probe 12MHz and gelly nearfield that revealed nodule into the skin, # 1cm in thickness which invaded the 'subskin' area.
Her RBC=3M/mL, WBC normal.

Because of the histopathologic result of the skin nodule was a poor differentiated carcinoma, a full body MSCT scanning was performed which revealed lesions of the breast and the skeleton system. So this case belonged to the breast carcinoma metastasizing to the skin and bones.

5 TIMES of G.I. MELENA due to MECKEL DIVERTICULITIS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-02-25T19:22:00.005+07:00

A 18 year-old male patient from Quang tri province suffered from GI bleeding 5 times that was suspected of bleeding from small intestine.
Ultrasound and MSCT 64 detected an abnormal structure in contact to a feeding artery which belonged to the superior mesenteric artery.

I suspected pre op that of an inflamed Meckel diverticulum.

On Feb 25, 2009, Prof Van Tan from Binh dan Hospital had removed this Meckel diverticulum by mean endoscopic surgery.

The specimen was similar to an appendix which was determined exactly pre op by endoscopic capsule (EC), ultrasound and MSCT 64. This Meckel diverticulum was in chronic inflamation with ectopic gastric mucosa inside persuading to believe that was the cause of melena.

"HEART KIDNEY", Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-02-16T19:17:00.000+07:00

18-year-old male patient with his chief complaint of being pain of his left flank. According to Ultrasound in Ba ria Vung tau province the result was a left kidney tumor.
In Binh dan Hospital on IVP and UPR films his left kidney was a silent kidney(Fig.1-2).
In Medic Center some pictures from ultrasound and MSCT 64=
Fig.3= The left kidney was like a heart.
Fig.4= With CDI the heart mimic had a vascular structure pattern.
Fig.5= Longitudinal section of the left kidney mimicked a heart.
Fig.6= MSCT 64 Cross section of the heart mimic without CE.
Fig.7= MSCT 64 Cross section the heart mimic with CE, arterial phase.

OPERATION WAS DONE by UROLOGIST of Binh Dan HOSPITAL on Feb 25. IT WAS a CONGENITAL URETEROPELVIC JUNCTION OBSTRUCTION. An ANASTOMOSIS REPAIREMENT WAS PERFORMED.

AML KIDNEY TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-02-09T14:52:00.000+07:00

50yo female patient suffered from hematuria and pain of her right kidney.
BD Hospital .. injected ATROPIN.
Chest X-rays, blood tests and urine test were normal.

Fig.1= Transversal section of Right kidney: a 3cm hyperechoic mass at upper pole of right kidney.

Fig.2= Transversal section at the hilum of right kidney: Hyperechoic avascular mass bent the hilum vessels of the right kidney.

Fig.3= Vascular structure of the tumor was in dilatation and shunting along the tumor border.

Fig.4= CT non CE : Tumor from right kidney with fatty tissue and retroperitoneal thickening.

Fig.5= CT with CE: Hypervascular tumor.

Fig.6= Hypervascular tumor from right kidney.

In removing this tumor, Dr. Nguyen Hoang Duc whose pre-op suspection was an AML of the right kidney, said that the 2cm tumor was fatty tissue by the look of it and connected the right kidney by its surface.

The histopathologic result of this specimen is an Angiomyolipoma (AML) of the right kidney.

PSEUDOKIDNEY CASE, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-02-03T15:16:00.000+07:00

65-year-old female patient suffered from abdominal pain, fever, diarrhoea and melena with leukocytosis (17,2 G/l). She belonged to Tam Duc Cardiac Hospital and had to come throught a valvuloplasty for 1 month.

Ultrasound Medic revealed a kidney-shaped mass which was next to the border of liver, represented a pseudokidney sign (Fig.1) at her RUQ.

In Fig .2, transversal section showed a normal right kidney and another one above.

In Fig. 3, longitudinal section showed the tubular structure mimicking GI tract and thick wall.

MSCT 64 proved this mass being right angle colon with a 15mm wall thickness.

After 2 week antibiotic treatment, ultrasound detected no mass and this patient was suspected about an ischemic colitis postop heart surgery.

MULTIPLE FOCAL of SPLEEN, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

2009-01-30T07:20:00.000+07:00

MSCT SAID THAT MULTIPLE FOCAL HYPODENSE. SUSGESTION: GRANULOMA OR HEMANGIOMA OF THE SPLEEN.
ULTRASOUND : MULTIPLE FOCAL HYPERECHOIC, NO BENDING NO DISTORSION VESSELS. SPLEEN SIZE WAS NORMAL. NO LYMPHATIC NODE ARROUNDING THE SPLEEN. SUSPECTED SPLEEN HEMANGIOMA.

AFTER A PROCEDURE OF SPLENECTOMY WAS PERFORMED AT TRUNG VUONG HOSPITAL, A SUSPECTION OF SPLEEN TUBERCULOSIS FOR THIS CASE WAS DONE BASED ON MICROSCOPIC RESULT .

PRECOCIOUS PUBERTY, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-01-24T10:56:00.000+07:00

02-year-old female child from Children No.2 Hospital went to MEDIC ultrasound examination as a vaginal bleeding.
In clinical her breast were enlargement in combining with her age.
Some lab data= FSH = 0.25 (1.4-21mIU), LH = <0.07(0.08-57mIU), Estradiol (E2)=108pg/mL(13-28ng/mL), hGH = 1.64>1pg/mL)
Abdominal ultrasound revealed a big uterus having thick and bright endometrium. On the left side of her uterus there was a 25mm-diameter cystic tumor. This one had a smaller cyst inside itself.
MRI showed normal brain in noting a hypertrophy of the right faciomaxillary bones.
How about your diagnosis?

EPIGASTRIC TUMOR, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-01-19T14:05:00.000+07:00

82-year-old male patient from Tien giang Province suffered from epigastric pain. He had been examined in a Military Hospital by X-rays barium meal and ultrasound. The former showed gastric deformities and gastritis, the latter suggested a retroperitoneal tumor.
Ultrasound in Medic Center revealed a big solid mass which appeared next to the left lobe of liver, 10cm in diameter with calcifications. This tumor did not belong to liver, pancreas or spleen and displaced the stomach filling with water laterally and posteriorly.
All blood tests (AFP, CEA, CA 19-9)were in normal limits.
64 MSCT without contrast agent showed that solid calcified tumor was not in relations of the liver, pancreas or spleen.

What is your idea?

PAROTID GLAND MASS, Dr PHAN THANH HAI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

2009-01-15T12:43:00.000+07:00

22-year-old male patient suffered from pain and swelling of his right parotid region. Clinical signs by the palpation in examination included hot and hard feelings.
Grey scale ultrasound revealed a well-bordered round mass inside the right parotid gland with strong posterior enhancement. On color Doppler imaging (CDI) there was no vascular of this mass which bent vessels around it. The Doppler wave pattern was shown as high flow feeding vessel on power Doppler imaging (PDI). And with compression technique vessels raised their flow while there was no changing of the tumor shape.
After performing a fine needle aspiration for cytology (FNAC) it had an amount of pus in withdrawn yellowish thick liquid. So that was thought to be an infected sebaceous cyst in the process of forming an abscess in the right parotid region.