Acoustic Radiation Force Impulse (ARFI) Imaging of Thyroid Nodules at MEDIC CENTER, Hung Thien Nguyen, Cuong Tuan Nguyen, Xuan Thanh thi Pham, Hai Thanh Phan.

Purpose: The aim of the present study was to evaluate the feasibility of ARFI-measurements in combining of VTI and eSie Touch images in the thyroid nodule.

Methods and materials: All patients underwent conventional ultrasound, ARFI-imaging and cytological assessment. ARFI-imaging (VTI and VTQ technology) and eSie Touch technology were performed  with 9L4 probe, using Siemens (ACUSON S2000) B-mode-ARFI combination transducer.

Results: 85 nodules were available for analysis. 67 nodules were benign on cytology, 13 nodules were malignant (13 papillary carcinomas), and 5 follicular lesions.

The median velocity of ARFI-imaging in benign and malignant thyroid nodules was of 2.06 m/s, and of 3.00 m/s, respectively. A specificity of ARFI-imaging of 95% could be achieved using a cut-off of 3.1 m/s (area under ROC curve is 0.778). We realized that should combine the ARFI velocity with VTI and eSie Touch images in the characterization of malignant nodules and follicular lesions which were in dark color from benign nodules, in bright color, because there was an overlapping of the ARFI velocity values between them.

Conclusions: ARFI can be performed in thyroid nodule with reliable results. ARFI might be the reference criteria for differentiation of benign and malignant thyroid nodules.

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An Interesting Case of T-Shape IUD Inducing Urinary Stone Formation for 10 Years at MEDIC CENTER, HCMC, Vietnam, Tai van Le, Triet Quang Duong, Nhan Thanh Nguyen Vo, Thien Minh Nguyen.

33yo female patient, PARA 4004, with chief complaints: hypogastric pain and dysuria for a long time.

She used a T-shape IUD after having a first child in 2002, but removed the IUD at the third month of the second pregnancy. She had more 2 another children from 2004 to 2008. And she reused IUD since then.

Ultrasound detected an intrauterine T-shape IUD  and a foreign body inside urinary bladder with dirty shadowing.

                       

Cystoscopy detected an adherent stone in urinary bladder (UB).

 

MDCT revealed 2 T-shape IUDs coexisting, one inside uterus, another perforating the uterus while the transversal tip of this IUD inserted the UB wall and inducing stone formation. The later IUD was a complicated migrating T- shape IUD.

 

At last, surgery removed the complicated migrating IUD which remained with 3 foeti, and proved that there were 2 IUDs coexisting in a patient, one of those inserted the UB wall and inducing UB stone formation.

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NONINVASIVE ELASTOGRAPHY of LIVER FIBROSIS EVALUATION on 554 CASES at MEDIC CENTER: COMPARISON ARFI to FIBROSCAN.

LIEM THANH LE, LINH HONG BUI, NHAT THONG LE, HAI THANH PHAN

MEDIC MEDICAL CENTER, HCMC, VIETNAM

Abstract

 Purpose: To compare acoustic radiation force impulse imaging (ARFI) with transient elastography (TE) and tests of serologic markers for assessing whether ARFI can substitute TE technique in non-invasive liver fibrosis evaluation.

Materials and methods: All subjects agree to join the study, which is completely free of charge, and the local ethics committee approves the research. ARFI causes displacement in liver tissue which propagates shear wave, was recorded in units of meters per second. All 554 cases (353 male, 201 female) (including 366 cases of chronic viral  hepatitis B, C and control group=188 cases), age from to 85 yo (mean = 44+/-13.2), BMI =14.8 to 32.4 (mean=22.06+/-2.85) were examined by 2 sonologists performing ARFI and TE techniques, and tested serologic markers in the same day. ARFI values are compared to TE values by MedCalc statistical software, and serologic markers tests are the standard reference.

 

 Results: Results of ARFI and TE technique are close correlattion with statistical significance of fibrosis staging (correlative coefficient r = 0.83 with P smaller than 0.0001, 95% CI = 0.804-0.855). The shear wave velocity means of ARFI range from 0.79 to 3.53 m/s (see table V0-V4) and there are statistical differences between V0-V4 with t<0.05, p<0.0001. Values of TE, from 2.2 to 75kPa. Close clinical agreement between FibroScan F4 and ARFI V4 for cirrhosis, kappa=0.8. 

 With the regressive equation y = 0.9458 + 0.04266 x (where x = FS  and y = VS), we propose a fibrosis staging of ARFI and TE as follows:

Conclusions: ARFI in liver fibrosis assessment in chronic viral hepatitis has accurate diagnosis which is in close correlation with TE in the present study of 554 cases. With advantages of ACUSON S2000, ARFI techniques (not blinded in ROI, not limited in the obese patient and ascites, convenient operation) may substitute for TE of FibroScan.

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OPTIC NERVE SHEATH DIAMETER and BRAIN TUMOR, Dr HUNG THIEN NGUYEN, Dr LAI THI HUYNH, and Dr HAI THANH PHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 23yo female patient with neurofibromatosis syndrome because she has got sebaceous adenomatosis around her nose, has usually loss of  her vision in short time for 2 months without headache nor nausea.

 Ultrasound detected edema of optic disc in both 2 eyes and optic nerve sheath diameter on right and left ocular in 5.1 and 5.5mm, respectively.

 Funduscopy of 2 oculars confirmed papilla in edema but the ocular pressures were still in normal values.

 A suggestion of  elevated intracranial pressure was established.

 MDCT showed a choroid plexus  tumor of 30mm in diameter which made secondary obstruction of the cerebral ventricle and raising intracranial pressure, into left ventricle with calcification close by the interventricular foramen.

So,  increasing measurement of ONSD and edema of papilla in ophthalmology ultrasound could lead more investigation to diagnose a brain tumor in a neurofibromatosis patient.

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PORTAL MEMBRANOUS OBSTRUCTION, Dr NGUYỄN NGHIỆP VĂN-Dr NGUYỄN ANH TUẤN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

An 8 yo female patient in portal hypertension from Hospital N0 1 suffered from hematemesis due to rupture of dilated esophageal veins. On abnormal  parenchyma of liver, ultrasound noted  a congenital anomaly of intrahepatic portal vein which presented as a cystic structure with an incomplete web about 5.1mm in length. B-mode ultrasound revealed smoke-like echo inside the dilated portal vein while color Doppler showed aliasing artifact. Hepatofugal flow of portal vein was noted with dilated venous collaterals at the hepatic hilus. MDCT confirmed an intrahepatic cystic dilatation of portal vein and its dilated branches.
 

The small girl went through an intravascular procedure to destroy the portal web. But portal hypertension came back after 3 months.  At last an open surgery had been done successfully,  resolving her portal hypertension, and the female patient remains well.

 In our knowledge, this is the first case of portal membranous obstruction diagnosed by ultrasound in combining of MDCT in Vietnam, and prooved abroad by surgery; and may be the third case of the world.

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

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

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.

 

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

 

 

 

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HONEYCOMB LIVER METASTASIS FROM A BREAST CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

HONEYCOMB LIVER METASTASIS FROM A BREAST CANCER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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 NORMALVALUE.
ENDOGASTROSCOPY WAS ALSO NEGATIVE.

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

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

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 A SPLENECTOMY IS DONE.
IN MACROSCOPIC SECTION, THE TUMOR IS WELL BORDERED, HOMOGENEOUS, CHOCOLATE-LIKE STRUCTURE.
THE MICROSCOPY RESULT IS A SPLENIC HAMARTOMA.

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

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SPLEEN ABSCESS, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 15yo female patient suffered from left upper quadrant pain and fever for 3 days. WBC=15,87×10^9/L, CRP=74,85mg/L, ESR =97mm and 127mm.

Ultrasound detected in spleen  2 focal hypoechoic necrotic at upper pole of 28x51mm  and close to splenic hilum, of 38x43mm without fluid in spleen region. There were no gas and no vascular signals into 2 spleen focal lesions.

 CT confirmed 2 focal lesions of her spleen with fluid density and no contrast media was caught.

ESR value decreased of 57 and 95mm, WBC=6,38×10^9/L , CRP= 4,13mg/L  and lesion sizes of 22-23mm with antibiotic therapy for 3 weeks. After 8 weeks both 2 abscesses completely disappeared.

So the spleen abscesses dissolved with a  conservative treatment.

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

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 THAT  APPEARES AS A RAILROAD SIGN OR INNER-TUBE SIGN IN LONGITUDINAL SECTION AND TARGET SIGN IN CROSS SECTION.

 

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


 ERCP XRAY: ASCARIS INTO CBD. LATER ASCARIS IS EXTRACTED OUT OF THE PATIENT BY VIA ERCP. IT STILL MOVES WEAKLY AFTER  4 DAYS  STUCK  WITH THE COMMON BILE DUCT. IT IS A FEMALE WORM WITH THE VULVAR WAIST. SHE LOST HER WAY WITH UNCERTAIN CAUSE THAT MAY BE EXPLAINED BY THE FACT OF ” ingenuity for probing and forcing herself into any aperature that she may encounter” (

John P Nicholson, Karl Kreiger, Barry Hartman, Wayne Isoin, and John H. Laragh: Cardiac Arrest Postoperatively in a Patient Infected with Ascaris, the Roundworm, Chest 1989;96;922-923). 


 

THE PATIENT GETS  WELL  AFTER EXTRACTING THE ASCARIS  FROM HER BILE DUCT,  AND FORTUNATELY NO NEED TO PASS THROUGH AN OPERATION .
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