A CIRCUMCAVAL URETER, Dr VÕ NGUYỄN THÀNH NHÂN, Dr NGUYỄN XUÂN HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 46yo male patient has been in pain at his right lumbar region without fever  for one month. He had  a history of  10 year kidney stone but now no trouble with urination. Sometimes the pain is getting to the right flank. Ultrasound detect his right hydronephrosis with right kidney stones and the upper part dilated ureter which is obstructed by nothing. No stone in right ureter, and the urine jet on the right side weaker than the left one.

MSCT reveals a right hydronephrosis and the upper part of right tortous ureter in dilatation which is look like a fish hook.  And the lower part of right ureter crepts posteriorly the inferior vena cava without in dilatation  then continues going down to the urinary bladder. This is a circumcaval ureter which  is blocked incompletly by the IVC, type low loop.

The patient went through an endoscopic surgery to  repair the right ureter and remains well. In this case ultrasound has a limited role to detect a right hydronephrosis and hydroureter while MSCT could find out exactly pre-op the congenital malformation of right ureter.

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Double T shape IUDs with one perforating the rectum, Dr PHAN THANH HẢI, Dr TRẦN QUỐC SỬ, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 42yo female patient suffered from bloody stool. Two years before she came to change her IUD which set up for 10 years, since then she usually got abdominal pain with bloody stool. In ultrasound examination, there is a T shape IUD into the uterus and a hyperechoic focal into the rectum. Later, CT scan confirmed 2 IUDs in the same patient, one into the uterus and others into the rectum. Endoscopic result proved that one IUD in penetrating the rectum which explained the bloody stool and her abdominal pain.

Migration of IUD may happen in women having IUD. In this case the patient had 2 IUDs because the old one could not removed and may had been excited by the new one and then perforating the wall of rectum. Ultrasound  discloses difficultly intraabdominal migrating cases but easily shows the IUD into the uterus. CT scan reveals exactly the migrating IUD inside  the rectum and detects another IUD inside the uterus. And in this case the findings of endoscopy is more impressive when prooves a perforated rectum by a  T shape IUD type.

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INTRAABDOMINAL MIGRATING of the INTRAUTERINE CONTRACEPTIVE DEVICE (IUD)

HUNG THIEN NGUYEN,  TRUNG CHI HO,  CONG VAN NGUYEN,  HAI THANH PHAN

MEDIC MEDICAL CENTER, HCMC, VIETNAM

 ABSTRACT:

 OBJECTIVE:

To compare ultrasound, X-rays and CT in detection of  the IUD migrating  because sometimes ultrasound could not reveal any IUD in whom said having an IUD.

 MATERIAL and METHODS:

A descriptive, cross-sectional prospective study from 2005 to 2010 in Medic Medical Center, HCM City. When X-rays detects a mispositioned IUD, the patient will be reexamined by ultrasound and then by CT.

 RESULTS:

05 cases of uncomplicated migrating and 01 case of complicated migrating. All of uncomplicated cases happened in over 50 year-old patients without clinical signs. Most of cases with Dana IUD type, and one case had removed the uterus (case 5). One case has a perforation of the rectum by one of two T shape type IUDs which exist together in a patient suffering bloody stools and abdominal pain for 2 years. An other case has 2 kinds of IUD together (case 4): one Dana and other T shape IUD type.

DISCUSSIONS:

One case on the left side of  abdominal cavity. 4/6 cases on the right side. Ultrasound  itself cannot disclose migrating IUD. Ultrasound failed to detect an intraabdominal IUD (case 3). Intra-abdominal migrating IUDs were uncertain masses of 21-45mm with mixed and hyperechoic pattern without acoustic shadowing.

CONCLUSIONS:

Migration of IUD may happen in women having IUD. X-rays has effective role to detect the intra and extrauterine IUD. Ultrasound discloses difficultly intraabdominal migrating cases. CT scan reveals exactly the migrating IUD inside / outside of hollow viscera (uterine tube, bladder, colon, appendix).

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

 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.

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QUANTITATIVE ELASTOGRAPHY with SUPERSONIC SHEAR IMAGING of 69 LIVER TUMORS, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

PHUC VINH DINH LE, THU DUY NGUYEN, HUNG  THIEN NGUYEN,  HAI  THANH PHAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 ABSTRACT:

PURPOSES: To compare the stiffness of malignant liver tumors to benign liver tumors by a new technique of ultrasound, quantitative shear wave elastography (SWE). MATERIAL and METHOD: A descriptive, cross-sectional, prospective study was carried out on 69 liver tumors at MEDIC MEDICAL CENTER, HCMC, VIETNAM  from April to December 2010. We had 2 groups of liver tumors which were noted with conventional ultrasound some morphological criteria (numbers, dimensions, margins, echogeneicity, homogeneity, halo sign, vascular invasion) and tumoral hemodynamics (vascularization, spectral pattern, velocity), and then, the stiffness by SWE . U test was used for statistical analysis. RESULTS: Group 1 (n=36 cases), average of age= 42, average of dimension= 28mm,  single tumor (92%), hyperechoic, homogeneous (85%), well-limited (90%), negative halo sign (100%), no Doppler signal (95%), with the average of stiffness (elastic score)=07.88kPa. Group 2 (n=33), average of age =56, average of dimension=46mm, single tumor (82%), multiple tumor (18%), hypoechoic (60%), mixed echogeneicity (30%), hyperechoic (10%), positive halo sign (65%), vascular bending (30%), hypervascular (80%),  with the average of stiffness (elastic score) = 84.34kPa . 2 groups of  liver tumors are distinctively different in the u-test  (α = 0.01). CONCLUSIONS: SWE  of Supersonic Imagine provides quantitatively  the stiffness, a new sonographic criteria for  charactization of the malignancy of liver tumor and others . It makes a reliable difference in diagnosing the benign liver tumors and the malignant ones and may becomes a potential method to characterize liver tumors.

                                                        Fig. 1 A, B= Hemangioma, Elastic score=17.31kPa. 

                                                  Fig. 2 A, B: Malignant tumor, Elastic score=41.76kPa.

                            Fig. 3 A: Multifocal HCC, ES=118.02kPa, B: CT scan: Multifocal HCC

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SARCOMA of ILEUM, Dr PHẠM THỊ THANH XUÂN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 For 4 months, a 50 yo female patient who was in 2 month menopause from Ninh thuan province suffered from a right lower quadrant pain. Her pain was getting worse.

 In relation to the cecum ultrasound disclosed a hypoechoic and hypervascular mass, with fluid in the central part of  the mass. That may belonged to a bowel tumor with the central part in necrosis.  Meanwhile both 2 ovaries were identified well in the transvaginal sonography (TVS ) examination.

 In her right lower fossa MSCT 64 detected a thickening  of the ileum wall which made a great mass in 62x81mm. The infiltrated mass catched inhomogenously the contrast media and wiped off the fatty tisue of mesentery. There were some lymph nodes and dilatation of bowels in the right lower fossa.

Surgery removed a 20cm in length of the ileum with tumor far from the cecum a distance of 40cm. The tumoral surface was not smooth. The microscopic result was an ileum sarcoma in poor differentiation.

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OBTURATOR HERNIA, Dr VO NGUYEN THANH NHAN, Dr NGUYEN TUAN, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 71 yo female patient from Tay ninh province, PARA =9007, 37kg in weight, suffered from an colicky abdominal pain for one month. Pain was getting worse and loss of bowel movement for 3 days. Ultrasound detected a dilatation from 3 to 4cm in diameter of small bowel and no air into the colon with a small amount of free fluid into her abdomen. CT disclosed a loop of small bowel which was between the right obturator and pectineus muscles and the small bowel obstruction.

 In second look, ultrasound showed a loop of small bowel behind the muscle in the section of the right  internal groin.

 Surgery proved a loop of small bowel which entered the right obturator foramen that caused the bowel obstruction. The patient had got well post-op for one month but died as a recurrent pain later.

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

 A 3yo male child had no pain no fever, got swollen his posterior lower right leg, without history of trauma. Ultrasound this area in cross-section showed a hypoechoic tumor which belonged to the soleus muscle. In longitudinal scan the tumor was in size 6×4 cm,  straitified structure like muscle, well limited in the muscular aponevrosis. In  Doppler it was a hypervascular tumor.

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

Opened biopsy was done in the CHILDREN HOSPITAL N0 2 on December 31. The microscopic result is an EMBRYONIC RHABDOMYOSARCOMA with specfic histo-immunologic staining, a very high malignant tumor.

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Intraparenchymal Pseudoaneurysm of Splenic Artery due to Trauma, Dr LÊ VĂN TÀI, MEDIC MEDICAL CENTER, HCMC.

Intraparenchymal pseudoaneurysm of splenic artery due to trauma is very rare. In majority of cases, pseudoaneurysm must be resected, ligated or endovascular transcatheter embolization to avoid the rupture of spleen causing hemoperitoneum . However, spontaneous thrombosis formation is occurred in a few cases that occludes the pseudoaneurysm.
We would like to present a case of 16-year-old boy, fought at left chest and left flank by color Doppler a pseudoaneurysm of splenic artery in injured lesion of spleen and then confirmed by MSCT.

Patient was treated conservatively in a hospital. After 2 weeks, pseudoaneurysm had no flow at color Doppler, corresponding to MSCT result, and that was explained to be a spontaneous thrombosis. Follow-up the case more than 7 months there was no problem in occurrence.

To our knowledge, delayed rupture of the spleen in conservative treatment, beside two stages of splenic rupture by expanding of subcapsular hematoma, there is another cause of intrasplenic pseudoaneurysm which is uncommon. Color Doppler is very helpful in diagnosing and monitoring of intrasplenic pseudoaneurysm of splenic artery.

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

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.

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