A 39-year-old woman who admitted to the hospital because of a headache and vomiting that develops slowly. she did a lumpectomy for 3 years ago. At Thu Duc Hospital we performed a ctscan first and then take Mri later. As we known, the best type of imaging to diagnose most types of brain tumours is MRI. However, on unenhenced ct scan we discovered 2 locations with the tumours inside actually. On Mri with Gado enhancement revealed the tumours clearly. Imaging characteristics of brain metastases could be any of the following signs:
– multiple tumours (Cerebellum more often)
– rim enhancement
– low intensity on DWI (In most tumours there is no restricted diffusion even in necrotic or cystic components. This results in a normal, low signal on DWI.)
A old woman who has very big calcified fibroid
A young boy arrived at hospital because of cheek swelling. Computed tomographic imaging revealed an ectopic tooth in front of left maxillary sinus wall. However we did not know whether or not having the presence of ameloblastoma inside the maxillary sinus because the ectopic tooth could not cause the formation of a mucocele and the destruction of the bony floor of the maxillary sinus. So that, we must make two different choices in which the ameloblastoma is the second diagnosis.
A 40 year old man who was admitted to Thu Duc hospital because of abdominal pain for 2 days. On ct scan, he has a large pancreas with diffusely increased density of peripancreatic fat (dirty fat) around and thickening of renal ( Gerota’s) fascia. Moreover pancreatic tissue enhances homogenneously with contrast medium. So that CTSI is 2 points. Please take a note that CTSI is ct-severity index which is the sum of grade of pancreatitis and degree of pancreastic necrosis.
A 92 year old woman patient who was admitted to the emergency room of Thu Duc hospital because of abdominal pain and unstable blood pressure (a state of shock). On CT scan, her inferior vena cava has been ruptured spontaneously at a level of renal vessels forming a haematoma caused the forward displacement of left kidney vein. It means that the renal veins were lifted off due to an underlying haematoma. In practice, we found that the spontenous rupture of IVC is so rare. The rarity of this condition prompted us to post this case.
We are thankful to Dr Hoa, Nguyen Thi Thanh who discovered this problem last week.
Please take a look at page2
Splenic injury was graded according to the different damage of surface area, Lac-capsular tear, intraparenchymal and involving trabecular vessels.
Now that abdominal ultrasound is the main choice of screening modalities to detect solid injuries in general. Take splenic fracture for example, we often found fluid inside abdominal space ( Morison’s pouch) as a truthful sign. According to AAST which is known as American Association for the Surgery of Trauma, there are 5 levels of splenic injury grading from I to V. However in practice, most surgeons tend to manage the patients symptomatically regardless of the grade.
Nonetheless, the Grades are as follows:
I- Hematoma – subcapsular <25% surface area, Lac-capsular tear, <1cm depth.
II-Hematoma- subcapsular 25-50% surface area, intraparenchymal 50% surface area. Intraparenchymal >10cm expanding. Lac- >3m involving trabecular vessels.
IV-Lac – involving segmental/hilar vessels with devascularization of >25%.
V- Lac- Shattered spleen. Vascular – Total splenic devascularization.
A young man who arrived at Thu Duc hospital because of blunt injury ( after fighting with another man). He was checked on abdominal ultrasound scan with hypoechoic fluid in his abdomen and splenic injury. On ct scan, he has same finding for splenic fracture with grades III because he has a laceration more than 30mm in depth.