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Thứ Tư, 14 tháng 8, 2013

MEDIC THAM DỰ AFSUMB 2013, Singapore


Hiện Medic có 4 bài:
1. Hình ảnh siêu âm nhiễm Sán lá gan lớn... Bs Lê Đình Vĩnh Phúc
2. ARFI và Fibroscan trong đánh giá Viêm gan mạn hoá xơ .. Bs Lê thanh Liêm
3. Hình ảnh siêu âm và ERCP trong Giun chui ống mật chủ..Bs Trần Ngân Châu
4. Hình ảnh siêu âm Sốt xuất huyết Dengue....Bs Lê  văn Tài






1/ CHARACTERISTICS OF ULTRASOUND IMAGES OF FASCIOLIASIS IN VIETNAM, PHAN THANH HAI1, LE DINH VINH PHUC2 , NGUYEN THIEN HUNG1,  NGUYEN THI THAO HIEN1, PHAM THI THU THUY3 , MEDIC Medical Center, HCMC, Vietnam


OBJECTIVE. The purpose of this study was to describe the imaging
findings in hepatobiliary fascioliasis.

METHODS. Total of 126 patients with fascioliasis were diagnosed from 1996. Diagnosis was confirmed in all patients by serologic methods using enzyme-linked immunosorbent assay (ELISA). 86 patients were female and 40 were male, living in central Vietnam, with an age range of 11-66 years (mean, 35 years).

Sonography was performed with a 3.5 MHz convex probe and some cases were confirmed by CT scanning.

RESULTS. 126 cases of liver focal infiltrating scanning were detected by ultrasound. Beside intrahepatic cases we have 02 cases of intra-abdominal, 06 cases in biliary tract, 01 case in gallbladder, 01 case of subcutaneous and 01 case of cutaneous lesions of fascioliasis.

The main characteristics of the ultrasound in fascioliasis: inhomogeneous parenchyma (100%), subcapsular (16.7%), 5-6th subsegment (35.7%), microabscess (50.0%), hypoechoic liver background (16.7%), hyperechoic liver background(24.6%), microcalcification (0%), hilar node (2.3%), like hemangioma (0.8%), biliary thickening (31%), gallbladder wall edema (0%), olympic ring sign (3.2%), extrahepatic fluid collection (1.6%), biliary foreign bodies (2.4%).

DISCUSSIONS:Most patients with fascioliasis have typical hepatobiliary imaging findings. Typical liver lesions were infectious lesions form with multiple small, confluent, and subcapsular nodules with well-defined borders.

Some biliary cases presented the late phase of fascioliasis while gallbladder case, subcutaneous abscess, cutaneous lesion and intraabdominal lesions are rare published cases in our knowledges.


CONCLUSION. Ultrasound is useful to find not only the images of liver damage but also the extrahepatic lesions in many cases in fascioliasis.


2/ Liver Stiffness Values Measured by Virtual Touch ARFI in Comparison to Fibroscan TE in a Large Sample, Phan Thanh Hai, Le Thanh Liem, Bui Hong Linh, Le Thong Nhat, Medic Medical Center, Ho Chi Minh City, VIETNAM

Abstract

Purpose: To compare Acoustic Radiation Force Impulse imaging (ARFI of Acuson S2000) to Transient Elastography (TE of FibroScan) in a large sample study for assessing whether ARFI can be a non-invasive technique in evaluating liver fibrosis.

Materials and methods: We conducted the study on 586 cases (369 males, including 382 cases of chronic viral hepatitis), age from 17 to 85yo (mean=44.23±13.37), BMI=14.82 to 32.39 (mean=22.22±2.9). All were examined by two sonologists performing ARFI and TE techniques in the same day. Medcalc statistical software was used to compare ARFI values (V=m/sec) and TE values (F=kPa).



Conclusions: Virtual Touch ARFI has a diagnostic accuracy similar to Fibroscan TE in assessing liver fibrosis in chronic viral hepatitis in the present study of 586 cases.   Further multicenter researchs  are necessary to determine whether the ARFI method can substitute for Fibroscan.

3/ ULTRASOUND and CBD ASCARIASIS at    MEDIC CENTER, PHAN THANH HAI - TRAN NGAN CHAU – LE THONG NHAT – HOANG NGUYEN NHAT ANH,  MEDIC MEDICAL CENTER

 ABSTRACT
  Purpose
          To evaluate the role of ultrasound in diagnosing common bile duct (CBD) ascariasis,  confirmed by endoscopic retrograde cholangiopancreatogram and what causes false positive.

  Material and methods

          A retrospective study was taken on 53 patients at Medic Center from 1999 to 2013. The patients had acute right subcostal or epigastric pain, diagnosed CBD  ascariasis based on ultrasound, confirmed and extracted worm  by ERCP.
Results

          All the patients underwent abdominal ultrasound detected 2 parallel echogenic lines in CBD presenting round worm. They continued to be done ERCP for confirmation and treatment.  Of 39/53 cases (73.6%) were revealed Ascaris in CBD ; 8/53 (15%) were admitted with choledocholithiasis whereas 14/53 cases (26.4% ) was not.
  Discussion and conclusion

          Ultrasonographic finding of  2 parallel echogenic strips with or without a central anechoic tube in CBD, bull’s eye sign or target sign on transversal section and no shadowing  might indicate Ascaris in CBD. It played an important role in diagnosing CBD ascariasis. Once diagnosed, ERCP was the first choice for  confirmation and treatment. Artifact or worm running away from CBD resulted in false positive.


4/ ULTRASOUND FINDINGS OF DENGUE HEMORRHAGIC FEVER in an OUTPATIENT CLINIC, Phan Thanh Hai, Le Van Tai, Nguyen Thien Hung, MEDIC Medical Center, HCMC, Vietnam


         PURPOSE: To describe ultrasound findings of Dengue hemorrhagic fever (DHF) and to evaluate the role of sonography in diagnosis.

         MATERIAL AND METHODS: Cross-sectional descriptive study of 16 patients at Medic Medical Center who had fever, epigastric or right abdominal pain with or without petechiae, ecchymosis or purpura, bleeding from gums, injection sites.

         RESULTS: We collected 16 cases of Dengue hemorrhagic fever (DHF) in which there were 15 cases (93,8 %) of gallbladder wall edema, 12 cases (80%) of abdominal free fluid, 3 cases (20%) of subcapsular hepatic fluid collection, 7 cases (47%) of subcapsular renal fluid collection  and 12 cases (80%) of pleural effusion, 11 (73,3%) cases of enlarged liver, 4 cases (26%) of enlarged spleen which were sonographic features on the fourth  to seventh day from onset of Dengue hemorrhagic fever (DHF).

        DISCUSSIONS AND CONCLUSIONS: Ultrasound findings include gallbladder wall edema, abdominal free fluid, pleural effusion, subcapsular hepatic and renal fluid collection which are highlighted markers of Dengue hemorrhagic fever (DHF) and can be helpful before serological tests.

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