RESUMO
We present the case of a 79-year-old male who underwent endoscopic retrograde cholangiopancreatography (ERCP) after cholangitis. The papilla was rigid and the biliary tract was dilated with sharpening of the distal bile duct, with no obvious cause. There was no bile flow after sphincterotomy, no stone after sweeping the duct with a balloon and the brush did not expand properly when trying to obtain cytologic material. Finally, a plastic stent was placed and purulent bile flowed. Biopsies of the papilla were taken due to the suspicion of tumor infiltration. The next day, the patient had pain in the right upper quadrant and blood tests highlighted mild anemization.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Hepatopatias , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Esfinterotomia EndoscópicaRESUMO
We present a case of rhabdomyolysis related to treatment with sorafenib in a patient with multifocal hepatocellular carcinoma. Rhabdomyolysis is a severe situation and potentially fatal. There are no laboratory data that can predict this condition. Early diagnosis is essential for prognosis. Rhabdomyolysis has been described as an adverse reaction of several drugs but it is not frequently related to sorafenib.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Rabdomiólise , Carcinoma Hepatocelular/tratamento farmacológico , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Prognóstico , Rabdomiólise/induzido quimicamente , Sorafenibe/efeitos adversosRESUMO
A 72-year-old female presented with abdominal pain and constipation and intestinal dilation was found. Abdominal computed tomography showed two areas of thickening and stenosis in the proximal jejunum and preterminal ileum, with an unknown etiology. Exploratory laparotomy was proposed but the patient suffered a sudden and progressive decrease in consciousness. Cranial computed tomography showed an ischemic area and a midline shift. Brain biopsies suggested infection by Aspergillus Fumigatus. Despite antifungal drugs, the patient had a progressive clinical deterioration and died. The autopsy concluded a systemic infection due to Aspergillus Fumigatus. Invasive aspergillosis is a serious fungal infection and usually occurs in immunocompromised patients. It mainly affects the lungs, followed by the gastrointestinal tract. The most frequent location in gastrointestinal involvement is the small bowel. Gastrointestinal involvement is more frequent in invasive disease. Although, there are case reports of isolated gastrointestinal aspergillosis, even in immunocompetent patients without risk factors. The prognosis is poor.
Assuntos
Aspergilose , Idoso , Antifúngicos/uso terapêutico , Aspergilose/complicações , Aspergilose/diagnóstico por imagem , Aspergilose/tratamento farmacológico , Feminino , Humanos , Hospedeiro Imunocomprometido , Intestino DelgadoRESUMO
Female of 17 years-old with Klippel-Trenaunay syndrome: port-wine stain, overgrowth of bone and soft tissue in limbs, dental malposition and intellectual disability. Moreover, severe portal hypertension due to portal vein malformation. The Klippel-Trenaunay syndrome includes venous and capillary malformations in the skin, hypertrophy of bones and soft tissue in a limb and, in some patients, lymphatic malformations. Structural abnormalities of the deep venous system can also occur in addition to the key clinical features, although there are few case reports with portal hypertension due to portal vein malformation published.
Assuntos
Hipertensão Portal/etiologia , Síndrome de Klippel-Trenaunay-Weber/complicações , Veia Porta/anormalidades , Adolescente , Feminino , Humanos , Hipertensão Portal/diagnóstico por imagemRESUMO
Peribiliary cysts involve cystic dilation of the extramural peribiliary glands in the liver hilum and portal tracts. Most peribiliary cysts are asymptomatic. We present the case of a patient without any prior liver disease who developed obstructive jaundice and a liver abscess due to peribiliary cysts. Peribiliary cysts usually appear in patients with severe chronic liver disease and are asymptomatic, although they sometimes appear in patients without prior liver disease and cause serious complications.
Assuntos
Doenças Biliares/diagnóstico por imagem , Cistos/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Doenças Biliares/tratamento farmacológico , Colangiopancreatografia por Ressonância Magnética , Colangite/diagnóstico por imagem , Colangite/etiologia , Cistos/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Sarcoidosis is a systemic granulomatous disease with an uncertain etiology, characterized by the production of non-necrotizing granulomas. The most frequent presentation is pulmonary and mediastinal, although it might affect any other organ. Hepatic alterations occur in 50 to 65% of the cases. Nevertheless, it is commonly subclinical or detected during a study of the alteration of liver enzymes. It is very unusual that disease onset occurs as an isolated hepatic tumor. A hepatic biopsy is usually required to confirm the diagnosis. A differential diagnosis must be established via any hepatic granulomatous disease, infectious or autoimmune disease as well as the exclusion of malignancy. We present a clinical case of a female diagnosed with an isolated hepatic sarcoidosis that simulated a unique hepatic metastatic lesion. The hepatic biopsy was diagnostic.
Assuntos
Hepatopatias/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Sarcoidose/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Granuloma/diagnóstico , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoidose/diagnóstico por imagem , Sarcoidose/terapiaAssuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Abscesso Hepático/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Flebite/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Abscesso Hepático/induzido quimicamente , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Flebite/induzido quimicamente , Tomografia Computadorizada por Raios XAssuntos
Esofagite/diagnóstico por imagem , Esofagoscopia , Hemorragia Gastrointestinal/diagnóstico por imagem , Alcoolismo/complicações , Pseudo-Obstrução do Colo/complicações , Esofagite/complicações , Esofagite/terapia , Alimentos Formulados , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Omeprazol/uso terapêutico , Nutrição Parenteral , Sepse/complicações , Fumar/efeitos adversos , Infecções Urinárias/complicaçõesAssuntos
Doenças do Esôfago/patologia , Penfigoide Mucomembranoso Benigno/patologia , Anti-Inflamatórios/uso terapêutico , Transtornos de Deglutição/etiologia , Doenças do Esôfago/complicações , Doenças do Esôfago/tratamento farmacológico , Feminino , Gastroscopia , Humanos , Imunossupressores/uso terapêutico , Pessoa de Meia-Idade , Penfigoide Mucomembranoso Benigno/complicações , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Estomatite Aftosa/complicações , Úlcera/etiologiaRESUMO
Liver cirrhosis is a risk factor for osteoporosis. Nevertheless, little is known about the mechanisms of bone mass loss in patients with viral cirrhosis. TNFalpha is a potent bone-resorbing agent. Serum concentrations of soluble TNF receptor p55 (sTNFR-55) correlate with clinical activity in liver cirrhosis. Our aim was to evaluate the possible role of sTNFR-55 in the pathogenesis of osteoporosis in patients with viral cirrhosis and its relationship with bone turnover markers. We studied 40 consecutive patients with viral cirrhosis and no history of alcohol intake and 26 healthy volunteers. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN). Patients with viral cirrhosis had reduced BMD (expressed as the z-score) in all sites [LS, -1.5 +/- 0.22 (P < 0.001); FN, -0.37 +/- 0.15 (P < 0.01)]. Serum concentrations of sTNFR-55 and urinary deoxypyridinoline, a biochemical marker of bone resorption, were significantly higher in patients with osteoporosis than in patients without osteoporosis (P < 0.001 and P < 0.05, respectively). Serum levels of sTNFR-55 correlated inversely with BMD in LS (r = -0.62; P < 0.005) and FN (r = -0.47; P < 0.05) and positively with urinary deoxypyridinoline (r = 0.72, P < 0.001). Our findings show that high serum concentrations of sTNFR-55 play a role in the pathogenesis of viral cirrhosis-associated bone mass loss and provide evidence of increased bone resorption related to the high serum sTNFR-55 levels.