RESUMO
Isolated angioedema of the small intestine is a rare adverse event in patients taking angiotensin-converting enzyme inhibitors. Here, we present a case of visceral angioedema in a 32-year-old woman who presented with left upper quadrant pain, nausea, vomiting, diarrhea, and characteristic radiographic signs of small bowel angio-edema, six months after starting lisinopril. Her symptoms improved within 48 hours of withholding the offending agent and with supportive care. We discuss the epidemiology, pathophysiology, diagnosis, and management of angiotensin-converting enzyme inhibitor- induced angioedema.
Assuntos
Angioedema , Inibidores da Enzima Conversora de Angiotensina , Dor Abdominal , Adulto , Angioedema/induzido quimicamente , Angioedema/diagnóstico por imagem , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Antivirais , Diarreia , Feminino , Humanos , Intestino Delgado/diagnóstico por imagemAssuntos
Dor Abdominal/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Esplenectomia/efeitos adversos , Esplenose/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Crônica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Esplenectomia/tendências , Esplenose/etiologiaRESUMO
Heterotopic pregnancies are rare and are usually diagnosed by transvaginal ultrasound. Despite the routine use of sonography in early pregnancy, artifact created by mirror imaging can drastically and erroneously alter medical decision making by interfering with image interpretation. A heterotopic pregnancy with a single intrauterine gestation and twin left adnexal ectopic gestational sacs was observed on ultrasound in a woman presenting with abdominal pain. During laparoscopy, an ectopic pregnancy was not identified, and subsequent intraoperative ultrasound reproduced the heterotopic pregnancy through manipulation of bowel, confirming mirror image artifact. This phenomenon is rarely seen in obstetric imaging; therefore, lack of awareness can lead to false diagnosis of heterotopic pregnancy. Techniques to verify correct diagnosis should be used to resolve potential mirror artifact before proceeding with surgical management.