Caso Clínico
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CASO CLÍNICO
Dr.Héctor Domínguez HernándezResidente Imagenología
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Historia Clínica• Paciente femenino de 64 años de
edad, quien ingresa por presentar dolor agudo, tipo cólico en hipocondrio derecho, con irradiación a la espalda, de 3 días de evolución. Nausea y vómitos.
• Refiere haber presentado un cuadro parecido de dolor hace 3 meses.
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Antecedentes• AHF. Negados.• APP. Refiere ingreso previo hace
1 año por litiasis vesicular. • Exploración física. Paciente con
ictericia, Murphy +.• Actualmente cursando su 2 día
de estancia hospitalaria presentando 2 picos febriles.
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Laboratorios• Hemoglobina 9.8 gr/dl• Hematocrito 29.7%• Bilirrubina Indirecta 0.60 mg/dl• Bilirrubina Directa 3md/dl.• ALT 111 U/L• AST 122 U/L• FA 687 U/L• Leucocitos 20,300 mm3• Amilasa 37 U/L.
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¿DIAGNÓSTICO?
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DIAGNÓSTICO
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DIAGNÓSTICO
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
ANATOMÍA DEL NORMAL DEL TRACTO BILIAR
Válvulas de Heister
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
ANATOMÍA DEL NORMAL DEL TRACTO BILIAR
Mide 2-4cm de longitud.Diámetro 1 a 5mm.Se une a la vía biliar extrahepática en su borde derecho en un 49.9% de los casos.
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
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• 95% de los casos, una colecistitis es causada por un lito que obstruye la luz del conducto cístico.
• Los litos <3mm pueden pasar rápidamente este conducto.
• Cuando existe una obstrucción litiásica, la inflamación y distención de la vesícula puede resulta en isquemia y necrosis transmural si la obstrucción persiste.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Únicamente el 15 al 20% de los litos son lo suficientemente densos para permitir la detección por radiografías.
VPP: 92%VPN:95% CT: 79%.
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100% SENSIBILIDAD
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
SX DE MIRIZZI
Ocurre cuando un lito vesicular impactado en el cístico condiciona compresión extrínseca y obstrucción del conducto hepático.
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
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Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
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Resolución laparoscópica de litiasis vesicular complicada colecistobiliar. Síndrome de Mirizzi. Omaira Rodriguez, Alexis Sanchez, et al. RFM Diciembre 2009
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DIAGNÓSTICO
COLEDOCOLITIASIS
VESICULA BILIAR ESCLEROATRÓFICA
AUSENCIA DE CONDUCTO CÍSTICO
SX DE MIRIZZI III
COLANGITIS
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VESICULA BILIAR ESCLEROATRÓFICA
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AUSENCIA DE CONDUCTO CÍSTICO
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MIRIZZI III/ COLEDOCOLITIASIS
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MIRIZZI III/ COLEDOCOLITIASIS
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Mirizzi Sindrome: History, current Knowledge and proposal of a simplified classification. Beltrán A. Marcelo. Work Journal of Gastroenterology. September 2012
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DILATACIÓN DE LA VÍA BILIAR
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COLANGITIS
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