Revisión Anatómica de Sistema Venoso Intrahepático. Hematoma Intrahepático Subcapsular en Colecistectomia Laparoscópica / Anatomical Review of Intrahepatic Venous System. Subcapsular Intrahepatic Hematoma In Laparoscopic Cholecystectomy

La aparición del hematoma intrahepático subcapsular (SHI) después de la colecistectomía laparoscópica es una complicación poco frecuente. El estudio anatómico de las venas suprahepáticas nos permitió observar que existen numerosos patrones de ramificación de estos. Presentamos el caso de una mujer de 37 años que, durante la intervención de colecistectomía laparoscópica, se observa en el acto quirúrgico, la formación espontánea de hematomas subcapsulares, secundario a la tracción forzada del fondo del órgano

The appearance of subcapsular intrahepatic hematoma (SHI) after laparoscopic cholecystectomy is an infrequent complication.The anatomical study of the suprahepatic veins allowed us to observe that there are numerous branching patterns of these. We present the case of a 37-year-old female who, during the laparoscopic cholecystectomy intervention, is observed in the surgical act, the spontaneous formation of subcapsular hematomas, secondary to forced traction of the fundus of the organ

Hepatic Sinusoidal Obstruction Syndrome Caused by Herbal Medicine: CT and MRI Features

OBJECTIVE: To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. MATERIALS AND METHODS: The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. RESULTS: Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). CONCLUSION: Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

Budd chiari syndrome: a rare complication of renal cancer

A 52 years old lady was admitted with 2 weeks history of abdominal distension and drowsiness. Laboratory workup confirmed the presence of de-compensated liver disease with negative viral serology. Abdominal ultrasound and CT abdomen revealed tumour in right kidney with tumour thrombus extending in inferior vena cava and hepatic vein resulting in Budd Chiari syndrome and ascites. Patient was managed with medications only due to advanced liver disease

Correlation of doppler waveform abnormalities of hepatic veins with histological findings in chronic liver disease [HCV infection]

To study the relationship of the abnormalities in Doppler waveform of hepatic veins with histologic findings in chronic liver disease [HCV infection]. cross- sectional study. Radiology Department Military Hospital Rawalpindi. The duration of study was one year from February 2004 to February 2005. 50 patients with non de-compensated HCV infection were studied, who were subjected to biopsy by medical specialists. Their Doppler waveforms of hepatic veins were noted. On histopathology, 4 cases [8%] had no evidence of fibrosis, 27 cases [54%] had mild, 15 cases [30%] had moderate and 4 cases [8%] had severe fibrosis. Three patterns of waveform were observed. These waveforms include normal triphasic waveform [type O], decreased amplitude of phasic oscillations without the reversed flow phase [type 1] and completely flat waveform [type 2]. Among 33 cases of type 0 flow, majority [85%] had either mild fibrosis. Twelve cases that had type 1 flow, majority [92%] had mild to moderate fibrosis. Out of 5 cases that were observed ultrasound type 2 flow, all had either moderate or severe fibrosis. The degree of fibrosis was related directly to the hepatic vein waveforms abnormalities [p<0.001]. Ultrasonographic abnormalities of Doppler waveforms of hepatic veins are equivalent to histology in predicting the progression of CLD

Evaluación de las derivaciones porto sistémicas por vía transyugular (TIPS) por medio de ultrasonido Doppler en color, Doppler de poder y ecorrealzadores / Color doppler, power doppler and enhanced doppler sonography evaluation of transjugular intrahepatic portosystemic shunts

Los autores estudiaron 10 pacientes con hipertensión portal tratados con derivaciones portosistémicas por vía transyugular (TIPS) en los que evaluaron el flujo en el interior de la prótesis por medio de ultrasonido Doppler en color, Doppler de potencia y análisis espectral, antes y después de la aplicación de ecorrealzadores. Dos pacientes tuvieron flujos normales demostrados con el Doppler en color y con reconstrucciones en tercera dimensión. En seis pacientes encontraron signos de estenosis con reducción del flujo, uno en la porción proximal, tres en la porción media y dos en la distal; el empleo de ecorrealzadores en estos permitió mejorar el estudio del flujo y delimitar mejor el sitio y la morfología de la estenosis. En un paciente no se demostró flujo, debido a obstrucción.

Enfermedad veno-oclusiva por ingestion de "infusión" de plantas / Veno-occlusive dissease by herbal infussion ingestion

En el niño la ingestión de Alcaloides Pirrolizidinas producen una endoflebitis de las venas hepáticas con el consiguiente desarrollo de Enfermedad Veno-Oclusiva que simula un Síndrome de Budd Chiari. También la ingestión de Aceites volátiles que se encuentran en numerosas plantas son capaces, por su efecto tóxico de producir esta patología. Presentamos el caso de 2 niños de sexo masculino provenientes del medio rural y urbano de 16 y 19 meses de edad respectivamente que recibieron "infusión" de plantas: PAZOTE: Chenopodium ambrosoides y una mezcla de POLEO: Saturcia bronnei con TILO: Tilia Europea, con propósitos medicamentosos y posterior a ello, presentaron en forma aguda: aumento de volumen del abdomen, ascitis y hepatomegalia progresiva, con alaninoaminotransferasas elevadas, disminución de la actividad de tromboplastina y del tiempo de protrombina, con signos de hipertensión portal y edema generalizado. La biopsia hepática reportó en ambos casos extensas zonas hemorrágicas intraparenquimatosas con necrosis hepato celular masiva, fibrosis septal severa y focal y engrosamiento del endotelio de los vasos intrahepáticos. La evolución clínica de ambos fue a la CIRROSIS HEPATICA

Enfermedad veno-oclusiva hepática: presentación de un caso / Vend occlusive disease of the liver: presentation a case

La enfermedad oclusiva hepática es una patología poco frecuente con una alta mortalidad y de tratamiento médico quirúrgico, dependiendo de su etiología; con manifestaciones clínicas del dolor abdominal, ascitis y hepatomegalia. Presentamos el caso de una paciente de 34 años, con las manifestaciones clínicas antes descritas, su evolución, exámenes realizados para determinar el sitio de la lesión y su etiología, con la finalidad de distinguir entre síndrome de Budd-Chiari (SBC) y enfermedad veno oclusiva hepática.