Subject(s)
Intestinal Neoplasms/diagnosis , Intestinal Neoplasms/pathology , Intestine, Small/pathology , Multiple Myeloma/pathology , Multiple Myeloma/secondary , Aged , Double-Balloon Enteroscopy , Histocytochemistry , Humans , Immunoglobulin lambda-Chains/analysis , Immunohistochemistry , Male , MicroscopySubject(s)
Anemia, Iron-Deficiency/diagnosis , Esophageal Diseases/chemically induced , Esophageal Diseases/diagnosis , Iron/adverse effects , Iron/therapeutic use , Ulcer/chemically induced , Ulcer/diagnosis , Anemia, Iron-Deficiency/drug therapy , Biopsy , Endoscopy, Gastrointestinal , Esophageal Diseases/pathology , Female , Histocytochemistry , Humans , Middle Aged , Ulcer/pathologyABSTRACT
PURPOSE: Same session endosonography (EUS) immediately prior to scheduled endoscopic retrograde cholangiopancreatography (ERCP) may eliminate the need for ERCP and its associated risks in pregnant patients with no evidence of choledocholithiasis on EUS. In patients with choledocholithiasis, EUS provides information regarding the location, size and number of stones present, which helps guide biliary interventions and confirm stone clearance without the use of fluoroscopy. METHODS: We retrospectively identified 10 pregnant patients referred to our tertiary endoscopy center for suspected choledocholithiasis between June 2008 and January 2012. All patients underwent same-session EUS-based ERCP. RESULTS: Of 10 pregnant patients managed with EUS-guided ERCP, six were found to have common bile duct stones and went on to ERCP. Four patients with no evidence of choledocholithiasis on EUS did not undergo ERCP. Patients with confirmed choledocholithiasis underwent ERCP without the use of fluoroscopy using the additional information provided by EUS. CONCLUSIONS: Same-session EUS immediately prior to scheduled ERCP may eliminate the need for ERCP and its risks in pregnant patients with no evidence of choledocholithiasis on EUS. In patients with confirmed choledocholithiasis, EUS provided additional information regarding the location, number and size of bile duct stones, which enabled the successful clearance of the bile duct without the use of fluoroscopy.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Choledocholithiasis/diagnostic imaging , Cholelithiasis/diagnostic imaging , Endosonography , Pregnancy Complications/diagnostic imaging , Adult , Female , Gallstones/diagnostic imaging , Humans , Pregnancy , Retrospective StudiesABSTRACT
Aspergillus is a saprophytic, spore-forming fungus that is ubiquitous in our daily environment. Inhalation of the airborne conidia leads to a variety of diseases, from asymptomatic colonization to disseminated disease. Immunocompromised patients are usually viewed as the population most susceptible to aspergillosis because of their lack of host immune defenses. However, a healthy immune system does not preclude an individual from susceptibility to aspergillosis. Our case illustrates an immunocompetent patient with disseminated aspergillosis involving the tricuspid valve. A high degree of suspicion is imperative in patients who present without the classic risk factors. Recognition of disseminated aspergillosis in such patients is necessary to promote early diagnosis, treatment, and improved outcomes in an otherwise fulminant, life-threatening infection.
