RESUMEN
CASE REPORT: A 72-year-old woman with a 30-year history of iron deficiency anaemia was admitted for fatigue and increasing weakness. On physical examination, the patient appeared dyspneic and pallor. The tongue showed angiodysplasias. Laboratory analysis showed a microcytary anaemia with an iron deficiency. Firstly a routine ultrasound examination (iU22, Philips Medical Systems) was performed. A left accessory artery, a dilated common hepatic artery and ectatic tortuous intrahepatic liver arteries were found. A contrast-enhanced ultrasound (CEUS) detected two intrahepatic arteriosystemic shunts in the left liver lobe. Endoscopy revealed multiple angiodysplasias of the stomach and the duodenum, 4 isolated angiodysplasias in the colon and telangiectasias in the oropharyngeal region. The angiodysplasias were treated with argon plasma coagulation. Osler's disease was diagnosed based on the Curacao criteria. CONCLUSION: Transabdominal B-mode sonography in combination with colour Doppler, pulsed wave Doppler and contrast-enhanced ultrasound is a very important tool to detect hepatic vascular malformations. It is an excellent procedure for the screening of patients with an iron deficiency anaemia. For the first time, we have demonstrated CEUS as an additional approach in the diagnosis of liver involvement in patients with Osler's disease.
Asunto(s)
Anemia Ferropénica/diagnóstico por imagen , Anemia Ferropénica/etiología , Aumento de la Imagen , Telangiectasia Hemorrágica Hereditaria/diagnóstico por imagen , Ultrasonografía Doppler en Color , Ultrasonografía Doppler de Pulso , Anciano , Anemia Ferropénica/cirugía , Angiodisplasia/diagnóstico por imagen , Angiodisplasia/cirugía , Coagulación con Plasma de Argón , Arterias/diagnóstico por imagen , Diagnóstico Diferencial , Dilatación Patológica/diagnóstico por imagen , Endoscopía Gastrointestinal , Femenino , Tracto Gastrointestinal/irrigación sanguínea , Arteria Hepática/diagnóstico por imagen , Humanos , Hígado/irrigación sanguínea , Telangiectasia Hemorrágica Hereditaria/cirugíaRESUMEN
HISTORY AND CLINICAL FINDINGS: A 72-year-old woman was admitted to the hospital with upper abdominal pain, nausea, vomiting, and obstipation. INVESTIGATIONS: Percutaneous ultrasound found aerobilia, a biliary-digestive fistula, and an ileus with gallstones within the small bowel. The findings were confirmed at computed tomography. TREATMENT AND COURSE: A gallstone ileus on the basis of a biliary-digestive fistula was diagnosed. The patient was treated by surgery and with antibiotics. CONCLUSION: This case report demonstrates that percutaneous ultrasonography should be used as the first imaging procedure in the diagnosis of acute abdominal pain. This procedure makes it possible to detect a gallstone ileus. It is important also to define various intestinal structures accurately.