RESUMEN
OBJECTIVE: We describe a case of spontaneous hepatic rupture associated with undiagnosed focal nodular hyperplasia of a patient in the third trimester of pregnancy. Additionally, we provide a brief review of literature. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague. RESULTS: We report the case of a 29 year old patient with otherwise physiological pregnancy, who was hospitalized with pain in left hypochondrium. The patient experienced painful respiration, increasing in intensity in supine position. The possibility of lung embolism was considered and ruled out. Based on a suspected haemoperitoneum, caesarean section was performed. During the inspection of peritoneal cavity a ruptured tumor on the liver was identified. Histological examination showed focal nodular hyperplasia. CONCLUSION: Focal nodular hyperplasia is a benign liver lesion. Complications involving rupture or bleeding are very rare. 17 cases of hepatic rupture associated with focal nodular hyperplasia were described in published reports with only one case related to pregnancy. Our case emphasizes the importance of a close cooperation between a gynaecologist, radiologist and surgeon.
Asunto(s)
Hiperplasia Nodular Focal/diagnóstico , Complicaciones del Embarazo/diagnóstico , Tercer Trimestre del Embarazo , Adulto , Cesárea , Femenino , Hiperplasia Nodular Focal/cirugía , Hemoperitoneo/diagnóstico , Hemoperitoneo/cirugía , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Embarazo , Complicaciones del Embarazo/cirugía , Rotura EspontáneaRESUMEN
hCG values and those of its alpha- and beta-subunits are assessed in the serum of all patients treated in the Centre of trophoblastic disease. Commercial RIA kits with conventional antibodies are used. There was an opportunity to work with kits of Serono Co. with monoclonal antibodies, the so-called hCG MAIA clone kit which assesses hCG and its beta-subunit. In this IRMA-MAIA system 240 sera of patients with choriocarcinoma were processed. Comparison of hCG values found in the IRMA-MAIA test with values assessed with kits from Kosice revealed the following: 33% of the values in MAIA were higher, 57% were in agreement. 10% of the specimens were MAIA negative, while the Kosice values were low (50-100 i.u./l) and a negative finding was assumed. The authors investigated low (or false positive) hCG values and values obtained during the so-called residual reaction. According to the obtained results in this system of three highly sensitive monoclonal antibodies no cross reaction with LH occurs.