Patología benigna y maligna de vesícula biliar
R1CG Edgar Vargas Flores
Colecistitis gangrenosa
• Hemorragia intramural• Necrosis• Microabscesos• Debris intraluminales• Exudados fibrinosos
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis gangrenosa
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis gangrenosa
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis gangrenosa
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis alitiásica
• Adultos graves• Viscosidad biliar• Necrosis mural• Mortalidad
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis alitiásica
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis alitiásica
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis alitiásica
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis enfisematosa
• <1% de colecistitis• Diabéticos 35%• Clostridium sp, Klebsiella sp, E.
Coli.• Riesgo de perforación 5x
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis enfisematosa
http://www.stritch.luc.edu/lumen/MedEd/Radio/curriculum/Surgery/cholecystitis.htm
Colecistitis enfisematosa
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Colecistitis enfisematosa
http://www.stritch.luc.edu/lumen/MedEd/Radio/curriculum/Surgery/cholecystitis.htm
Perforación vesicular
• 5 a 10% de colecistitis• Colecistitis gangrenosa• Fondo vesicular• Pacientes tóxicos
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Perforación vesicular
http://www.ultrasoundcases.info/Slide-View.aspx?cat=165&case=3113
Perforación vesicular
http://www.ultrasoundcases.info/Slide-View.aspx?cat=165&case=3113
Perforación vesicular
http://www.ultrasoundcases.info/Slide-View.aspx?cat=165&case=3113
Vesícula en porcelana
• <1%• Capa muscular, mucosa y/o
submucosa• 5x más frecuente en hombres• 11-33% Ca vesicular.
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Vesícula en porcelana
http://www.revise4finals.co.uk/cms/image-xray-menu/axrnoflash/view-image/4f7f862df81f046ac762e1b98d0806d8/gif
Vesícula en porcelana
http://quizlet.com/9614492/fcm-gi-gb-pancreas-path-flash-cards/
Vesícula en porcelana
http://www.radiologyassistant.nl/en/p43a0746accc5d#i43dfe4da786f8
Vesícula en porcelana
http://www.radiologyassistant.nl/en/p43a0746accc5d#i43dfe4da786f8
Vesícula en porcelana
http://www.ultrasoundcases.info/Slide-View.aspx?cat=152&case=2977
Vesícula en porcelana
http://www.indianjcancer.com/viewimage.asp?img=IndianJournalofCancer_2011_48_1_132_76646_u2.jpg
Adenomiomatosis
• Proliferación epitelial con hipertrofia muscular y divertículos mucosos-submucosos.
• Difusa, segmentaria y Localizada (fondo).
• Nódulos de Rokitansky Aschoff
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Adenomiomatosis
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Adenomiomatosis
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Adenomiomatosis
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Adenomiomatosis
http://radiology.rsna.org/content/227/1/80/F3.expansion.html
Pólipos
• Colesterol: 5%, adenomatosos: 0.4%
• 0.1 a 2.5 cm de diámetro• >1 cm: sospechar malignidad
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Pólipos
http://myradnotes.wordpress.com/2008/06/06/gallbladder-polyps/
Pólipos
http://myradnotes.wordpress.com/2008/06/06/gallbladder-polyps/
Pólipos
http://www.ultrasoundcases.info/Case-List.aspx?cat=167
Pólipos
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Carcinoma vesicular
• 5ª GI más frecuente• 1-3% de colecistectomías• Litiasis, colecistitis crónica y
vesícula en porcelana.• Mujeres• 60-70 años.• DX difícil y tardío• Sobrevida a 5 años: <5%
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Carcinoma vesicular
• 3 formas de presentación– Engrosamiento de pared focal– Tumor intraluminal polipoide >2 cm
(25%).– Tumoración subhepática (40-65%)
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Carcinoma vesicular
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Carcinoma vesicular
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Carcinoma vesicular
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Carcinoma vesicular
Gore RM, Yaghmai V, Newmark G et al. Imaging benign and malignant disease of the gallbladder. Radiol Clin N Am 40. 1307– 1323. Evanston, IL. 2002.
Neoplasias de vías biliares
Tumores benignos de vía biliar
• Raros• Adenoma de vía biliar• Pequeños (incidentales)• Defectos de llenado
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Adenoma de vía biliar
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Cistadenoma/Cistadenocarcinoma biliar
• Intrahepáticos• Mujeres de edad media• Tumoraciones grandes solitarias• Tumoraciones quísitcas –
tumoraciones nodulares septadas• Calcificaciones finas o irregulares
abundantes• Premalignos
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Cistadenoma biliar hiliar
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Cistadenoma biliar hiliar
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Colangiocarcinoma
• Más común• Intrahepáticos (20-30%)• Semejan metástasis
• Hiliares (Klatskin) (más comunes)• Confluencia del hepático derecho o izquierdo• USG. ”Ventana hepàtica”
• Ductales distales• Menos común• Mejor pronóstico• USG
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Colangiocarcinoma intrahepático
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Colangiocarcinoma hiliar
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Colangiocarcinoma hiliar
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Colangiocarcinoma ductal distal
Barón RL, Tublin V, Peterson M. Imaging the spectrum of biliary tract dsease. Radiol Clin N Am 40. 1325– 1743. Pittsburgh, PA. 2002.
Gracias