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domingo, 19 de abril de 2009

Coledocolitiasis

Masculino 45 años edad. Diagnosticos de ingreso: (a) Endocarditis Infecciosa Valvula Aortica, (b) Insuficiencia Cardiaca grado II,(c) Valvula Aortica Bicuspide,(d) Insuficiencia Aortica severa, ( e) Trombo intracavitario
Analitica : Bilirrubina aumentada Total 3.7, sobre todo a expensas de la Directa: 2.3 mlgs, GOT 139 /GPT 174

Clinicamente disnea de reposo, optopnea, tos seca , no productiva de tres dias de evolucion.
En la sonografia se apreció: Hepatomegalia 19.96 cms ( normal hasta 15 cms ), con presencia de algunas pequeñas imagenes hiper-ecogenicas (calculos) en tercio inferior del coledoco con produccion se sombras ecogenicas posteriores ( coledocolitiasis ).
Vesicula con paredes engrosadas, edematosas, infiltradas.La pared anterior mide 13.99 mm ( normal hasta 3 mm)-Colecistitis Aguda A-litiasica. Derrame pericardico leve .
Pancreas, riñones y Bazo dentro de los parametros normales.


Choledocholithiasis


Male 45 years old. Diagnosis on admission: (a) Infectious Endocarditis , Aortic valve, (b) Heart Failure grade II (c) aortic valve bicuspids, (d) Severe Aortic insufficiency, (e) Intracavitary thrombus Analytical: 3.7 Total bilirubin increased, especially at the expense of the Direct : 2.3 mlgs, GOT 139 / GPT 174 Clinically, resting dyspnea, optopnea, dry cough, non-productive, three days of evolution. At sonography showed: Hepatomegaly 19.96 cms (normal up to 15 cms), with some small images of hyper-echogenic stones in lower third of the bile duct with subsequent production is echogenic shadows (choledocholithiasis). Gallbladder walls thickened, oedematous, infiltrative.The anterior wall measured 13.99 mm (normal up to 3 mm)-Cholecystitis-acute A-lithiasic. Mild pericardial effusion. Pancreas, kidneys and spleen within normal parameters.








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