Hola amigos, hoy os presento un caso preparado por mi buen amigo Jordi Puig. Se trata de una ecografía hepática realizada por colestasis en un varón de 43 años, asintomático. ¿Cuál seria vuestro diagnóstico?
1. Hepatopatía crónica
2. Hamartomatosis biliar
3. Infiltración difusa metastásica
4. Microabscesos hepáticos
Deja tu opinión y vuelve el viernes para ver la respuesta.
Hallazgos ecográficos:
- Hepatomegalia heterogénea de superficie lisa
- Múltiples pequeños quistes (A,B, flechas rojas)
- Múltiples imágenes nodulares milimétricas, puntiformes, hiperecoicas (A,B, flechas)
- Venas suprahepáticas no comprimidas (C, flechas)
En un paciente asintomático, sin antecedentes patológicos de interés, el diagnóstico más probable reside entre hamartomatosis biliar o hepatopatía crónica no conocida. En la hepatopatía crónica se observan rasgos morfológicos tales como la hipertrofia del lóbulo izquierdo (A, asterisco) y del lóbulo caudado (A, asterisco rojo), atrofia del lóbulo derecho (B,C, asteriscos) e irregularidad de la superficie hepática (B,D, flechas), no presentes en este estudio.
Para un diagnóstico definitivo, es aconsejable completar el estudio con TC o RM hepática. En este paciente la secuencia potenciada en T2 muestra múltiples pequeñas imágenes hiperintensas, algunas puntiformes, con distribución bilobar.
Diagnóstico final: Hamartomatosis biliar (enfermedad de Von Meyenburg)
La hamartomatosis biliar es una malformación biliar benigna consistente en grupos de conductos biliares dilatados (flechas) rodeados de colágeno (asterisco). Los conductos no superan los 5 mm. y no están conectados a la vía biliar.
Los hallazgos que permiten el diagnóstico de esta entidad son:
En ecografía:
- Innumerables focos puntiformes hipercoicos
- Múltiples pequeños quistes < 10mm
- Distribución uniforme por todo el hígado
- Ausencia de cambios morfológicos
En TAC se observan múltiples imágenes nodulares muy hipodensas, que no captan contraste (A, círculos).
La RM muestra múltiples imágenes nodulares, algunas puntiformes, hiperintensas en T2 (B, círculos) e hipointensas en T1.
Hamartomatosis
Hamartomatosis bilier
Parénquima hepático heterogéneo con múltiples pequeños nódulos hiperecogénicos de márgenes mal delimitados, algunos con el signo de cola de cometa yo creo que en relacion con hamartomatosis biliar (en principio no se refieren antecedentes de neoplasia, inmunosupresión ni signos infecciosos). También existen lesiones anecoicas de mayor tamaño y mejor definidos, con refuerzo acústico posterior que creo son quistes simples.
Hamartomatosis biliar
Hamartomatosis
Hamartomatosis biliar
Hepatitis viral…imagen en cielo estrellado sí podría ver la vesícula se observaría el edema de pared de la misma
hamartomatosis biliar o Von Meyenburg
hamartomotosis biliares
hamartomas biliares
Hamartomas biliares
Hamartomatosis, Von Meyenburg Complex
Hamartomatosis biliar
Veo que los partidarios de la hamartomasis van ganando por goleada!
Respuesta el viernes
Es jueves por la tarde, el momento de reconocera los ganadores. Creo que la fama va al Dr. Feti, que fué el primero que hizo el diagnóstico.
Más información mañana.
Buen fin de semana a todos.
Hamartomatosis biliar
HAMARTOMATOSIS BILIAR
Your diagnoses are very accurate and I believe you are a highly qualified person.
Based on the information provided on a liver ultrasound performed for cholestasis in an asymptomatic 43-year-old man, my suggested diagnosis would be option 2: Biliary hamartomatosis.
I need a closer look before giving a diagnosis
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¡Hola! Qué interesante caso has compartido, gracias a ti y a Jordi Puig por presentarlo. La ecografía hepática en un paciente asintomático con colestasis siempre es un desafío diagnóstico.
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Mi opinión es la opción 2: Hamartomatosis biliar. ¡Interesante caso!
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I believe it’s option 2, hamartomatosis biliar. I’ve seen similar sonographic findings in a patient with complex biliary hamartomas. The diffuse hyperechogenic lesions distributed throughout the liver parenchyma are characteristic. When explaining these benign lesions to patients, I sometimes use the analogy of cosmic bodies – like in the game Solar Smash – scattered across the liver tissue. Waiting eagerly for Dr. Pepe’s explanation on Friday!
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Hey everyone, interesting case study! Based on the information given and without knowing the ultrasound findings, I’d lean towards either chronic liver disease or biliary hamartomatosis. Metastatic infiltration seems less likely given the asymptomatic nature. Microabscesses would usually present with other symptoms. It really depends on the image itself though – are there any visual clues pointing to one over the other? It’s fascinating how different liver conditions can present in subtle ways. Reminds me of some simulations I saw, almost like a crazy cattle 3D view, that really helped visualize the internal structures. Looking forward to seeing the answer on Friday!
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