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