03/03/2022   0 Comments

Case Report A 42-years-old Caucasian male, without relevant past medical history, was diagnosed with B-cell acute lymphoblastic leukemia. He completed the induction phase of the PETHEMA LAL Ph-2008 protocol, without complications. Later, the patient was readmitted to start the consolidation phase. However, it was noticed new-onset cytocholestasis and hyperbilirubinemia, without coagulopathy or encephalopathy. He had no personal or family history of liver disease. The metabolic, virological and autoimmune study was negative. Abdominal computed tomography scan revealed a liver with normal morphology and without hepatic metastasis or portal thrombosis. Magnetic resonance cholangiopancreatography showed normal intrahepatic and extrahepatic bile ducts. Endoscopic ultrasound (EUS) revealed no focal liver lesions. EUS-guided fine needle biopsy using a 22G needle was performed (2 passes; 22G Acquire, Boston Scientific) obtaining material that was sent for evaluation. The histological examination showed marked canalicular and hepatocytic cholestasis and ductopenia probably due to hepatic drug toxicity. Ten days after the liver biopsy, the patient presented sudden epigastric pain. He was hemodynamically stable. The abdomen was soft, with epigastric tenderness, without rebound tenderness. Hemoglobin and hepatic profile remained stable and there was no elevation of inflammatory markers. The abdominal ultrasound (US) revealed a heterogeneous lesion with 56 mm located in segment VIII of the liver (Fig. 1). Quiz Discussion The abdominal computed tomography scan revealed a hepatic pseudoaneurysm and an adjacent intrahepatic hematoma (Fig. 2). After the diagnosis, the patient underwent a transcatheter arterial embolization. Complete embolization of pseudoaneurysm was accomplished after 3 embolization sessions, performed during 1 week. During hospitalization, the patient maintained hemodynamic stability, without […]

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