Primary Sjögren’s syndrome (pSS) is a progressive autoimmune disease and is characterized by eye and mouth dryness due to lymphocytic infiltration in lacrimal and salivary glands leading to tissue destruction, but it can also present systemic manifestations including lung involvement. Respiratory manifestations in pSS have a prevalence of 9-20% and can be due to airway and/or lung parenchyma involvement, such as in particular in interstitial lung diseases like lymphocytic interstitial pneumonia (LIP). LIP is an inflammatory diffuse parenchymal lung disease, which is almost invariably associated with other conditions, such as autoimmune diseases and immunodeficiency states, and usually affects women with a mean age of 50 years. We described a case of patient with LIP who was referred to our Internal Medicine Unit and the diagnostic issues related to the patient age and comorbidities.
Hemorrhage within the biliary system (hemobilia), is an infrequent complication that can arise during percutaneous procedures involving the liver. The clinical diagnosis of hemobilia is often challenging, as symptoms are quite unspecific and often display a late onset. In such cases, sonography of the gallbladder can play a crucial role in the early detection of hemobilia. A case report is provided of a 72-year-old man who underwent a sonography-guided percutaneous biopsy of a 22-mm focal lesion, within the eighth segment of the liver. In this patient, asymptomatic active hemobilia was promptly identified through contrast-enhanced ultrasound (CEUS) which was performed immediately after the invasive procedure. Crucially, this postprocedural complication may have gone undiagnosed without an early postprocedure grayscale visual analysis and CEUS evaluation, since the patient was completely asymptomatic. In conclusion, a grayscale sonogram of the gallbladder is suggested and should be considered before and immediately after percutaneous invasive procedures of the liver. In the instances where suspicion of hemobilia arises, CEUS can be used to assess the presence of active bleeding. Implementing this type of imaging protocol may possibly reveal a higher frequency of hemobilia than is commonly reported.
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