Múltiplos pequenos nódulos hepáticos hiperecogênicos sem reverberação sonora posterior: outra forma de apresentação dos hamartomas dos ductos biliares

Abstract

O aspecto ultra-sonográfico dos hamartomas dos ductos biliares pode variar, sendo importante reconhecer suas diferentes formas de apresentação, para que possam ser lembrados no diagnóstico diferencial de lesões focais hepáticas. Neste trabalho, os autores apresentam um caso desta afecção em que foram identificados inúmeros nódulos hiperecogênicos dispersos pelo parênquima hepático, com os maiores atingindo 1,6 cm, sem produzir reverberação sonora posterior.

Neoplasias hepáticas: caracterização por métodos de imagem

“…With the dissemination of imaging diagnosis devices as well as their increasingly widespread utilization, the occurrence of incidentally found hepatic nodules has become more and more frequent in patients submitted to imaging studies or screening for tumors (48)(49)(50)(51) . The technological development of these apparatuses has allowed the detection of increasingly smaller lesions, difficulting their characterization that later might be affected by the findings of pseudo-hepatic lesions at contrast-en-hanced CT and MRI (52,53) .…”

Von Meyenburg complex (hamartoma of the bile duct) mimicking liver metastases

“…The definitive diagnosis of this lesion was confirmed by biopsy of the liver. The ultrasonographic findings of the von Meyenburg complex are diversiform lesions which include hyperechogenic and hypoechogenic nodules with poorly or well limited margins 11,[13][14][15] . Nagano et al 16 reported that magnetic resonance cholangiography is the best method for examination of hamartomas of the bile duct.…”

Complexo de von Meyenburg: relato de caso e revisão da literatura

“…The sonographic findings of von Meyenburg complex are variable, including multiple, small, hyperechogenic images, with poorly delimited margins, with or with- out posterior reverberation, or even hypoechogenic images with a "target" pattern and well delimited margins (3,6) . As regards the number of hamartomas at imaging studies, they may present as a uninodular lesion, but most frequently they are multinodular (1,3,6) .…”

“…The sonographic findings of von Meyenburg complex are variable, including multiple, small, hyperechogenic images, with poorly delimited margins, with or with- out posterior reverberation, or even hypoechogenic images with a "target" pattern and well delimited margins (3,6) . As regards the number of hamartomas at imaging studies, they may present as a uninodular lesion, but most frequently they are multinodular (1,3,6) . Such characteristic leads to further investigation, particularly in the presence of some known tumor, considering its similarity with metastases, which represents an additional burden for the health system besides physical and psychological distress for the patient (3) .…”