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HUSM
SERVIÇO DE DIAGNÓSTICO POR IMAGEM
DOENÇAS HEPÁTICAS DIFUSAS
R2 RÉGIS SILVA
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FIGADO
-Peso: 1,4 – 1,7 Kg
-Medida transversal 20 - 26 cm
-Medida vertical 15 - 21 cm
-20 – 25 % do suprimento artéria hepática
-75 – 80% do suprimento veia porta
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SEGMENTAÇAO DE COUINAUD
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DOENÇA DO FÍGADO GORDUROSO-E uma resposta uma lesão e a toxina-Acúmulo de colesterol e triglicerídios-Alcoolismo, obesidade, desnutrição, hiperalimentação, costicóide, DM, pancreatite …-Exames de imagem é o melhor método-Avaliação:
- TC: densidade menor do que do baço- RM: identificar esteatose focal
-Esteatose focal- Distribuição segmentar, sub capsular, VB, lig falciforme- Margem nítida e em linha reta- Não desloca vasos
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chc
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HEMOCROMATOSE-Primária(hereditária)
- Aumento da reabsorção gastrointestinal- 4ª e 5ª década de vida- DM, IC, artralgia…
-Secundária(aumento do aporte)- Anemia crônica com múltiplas transfusões- Ingestão excessiva, porfiria,
-TC: fígado com densidade > 70 HU – sobrecarga de ferro-Ouro coloidal, doença de Wilson, d. armaz. de glicogênio-RM: Redução da intensidade do sinal em T1 e T2. hiperintenso no baço.-Hemossiderose, d. de Wilson…
-X
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TROMBOSE DA VEIA PORTA-Complicação de cirrose-Invasão ou compressão tumoral-Hipercoagulabilidade-Inflamação-Incidência de 5% na hipertensão portal e próximo de 30% no CHC-TC: Esplenomegalia, formação de colaterais, ascite, e pode ter alta atenuação na fase arterial.-RM: trombo agudo hiper em T1 e T2, crônico hipo em T1 e hiper em T2.
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BUDD-CHIARI-Hipercoagulabilidade-Compressão – tumor-Membrana da VCI
-Dor abdominal, hepatomegalia e ascite.
- TC: hepatomegalia heterogênea, não visualização das veias hepática, ascite, realce hepático central, lobo caudado preservado ou aumentado.
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INFARTO HEPÁTICO
-Raro
-Choque agudo, trauma hipercoagulabilidade
-Elevação da enzimas hepáticas e plaqueta baixa
-Achados: área periférica em forma de cunha, não apresenta efeito de massa, nem realce pelo contraste.
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DOENÇA HEPATICA VENO-OCLUSIVA
-Relacionada principalmente a transplante e neoplasias no público pediátrico.-Lesão hepática sinusoidal
Clínica-Ganho de peso não imputáveis à sobrecarga de fluido, hepatomegalia dolorosa, icterícia e ascite-Nos primeiros 20 dias pós transplante
Achados da TC-Ascite, hepatomegalia, espessamento da VB e estreitamento das veias hepaticas
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GÁS NO SISTEMA PORTA
-Mais frequentemente associado:-Isquemia intestinal nos adultos-Enterocolite necrosante nos RN
-Outras causas: colonoscopia recente, sonda de gastrostomia, DII, diveticulite, abscesso abdominal…
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HEPATITE AGUDA- Comumente não produz anormalidades específicas nos exames de imagem.- Achados: hepatomegalia, atenuação heterogênea e perfusão irregular.
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HEPATITE CRONICA-Inflamação e fibrose portais e perilobulares-Em geral o fígado não está aumentado, no inicio as alterações são mínimas.
CIRROSE
-Destruição difusa do parenquima, fibrose com alteração da arquitetura hepática e inúmeros nódulos regenerativos.-Causas:
- Toxinas , Infecção, Obstrução biliar, Hereditária ou criptogênica.
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CIRROSE
-Achados: - Superfície lisa ou micronodular, Atrofia hepática, Adenopatia
porta hepatis, hipertrofia do lobo caudado, nódulos de regeneração
- Sinais indiretos – hipertensão portal
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CIRROSE
NÓDULOS- Nódulos regenerativos: 3-10mm, a maioria são isodensos, sinal variável em T1, T2 hipo ou isointenso.
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CIRROSE- Fibrose hepática confluente- Áreas de fibrose semelhantes a massa, forma de cunha, hipodensas, perda de volume da porção afetada do fígado- São hiperintensas em T2 e hipo em T1.
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Sarcoidose - Boeck
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Peliose hepática
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