9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

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ABDOMINAL ULTRASOUND
The ultrasound appearances are usually of widespread
intrahepatic duct dilatation, with both saccular
and fusiform biliary ectasia. Because it is also
associated with biliary stone formation, the diagnosis
is often not clear. The dilatation is also associated
with cholangitis and signs of infection may
be present in the form of debris within the ducts.
Sometimes, frank choledocal cysts can be located.
Advanced disease is associated with portal hypertension
and, in some cases, cholangiocarcinoma. 35
Parasites
Parasitic organisms, such as the Ascaris worm and
liver fluke, are extremely rare in the UK. However,
they are a common cause of biliary colic in Africa,
A
C
r
k
B
D
Figure 3.42 Caroli’s disease. (A) Dilated biliary tree and ascites. (B) TS of a different patient with end-stage disease.
The grossly abnormal liver texture contrasts with the right kidney. (C) A small section of focal CBD dilatation persisted
in a symptomatic patient, with normal-calibre distal CBD. This was confirmed on ERCP and thought to be a dyskinetic
segment, causing biliary reflux, but was later diagnosed as a mild form of Caroli’s. (D) 3D CT reconstruction of the case
in (C), confirming the ultrasound appearances. Note the tiny ectatic ‘pouchings’ of the intrahepatic ducts characteristic
of Caroli’s.