Caso cerrado resuelto: Leiomiomatosis intravascular
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Transcript of Caso cerrado resuelto: Leiomiomatosis intravascular
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Caso Cerrado 2 Octubre
Roberto Correa
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Historia clínica
• Mujer de 50 años con disnea
• Angio CT de tórax negativo para TEP
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Hallazgos
• Masa pélvica
– Útero
• Aumentado de tamaño con masa que realza de manera heterogénea en el TC CC.
• RM T1+C: Masa uterina con realce ávido.
• RM T2: Tumor hiperintenso en VCI.
• Defecto de repleción de VCI
• Dilatación de venas pélvicas
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DIAGNÓSTICO DIFERENCIAL
• Leiomiosarcoma.
• Leiomiomatosis difusa.
• Leiomiomatosis diseminada.
• Leiomiomatosis benigna metastásica.
• Carcinoma de células renales con invasión a VCI.
• Trombosis venosa ovárica.
• Leiomiomatosis intravascular.
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LEIOMIOSARCOMA
• Tumor raro• Mujeres 5ª década• Clínica• Masa• Tamaño• Metástasis
• TC• Realce heterogéneo• Hemorragia• Necrosis
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LEIOMIOSARCOMA
• RM• T1• T2• T1+C
• Puede confundirse con Leiomioma• Masa de crecimiento rápido
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LEIOMIOSARCOMA
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LEIOMIOSARCOMA
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LEIOMIOMATOSIS DIFUSA
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LEIOMIOMATOSIS DIFUSA
• 40% mujeres > 35ª• Clínica• Masa• Tamaño
• TC• Calcificaciones• Efecto masa• Masa homogénea
• Degeneración
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LEIOMIOMATOSIS DIFUSA
• RM• T1• T2
• Homogénea• Hipointensa• Bien definida
• T1+C• Degeneración
• Mixoide• Quística• Hialina• Hemorrágica
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LEIOMIOMATOSIS DIFUSA
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LEIOMIOMATOSIS DIFUSA
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LEIOMIOMATOSIS DIFUSA
• Puede confundirse con Leiomiosarcoma• Masa de crecimiento lento• No metástasis
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LEIOMIOMATOSIS DISEMINADA
• Nódulos de músculo liso • Implantan cavidad abdominal• Benignos
• 100 casos reportados
• Estrógeno dependientes
• TC y RM• Músculo liso o miometrio
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LEIOMIOMATOSIS DISEMINADA
• No infiltran• No ascitis
• Imitan carcinomatosis peritoneal
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LEIOMIOMATOSIS DISEMINADA
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LEIOMIOMATOSIS BENIGNA METASTÁSICA
• Leiomiomas benignos extrauterinos
• 75 casos reportados
• Asintomático
• Pulmón• Hígado
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LEIOMIOMATOSIS BENIGNA METASTÁSICA
• Nódulos pulmonares incidentales• Antecedentes de leiomioma• Bien definidos, bilaterales• No calcifican• No adenopatías• No derrame pleural• No realzan significativamente
• Clínica• Tos no productiva• Disnea• Dolor torácico
T1+C: Múltiples nódulos que realzan.
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CARCINOMA DE CÉLULAS RENALES CON INVACIÓN DE VCI
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CARCINOMA DE CÉLULAS RENALES CON INVACIÓN DE VCI
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CARCINOMA DE CÉLULAS RENALES CON INVACIÓN DE VCI
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TROMBOSIS VENOSA OVÁRICA
• Tromboflebitis ascendente• Postparto
• Clínica
• Vaso• Dilatado• Engrosado• Alteración de grasa adyacente• Defecto de llenado
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TROMBOSIS VENOSA OVÁRICA
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TROMBOSIS VENOSA OVÁRICA
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LEIOMIOMATOSIS INTRAVASCULAR
• Masa uterina• Realce heterogéneo• Crecimiento intravenoso
• 200 casos reportados
• 25 – 75 años
• Clínica
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LEIOMIOMATOSIS INTRAVASCULAR
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LEIOMIOMATOSIS INTRAVASCULAR
• Masas nodulares intravasculares
• Extensión variable
• TC
• RM• T1+C
• Realce heterogéneo y ávido.
Útero con realce irregularVenas pélvicas dilatadas
Tumor en vena ovárica derecha, VCI y AD.
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LEIOMIOMATOSIS INTRAVASCULAR
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Historia clínica
• Mujer de 50 años con disnea
• Angio CT de tórax negativo para TEP
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• LEIOMIOMATOSIS INTRAVASCULAR
– LEIOMIOMATOSIS
• (DEGENERACIÓN MIXOIDE, QUÍSTICA O HEMORRÁGICA)
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LEIOMIOMATOSIS INTRAVASCULAR
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LEIOMIOMATOSIS INTRAVASCULAR