Dra renata de oliveira s brenner (r3 ddi)
-
Upload
adriano-pires -
Category
Documents
-
view
341 -
download
4
Transcript of Dra renata de oliveira s brenner (r3 ddi)
![Page 1: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/1.jpg)
Reunião 12.08.09
Dra Renata de Oliveira S Brenner (R3 DDI)
![Page 2: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/2.jpg)
Caso clínico
• Exame ambulatorial de RM de abdome
• Pedido do médico solicitante:
• paciente com pancreatopatia crônica, avaliar imagem sugestiva de pseudocisto vista na tomografia...
![Page 3: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/3.jpg)
![Page 4: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/4.jpg)
![Page 5: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/5.jpg)
![Page 6: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/6.jpg)
![Page 7: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/7.jpg)
![Page 8: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/8.jpg)
![Page 9: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/9.jpg)
![Page 10: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/10.jpg)
Diagnóstico...
![Page 11: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/11.jpg)
Pancreatite de sulco
Diagnóstico...
![Page 12: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/12.jpg)
Pancreatite de sulco• Groove pancreatitis: a diagnostic
challenge; Eur Radiol 2009; C.Triantopoulou
• MRI features of groove pancreatitis; AJR 2007; R.Blasbalg
• A clinical and radiologic review of uncommon types and causes of pancreatitis; Radiographics 2009; A.K.P.Shanbhogue
![Page 13: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/13.jpg)
Pancreatite de sulco• Becker, 1973
• forma incomum de pancreatite crônica
• homens jovens, abuso de álcool
• prevalência desconhecida, muito variada entre séries de casos (pancreatoduodenectomia por pancreatite crônica)
• crucial: diferenciar com carcinoma pancreático, evitando a cirurgia oncológica em casos de pancreatite de sulco...
![Page 14: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/14.jpg)
Pancreatite de sulco - patogênese• úlceras pépticas
• hipersecreção gástrica
• ressecção gástrica
• cistos verdadeiros na parede duodenal
• heterotopia pancreática na parede duodenal
• alteração do fluxo no ducto de Santorini
![Page 15: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/15.jpg)
Pancreatite de sulco - patogênese• Espectro: “pancreatite
paraduodenal”
• pancreatite de sulco
• distrofia cística do duodeno
• cistos paraduodenais
• ao redor da papila, ductos dilatados, cistos duodenais, hiperplasia das glândulas de Brunner, tecido pancreático hamartomatoso no sulco (heterotopia pancreática na parede duodenal)
![Page 16: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/16.jpg)
Pancreatite de sulco
tecido pancreático (estrela) na submucosa duodenal (seta indicando mucosa)
dois ductos pancreáticos dilatados (setas) na muscular própria hipertrofiada do duodeno (estrelas)
![Page 17: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/17.jpg)
Pancreatite de sulco - sinais e sintomas• espessamento das paredes duodenais
> vômitos
• sintomas de obstrução biliar raramente precedem os de obstrução duodenal
• icterícia é infrequente e se presente, flutua
• cistos na parede duodenal, pequenos ou grandes
• realce pós contraste > heterotopia pancreática
• realce tardio > fibrose
![Page 18: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/18.jpg)
Pancreatite de sulco - RM• massa retangular no sulco, em placa,
hipointensa em T1 e iso a levemente hiperintensa em T2 (componente fibroso)
![Page 19: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/19.jpg)
Pancreatite de sulco - RM• realce tardio
equilíbrio
arterial portal
![Page 20: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/20.jpg)
Pancreatite de sulco - RM
• cistos: hiperintensos em T2
![Page 21: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/21.jpg)
Pancreatite de sulco - RM
• estenose duodenal
![Page 22: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/22.jpg)
Pancreatite de sulco - RM• afilamento gradual dos ductos biliares
adenocarcinoma: interrupção abrupta
![Page 23: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/23.jpg)
Pancreatite de sulco - RM• afastamento entre a luz distal dos
ductos biliares e a luz duodenal
![Page 24: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/24.jpg)
Pancreatite de sulco - RM• vesícula biliar “em banana”
(comumente encontrado em pancreatite crônica)
![Page 25: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/25.jpg)
Pancreatite de sulco - RM• alterações do parênquima pancreático > varia
conforme tipo:
• PS pura - limitada ao sulco - pâncreas e ducto pancreático principal com aspecto normal
• PS segmentar - envolve a cabeça pancreática - sinais de pancreatite crônica
![Page 26: Dra renata de oliveira s brenner (r3 ddi)](https://reader033.fdocument.pub/reader033/viewer/2022052311/5584721bd8b42a6b4d8b4c36/html5/thumbnails/26.jpg)
Pancreatite de sulco -diferenciais
• carcinoma de sulco (principalmente carcinomas esquirrosos: comportamento fibrótico)
• carcinoma periampular
• carcinoma duodenal
• pancreatite aguda com alterações inflamatórias na cabeça