Naslov
SLE patient with opstructive jaundice and midle lobe atelectasis – case report

Autori
Žokalj, Ivan ; Igrec, Jasminka ; Pavčec, Zlatko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Book of Abstracts / Nagy, Gyöngyi - Zalaegerszeg : Hungarian Society of Radiology, 2009, 48-48

Skup
9th Hungarian-Croatian-Slovenian Radiological Symposium

Mjesto i datum
Kehidakustány, Mađarska, 13.11.2009. - 14.11.2009

Vrsta sudjelovanja
Poster

Vrsta recenzije
Nije recenziran

Ključne riječi
SLE; opstructive; jaundice; X-ray; ultrasound

Sažetak
Aim:Non-specific symptoms like weaknes and clinical signs like high temperature in chronically ill patients with long history of seronegative spondiloarthropaty can be misleading because lot of side-effects of long-term therapy. Case report:Male patient, 54 year was admitted to the emergency department because of weaknes and elevated body temperature 38, 3ºC. Patient had three chronical diseases, 20 year long history of systemic lupus eritematodes (SLE), arterial hypertension and insulin-dependent diabetes mellitus. 19 years before partial pancreatectomy with pancreatojejunoanastomosis, cholecystectomy and splenectomy were performed because of necrotizing pancreatitis. Two years before this episode patient suffered of opstructive jaundice because of stenosis of anastomosis which was confirmed with endoscopic retrograde cholangiopancreatography (ERCP) and resolved with sphincterotomy and stenting of anastomosis. First chest X-ray at the admition showed pleural effusion in the right hemithoax base. First biochemistry tests revealed signs of hepatic function lesion, hyperbilirubinemia with 186µmol/L (norm.3-20). C-reactive protein (CRP) was highly elevated 231, 8mg/l (norm. <5, 0). Total leukocyte count was elevated 16x109 /L and erythrocyte decreased 3, 47x1012 /L. First abdominal ultrasound depicted pleural effusion in right hemithorax base, dilated intrahepatic end extrahepatic bille ducts with stones in common bile duct. Computed tomography (CT) of thorax and abdomen confirmed calculosis of common bile duct, dilatation of bile ducts, stenosis of distal part of common bile duct and depicted disruption of the stent. CT also revealed midle lobe atelectasis. During bronchoscopy intraluminal tumor of the main midle lobe bronchus has been diagnosed – patohistologic analysis showed planocellular carcinoma. Patient was temporarly transfered in another institution in atempt to resolve hyperbilirubinemia with repeated endoscopic intervention. After cholangiopancreatography which confirmed ultrasound and CT finding papilotomy and dilatation with baloon-catheter were performed. Two more stents were placed in stenotic distal part of common bile duct and anastomosis.Hyperbilirubinemia and CRP level gradualy decreased after intervention, but signs of hepatic function lesion remained unchanged. Diminished liver function, comorbidity conected with high risk of perioperative complications were reasons for decision of paliative treatment of midle lobe bronchi carcinoma with therapeutic irradiation. Conclusion: Diagnostic evaluation of patients with long-standing chronical diseases in emergency situations can be very demanding and close coordination between physicians of various specialities is needed to resolve the acute problems.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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