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Tabla 6-1. Causas frecuentes de esplenomegalia Congestiva
Cirrosis,
Tumoral Infecciones Procesos inflamatorios Procesos infiltrativos (no tumorales) Enfermedades tumorales)
hematológicas
(no
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trombosis
portal Linfoma, leucemias agudas y crónicas, síndromes mieloproliferativos, tumores primarios o metastásicos del bazo Virus (hepatitis, mononucleosis infecciosa, infección VIH), parásitos (malaria, leishmania), endocarditis infecciosa Sarcoidosis, lupus eritematoso sistémico, artritis reumatoide (sd de Felty) Amiloidosis, Enf de Gaucher, Enf de Niemann-Pick, glucogenosis, Anemias hemolíticas agudas y crónicas, drepanocitosis, uso crónico de factor estimulante de las colonias de los granulocitos
Figura 6-1. Esplenomegalia evidente (más de 16 cm de diámetro longitudinal) en paciente con fiebre prolongada y pancitopenia en relación con leishmaniasis visceral.
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Figura 7-1. Segmentación hepática de Couinaud
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Figura 7.2. Ecoestructura de un hígado normal. La ecogenicidad del parénquima hepático es similar a la del bazo y algo mayor a la corteza renal
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Figura 7.3. Lóbulo hepático izquierdo normal, con bordes rectilíneos y ángulo menor de 45º
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Tabla 7.1 Clasificación de las lesiones focales hepáticas según su ecogenicidad
Densidad ecográfica
Tipo de lesión focal
Anecoicas
Quistes simples Hidatidosis hepática Poliquistosis hepática Abscesos Enfermedad de Caroli Metástasis con necrosis Malformaciones arteriovenos as Quistes del colédoco Metástasis Linfoma Abscesos Hiperplasi a nodular Angioma atípico Hepatocarcinoma Nódulos regenerativos cirróticos Quistes complejos Angiomas hepáticos Metastásis (30% hiperecoica s) Esteatosis parcheada Adenomas Hepatocarcinoma Angiosarcoma Granulomas
Hipoecoicas
Hiperecoica s
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Medidas de referencia
MUJER
HOMBRE
Paraesternal eje largo Normal
Leve
Moderado
Diámetro telediastólico de VI (mm)
39-53
54-57
58-61
!
Tabique interventricular (mm)
6-9
10-12
13-15
!
FEVI (%)
Severo
Normal
Leve
Moderado
Severo
62
42-59
60-63
64-68
!
16
6-10
11-13
14-16
!
69
17
55
45-54
30-44
<30
55
45-54
30-44
<30
AI
27-40
41-45
45-50
!
50
30-40
41-46
47-52
!
Diámetro AD (eje menor)(mm)
29-45
46-50
51-54
!
55
29-45
46-50
51-54
!
Diámetro de la raíz aórtica (sinusal)(mm)
< 39
!
Diámetro (mm)
!
55
55
<39
Eje apical cuatro cámaras Diámetro VD (basal)(mm)
20-28
29-33
34-38
!
39
20-28
29-33
34-38
!
Diámetro
27-33
34-37
38-41
!
42
27-33
34-37
38-41
!
20
20-30
30-40
!
40
"
20
20-30
30-40
!
VD
(medio)(mm) Área AI (cm 2)
"
39
42
40
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