MULTIMODAL DIAGNOSTICS OF PRIMARY NECROSIS OF THE ROUND LIGAMENT OF THE LIVER USING A CLINICAL CASE
Abstract
Necrosis of the round ligament of the liver is a rare pathology of unknown etiology, which can complicate the accuracy and timeliness of diagnosis. Clinical manifestations of necrosis of the round ligament of the liver are nonspecific and can imitate a variety of diseases included in the acute abdomen syndrome, such as pancreatitis, acute cholecystitis, appendicitis. In this clinical case, an elderly patient had a combined pathology — necrosis of the round ligament against the background of choledocholithiasis and chronic calculous cholecystitis, complicated by mediastinitis. The task of the work was to analyze the complexity of complex radiation diagnostics of this pathology (ultrasound, MRI and MSCT data). A 91-year-old female patient was hospitalized with complaints of abdominal pain. Laboratory studies showed a general inflammatory response. According to ultrasound data, stones were found in the gallbladder, according to MSCT — obstructive choledocholithiasis and cholecystolithiasis, as well as infiltrative changes in the area of the round ligament of the liver. On the 6th day of treatment, an MRI was performed, the results of which revealed an extensive infiltrate of the abdominal cavity, an infiltrate of the anterior mediastinal tissue and suggested the presence of necrosis of the round ligament of the liver. Based on radiological diagnostic methods, emergency surgery was performed on the patient. Intraoperatively, the diagnosis was confirmed — necrosis of the round ligament of the liver; the ligament was removed, as well as cholecystectomy. The postoperative period proceeded without complications. The patient was discharged in satisfactory condition. The described clinical case demonstrates an extremely rare inflammatory disease of the round ligament of the liver, the mechanism of development of which is not clear enough. However, accurate MRI verification of the disease allowed surgeons to choose the correct surgical treatment tactics and led to a positive outcome of the disease.
References
Greco A., Marinelli C., Fusconi M. Clinic manifestations in granulomatosis with polyangiitis // Int. J. Immunopathol. Pharmacol. 2016. Vol. 29, No 2. P. 151–159.
А.В. Байрашевская, Н.Д. Дегтярова, С.Г. Раденска-Лоповок. АНЦА-ассоциированные васкулиты. Архив патологии. 2022. Т. 84, № 1. С. 50-58.
A. Srouji et al. Patterns of presentation and diagnosis of patients with Wegener’s granulomatosis: ENT aspects // The Journal of Laryngology & Otology. 2007. Vol. 121. P. 653–658.
Naohiro Yoshida, Yukiko Iino. Pathogenesis and Diagnosis of Otitis Media with ANCA-Associated Vasculitis // Allergology International. 2016. Vol. 63 (4). P. 523–532.
Cees G.M. Kallenberg. Pathogenesis of ANCA-associated vasculitides //Annals of the Rheumatic Diseases. 2011. Vol. 70(Suppl 1). P. 59–63.
А.Р. Бабаева, Е.В. Калинина, М.С. Звоноренко. Трудности диагностики гранулематоза Вегенера у взрослых в современной клинической практике (клиническое наблюдение) // Волгоградский научно-медицинский журнал 3. 2016. С. 49-54.
Yasuaki Harabuchi, Kan Kishibe, Kaori Tateyama et al. Clinical features and treatment outcomes of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV): A retrospective analysis of 235 patients from a nation wide survey in Japan // Mod Rheumatol 2017. Vol. 27:87. P. 87-94.
Naohiro Yoshida, Mariko Hara, Masayo Hasegawa et al. Reversible cochlear function with ANCA-associated vasculitis initially diagnosed by otologic symptoms // Otology & Neurotology. 2014. Vol. 35(1). P. 114-120.
Dana M. Hartl; Patrick Aïdan; Olivier Brugière; Olivier Sterkers (1998). Wegener's granulomatosis presenting as a recurrence of chronic otitis media // American Journal of Otolaryngology. 1998. Volume 19, Issue 1. P. 54-60.
M. Yates, R.A. Watts, I.M. Bajema et al. EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis // Annals of the Rheumatic Diseases – 2016. Vol. 75. P. 1583–1594.
Naohiro Yoshida. Intractable otitis media — Pathogenesis and treatment of Eosinophilic otitis media (EOM) and otitis media with Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) // Auris Nasus Larynx. 2023. Vol. 50, Issue 2. P. 171-179.
André Souza de Albuquerque Maranhao,Vitor Guo Chen, Bruno Almeida Antunes Rossini, Jose Ricardo Gurgel Testa, Norma de Oliveira Penido. Mastoiditis and facial paralysis as initial manifestations of Wegener’s Granulomatosis // Brazilian Journal of Otorhinolaryngology. 2012. Vol. 78(2). P. 80–86.
Kwee Yen Goh , Ross Bannon, Helin Nie Darat, Bhaskar Ram, Raghav C Dwivedi. Intractable chronic otitis media, rhinosinusitis and facial palsy: a case of active granulomatosis with polyangiitis // BMJ Case Reports. 2020. Vol. 13(9).
