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Iatrogenia diagnóstica : riscos assumidos e danos colaterais
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Procedeu-se a uma revisão alargada da bibliografia referente às complicações da biópsia hepática eco-guiada. Apresenta-se o caso de um doente com suspeita de metastização hepática por neoplasia oculta, que foi alvo de investigação exaustiva e proposto para realizar este exame, que resultou em hemoperitoneu com choque hemorrágico e necessidade de abordagem cirúrgica com tromboembolismo pulmonar (TEP) decorrente de interrupção da terapêutica antiagregante plaquetária e anticoagulante. Discutem-se os riscos envolvidos, as indicações e a pertinência de optar por este procedimento diagnóstico invasivo bem como a implicação dos danos colaterais sofridos.
The analysis of this clinical case was preceded by a broad review on the complications of liver biopsy with special attention to those performed under ultrasound (US) guidance. We present a patient who was suspected to have liver metastasis of an unknown primary tumor; extensive diagnostic investigation was undertaken and thus the patient was subjected to a US-guided liver biopsy that resulted in a haemoperitoneum with a hypovolemic shock managed by surgery, and a pulmonary embolism concurrent with the suspension of anti-platelet and anticoagulant drugs. We further discuss the risks, indications and the relevance of this invasive diagnostic procedure as well as the collateral damage implicated.
The analysis of this clinical case was preceded by a broad review on the complications of liver biopsy with special attention to those performed under ultrasound (US) guidance. We present a patient who was suspected to have liver metastasis of an unknown primary tumor; extensive diagnostic investigation was undertaken and thus the patient was subjected to a US-guided liver biopsy that resulted in a haemoperitoneum with a hypovolemic shock managed by surgery, and a pulmonary embolism concurrent with the suspension of anti-platelet and anticoagulant drugs. We further discuss the risks, indications and the relevance of this invasive diagnostic procedure as well as the collateral damage implicated.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Doença iatrogénica Biópsia Fígado