원광대학병원 소화기내과 김태현, 오성렬, 김동, 김송이 CBD dilatation due to? 원광대학병원 소화기내과 김태현, 오성렬, 김동, 김송이

A/S 73/M C/C abdominal discomfort onset : 약 1주 전부터 site : RUQ area associated symptom : no fever, chills P/I : 본 73세 남자 환자는 우연히 발견된 mediastinal mass로 본원 CS 입원하여 biopsy 시행 결과 thymic Squamous cell carcinoma 소견 관찰되어 mass excision 시행하고 conservative care 중이던 환자로 abdominal discomfort 지속되며 LFT의 상승되어 내과에 consultation.

P/Hx : HTN(+), VAP(+), BPH(+), old CVA(+) & med 10.1.26 open excisional biopsy ->thymic squamous cell carcinoma 10.2.5 thymus total excision 시행 10.2.17 central catheter tip culture : S. Epidermidis(+) ->2.17~2.24 vancomycin IV antibiotic Tx. 시행 F/Hx : Non-specific S/Hx: Non-smoker, No alcohol drinking P/Ex : RUQ area discomfort & mild DT (+)

Laboratory finding I 검사항목 기준치 의뢰시(10.3.2) Hb(g/ul) 12-18 12.4 WBC(/ul) 4.0-10x103 8270 Eosinophil(/ul) 0.04-0.5x103 750(9.1%) PLT(/ul) 140-450x103 304 APTT(sec) 25-32 34.1 PT(sec) 10.7-14.5 12.7

Laboratory finding II T. bil(mg/dL) 0.2~1.4 0.61 D.bil(mg/dL) 0~0.7 0.23 AST (IU/l) 5~35 143 ALT (IU/l) 5~35 256 ALP (IU/l) 104~338 1427 GGT (IU/l) 8~61 516 CRP (mg/L) 0~5 15.7 IgE (IU/mL) 1~100 >2500 IgG (IU/mL) 700~1600 1221 CA 19-9(IU/mL) 0~33 2.98 ANA ~Neg mod.(+)

Biopsy in ampulla Eosinophilic duodenitis

Tentative diagnosis R/O Eosinophilic cholangiopathy

Eosinophilic cholangiopathy

Rare benign cause of biliary obstruction. Characterized by dense transmural esosinophilic infiltration of the biliary tract. GB and bile duct simultaneously Eosinophilic cholecystitis : affect only the GB Eosinophilic cholangitis : only the bile duct Cause : unknown Eosinophilic cholangiopathy is part of a spectrum of diseases definede by eosinophilic infiltration of tissues and organs with or without peripheral eosinophilia. The severity and prognosis of the disease vary. Pathogenesis of eosinophilic infiltration is poorly understood.

D/Dx with eosinophilic cholecystitis Eosinophilic cholangiopathy appears to follow a benign course even when there is multifocal involvement. D/Dx with eosinophilic cholecystitis Acalculous cholecystitis Hypertrophic cholecystosis Gallbladder ca Leukemic infiltration The diagnosis of eosinophilic cholangiopathy was determined on the basis of the anatomic findings, the presence of peripheral eosinophilia, the scant eosinophilic infiltration of the periportal spaces, and the lack of other causes. Treatment Steroid Tx.