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Trombosis venosa inusual como primera manifestación de neoplasia pulmonar
Atypical Deep Venous Thrombosis as the First Manifestation of Pulmonary Neoplasm
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Sánchez, Ana María Andrés Blanco, Laura Abad Manteca" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Soraya" "apellidos" => "Jodra Sánchez" "email" => array:1 [ 0 => "sorayajodra_9@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana María" "apellidos" => "Andrés Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Laura" "apellidos" => "Abad Manteca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Río Hortega, Valladolid, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Atypical Deep Venous Thrombosis as the First Manifestation of Pulmonary Neoplasm" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 975 "Tamanyo" => 84193 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Trombosis venosa bilateral y neoplasia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Es bien conocido el estado de hipercoagulabilidad en las neoplasias que conlleva una estrecha asociación entre estas y los fenómenos tromboembólicos. La incidencia de neoplasia tras un episodio tromboembólico oscila entre el 2 al 25%, siendo los tumores más frecuentemente implicados los hematológicos, páncreas, ovario, hígado, riñón y pulmón. La trombosis venosa en miembros inferiores y el tromboembolismo pulmonar representan las localizaciones más frecuentes, siendo minoritarios los casos descritos en territorios venosos inusuales.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos el caso de un varón de 68 años, fumador de más de 40 paquetes/año, que es valorado en consulta de oftalmología por pérdida de visión en ojo derecho de 20 días de evolución. En la exploración ocular se detecta una trombosis venosa retiniana bilateral. Se amplía el estudio para descartar enfermedad sistémica secundaria. El estudio analítico, coagulación, serológico y autoinmune, junto con tomografía axial computarizada (TAC) cerebral, fue negativo. Se realiza radiografía de tórax detectándose un nódulo en lóbulo superior izquierdo (LSI). El TAC torácico confirma la existencia de una imagen nodular espiculada en la región posterior del LSI de 14<span class="elsevierStyleHsp" style=""></span>mm compatible con neoplasia (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). El diagnóstico anatomopatológico fue congruente con adenocarcinoma pulmonar y el estudio por PET-TAC no demostró captaciones patológicas a otro nivel.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Como conclusión decir que sigue siendo muy debatido si es adecuado o no realizar estudios extensos para detectar neoplasias ocultas tras fenómenos tromboembólicos idiopáticos. Las últimas evidencias señalan que la realización de estudios extensos para cribado de neoplasias tras fenómenos tromboembólicos no está justificado salvo pacientes de alto riesgo (episodios recurrentes trombóticos a pesar del tratamiento anticoagulante y trombosis venosa portal o hepática), por el alto coste sanitario que supondrían, pero la realización de estudios básicos de despistaje mediante analítica, <span class="elsevierStyleItalic">screening</span> protocolizados según edad y radiografía de tórax sí tiene su interés<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a>. Finalmente, destacar que a pesar que los territorios más frecuentemente afectados sean el sistema venoso de miembros inferiores y el lecho pulmonar, existe un pequeño porcentaje de trombosis venosas de localización inusual que también pueden ser la forma de presentación de neoplasias ocultas u otras enfermedades sistémicas, lo que precisa valorar individualmente cada caso y plantear un despistaje con un mínimo estudio básico.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 601 "Ancho" => 975 "Tamanyo" => 84193 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Trombosis venosa bilateral y neoplasia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thrombophilic state in cancer, part I: Biology, incidence, and risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.J. Dipasco" 1 => "S. Misra" 2 => "L.G. Koniaris" 3 => "F.L. Moffat Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.21925" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol" "fecha" => "2011" "volumen" => "104" "paginaInicial" => "316" "paginaFinal" => "322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21480262" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: The Trousseau syndrome revisited: Should we screen extensively for cancer in patients with venous thromboembolism?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Carrier" 1 => "G. Le Gal" 2 => "P.S. Wells" 3 => "D. Fergusson" 4 => "T. Ramsay" 5 => "M.A. Rodger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2008" "volumen" => "149" "paginaInicial" => "323" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18765702" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer and venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Prandoni" 1 => "A. Falanga" 2 => "A. Piccioli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(05)70207-2" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2005" "volumen" => "6" "paginaInicial" => "401" "paginaFinal" => "410" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15925818" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trombosis venosa profunda en sitios inusuales y trombosis superficial. Resultados preliminares de una encuesta multicéntrica de la Sociedad Argentina de Hematología" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Subcomisión de Hemostasia y Trombosis de la Sociedad Argentina de Hematología" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hematologia." 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