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Embolismo pulmonar agudo tras una inyección sellante endoscópica para escleroterapia
Acute pulmonary embolism following endoscopic glue injection for sclerotherapy
Bruno Niemeyer de Freitas Ribeiroa, Ana Luiza Vianna Sobral de Magalhães Oliveirab, Edson Marchioric,
Corresponding author
a Department of Radiology, Instituto Estadual do Cerebro Dr Paulo Niemeyer and Hospital Casa de Portugal, Rio de Janeiro, RJ, Brasil
b Department of Gastroenterology, Hospital Universitário Antônio Pedro, Niteroi, RJ, Brasil
c Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil
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En la imagen B también se observan émbolos similares en el fondo gástrico.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Un varón de 35 años de edad con cirrosis hepática de clase Child-Pugh B debida a una colangitis esclerosante primaria presentó una hemorragia digestiva alta por rotura de varices gástricas, evidenciada mediante endoscopia. El paciente se sometió a escleroterapia con cianoacrilato y presentó disnea e inestabilidad hemodinámica. La tomografía computarizada reveló múltiples émbolos hiperdensos en las arterias pulmonares (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>) compatibles con embolismo pulmonar por cianoacrilato, y se observaron imágenes similares en el fondo gástrico (fig. 1B). El paciente evolucionó favorablemente con tratamiento sintomático.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El uso del cianoacrilato para el tratamiento de las varices sangrantes está muy generalizado, y el porcentaje de hemostasia inicial se sitúa entre el 87 y el 100%. La mezcla de cianoacrilato y Lipiodol<span class="elsevierStyleSup">®</span> modera la polimerización y mejora la visualización durante la escleroterapia. Las complicaciones, aunque infrecuentes, incluyen infección, perforación esofágica y embolización. El 1% de los casos se complica con embolismo pulmonar que, en general, evoluciona positivamente. Los factores de riesgo comprenden las inyecciones rápidas y de gran volumen, las venas varicosas de gran calibre y la presencia de derivaciones portosistémicas periesplénicas. Para reducir el riesgo, se recomienda administrar únicamente 1<span class="elsevierStyleHsp" style=""></span>ml de mezcla por sesión<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a>. Los anticoagulantes y trombolíticos no son eficaces, por lo que el tratamiento es complejo. En los casos graves, la alternativa es la embolectomía.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0015" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ningún conflicto de intereses.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicto de intereses" ] 1 => array:1 [ "titulo" => "Bibliografía" ] ] ] "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" => 500 "Ancho" => 1286 "Tamanyo" => 118193 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imágenes axial (A) y coronal (B) de la tomografía computarizada que muestran múltiples émbolos hiperdensos en las arterias pulmonares. En la imagen B también se observan émbolos similares en el fondo gástrico.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0010" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Education and imaging: gastrointestinal: Pulmonary embolism of cyanoacrylate glue following endoscopic injection of gastric varices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Kazi" 1 => "M. Spanger" 2 => "J. Lubel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Gastroenterol Hepatol" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "1874" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23304730" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000006/v1_201605260144/S0300289615001337/v1_201605260144/es/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005200000006/v1_201605260144/S0300289615001337/v1_201605260144/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615001337?idApp=UINPBA00003Z" ]
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