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Tos crónica e insuficiencia respiratoria. ¿Por qué?
Finding the Cause of Chronic Cough and Respiratory Failure
João Carvalho
, Inês Faria, Carvalheira Santos
Corresponding author
Respiratory Intensive Intermediate Care Unit, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "274" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "João Carvalho, Inês Faria, Carvalheira Santos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "João" "apellidos" => "Carvalho" "email" => array:1 [ 0 => "joaobettencourtcarvalho@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Inês" "apellidos" => "Faria" ] 2 => array:2 [ "nombre" => "Carvalheira" "apellidos" => "Santos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Respiratory Intensive Intermediate Care Unit, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Finding the Cause of Chronic Cough and Respiratory Failure" ] ] "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" => 633 "Ancho" => 1400 "Tamanyo" => 98404 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Radiografía de tórax que muestra atelectasias e infiltrados en la base del pulmón derecho compatibles con un diente. B) TAC que muestra una opacidad en el lóbulo inferior derecho y un cuerpo extraño endobronquial de 13<span class="elsevierStyleHsp" style=""></span>mm.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mujer de 59 años de edad, no fumadora, con diagnóstico de hipertensión arterial, diabetes mellitus y «rinitis crónica» de 20 años de evolución, caracterizada por tos seca que no mejoraba con tratamiento inhalado o antihistamínico. La paciente negó haber sido sometida a pruebas de tomografía axial computarizada (TAC) o pruebas funcionales respiratorias complementarias previas.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Acudió al servicio de urgencias por empeoramiento de la tos, disnea y dolor torácico. La gasometría arterial (GA) (FiO<span class="elsevierStyleInf">2</span>: 40%) indicó insuficiencia respiratoria de tipo 1 (PaO<span class="elsevierStyleInf">2</span>: 52<span class="elsevierStyleHsp" style=""></span>mmHg) y la radiología de tórax reveló la presencia de infiltrados pulmonares en la base del pulmón derecho. Se le diagnosticó una neumonía extrahospitalaria y se inició tratamiento de antibioterapia empírica con levofloxacino.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Debido al deterioro clínico de la paciente, se realizó una nueva radiografía de tórax (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>A) que reveló atelectasias en el lóbulo inferior derecho (LID). El TAC torácico (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>B) mostró una neumonía por un cuerpo extraño endobronquial impactado en la raíz del bronquio del LID.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Se practicó una broncoscopia rígida que reveló la presencia de un diente, que se extrajo.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Al volver a interrogar a la paciente, comunicó un episodio de ahogo hacía 20 años, que no consideró de interés.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Un mes más tarde la paciente estaba asintomática y los resultados de la GA y la espirometría funcional se habían normalizado.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los síntomas crónicos se deben investigar siempre. En ocasiones, las exploraciones broncoscópicas revelan la presencia de cuerpos extraños, y los más habituales son restos de comida, uñas y piezas de juguetes<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a>.</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" => 633 "Ancho" => 1400 "Tamanyo" => 98404 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Radiografía de tórax que muestra atelectasias e infiltrados en la base del pulmón derecho compatibles con un diente. B) TAC que muestra una opacidad en el lóbulo inferior derecho y un cuerpo extraño endobronquial de 13<span class="elsevierStyleHsp" style=""></span>mm.</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:1 [ "referenciaCompleta" => "Warshawsky Martin E. Foreign Body Aspiration: Background, Pathophysiology, Epidemiology. 2013. Disponible en: http://emedicine.medscape.com/article/298940" ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000005/v1_201604270107/S0300289615002008/v1_201604270107/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/03002896/0000005200000005/v1_201604270107/S0300289615002008/v1_201604270107/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615002008?idApp=UINPBA00003Z" ]
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