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El hemograma revel&#243; un alto recuento de linfocitos en sangre&#44; con desviaci&#243;n hacia la izquierda&#46; El resto de resultados anal&#237;ticos fueron anodinos&#46; La tomograf&#237;a computarizada mostr&#243; una masa heterog&#233;nea en el l&#243;bulo inferior derecho&#44; adyacente a la superficie pleural &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; La broncoscopia revel&#243; mucosa bronquial inflamada hiper&#233;mica sin purulencia o evidencia de necrosis y en el lavado broncoalveolar se hallaron numerosos macr&#243;fagos cargados de l&#237;pidos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; Se trat&#243; al paciente con esteroides sist&#233;micos y antibi&#243;ticos&#46; La tomograf&#237;a computarizada realizada 2 semanas despu&#233;s del ingreso mostr&#243; una notable mejor&#237;a&#44; con reabsorci&#243;n de la masa dejando cicatrices residuales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La causa de la neumon&#237;a del tragafuegos es la aspiraci&#243;n aguda accidental de hidrocarburos durante un espect&#225;culo de lanzafuego<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a>&#44; donde el ejecutante sopla una bocanada de hidrocarburo l&#237;quido contra una antorcha&#44; creando as&#237; un aerosol que se inflama en torno a ella<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; Estos hidrocarburos pueden difundirse r&#225;pidamente por todo el &#225;rbol bronquial&#44; induciendo edema bronquial&#44; da&#241;o tisular y destrucci&#243;n del tensioactivo&#46; En consecuencia&#44; los compuestos provocan la activaci&#243;n de macr&#243;fagos y causan reacci&#243;n inflamatoria local<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de neumon&#237;a lipoidea del tragafuegos requiere la cuidadosa evaluaci&#243;n de la anamnesis del paciente y las caracter&#237;sticas cl&#237;nicas&#46; Los s&#237;ntomas de presentaci&#243;n incluyen tos&#44; disnea&#44; fiebre y dolor en el pecho tras aspirar hidrocarburos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Tambi&#233;n se puede confirmar el diagn&#243;stico por la presencia de macr&#243;fagos cargados de l&#237;pidos en el lavado broncoalveolar tras una exposici&#243;n reciente a hidrocarburos vol&#225;tiles<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; Los hallazgos tomogr&#225;ficos en pacientes con neumon&#237;a del tragafuegos incluyen consolidaci&#243;n unilateral o bilateral de pulm&#243;n&#44; con o sin atenuaci&#243;n baja causada por la densidad de los l&#237;pidos o necrosis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#44; n&#243;dulos bien definidos&#44; neumatoceles &#40;n&#243;dulos cavitarios bien definidos&#41;&#44; derrame pleural y neumot&#243;rax espont&#225;neo<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; Las lesiones habitualmente afectan a ambos l&#243;bulos inferiores<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Esta neumon&#237;a es una enfermedad pulmonar seudoinfecciosa caracterizada por la intensa liberaci&#243;n de citoquinas inflamatorias&#46; El tratamiento con esteroides es controvertido&#44; pero puede mejorar el resultado en pacientes gravemente afectados&#46; Los antibi&#243;ticos profil&#225;cticos parecen ser beneficiosos&#44; ya que puede aparecer fiebre y alto recuento leucocitario&#44; los cuales podr&#237;an ser indicativos de neumon&#237;a bacteriana asociada<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; La mayor&#237;a de los pacientes con neumon&#237;a del tragafuegos experimentan mejor&#237;a completa tras algunas semanas&#46; Sin embargo&#44; pueden aparecer complicaciones como abscesos pulmonares&#44; 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Carta científica
Neumonía del tragafuegos: el papel de la tomografía computarizada
Fire eater's pneumonia: The role of computed tomography
Edson Marchiori
Corresponding author
edmarchiori@gmail.com

Autor para correspondencia.
, Arthur Soares-Souza, Gláucia Zanetti
Departamento de Radiología, Federal University of Rio de Janeiro, Río de Janeiro, Brasil
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Tomograf&#237;a computarizada en ventana mediast&#237;nica que muestra una masa en el l&#243;bulo inferior derecho junto a la superficie pleural&#46; B&#41; Macr&#243;fagos alveolares del lavado broncoalveolar&#46; El citoplasma presenta grandes vacuolas redondeadas que desplazan los n&#250;cleos a la periferia&#46; C&#41; Tomograf&#237;a computarizada de seguimiento en ventana pulmonar que mostr&#243; reabsorci&#243;n de la masa con cicatriz residual&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos le&#237;do con gran inter&#233;s la reciente carta al editor de Lizarz&#225;bal Su&#225;rez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#44; que describe el caso de un var&#243;n de 19 a&#241;os de edad que aspir&#243; parafina l&#237;quida durante un espect&#225;culo de tragafuegos&#46; El paciente desarroll&#243; neumon&#237;a lipoidea y la tomograf&#237;a computarizada tor&#225;cica mostr&#243; 3 lesiones cavitarias en el par&#233;nquima pulmonar&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Nos gustar&#237;a destacar los resultados de un caso similar que apareci&#243; recientemente&#46; Un var&#243;n de 26 a&#241;os de edad ingres&#243; por disnea&#44; tos&#44; fiebre &#40;39<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; y dolor pectoral&#46; Dos d&#237;as antes de su ingreso hab&#237;a aspirado accidentalmente parafina l&#237;quida al realizar actividades de tragafuegos&#46; El hemograma revel&#243; un alto recuento de linfocitos en sangre&#44; con desviaci&#243;n hacia la izquierda&#46; El resto de resultados anal&#237;ticos fueron anodinos&#46; La tomograf&#237;a computarizada mostr&#243; una masa heterog&#233;nea en el l&#243;bulo inferior derecho&#44; adyacente a la superficie pleural &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; La broncoscopia revel&#243; mucosa bronquial inflamada hiper&#233;mica sin purulencia o evidencia de necrosis y en el lavado broncoalveolar se hallaron numerosos macr&#243;fagos cargados de l&#237;pidos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; Se trat&#243; al paciente con esteroides sist&#233;micos y antibi&#243;ticos&#46; La tomograf&#237;a computarizada realizada 2 semanas despu&#233;s del ingreso mostr&#243; una notable mejor&#237;a&#44; con reabsorci&#243;n de la masa dejando cicatrices residuales &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">La causa de la neumon&#237;a del tragafuegos es la aspiraci&#243;n aguda accidental de hidrocarburos durante un espect&#225;culo de lanzafuego<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a>&#44; donde el ejecutante sopla una bocanada de hidrocarburo l&#237;quido contra una antorcha&#44; creando as&#237; un aerosol que se inflama en torno a ella<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; Estos hidrocarburos pueden difundirse r&#225;pidamente por todo el &#225;rbol bronquial&#44; induciendo edema bronquial&#44; da&#241;o tisular y destrucci&#243;n del tensioactivo&#46; En consecuencia&#44; los compuestos provocan la activaci&#243;n de macr&#243;fagos y causan reacci&#243;n inflamatoria local<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de neumon&#237;a lipoidea del tragafuegos requiere la cuidadosa evaluaci&#243;n de la anamnesis del paciente y las caracter&#237;sticas cl&#237;nicas&#46; Los s&#237;ntomas de presentaci&#243;n incluyen tos&#44; disnea&#44; fiebre y dolor en el pecho tras aspirar hidrocarburos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Tambi&#233;n se puede confirmar el diagn&#243;stico por la presencia de macr&#243;fagos cargados de l&#237;pidos en el lavado broncoalveolar tras una exposici&#243;n reciente a hidrocarburos vol&#225;tiles<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; Los hallazgos tomogr&#225;ficos en pacientes con neumon&#237;a del tragafuegos incluyen consolidaci&#243;n unilateral o bilateral de pulm&#243;n&#44; con o sin atenuaci&#243;n baja causada por la densidad de los l&#237;pidos o necrosis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#44; n&#243;dulos bien definidos&#44; neumatoceles &#40;n&#243;dulos cavitarios bien definidos&#41;&#44; derrame pleural y neumot&#243;rax espont&#225;neo<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; Las lesiones habitualmente afectan a ambos l&#243;bulos inferiores<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Esta neumon&#237;a es una enfermedad pulmonar seudoinfecciosa caracterizada por la intensa liberaci&#243;n de citoquinas inflamatorias&#46; El tratamiento con esteroides es controvertido&#44; pero puede mejorar el resultado en pacientes gravemente afectados&#46; Los antibi&#243;ticos profil&#225;cticos parecen ser beneficiosos&#44; ya que puede aparecer fiebre y alto recuento leucocitario&#44; los cuales podr&#237;an ser indicativos de neumon&#237;a bacteriana asociada<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;4</span></a>&#46; La mayor&#237;a de los pacientes con neumon&#237;a del tragafuegos experimentan mejor&#237;a completa tras algunas semanas&#46; Sin embargo&#44; pueden aparecer complicaciones como abscesos pulmonares&#44; derrames&#44; formaci&#243;n de una f&#237;stula broncopleural y superinfecci&#243;n bacteriana<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; En conclusi&#243;n&#44; esta enfermedad deber&#237;a incluirse en el diagn&#243;stico diferencial de las neumon&#237;as&#46; La exposici&#243;n reciente a hidrocarburos vol&#225;tiles proporciona una base para el diagn&#243;stico cl&#237;nico&#44; ya que los s&#237;ntomas y los hallazgos radiol&#243;gicos son inespec&#237;ficos&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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