Imagen clínica
Imagen poco habitual en el árbol bronquial: como «piedras de río»
Pebble-like lesions: A rare sight in the bronchial tree
Anna Sala Marín
, Ruben Lera Alvarez, Alejandro Betancurt Diaz
Corresponding author
Servicio de Neumología, Hospital Universitario Dr. Peset, Valencia, España
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Todas las especies de <span class="elsevierStyleItalic">Aspergillus</span> pueden producir un aspergiloma, que surge como resultado de la colonización por el hongo de una cavidad, quiste o ampolla ya existentes<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>. Presentamos el caso de un aspergiloma sobre una caverna tuberculosa, con el hallazgo excepcional en la broncoscopia de una imagen como de «piedras de río».</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mujer de 55 años, fumadora de 10 paquetes-años, que consulta por tos crónica. Como antecedentes personales, tuberculosis pulmonar hace 25 años, que recibió un tratamiento completo. En la TAC de tórax se objetivó una atelectasia cicatricial del lóbulo superior izquierdo, con engrosamiento pleural, tractos fibrosos, nódulos, bronquiectasias y cavidades que estaban ocupadas por micetomas. Además había una marcada hipertrofia del tronco arterial bronquial izquierdo y de los vasos sistémicos que se dirigían hacia la lesión cicatricial tuberculosa. El <span class="elsevierStyleItalic">prick test</span> fue positivo para <span class="elsevierStyleItalic">Aspergillus</span>+++, la IgE total fue de 899<span class="elsevierStyleHsp" style=""></span>kU/l, con IgE específica a <span class="elsevierStyleItalic">Aspergillus fumigatus</span> de 11,6<span class="elsevierStyleHsp" style=""></span>kUA/l. Los esputos seriados fueron negativos. Se realizó una broncoscopia en la que se observaron en la entrada del bronquio subsegmentario del bronquio apical del LSI múltiples lesiones de aspecto nodular y marronáceas, imagen como de «piedras de río» (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). En la biopsia de la lesión endobronquial se encontraron hifas de <span class="elsevierStyleItalic">Aspergillus</span> spp, que no invadían vasos ni parénquima pulmonar. Se decidió tratar quirúrgicamente debido al riesgo elevado de hemoptisis, por la gran irrigación de la lesión, y por estar abierta a bronquios principales.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></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" => 610 "Ancho" => 925 "Tamanyo" => 64941 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen broncoscópica del bronquio segmentario del LSI, similar a «piedras de río».</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Aspergillus</span> y pulmón" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Díaz Sánchez" 1 => "A. López Viña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "114" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14998475" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspergilosis: formas clínicas y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Fortún" 1 => "Y. Meije" 2 => "G. Fresco" 3 => "S. Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2011.12.005" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "201" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22341751" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000012/v1_201611260110/S0300289616300011/v1_201611260110/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/03002896/0000005200000012/v1_201611260110/S0300289616300011/v1_201611260110/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616300011?idApp=UINPBA00003Z" ]
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