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ANCAS y anticoagulante l&#250;pico&#8212; negativos&#41; sin llegar a un diagn&#243;stico&#46; Ante ello se realiz&#243; una cirug&#237;a v&#237;deo toracosc&#243;pica asistida &#40;VATS&#41; <span class="elsevierStyleItalic">single port</span>&#44; apreci&#225;ndose&#44; despu&#233;s de evacuar el derrame&#44; un tumor pleural en la cisura posterior de 5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#46; Fue necesario efectuar una toracotom&#237;a anterolateral para resecar la lesi&#243;n de la pleura con m&#225;rgenes de 2<span class="elsevierStyleHsp" style=""></span>cm de pleura sana en torno al ped&#237;culo&#44; tras comprobar que no infiltraba ninguna otra estructura&#46; Se realizaron estudios inmunohistoqu&#237;micos con positividad para CD31 y factor 8&#44; y un &#237;ndice de proliferaci&#243;n Ki67 menor del 5&#37;&#44; siendo el diagn&#243;stico anatomopatol&#243;gico definitivo de hemangioma capilar de localizaci&#243;n pleural&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Los hemangiomas son neoplasias caracterizadas por un n&#250;mero aumentado de vasos&#44; que a veces incluso se confunden con otras enfermedades como malformaciones vasculares arteriovenosas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Se dividen en cavernosos o capilares&#44; en funci&#243;n del di&#225;metro de los canales vasculares de que se compone el tumor<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La patog&#233;nesis de los hemangiomas es desconocida&#46; Se pueden encontrar en cualquier parte del cuerpo&#44; aunque la localizaci&#243;n t&#237;pica es piel e h&#237;gado&#44; siendo muy raros en localizaciones como el t&#243;rax&#46; Menos frecuentes a&#250;n son las costillas<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> o el mediastino&#44; donde la incidencia de estos tumores es menor del 0&#44;5&#37; de las masas en esta localizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Que conozcamos&#44; solo est&#225;n descritos 2 casos&#44; hasta la fecha de hemangioma pleural&#46; Uno de ellos acompa&#241;ado de derrame pleural hem&#225;tico<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#44; como es lo esperado&#44; y otro con derrame no hem&#225;tico&#44; pero de tipo cavernoso<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> y no capilar como en nuestro caso&#46; La mayor&#237;a de hemangiomas suelen observarse en adultos j&#243;venes antes de los 35 a&#241;os&#46; Generalmente se descubren incidentalmente o tras rotura espont&#225;nea que provoca sangrados o derrames pleurales hemorr&#225;gicos&#46; Los s&#237;ntomas suelen ser inespec&#237;ficos como tos&#44; dolor tor&#225;cico y disnea<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#44; como presentaba nuestra paciente&#46; El tratamiento debe ser individualizado&#44; dependiendo de la localizaci&#243;n y profundidad de la infiltraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; Los m&#225;s habituales son la resecci&#243;n quir&#250;rgica &#40;como en nuestra paciente&#41;&#44; crioterapia&#44; embolizaci&#243;n o ligadura vascular&#46; Tambi&#233;n se han utilizado corticoesteroides o ciclofosfamida&#46; Las recurrencias de los hemangiomas no son frecuentes&#44; como as&#237; sucede con nuestra paciente&#44; que no ha vuelto a presentar recidiva del derrame pleural tras 5 meses desde la cirug&#237;a&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; presentamos un caso de hemangioma capilar de localizaci&#243;n pleural&#44; que es extremadamente infrecuente en esta ubicaci&#243;n y que&#44; adem&#225;s&#44; se acompa&#241;a de un derrame pleural no hemorr&#225;gico en contra de lo esperado en este tipo de tumores&#46;</p></span>"
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Derrame pleural secundario a un hemangioma capilar de localización pleural
Pleural effusion caused by a capillary hemangioma in the pleural cavity
Luis Alfonso Sota Yoldia,
Corresponding author
lsotayol@hotmail.com

Autor para correspondencia.
, Laura Vigil Vigilb, Rocío Arceo Solisc
a Servicio de Neumología, Fundación Hospital de Jove, Gijón, Asturias, España
b Servicio de Neumología, Hospital de Cabueñes, Gijón, Asturias, España
c Servicio de Medicina Interna, Fundación Hospital de Jove, Gijón, Asturias, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Presentamos el caso de una mujer de 49 a&#241;os de edad&#44; no fumadora&#44; con hipertensi&#243;n arterial y asm&#225;tica&#44; que acude a nuestro centro por disnea y dolor tor&#225;cico&#44; de aproximadamente 2 semanas de evoluci&#243;n&#46; Es diagnosticada de derrame pleural izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Realizamos una toracocentesis evacuadora para aliviar los s&#237;ntomas&#44; obteni&#233;ndose un l&#237;quido de aspecto nacarado&#44; compatible con un exudado escasamente celular&#44; valor normal de adenosina desaminasa &#40;ADA&#41;&#44; y citolog&#237;a y microbiolog&#237;a negativas&#46; Descartamos las causas habituales de exudados mediante estudios de imagen &#40;ecocardiograma&#44; tomograf&#237;a axial computarizada&#41; y pruebas anal&#237;ticas &#40;hemograma normal&#44; funci&#243;n renal y hep&#225;tica normales y autoanticuerpos &#8212;ANAS&#44; ANCAS y anticoagulante l&#250;pico&#8212; negativos&#41; sin llegar a un diagn&#243;stico&#46; Ante ello se realiz&#243; una cirug&#237;a v&#237;deo toracosc&#243;pica asistida &#40;VATS&#41; <span class="elsevierStyleItalic">single port</span>&#44; apreci&#225;ndose&#44; despu&#233;s de evacuar el derrame&#44; un tumor pleural en la cisura posterior de 5<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>cm&#46; Fue necesario efectuar una toracotom&#237;a anterolateral para resecar la lesi&#243;n de la pleura con m&#225;rgenes de 2<span class="elsevierStyleHsp" style=""></span>cm de pleura sana en torno al ped&#237;culo&#44; tras comprobar que no infiltraba ninguna otra estructura&#46; Se realizaron estudios inmunohistoqu&#237;micos con positividad para CD31 y factor 8&#44; y un &#237;ndice de proliferaci&#243;n Ki67 menor del 5&#37;&#44; siendo el diagn&#243;stico anatomopatol&#243;gico definitivo de hemangioma capilar de localizaci&#243;n pleural&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Los hemangiomas son neoplasias caracterizadas por un n&#250;mero aumentado de vasos&#44; que a veces incluso se confunden con otras enfermedades como malformaciones vasculares arteriovenosas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Se dividen en cavernosos o capilares&#44; en funci&#243;n del di&#225;metro de los canales vasculares de que se compone el tumor<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La patog&#233;nesis de los hemangiomas es desconocida&#46; Se pueden encontrar en cualquier parte del cuerpo&#44; aunque la localizaci&#243;n t&#237;pica es piel e h&#237;gado&#44; siendo muy raros en localizaciones como el t&#243;rax&#46; Menos frecuentes a&#250;n son las costillas<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> o el mediastino&#44; donde la incidencia de estos tumores es menor del 0&#44;5&#37; de las masas en esta localizaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Que conozcamos&#44; solo est&#225;n descritos 2 casos&#44; hasta la fecha de hemangioma pleural&#46; Uno de ellos acompa&#241;ado de derrame pleural hem&#225;tico<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#44; como es lo esperado&#44; y otro con derrame no hem&#225;tico&#44; pero de tipo cavernoso<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> y no capilar como en nuestro caso&#46; La mayor&#237;a de hemangiomas suelen observarse en adultos j&#243;venes antes de los 35 a&#241;os&#46; Generalmente se descubren incidentalmente o tras rotura espont&#225;nea que provoca sangrados o derrames pleurales hemorr&#225;gicos&#46; Los s&#237;ntomas suelen ser inespec&#237;ficos como tos&#44; dolor tor&#225;cico y disnea<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#44; como presentaba nuestra paciente&#46; El tratamiento debe ser individualizado&#44; dependiendo de la localizaci&#243;n y profundidad de la infiltraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; Los m&#225;s habituales son la resecci&#243;n quir&#250;rgica &#40;como en nuestra paciente&#41;&#44; crioterapia&#44; embolizaci&#243;n o ligadura vascular&#46; Tambi&#233;n se han utilizado corticoesteroides o ciclofosfamida&#46; Las recurrencias de los hemangiomas no son frecuentes&#44; como as&#237; sucede con nuestra paciente&#44; que no ha vuelto a presentar recidiva del derrame pleural tras 5 meses desde la cirug&#237;a&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; presentamos un caso de hemangioma capilar de localizaci&#243;n pleural&#44; que es extremadamente infrecuente en esta ubicaci&#243;n y que&#44; adem&#225;s&#44; se acompa&#241;a de un derrame pleural no hemorr&#225;gico en contra de lo esperado en este tipo de tumores&#46;</p></span>"
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Article information
ISSN: 03002896
Original language: Spanish
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