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Calcificación miocárdica: una complicación excepcional de la neumonía y la sepsis
Myocardial calcification: A rare complication of pneumonia and sepsis
Aldo Mateo Torracchi Carrasco
Universidad del Azuay, Cuenca, Ecuador
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"tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "271" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Traumatic Thoracoplasty: Conservative Treatment or Surgery?" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "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" => 652 "Ancho" => 909 "Tamanyo" => 90535 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Corte transversal, de la tomografía axial computarizada de tórax, mostrando segmento de costilla izquierda enclavado en el pulmón (flecha) con hemotórax asociado.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Garví López, Ana M. 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B) Similar corte tomográfico realizado 7 días después, donde destaca el miocardio ventricular calcificado. C y D) Calcificación extensa de todo el miocardio ventricular izquierdo (día 30).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Una mujer de 28 años, previamente sana, fue ingresada en la unidad de cuidados intensivos con un diagnóstico de neumonía bilateral, derrame pleural y <span class="elsevierStyleItalic">shock</span> séptico. A su ingreso presentaba signos de hipoperfusión, así como obnubilación y presión arterial de 50/40<span class="elsevierStyleHsp" style=""></span>mmHg. La tomografía computarizada (TC) mostró la presencia de neumonía y derrame pleural bilateral (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1A: panel A</a>). La paciente precisó soporte hemodinámico y ventilatorio, antibióticos de amplio espectro y drenaje pleural bilateral. Los resultados del líquido pleural fueron compatibles con empiema, y en el cultivo se aisló <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>. Una nueva TC torácica, realizada al sexto día, evidenció importante mejoría de la condensación, disminución del derrame pleural y una inusual calcificación miocárdica<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1B: panel B</a>). Fue dada de alta de la UCI en condición estable, pero taquicárdica y con dolor torácico de características pleuríticas. Veinte días después se realiza una nueva TC de tórax, en la que se observa mínimo derrame pleural, mejoría de la condensación y un aumento de la calcificación que afecta al miocardio ventricular izquierdo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">figs. 1C y D: panel C</a>). La fisiopatología de la calcificación miocárdica no está completamente explicada, pero suele representar la secuela de un daño tisular local, alteración de la membrana o necrosis celular y no guarda relación con alteraciones en los niveles o en el metabolismo del calcio. La etiología más frecuente es el infarto de miocardio, aunque también se ha reportado en el contexto de traumas, infecciones, procesos inflamatorios o neoplásicos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a>.</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" => 1083 "Ancho" => 1284 "Tamanyo" => 153689 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Tomografía de ingreso, que muestra la presencia de derrame pleural bilateral y consolidaciones pulmonares. B) Similar corte tomográfico realizado 7 días después, donde destaca el miocardio ventricular calcificado. C y D) Calcificación extensa de todo el miocardio ventricular izquierdo (día 30).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sepsis-related myocardial calcification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.C.M. Van Kruijsdijk" 1 => "J.J. van der Heijden" 2 => "R. Uijlings" 3 => "L.C. Otterspoor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCHEARTFAILURE.111.962183" "Revista" => array:6 [ "tituloSerie" => "Circ Heart Fail" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "e16" "paginaFinal" => "e18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21934087" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial calcification following septic shock" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Schellhammer" 1 => "S. Ansen" 2 => "G. Arnold" 3 => "H.G. Brochhagen" 4 => "K. Lackner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "64670" "Revista" => array:6 [ "tituloSerie" => "Cardiology" "fecha" => "2002" "volumen" => "98" "paginaInicial" => "102" "paginaFinal" => "103" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12373056" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myocardial calcifications: Pathophysiology, etiologies, differential diagnoses, and imaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.W. Nance Jr." 1 => "G.M. Crane" 2 => "M.K. Halushka" 3 => "E.K. Fishman" 4 => "S.L. Zimmerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcct.2014.10.004" "Revista" => array:6 [ "tituloSerie" => "Journal of cardiovascular computed tomography" "fecha" => "2015" "volumen" => "9" "paginaInicial" => "58" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25456525" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005300000005/v1_201704280943/S0300289616303234/v1_201704280943/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/03002896/0000005300000005/v1_201704280943/S0300289616303234/v1_201704280943/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616303234?idApp=UINPBA00003Z" ]
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