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Fístula pancreato-torácica, una inusual complicación de la pancreatitis
Pancreatic-Thoracic Fistula. An Unusual Complication of Pancreatitis
Nuria Alonso Ordás
, Helena Gómez Herrero, Lesly Ortega Molina
Corresponding author
Servicio de Radiología, Complejo Hospitalario de Navarra. Pamplona, Navarra, España
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Pamplona, Navarra, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pancreatic-Thoracic Fistula. An Unusual Complication of Pancreatitis" ] ] "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" => 600 "Ancho" => 1447 "Tamanyo" => 146922 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A y B) Reconstrucciones coronales de la TC en paciente de 47 años con antecedente de pancreatitis crónica complicada con fístula pancreato-torácica. La TC muestra un derrame pleural loculado (estrella en B) con comunicación (flecha en A) con el seudoquiste (estrella en A) que a su vez conecta con el Wirsung (flecha en B). C) La TC de control realizada a los 12 días, tras CPRE con colocación de prótesis (flecha en C) que drena el seudoquiste y la colección pleural a través del Wirsung a duodeno.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paciente varón de 47 años con antecedente de pancreatitis crónica con seudoquiste pancreático que ingresa por cuadro constitucional, vómitos, fiebre y dolor torácico pleurítico. En la TC observamos derrame pleural bilateral loculado con un trayecto fistuloso transdiafragmático entre el seudoquiste y el conducto pancreático y una colección paramediastínica derecha (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El paciente presenta insuficiencia respiratoria progresiva con traslado a la UCI.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Tras los hallazgos se colocan tubos de drenaje pleural bilaterales obteniéndose líquido con citología inflamatoria aguda y amilasa elevada. Se coloca una prótesis pancreática por CPRE (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">El paciente presenta mejoría clínica y radiológica tras los procedimientos.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las complicaciones torácicas de las pancreatitis son infrecuentes (15-50%). La más frecuente es la neumonía con derrame pleural. Más raras son el seudoquiste con extensión mediastínica, la fístula pancreato-torácica y la mediastinitis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">La fístula pancreático pleural (0,4%) es una comunicación anómala entre el conducto pancreático y la pleura, más frecuente secundaria a pancreatitis crónica enólica y debe sospecharse ante un derrame pleural voluminoso (sobre todo izquierdo) persistente con amilasa elevada. La demostración de la fístula se realiza por TC, RM o endoscopia<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">El tratamiento incluye control del derrame, inhibición de la secreción pancreática y aislamiento de la fístula vía endoscópica o cirugía.</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" => 600 "Ancho" => 1447 "Tamanyo" => 146922 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A y B) Reconstrucciones coronales de la TC en paciente de 47 años con antecedente de pancreatitis crónica complicada con fístula pancreato-torácica. La TC muestra un derrame pleural loculado (estrella en B) con comunicación (flecha en A) con el seudoquiste (estrella en A) que a su vez conecta con el Wirsung (flecha en B). C) La TC de control realizada a los 12 días, tras CPRE con colocación de prótesis (flecha en C) que drena el seudoquiste y la colección pleural a través del Wirsung a duodeno.</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" => "Mediastinitis secundaria a una pancreatitis aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Ayuso-Velasco" 1 => "S. García-Barajas" 2 => "M. García-Sáez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2011.01.007" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2011" "volumen" => "47" "paginaInicial" => "318" "paginaFinal" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21420221" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thoracopancreatic fistula: Clinical and imaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Fulcher" 1 => "G.W. Capps" 2 => "M.A. Turner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Comput Assist Tomogr" "fecha" => "1999" "volumen" => "23" "paginaInicial" => "181" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10096323" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005300000006/v2_201707150129/S0300289616303507/v2_201707150129/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/03002896/0000005300000006/v2_201707150129/S0300289616303507/v2_201707150129/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616303507?idApp=UINPBA00003Z" ]
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