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la desaparici&#243;n del n&#243;dulo intensificado y en la radiograf&#237;a de t&#243;rax del tercer d&#237;a se observ&#243; una marcada disminuci&#243;n del tama&#241;o del absceso &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41;&#46; Un mes m&#225;s tarde&#44; la radiograf&#237;a de t&#243;rax mostr&#243; la resoluci&#243;n casi completa del absceso &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>E&#41;&#46; Sin embargo&#44; el paciente falleci&#243; repentinamente 39 d&#237;as despu&#233;s de su ingreso&#46; La causa de la muerte no se pudo esclarecer porque la familia rechaz&#243; la necropsia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">El di&#225;metro del absceso pulmonar era superior a 6<span class="elsevierStyleHsp" style=""></span>cm&#44; por lo que se podr&#237;a haber decidido tratarlo quir&#250;rgicamente&#44; mediante drenaje tor&#225;cico o resecci&#243;n&#44; adem&#225;s del tratamiento antibi&#243;tico<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;8</span></a>&#46; En cuanto al tratamiento quir&#250;rgico se podr&#237;a haber optado por un drenaje tor&#225;cico&#44; debido a que el estado general del paciente no permit&#237;a efectuar una resecci&#243;n quir&#250;rgica y el absceso era contiguo a la pleura&#46; Sin embargo&#44; durante la hospitalizaci&#243;n&#44; el paciente present&#243; hemoptisis&#44; se le diagnostic&#243; PAP y se practic&#243; una embolizaci&#243;n de la arteria pulmonar&#44; que tuvo como resultado una mejor&#237;a considerable de las im&#225;genes radiol&#243;gicas&#46; Esta evoluci&#243;n cl&#237;nica sugiri&#243; riesgo de hemorragia&#44; una complicaci&#243;n potencialmente mortal del drenaje tor&#225;cico&#46; Creemos que informar de nuestra experiencia podr&#237;a influir en la selecci&#243;n de los tratamientos para los abscesos pulmonares de gran tama&#241;o&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El paciente falleci&#243; repentinamente y&#44; debido a que su familia rechaz&#243; la necropsia&#44; no se pudo averiguar la causa de la muerte&#46; Pese a ello&#44; cabe se&#241;alar que el d&#237;a de su fallecimiento el paciente ten&#237;a fiebre&#46; La embolizaci&#243;n con espiral endovascular se asocia a un riesgo de complicaciones infecciosas<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a>&#44; por lo que es posible que el paciente falleciera debido a una complicaci&#243;n infecciosa asociada al material endovascular extra&#241;o&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Este caso nos llev&#243; a revisar el abordaje de los abscesos pulmonares de gran tama&#241;o&#44; cuyo tratamiento habitual podr&#237;a no ser aplicable a pacientes de edad avanzada y mayor morbilidad&#46; La presencia de un seudoaneurisma es un factor que es necesario tener en cuenta al elegir los procedimientos a utilizar&#44; con el fin de evitar complicaciones&#46;</p></span>"
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Gran absceso pulmonar con seudoaneurisma de la arteria pulmonar
Large Lung Abscess with Pulmonary Artery Pseudoaneurysm
Satoshi Hamadaa,
Corresponding author
sh1124@kuhp.kyoto-u.ac.jp

Autor para correspondencia.
, Akira Nakanob, Mitsuhiro Tsukinoa
a Department of Respiratory Medicine, Hikone Municipal Hospital, Hikone, Japón
b Department of Cardiology, Hikone Municipal Hospital, Hikone, Japón
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Asimismo se ha observado regresi&#243;n espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> y desaparici&#243;n del PAP &#250;nicamente con tratamiento antibi&#243;tico<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a>&#46; No obstante&#44; la tasa de mortalidad por rotura del PAP es superior al 50&#37; en los pacientes que reciben tratamiento conservador<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Informamos del caso de un paciente que presentaba un absceso pulmonar de gran tama&#241;o y un PAP que se resolvi&#243; de forma extraordinaria utilizando una t&#233;cnica menos invasiva&#44; la embolizaci&#243;n de la arteria pulmonar&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Un var&#243;n exfumador de 79 a&#241;os acudi&#243; a nuestro hospital por presentar tos h&#250;meda y p&#233;rdida de peso de un mes de evoluci&#243;n&#46; Un a&#241;o antes se le hab&#237;a diagnosticado infarto cerebral y fibrilaci&#243;n auricular cr&#243;nica y recib&#237;a 15<span class="elsevierStyleHsp" style=""></span>mg de rivaroxab&#225;n una vez al d&#237;a&#46; La radiograf&#237;a de t&#243;rax mostr&#243; una masa de 12&#44;8<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>7&#44;0<span class="elsevierStyleHsp" style=""></span>cm en el &#225;rea inferior del pulm&#243;n derecho &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; En la fibrobroncoscopia se observaron esputos purulentos en gran volumen&#44; que no obstru&#237;an la v&#237;a a&#233;rea&#44; compatibles con un absceso pulmonar&#46; El cultivo del esputo result&#243; negativo&#44; por lo que se inici&#243; tratamiento antibi&#243;tico emp&#237;rico con tazobactam&#47;piperacilina&#46; En la radiograf&#237;a de t&#243;rax realizada tras 4 d&#237;as de hospitalizaci&#243;n se observ&#243; 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la desaparici&#243;n del n&#243;dulo intensificado y en la radiograf&#237;a de t&#243;rax del tercer d&#237;a se observ&#243; una marcada disminuci&#243;n del tama&#241;o del absceso &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41;&#46; Un mes m&#225;s tarde&#44; la radiograf&#237;a de t&#243;rax mostr&#243; la resoluci&#243;n casi completa del absceso &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>E&#41;&#46; Sin embargo&#44; el paciente falleci&#243; repentinamente 39 d&#237;as despu&#233;s de su ingreso&#46; La causa de la muerte no se pudo esclarecer porque la familia rechaz&#243; la necropsia&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">El di&#225;metro del absceso pulmonar era superior a 6<span class="elsevierStyleHsp" style=""></span>cm&#44; por lo que se podr&#237;a haber decidido tratarlo quir&#250;rgicamente&#44; mediante drenaje tor&#225;cico o resecci&#243;n&#44; adem&#225;s del tratamiento antibi&#243;tico<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;8</span></a>&#46; En cuanto al tratamiento quir&#250;rgico se podr&#237;a haber optado por un drenaje tor&#225;cico&#44; debido a que el estado general del paciente no permit&#237;a efectuar una resecci&#243;n quir&#250;rgica y el absceso era contiguo a la pleura&#46; Sin embargo&#44; durante la hospitalizaci&#243;n&#44; el paciente present&#243; hemoptisis&#44; se le diagnostic&#243; PAP y se practic&#243; una embolizaci&#243;n de la arteria pulmonar&#44; que tuvo como resultado una mejor&#237;a considerable de las im&#225;genes radiol&#243;gicas&#46; Esta evoluci&#243;n cl&#237;nica sugiri&#243; riesgo de hemorragia&#44; una complicaci&#243;n potencialmente mortal del drenaje tor&#225;cico&#46; Creemos que informar de nuestra experiencia podr&#237;a influir en la selecci&#243;n de los tratamientos para los abscesos pulmonares de gran tama&#241;o&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El paciente falleci&#243; 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Article information
ISSN: 03002896
Original language: Spanish
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