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Embolismo tumoral pulmonar de metástasis cardíaca de carcinoma broncogénico
Pulmonary Tumor Embolism due to Cardiac Metastasis of Lung Cancer
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(D–F) PET/CT after administration of 18F-FDG. Mass in right upper lobe with large areas of necrosis and cavitation (A) with increased peripheral glucose metabolism (D). Lesion in the apex of the right ventricle (B and E, arrow) suggestive of cardiac metastasis. Image of peripheral base nodule containing air space in the right lower lobe (C, arrow) suggestive of pulmonary infarction. This lesion was metabolic on the PET/CT (F, arrow), and a hypermetabolic arterial embolism was observed in the feeding artery of that segment (E, gray arrow) consistent with tumor embolism.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Corominas, Ivan Vollmer, Pilar Paredes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "Corominas" ] 1 => array:2 [ "nombre" => "Ivan" "apellidos" => "Vollmer" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "Paredes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289617300182" "doi" => "10.1016/j.arbres.2017.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300182?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301702?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301702/v1_201706290145/en/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S0300289617300108" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.12.006" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1533" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2017;53:397" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2924 "formatos" => array:3 [ "EPUB" => 128 "HTML" => 2306 "PDF" => 490 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen clínica</span>" "titulo" => "Tuberculosis miliar y genital simultáneas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "397" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Simultaneous Miliary and Genital Tuberculosis" ] ] "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" => 780 "Ancho" => 1040 "Tamanyo" => 123406 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Radiografía simple de tórax. B) Corte axial de la TAC de tórax. C) Corte axial de la TAC de pelvis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Montes Ruiz-Cabello, Emilio Guirao Arrabal, Leonardo Mauro Aisa Denaroso" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Montes Ruiz-Cabello" ] 1 => array:2 [ "nombre" => "Emilio" "apellidos" => "Guirao Arrabal" ] 2 => array:2 [ "nombre" => "Leonardo Mauro" "apellidos" => "Aisa Denaroso" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212917301726" "doi" => "10.1016/j.arbr.2017.05.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301726?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300108?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289617300108/v2_201706291228/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0300289617300200" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.12.010" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1543" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2017;53:395" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5228 "formatos" => array:3 [ "EPUB" => 109 "HTML" => 4470 "PDF" => 649 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen clínica</span>" "titulo" => "Bulla pulmonar gigante sobreinfectada" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "395" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Giant Pulmonary Bulla Superinfection" ] ] "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" => 1696 "Ancho" => 2085 "Tamanyo" => 214257 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A y B) Radiografía simple de tórax postero-anterior y lateral que muestran lesión quística con paredes calcificadas que ocupa prácticamente la totalidad del hemitórax derecho con nivel hidroaéreo en su interior. C y D) TAC de tórax donde se objetiva que dicha imagen quística condiciona atelectasia de gran parte del parénquima pulmonar del hemitórax derecho y desplazamiento del mediastino hacia la izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana I. Córdoba Alonso, Maite Arlabán Carpintero, José M. Olmos Martínez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Ana I." "apellidos" => "Córdoba Alonso" ] 1 => array:2 [ "nombre" => "Maite" "apellidos" => "Arlabán Carpintero" ] 2 => array:2 [ "nombre" => "José M." "apellidos" => "Olmos Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212917301696" "doi" => "10.1016/j.arbr.2017.05.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301696?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300200?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289617300200/v2_201706291228/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen clínica</span>" "titulo" => "Embolismo tumoral pulmonar de metástasis cardíaca de carcinoma broncogénico" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "396" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Daniel Corominas, Ivan Vollmer, Pilar Paredes" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Daniel" "apellidos" => "Corominas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ivan" "apellidos" => "Vollmer" "email" => array:1 [ 0 => "vollmer@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Pilar" "apellidos" => "Paredes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Centro de Diagnóstico por la Imagen Clínic, Hospital Clínic, Barcelona, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Centro de Diagnóstico por la Imagen Clínic, Hospital Clínic, Barcelona, España" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pulmonary Tumor Embolism due to Cardiac Metastasis of Lung Cancer" ] ] "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" => 738 "Ancho" => 975 "Tamanyo" => 133405 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A-C) TC de tórax tras la administración de contraste yodado intravenoso en ventanas de pulmón (A y C) y de mediastino (B). D-F) PET/TC tras la administración de <span class="elsevierStyleSup">18</span>F-FDG. Masa lobar superior derecha con amplias zonas de necrosis y cavitación (A) que mostraba elevado metabolismo glucídico en su periferia (D). Lesión en ápex del ventrículo derecho (B y E, flecha) sugestiva de metástasis cardíaca. Imagen nodular de base periférica con centro aéreo en lóbulo inferior derecho (C, flecha) sugestiva de infarto pulmonar. En la exploración PET/TC, esta lesión mostraba metabolismo (F, flecha) y se evidenciaba un émbolo arterial hipermetabólico en la rama aferente de dicho segmento (E, flecha gris) compatible con un embolismo tumoral.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Se trata de un paciente de 64 años con clínica de síndrome constitucional que tras el ingreso en nuestro centro presenta un cuadro de neumonía obstructiva. Se practicó una TC en la que se observó una masa pulmonar en el lóbulo superior derecho con gran centro necrótico, una lesión cardíaca hipodensa de 20<span class="elsevierStyleHsp" style=""></span>mm en ápex del ventrículo derecho compatible con metástasis y una imagen sugestiva de infarto pulmonar de localización subpleural en el lóbulo inferior derecho (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1A-C</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Se realizó una fibrobroncoscopia con toma de muestras que filió la masa pulmonar como un carcinoma broncogénico de célula no pequeña. Para el estudio de extensión se llevó a cabo una PET/TC con <span class="elsevierStyleSup">18</span>F-FDG que demostró hipermetabolismo de la masa pulmonar, de la lesión cardíaca, de la zona de infarto pulmonar y en una arteria pulmonar del lóbulo inferior derecho (<a class="elsevierStyleCrossRef" href="#fig0005">figs. 1D-F</a>). La captación del infarto pulmonar sugirió que la causa del mismo fuera un embolismo tumoral.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las metástasis cardíacas, aunque son más frecuentes que los tumores cardíacos primarios, tienen una incidencia de solo el 1% de los pacientes oncológicos, siendo el adenocarcinoma pulmonar la etiología más frecuente<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>. El embolismo pulmonar tumoral es una posible manifestación de las metástasis cardíacas aun cuando un 90% son clínicamente silentes<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>.</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" => 738 "Ancho" => 975 "Tamanyo" => 133405 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A-C) TC de tórax tras la administración de contraste yodado intravenoso en ventanas de pulmón (A y C) y de mediastino (B). D-F) PET/TC tras la administración de <span class="elsevierStyleSup">18</span>F-FDG. Masa lobar superior derecha con amplias zonas de necrosis y cavitación (A) que mostraba elevado metabolismo glucídico en su periferia (D). Lesión en ápex del ventrículo derecho (B y E, flecha) sugestiva de metástasis cardíaca. Imagen nodular de base periférica con centro aéreo en lóbulo inferior derecho (C, flecha) sugestiva de infarto pulmonar. En la exploración PET/TC, esta lesión mostraba metabolismo (F, flecha) y se evidenciaba un émbolo arterial hipermetabólico en la rama aferente de dicho segmento (E, flecha gris) compatible con un embolismo tumoral.</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" => "Cardiac metastasis: A cause of recurrent pulmonary emboli" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.D. Borsaru" 1 => "K.K. Lau" 2 => "P. Solin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr/94870835" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2007" "volumen" => "80" "paginaInicial" => "e50" "paginaFinal" => "e53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17495056" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poorly differentiated thyroid carcinoma with cardiac metastasis and pulmonary embolism as first clinical presentation: Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Pazzano" 1 => "M.L. Narducci" 2 => "P. Santangeli" 3 => "D. Pedicino" 4 => "F. Glieca" 5 => "C.A. Rota" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF03347050" "Revista" => array:6 [ "tituloSerie" => "J Endocrinol Invest" "fecha" => "2011" "volumen" => "34" "paginaInicial" => "164" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21502799" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289617300182/v2_201706291228/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/03002896/0000005300000007/v2_201706291228/S0300289617300182/v2_201706291228/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300182?idApp=UINPBA00003Z" ]
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