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Chagas Disease: An Important Cause of Megaesophagus in Latin America
La enfermedad de Chagas: una causa importante del megaesófago en América Latina
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(a) Posteroanterior chest X-ray shows hyperlucent upper parts of both lung fields, approx. upper half on the right side and upper third on the left side. Residual lung parenchyma has increased bronchovascular markings; (b) Chest CT (sagittal reconstruction) at the level of left hilum shows vanishing lung in the upper third of left lung; (c) Chest CT (coronal reconstruction) at the level of main bronchi shows bronchiectasis in the left upper lobe ending in severe emphysematous changes of lung parenchyma, vanishing lung in both upper zones, large bulla in the right lower lobe and consolidation in basolateral part of the right upper lobe.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Libor Fila, Vojtech Suchanek, Miloslav Marel" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Libor" "apellidos" => "Fila" ] 1 => array:2 [ "nombre" => "Vojtech" "apellidos" => "Suchanek" ] 2 => array:2 [ "nombre" => "Miloslav" "apellidos" => "Marel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212917302306" "doi" => "10.1016/j.arbr.2017.01.024" "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/S1579212917302306?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300406?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000008/v1_201707280103/S0300289617300406/v1_201707280103/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0300289617300923" "issn" => "03002896" "doi" => "10.1016/j.arbres.2017.04.002" "estado" => "S300" "fechaPublicacion" => "2017-08-01" "aid" => "1608" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2017;53:443-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 22861 "formatos" => array:3 [ "EPUB" => 187 "HTML" => 18511 "PDF" => 4163 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo especial</span>" "titulo" => "Consenso sobre el solapamiento de asma y EPOC (ACO) entre la Guía española de la EPOC (GesEPOC) y la Guía Española para el Manejo del Asma (GEMA)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "443" "paginaFinal" => "449" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Consensus on the Asthma-COPD Overlap Syndrome (ACOS) Between the Spanish COPD Guidelines (GesEPOC) and the Spanish Guidelines on the Management of Asthma (GEMA)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "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" => 2092 "Ancho" => 1583 "Tamanyo" => 133822 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Confirmación diagnóstica de ACO (solapamiento asma y EPOC).</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">*</span> Mantenida tras tratamiento con GCI/LABA (6 meses). En algunos casos además tras ciclo de glucocorticoides orales (15 días).</p> <p id="spar9035" class="elsevierStyleSimplePara elsevierViewall">ACO: solapamiento asma y EPOC; céls: células; GCI: glucocorticoides inhalados; LABA: agonista β<span class="elsevierStyleInf">2</span> adrenérgico de acción larga; Paq: paquetes; PBD: prueba broncodilatadora.</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Fuente: Reproducido con permiso de la European Respiratory Society<span class="elsevierStyleSup">©</span>: Eur Respir J 2017; 49: 1700068 <span class="elsevierStyleInterRef" id="intr0005" href="doi:10.1183/13993003.00068-2017">doi:10.1183/13993003.00068-2017</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vicente Plaza, Francisco Álvarez, Myriam Calle, Ciro Casanova, Borja G. 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Axial (B), coronal (C), and sagittal (D) reformatted CT images reveal marked esophageal dilatation with residue and multiple air bubbles.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 75-year-old Brazilian woman who presented with weight loss, dyspnea, cough, and recurring pneumonia. She had a 15-year history of dysphagia. A chest radiograph showed mediastinal widening with an air-fluid level, compatible with megaesophagus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Computed tomography of the thorax revealed marked esophageal dilatation, with intraluminal content interpreted as food stasis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D). A diagnosis of Chagas disease (CD) was made based on positive serological test results.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">CD (American trypanosomiasis) is caused by <span class="elsevierStyleItalic">Trypanosoma cruzi</span>, a flagellated protozoan that is transmitted to humans by triatomine insects. CD is common in Latin America. It has been reported from all countries in the Americas except Canada. The chronic form of CD develops some decades after initial infection, causing irreversible damage to the heart, esophagus, and colon, with megaesophagus and megacolon.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> The esophageal manifestations of CD are very similar to those of idiopathic achalasia. The dilated esophagus is usually apparent radiographically as a shadow projecting to the right of the mediastinum. An air-fluid level may be observed in the dilated esophagus. The final diagnosis of CD in the chronic phase is based on serological tests. Surgery is currently the best form of treatment.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1504 "Ancho" => 1500 "Tamanyo" => 330732 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A chest radiograph (A) shows mediastinal widening with an air-fluid level, compatible with megaesophagus. Axial (B), coronal (C), and sagittal (D) reformatted CT images reveal marked esophageal dilatation with residue and multiple air bubbles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "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" => "Treatment of achalasia: lessons learned with Chagas’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.A. Herbella" 1 => "J.L. Aquino" 2 => "S. Stefani-Nakano" 3 => "E.L. Artifon" 4 => "P. Sakai" 5 => "E. Crema" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1442-2050.2008.00811.x" "Revista" => array:6 [ "tituloSerie" => "Dis Esophagus" "fecha" => "2008" "volumen" => "21" "paginaInicial" => "461" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18430188" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chagas disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Rassi Jr." 1 => "A. Rassi" 2 => "J.A. Marin-Neto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(10)60061-X" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2010" "volumen" => "375" "paginaInicial" => "1388" "paginaFinal" => "1402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20399979" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005300000008/v1_201707280103/S0300289617300340/v1_201707280103/en/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/03002896/0000005300000008/v1_201707280103/S0300289617300340/v1_201707280103/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300340?idApp=UINPBA00003Z" ]
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