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Síndrome coronario como primera manifestación de timoma invasivo
Coronary syndrome as the first manifestation of invasive thymoma
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Panels A, C are cuts from pre-procedure scan. Panels B, D are the same cuts from post procedure scan. Calcified right hilar lesion (arrow, panel A). Collapsed RLL segmental bronchi (arrows, panel C). Post procedure, patent RLL bronchus (arrow, panel B). 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La coronariografía urgente no demotró lesiones coronarias. Se realizó radiografía de tórax sin alteraciones y analítica con D-dímero de 650<span class="elsevierStyleHsp" style=""></span>ng/ml, por lo que se hizo angio-TAC torácico que detectó una masa en mediastino anterior (<a class="elsevierStyleCrossRef" href="#fig0005">figs. 1</a>B y C). El ecocardiograma mostró derrame pericárdico ligero con implantes pericárdicos. Además, el tumor comprimía el infundíbulo del ventrículo derecho y la arteria pulmonar (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>D). Se realizó punción con aguja gruesa y la biopsia evidenció células epiteliales neoplásicas positivas para CK5/6 y CKAE1/AE3, compatible con timoma tipo A (<a class="elsevierStyleCrossRef" href="#fig0005">figs. 1</a>E y F). Si bien se planteó la opción quirúrgica con resección del tumor y revascularización mediante <span class="elsevierStyleItalic">bypass</span> aorto-coronario, dada la importante invasión pericárdica (estadio IV) no se consideró subsidiario de este tratamiento por lo que se iniciaron radio y quimioterapias.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El timoma maligno es el tumor del mediastino anterior más frecuente y aunque puede provocar dolor torácico, otras manifestaciones cardiovasculares son infrecuentes<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>. La proximidad e invasión de estructuras cardiacas pueden provocar compresión coronaria, pericarditis, taponamiento pericárdico, obstrucción hemodinámica (como en este caso) o síndrome de vena cava superior<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" => 812 "Ancho" => 1500 "Tamanyo" => 271467 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Síndrome coronario como primera manifestación de timoma invasivo.</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" => "Thymomas: Clinicopathologic features, therapy and prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.A. Batata" 1 => "V. Martini" 2 => "A.G. Huvos" 3 => "R.I. Aguilar" 4 => "E.J. Beati" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cancer" "fecha" => "1984" "volumen" => "34" "paginaInicial" => "93" "paginaFinal" => "96" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant ghymoma causing tricuspid valve obstruction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Gunn" 1 => "D. Walker" 2 => "R. Boyle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "1990" "volumen" => "11" "paginaInicial" => "48" "paginaFinal" => "56" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2226541" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005400000001/v1_201801020552/S0300289617301606/v1_201801020552/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/03002896/0000005400000001/v1_201801020552/S0300289617301606/v1_201801020552/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617301606?idApp=UINPBA00003Z" ]
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