Imagen clínica
Fístula broncoesofágica adquirida de larga evolución
Long-Term Acquired Bronchoesophageal Fistula
Julio Fernández Gajardo
, Helena Gómez Herrero, Guillermo Viteri Ramírez
Corresponding author
Servicio de Radiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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(B) Chest CT, minIP coronal reconstruction, showing the fistula (thin arrow) from the esophageal lumen to the right intermediate bronchus (thick arrow). Consolidations can also be seen in both lower lobes. (C) Chest CT, axial reconstruction, pulmonary parenchyma window. Due to multiple previous episodes of aspirations, the patient had bilateral pneumonia. 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B) TC torácica, reconstrucción coronal minIP: muestra la fístula (flecha fina) desde la luz esofágica al bronquio intermediario derecho (flecha gruesa). Además se aprecian condensaciones en ambos lóbulos inferiores. C) TC torácica, reconstrucción axial, ventana del parénquima pulmonar. Debido a múltiples episodios previos de aspiraciones, la paciente presentaba neumonía bilateral. Se observan condensaciones pulmonares en LM y lóbulos inferiores con algunas bronquiectasias asociadas en LM.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Paciente con antecedente de procedimiento endoscópico digestivo alto hace 16 años. Acude por cuadro de neumonías de repetición, tos crónica, disfagia y sensación de goteo intratorácico con el decúbito lateral derecho. Se realiza TC torácica que muestra una fístula broncoesofágica (FBE) con el bronquio intermediario derecho y extensas condensaciones pulmonares bilaterales con bronquiectasias por episodios repetidos de aspiración (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). Se confirma con broncoscopia y gastroscopia. Se decide la reparación quirúrgica de la FBE con bilobectomía inferior y media.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Las FBE pueden ser congénitas o adquiridas. Las FBE adquiridas son causadas por enfermedad neoplásica o benigna. La causa neoplásica más frecuente es el cáncer de esófago. Las causas benignas pueden ser infecciosas como la tuberculosis, la sífilis y la histoplasmosis; traumáticas como la intubación endotraqueal prolongada, el traumatismo torácico cerrado o la ingestión de un cuerpo extraño; e inflamatorias como el Crohn y el Behçet. Los procedimientos endoscópicos infrecuentemente producen FBE.</p><p id="par0015" class="elsevierStylePara elsevierViewall">El tratamiento puede ser intervencionista o quirúrgico. El primero puede ser la colocación de un <span class="elsevierStyleItalic">stent</span> en el esófago o el bronquio, el cierre con pegamento biológico y la electrocoagulación. El tratamiento quirúrgico incluye la reparación de la fístula, cierre de la fístula con <span class="elsevierStyleItalic">flap</span> muscular u omental y el <span class="elsevierStyleItalic">bypass</span> esofágico con resección fistular<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" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 741 "Ancho" => 896 "Tamanyo" => 114682 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Esofagograma con contraste oral yodado: se observa el paso de contraste a través de la fístula (flecha fina) desde el esófago al bronquio intermediario derecho (flecha gruesa). B) TC torácica, reconstrucción coronal minIP: muestra la fístula (flecha fina) desde la luz esofágica al bronquio intermediario derecho (flecha gruesa). Además se aprecian condensaciones en ambos lóbulos inferiores. C) TC torácica, reconstrucción axial, ventana del parénquima pulmonar. Debido a múltiples episodios previos de aspiraciones, la paciente presentaba neumonía bilateral. Se observan condensaciones pulmonares en LM y lóbulos inferiores con algunas bronquiectasias asociadas en LM.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The treatment strategy for tracheoesophageal fistula" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Ke" 1 => "X. Wu" 2 => "J. Zeng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2072-1439.2015.12.11" "Revista" => array:6 [ "tituloSerie" => "J Thorac Dis" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "S389" "paginaFinal" => "S397" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26807286" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheoesophageal fistula" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.F. Reed" 1 => "D.J. Mathisen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest Surg Clin N Am" "fecha" => "2003" "volumen" => "13" "paginaInicial" => "271" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12755313" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005400000005/v1_201805020858/S0300289617303988/v1_201805020858/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/03002896/0000005400000005/v1_201805020858/S0300289617303988/v1_201805020858/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617303988?idApp=UINPBA00003Z" ]
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