Clinical Image
A Complex Pulmonary Vascularization: Bilateral Meandering Pulmonary Veins
Una vascularización pulmonar compleja: venas pulmonares sinuosas bilaterales
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A) Radiografía de tórax, proyección PA, se visualiza lesión cavitada en LSD superpuesta a clavícula y arco de segunda costilla. B) Corte axial de TC torácica donde se visualiza lesión cavitada de 15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>mm en LSD. C) muestra histológica de biopsia pulmonar quirúrgica, tinción hematoxilina-eosina ×40. Infiltrado linfohistiocitario con células gigantes multinucleadas (estrella roja). Cuerpo extraño, restos de polímeros de silicona (estrella amarilla).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Muñiz González, Fátima Hermoso Alarza, María del Puerto Cano Aguirre" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Muñiz González" ] 1 => array:2 [ "nombre" => "Fátima" "apellidos" => "Hermoso Alarza" ] 2 => array:2 [ "nombre" => "María del Puerto" "apellidos" => "Cano Aguirre" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212918303112" "doi" => "10.1016/j.arbr.2018.09.003" "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/S1579212918303112?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618300735?idApp=UINPBA00003Z" "url" => "/03002896/0000005400000011/v1_201811020632/S0300289618300735/v1_201811020632/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0300289618301984" "issn" => "03002896" "doi" => "10.1016/j.arbres.2018.05.008" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "1921" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2018;54:578" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1370 "formatos" => array:3 [ "EPUB" => 81 "HTML" => 1083 "PDF" => 206 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen clínica</span>" "titulo" => "Obstrucción de la vía aérea superior sin respuesta a CPAP" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "578" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "CPAP-Resistant Upper Airway Obstruction" ] ] "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" => 662 "Ancho" => 850 "Tamanyo" => 85185 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Poligrafía respiratoria con eventos obstructivos. 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Enhanced chest computed tomography (CT) examination with axial (B) and coronal (C) maximum intensity projection imaging, which demonstrated bilateral pulmonary veins with anomalous routes in the lower pulmonary regions (yellow arrowheads), but draining normally into the left atrium. Coronal volume-rendering 3D reconstruction (D) shows the anomalous veins (red) and normal pulmonary arteries (blue).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 22-year-old asymptomatic female was referred to our hospital due to an abnormal finding on a chest radiograph during a routine check-up (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Physical examination was unremarkable. She underwent enhanced chest computed tomography (CT) examination (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D), which demonstrated bilateral pulmonary veins with anomalous routes in the lower pulmonary regions, and normal drainage into the left atrium. The diagnosis of bilateral meandering pulmonary veins (MPV) was made based on the CT findings, and the patient was discharged with no further investigation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">It is important to distinguish between pulmonary venous return malformation (PVRM) and MPV. PVRM (e.g., scimitar syndrome) results in a left-to-right shunt, which can lead to cyanosis and may require surgical correction. Consequently, patients are often symptomatic and present at a young age. In contrast, MPV involves no left-to-right shunt.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> As in our case, patients with MPV are usually asymptomatic, with the diagnosis made incidentally. Recognition of these variations is important for the clinician to avoid unnecessary investigation when the differential diagnosis includes vascular malformations requiring surgical or interventional treatment. Furthermore, when patients with MPV require surgery for other reasons, thoracic surgeons should be aware of the anomaly to avoid injury to the anomalous vein. Treatment has not been required in any reported case of MPV.</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" => 1335 "Ancho" => 1333 "Tamanyo" => 233150 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior chest radiograph (A) showing bilateral anomalous curvilinear vessels in the lower pulmonary regions. Enhanced chest computed tomography (CT) examination with axial (B) and coronal (C) maximum intensity projection imaging, which demonstrated bilateral pulmonary veins with anomalous routes in the lower pulmonary regions (yellow arrowheads), but draining normally into the left atrium. Coronal volume-rendering 3D reconstruction (D) shows the anomalous veins (red) and normal pulmonary arteries (blue).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "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" => "A unique pulmonary vascular pattern: bilateral anomalous single pulmonary veins" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.S. Souza Jr." 1 => "L.S. de Souza" 2 => "G. Zanetti" 3 => "E. Marchiori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/thoraxjnl-2013-203732" "Revista" => array:5 [ "tituloSerie" => "Thorax" "fecha" => "2014" "volumen" => "69" "paginaInicial" => "687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23843357" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidental meandering right pulmonary vein, literature review and proposed nomenclature revision" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Rodrigues" 1 => "G. Ritchie" 2 => "J.T. Murchison" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4329/wjr.v5.i5.215" "Revista" => array:6 [ "tituloSerie" => "World J Radiol" "fecha" => "2013" "volumen" => "5" "paginaInicial" => "215" "paginaFinal" => "219" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23805372" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005400000011/v1_201811020632/S0300289618302072/v1_201811020632/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/03002896/0000005400000011/v1_201811020632/S0300289618302072/v1_201811020632/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289618302072?idApp=UINPBA00003Z" ]
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