array:24 [
  "pii" => "S0300289619302662"
  "issn" => "03002896"
  "doi" => "10.1016/j.arbres.2019.05.011"
  "estado" => "S300"
  "fechaPublicacion" => "2019-12-01"
  "aid" => "2189"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Arch Bronconeumol. 2019;55:661-3"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 150
    "formatos" => array:2 [
      "HTML" => 116
      "PDF" => 34
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S1579212919302903"
      "issn" => "15792129"
      "doi" => "10.1016/j.arbr.2019.05.014"
      "estado" => "S300"
      "fechaPublicacion" => "2019-12-01"
      "aid" => "2189"
      "copyright" => "SEPAR"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Arch Bronconeumol. 2019;55:661-3"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1
        "HTML" => 1
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
        "titulo" => "Spontaneous pneumomediastinum and subcutaneous emphysema&#58; Hamman&#8217;s syndrome"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "661"
            "paginaFinal" => "663"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Neumomediastino y enfisema subcut&#225;neo espont&#225;neo&#58; s&#237;ndrome de Hamman"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alejandra Garc&#237;a-Garc&#237;a, Alejandro Parra-Virto, Francisco Galeano-Valle, Pablo Demelo-Rodr&#237;guez"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Alejandra"
                "apellidos" => "Garc&#237;a-Garc&#237;a"
              ]
              1 => array:2 [
                "nombre" => "Alejandro"
                "apellidos" => "Parra-Virto"
              ]
              2 => array:2 [
                "nombre" => "Francisco"
                "apellidos" => "Galeano-Valle"
              ]
              3 => array:2 [
                "nombre" => "Pablo"
                "apellidos" => "Demelo-Rodr&#237;guez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "es" => array:9 [
          "pii" => "S0300289619302662"
          "doi" => "10.1016/j.arbres.2019.05.011"
          "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/S0300289619302662?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919302903?idApp=UINPBA00003Z"
      "url" => "/15792129/0000005500000012/v2_201912171000/S1579212919302903/v2_201912171000/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0300289619302674"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2019.05.012"
    "estado" => "S300"
    "fechaPublicacion" => "2019-12-01"
    "aid" => "2190"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2019;55:663-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 214
      "formatos" => array:2 [
        "HTML" => 130
        "PDF" => 84
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta Cient&#237;fica</span>"
      "titulo" => "Evoluci&#243;n tras la retirada de la oxigenoterapia domiciliaria&#46; Perfil del paciente en el que hay que reintroducirla"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "663"
          "paginaFinal" => "665"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Progress After the Withdrawal of Home Oxygen Therapy&#46; The Profile of Patients Requiring Reintroduction"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Tamara Lourido-Cebreiro, Francisco J&#46; Gonz&#225;lez-Barcala, Carlos R&#225;bade, Romina Abelleira-Paris, Tara Pereiro-Brea, Luis Vald&#233;s"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Tamara"
              "apellidos" => "Lourido-Cebreiro"
            ]
            1 => array:2 [
              "nombre" => "Francisco J&#46;"
              "apellidos" => "Gonz&#225;lez-Barcala"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "R&#225;bade"
            ]
            3 => array:2 [
              "nombre" => "Romina"
              "apellidos" => "Abelleira-Paris"
            ]
            4 => array:2 [
              "nombre" => "Tara"
              "apellidos" => "Pereiro-Brea"
            ]
            5 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Vald&#233;s"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S1579212919302915"
        "doi" => "10.1016/j.arbr.2019.05.015"
        "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/S1579212919302915?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302674?idApp=UINPBA00003Z"
    "url" => "/03002896/0000005500000012/v2_202003060719/S0300289619302674/v2_202003060719/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0300289619302625"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2019.05.010"
    "estado" => "S300"
    "fechaPublicacion" => "2019-12-01"
    "aid" => "2188"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2019;55:659-61"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 63
      "formatos" => array:2 [
        "HTML" => 40
        "PDF" => 23
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Echogenic Swirling Seen on Ultrasound and Outcome of Pleurodesis in Malignant Pleural Effusion"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "659"
          "paginaFinal" => "661"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ecograf&#237;a con signo de remolino y resultado de la pleurodesis en un derrame pleural maligno"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Maged Hassan, Rachelle Asciak, Rachel M&#46; Mercer, David J&#46; McCracken, Stamatoula Tsikrika, Hany Shaarawy, Anwar Elganady, John M&#46; Wrightson, Najib M&#46; Rahman"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Maged"
              "apellidos" => "Hassan"
            ]
            1 => array:2 [
              "nombre" => "Rachelle"
              "apellidos" => "Asciak"
            ]
            2 => array:2 [
              "nombre" => "Rachel M&#46;"
              "apellidos" => "Mercer"
            ]
            3 => array:2 [
              "nombre" => "David J&#46;"
              "apellidos" => "McCracken"
            ]
            4 => array:2 [
              "nombre" => "Stamatoula"
              "apellidos" => "Tsikrika"
            ]
            5 => array:2 [
              "nombre" => "Hany"
              "apellidos" => "Shaarawy"
            ]
            6 => array:2 [
              "nombre" => "Anwar"
              "apellidos" => "Elganady"
            ]
            7 => array:2 [
              "nombre" => "John M&#46;"
              "apellidos" => "Wrightson"
            ]
            8 => array:2 [
              "nombre" => "Najib M&#46;"
              "apellidos" => "Rahman"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S1579212919303647"
        "doi" => "10.1016/j.arbr.2019.05.018"
        "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/S1579212919303647?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302625?idApp=UINPBA00003Z"
    "url" => "/03002896/0000005500000012/v2_202003060719/S0300289619302625/v2_202003060719/en/main.assets"
  ]
  "es" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Carta Cient&#237;fica</span>"
    "titulo" => "Neumomediastino y enfisema subcut&#225;neo espont&#225;neo&#58; s&#237;ndrome de Hamman"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Estimado Director&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "661"
        "paginaFinal" => "663"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alejandra Garc&#237;a-Garc&#237;a, Alejandro Parra-Virto, Francisco Galeano-Valle, Pablo Demelo-Rodr&#237;guez"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Alejandra"
            "apellidos" => "Garc&#237;a-Garc&#237;a"
            "email" => array:1 [
              0 => "alejandra.garciag90@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Alejandro"
            "apellidos" => "Parra-Virto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Francisco"
            "apellidos" => "Galeano-Valle"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Pablo"
            "apellidos" => "Demelo-Rodr&#237;guez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Medicina Interna&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Investigaci&#243;n Sanitaria Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Spontaneous Pneumomediastinum and Subcutaneous Emphysema&#58; Hamman&#39;s Syndrome"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El neumomediastino se define por la presencia de aire libre en el mediastino y suele acompa&#241;arse de enfisema subcut&#225;neo&#46; Se clasifica en espont&#225;neo cuando no existe una causa evidente y en traum&#225;tico cuando ocurre de manera secundaria a una intervenci&#243;n&#44; perforaci&#243;n o traumatismo a dicho nivel&#46; El neumomediastino espont&#225;neo se debe a la rotura de los alv&#233;olos terminales secundaria a una hiperinsuflaci&#243;n traqueal<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46; Una de las causas menos conocidas de neumomediastino espont&#225;neo es el s&#237;ndrome de Hamman &#40;descrito por Louis Hamman en 1939&#41;&#44; que hace referencia al neumomediastino espont&#225;neo asociado a enfisema subcut&#225;neo que se produce en el posparto<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Es una entidad poco frecuente&#44; con tan solo 200 casos descritos en la literatura hasta 1994<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; Exponemos el caso de una mujer de 29 a&#241;os que tras un parto vaginal present&#243; neumomediastino y enfisema subcut&#225;neo&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mujer de 29 a&#241;os primigesta de 40<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 semanas&#44; sin antecedentes m&#233;dicos&#44; que acudi&#243; a urgencias por din&#225;mica uterina irregular cada 15<span class="elsevierStyleHsp" style=""></span>min de 12<span class="elsevierStyleHsp" style=""></span>h de evoluci&#243;n&#46; No presentaba sangrado vaginal ni rotura de bolsa amni&#243;tica&#46; La paciente hab&#237;a realizado un correcto seguimiento del embarazo&#44; sin incidencias&#46; En el inicio de la din&#225;mica de parto&#44; una ecograf&#237;a abdominal y un registro cardiotocogr&#225;fico fetal no mostraron alteraciones&#46; La paciente tuvo un parto espont&#225;neo eut&#243;cico con presentaci&#243;n cef&#225;lica&#44; siendo el reci&#233;n nacido un var&#243;n de 3&#44;2<span class="elsevierStyleHsp" style=""></span>kg con Apgar de 10 en el primer minuto&#46; El parto dur&#243; 10<span class="elsevierStyleHsp" style=""></span>h y no se registraron complicaciones&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A las 18<span class="elsevierStyleHsp" style=""></span>h de finalizar el parto la paciente present&#243; odinofagia y sensaci&#243;n de crepitaci&#243;n en la regi&#243;n cervical&#44; sin disnea&#46; La presi&#243;n arterial era de 126&#47;73<span class="elsevierStyleHsp" style=""></span>mmHg&#44; la frecuencia card&#237;aca de 80<span class="elsevierStyleHsp" style=""></span>lpm y la saturaci&#243;n de ox&#237;geno del 98&#37; respirando aire ambiente&#46; La auscultaci&#243;n pulmonar era normal&#46; Una radiograf&#237;a de t&#243;rax mostr&#243; enfisema subcut&#225;neo en ambas regiones claviculares y cervical bilateral&#44; sin evidencia de neumot&#243;rax&#46; Un an&#225;lisis de sangre mostr&#243; hemoglobina de 11&#44;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; 113&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span>&#44; 12&#46;700 leucocitos&#47;mm<span class="elsevierStyleSup">3</span> &#40;82&#44;3&#37; neutr&#243;filos&#41;&#46; La funci&#243;n renal&#44; iones y funci&#243;n hep&#225;tica eran normales&#46; Una tomograf&#237;a computarizada &#40;TC&#41; de t&#243;rax demostr&#243; un extenso enfisema subcut&#225;neo y profundo cervical y extenso neumomediastino&#46; Se descart&#243; la presencia de mediastinitis&#44; l&#237;quido libre o rotura esof&#225;gica&#46; Se realiz&#243; el diagn&#243;stico de neumomediastino espont&#225;neo secundario a trabajo de parto y se decidi&#243; un manejo conservador&#46; La evoluci&#243;n posterior fue favorable&#44; encontr&#225;ndose asintom&#225;tica y con resoluci&#243;n completa de las lesiones a las 2 semanas de seguimiento&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de Hamman&#44; descrito en 1939&#44; se define por la asociaci&#243;n de enfisema subcut&#225;neo extenso y neumomediastino en el puerperio inmediato y es una rara complicaci&#243;n asociada al trabajo del parto&#44; con una incidencia aproximada de uno de cada 100&#46;000 partos<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;5</span></a>&#44; aunque tambi&#233;n se ha descrito asociado a otros procesos no limit&#225;ndose al posparto&#44; como los gritos&#44; la tos&#44; la hiper&#233;mesis&#44; las infecciones respiratorias o el esfuerzo f&#237;sico<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Es m&#225;s frecuente en mujeres j&#243;venes prim&#237;paras y se asocia a partos de fetos macros&#243;micos<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46; Se ha postulado que puede producirse tambi&#233;n durante el periodo perinatal en aquellas pacientes con hiper&#233;mesis grav&#237;dica&#46; Sin embargo&#44; la mayor&#237;a de los casos ocurren en la segunda etapa del parto en aquellas primigr&#225;vidas que presentan un parto prolongado y dif&#237;cil debido al esfuerzo realizado durante las maniobras de Valsalva&#46; Los s&#237;ntomas suelen aparecer en la tercera o cuarta etapas del parto<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra los casos publicados de s&#237;ndrome de Hamman en los &#250;ltimos 10 a&#241;os&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La fisiopatolog&#237;a del s&#237;ndrome de Hamman se basa en la rotura de los alv&#233;olos marginales secundaria a un aumento de la presi&#243;n intraalveolar con maniobras de Valsalva sostenidas &#40;espiraci&#243;n forzada contra una glotis cerrada&#41; asociada a tos&#44; v&#243;mitos&#44; gritos y los pujos del parto&#46; Se puede llegar a aumentar la presi&#243;n intrator&#225;cica hasta 50<span class="elsevierStyleHsp" style=""></span>cm de agua<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; El aumento de esta presi&#243;n en presencia de un calibre vascular disminuido establece un gradiente de presi&#243;n en la vaina vascular a lo largo del cual el aire puede disecar el mediastino&#44; migrando el aire desde este hasta los planos subcut&#225;neos&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La presentaci&#243;n cl&#237;nica m&#225;s frecuente del s&#237;ndrome de Hamman consiste en dolor tor&#225;cico retroesternal&#44; disnea&#44; dolor facial o de cuello&#44; odinofagia y disfagia&#46; Dado que la presencia de dolor tor&#225;cico durante el parto puede tener distintas etiolog&#237;as&#44; deben ser descartadas en primer lugar patolog&#237;as urgentes como la embolia pulmonar&#44; la embolia de l&#237;quido amni&#243;tico&#44; el infarto de miocardio&#44; el neumot&#243;rax y la disecci&#243;n a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46; En el caso de que exista hiper&#233;mesis se debe descartar rotura esof&#225;gica&#44; ya que puede ser precipitada por los mismos factores&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La radiograf&#237;a de t&#243;rax es la t&#233;cnica diagn&#243;stica inicial&#46; La TC se considera el <span class="elsevierStyleItalic">gold standard</span> para descartar aire mediast&#237;nico ya que puede detectar peque&#241;as cantidades de aire que no se aprecian en una radiograf&#237;a de t&#243;rax&#44; lo que ocurre hasta en un 30&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;10</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La recurrencia del s&#237;ndrome de Hamman es poco frecuente y las pacientes suelen responder favorablemente al tratamiento conservador&#44; consistente fundamentalmente en analgesia a demanda&#44; oxigenoterapia en aquellos casos necesarios y reposo&#46; Las pacientes pueden ser dadas de alta a domicilio con tratamiento analg&#233;sico de manera segura&#46; En casos muy excepcionales&#44; si presenta neumot&#243;rax asociado&#44; puede ser necesario la colocaci&#243;n de un tubo de t&#243;rax<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; el neumomediastino espont&#225;neo&#44; pese a ser una enfermedad poco frecuente&#44; debe ser considerado en el diagn&#243;stico diferencial del dolor tor&#225;cico en el posparto inmediato&#46; La radiograf&#237;a de t&#243;rax constituye una herramienta &#250;til pero no siempre es diagn&#243;stica&#44; siendo la TC tor&#225;cica la prueba diagn&#243;stica de referencia&#46; La evoluci&#243;n es favorable&#44; con recurrencias infrecuentes y el manejo a menudo es conservador&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">h&#58; horas&#59; min&#58; minutos&#59; NE&#58; no especificado&#59; TC&#58; tomograf&#237;a computarizada&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autor &#40;a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gestaci&#243;n &#40;semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duraci&#243;n del parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complicaciones en el parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Manifestaciones cl&#237;nicas principales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo desde el fin del parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evoluci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kandiah et al&#46; &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ces&#225;rea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>h y 16<span class="elsevierStyleHsp" style=""></span>min &#40;2&#46;<span class="elsevierStyleSup">a</span> fase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desproporci&#243;n c&#233;rvico-cef&#225;lica que propici&#243; ces&#225;rea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfisema subcut&#225;neo y molestias tor&#225;cicas&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">En la sala de parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&#58; analgesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n completa al 5&#46;<span class="elsevierStyleSup">o</span> d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kandiah et al&#46; &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No recibi&#243; anestesia epidural&#59; dolor y gritos intensos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alteraciones fonatorias&#46; Hinchaz&#243;n y rigidez cervical&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;<span class="elsevierStyleSup">er</span> d&#237;a posparto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&#46; Tr&#225;nsito esof&#225;gico descart&#243; rotura esof&#225;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n completa al 5&#46;<span class="elsevierStyleSup">o</span> d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cho et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hinchaz&#243;n del cuello y cara&#44; dolor tor&#225;cico y disfon&#237;a&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inmediatamente tras el parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&#46; Analgesia y antibioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alta a las 24<span class="elsevierStyleHsp" style=""></span>h&#46; Asintom&#225;tica a los 4 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khurram et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inducci&#243;n del parto&#44; instrumental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rigidez de cuello y dolor tor&#225;cico&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax y TC de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mejor&#237;a radiol&#243;gica a las 48<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sagar et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h y 55<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hinchaz&#243;n de cuello y disnea con enfisema palpable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a y TC de t&#243;rax&#44; endoscopia &#40;no perforaci&#243;n esof&#225;gica&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n completa 3 semanas despu&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khan et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disnea&#44; tos y hemoptisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC t&#243;rax &#40;se diagnostic&#243; de neumon&#237;a bilateral&#44; neumomediastino y enfisema subcut&#225;neo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento antibi&#243;tico y vigilancia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n radiol&#243;gica 4 d&#237;as despu&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee y Young &#40;2019&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>h y 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema facial y periorbitario&#46; Odinofagia&#46; Dolor tor&#225;cico y crepitaci&#243;n cervical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Durante el parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n radiol&#243;gica a las 3 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nuestro caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Crepitaci&#243;n en zona clavicular y dolor en cuello con odinofagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax y TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n radiol&#243;gica a los 12 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2255528.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Casos de s&#237;ndrome de Hamman publicados en la literatura en los &#250;ltimos 10 a&#241;os</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neumomediastino y enfisema subcut&#225;neo espont&#225;neos postparto&#58; informe de un caso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; L&#243;pez-Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ginecol Obstet Mex&#46;"
                        "fecha" => "2015"
                        "volumen" => "83"
                        "paginaInicial" => "116"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25993775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous mediastinal emphysema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Hamman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull Johns Hopkins Hosp&#46;"
                        "fecha" => "1939"
                        "volumen" => "64"
                        "paginaInicial" => "1"
                        "paginaFinal" => "21"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum and subcutaneous emphysema &#40;Hamman&#39;s syndrome&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Elshirif"
                            1 => "J&#46; Tyagi-Bhatia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/01443615.2015.1060205"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Obstet Gynaecol&#46;"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "paginaInicial" => "281"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26648245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumomediastinum and subcutaneous emphysema following vaginal delivery&#46; Case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;J&#46; Seidl"
                            1 => "G&#46;L&#46; Brotzman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Fam Pract&#46;"
                        "fecha" => "1994"
                        "volumen" => "39"
                        "paginaInicial" => "178"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8057069"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pneumomediastinum &#40;Hamman&#39;s syndrome&#41;&#58; a rare cause of postpartum chest pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Cho"
                            1 => "J&#46;R&#46; Parratt"
                            2 => "S&#46; Smith"
                            3 => "R&#46; Palet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bcr-2014-208269"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ Case Rep&#46;"
                        "fecha" => "2015"
                        "volumen" => "2015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25948848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidural pneumorrhachis consequent to Hamman syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Krishnan"
                            1 => "S&#46; Das"
                            2 => "C&#46; Bhattacharyya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0976-3147.193525"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosci Rural Pract&#46;"
                        "fecha" => "2017"
                        "volumen" => "8"
                        "paginaInicial" => "118"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28149094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman&#39;s syndrome &#40;spontaneous pneumomediastinum presenting as subcutaneous emphysema&#41;&#58; a rare case of the emergency department and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Konstantinos"
                            1 => "T&#46; Zoi"
                            2 => "L&#46; Vasileios"
                            3 => "K&#46; Sotirios"
                            4 => "C&#46; Kotoulas"
                            5 => "K&#46; Efstratios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmcr.2017.12.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Med Case Rep&#46;"
                        "fecha" => "2018"
                        "volumen" => "23"
                        "paginaInicial" => "63"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29276676"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2213260015005214"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman&#39;s syndrome &#40;spontaneus pneumomediastinum&#41; in a parturient&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;M&#46; Bonin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1701-2163(16)32056-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Obstet Gynaecol Can&#46;"
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "128"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16643714"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum &#40;Hamman syndrome&#41;&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;I&#46; Khan"
                            1 => "R&#46; Shah"
                            2 => "S&#46; Yasir"
                            3 => "M&#46;S&#46; Ahmed"
                            4 => "S&#46; Qadri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pak Med Assoc&#46;"
                        "fecha" => "2018"
                        "volumen" => "68"
                        "paginaInicial" => "1108"
                        "paginaFinal" => "1109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30317313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman&#39;s syndrome&#58; a rare cause of chest pain in a postpartum patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Khurram"
                            1 => "B&#46; Patel"
                            2 => "M&#46;W&#46; Farra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2015/201051"
                      "Revista" => array:5 [
                        "tituloSerie" => "Case Rep Pulmonol&#46;"
                        "fecha" => "2015"
                        "volumen" => "2015"
                        "paginaInicial" => "201051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25688319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pneumomediastinum &#40;Hamman&#39;s syndrome&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Kelly"
                            1 => "S&#46; Hughes"
                            2 => "S&#46; Nixon"
                            3 => "S&#46; Paterson-Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surge.2009.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgeon&#46;"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "63"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20303884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pneumomediastinum&#58; a benign curiosity or a significant problem&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;E&#46; Newcomb"
                            1 => "C&#46;P&#46; Clarke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.128.5.3298"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "3298"
                        "paginaFinal" => "3302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16304275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum and subcutaneous emphysema&#58; two case reports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Kandiah"
                            1 => "H&#46; Iswariah"
                            2 => "S&#46; Elgey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2013/735154"
                      "Revista" => array:5 [
                        "tituloSerie" => "Case Rep Obstet Gynecol&#46;"
                        "fecha" => "2013"
                        "volumen" => "2013"
                        "paginaInicial" => "735154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23533868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum and subcutaneous emphysema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Sagar"
                            1 => "T&#46;K&#46; Rogers"
                            2 => "A&#46; Adeni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bcr-2018-226181"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ Case Rep&#46;"
                        "fecha" => "2018"
                        "volumen" => "2018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30413448"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman syndrome&#58; spontaneous postpartum pneumomediastinum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;Y&#46; Lee"
                            1 => "A&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/imj.14171"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med J&#46;"
                        "fecha" => "2019"
                        "volumen" => "49"
                        "paginaInicial" => "130"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30680904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/03002896/0000005500000012/v2_202003060719/S0300289619302662/v2_202003060719/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "49741"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Scientific Letters / Cartas cient&#237;ficas"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005500000012/v2_202003060719/S0300289619302662/v2_202003060719/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302662?idApp=UINPBA00003Z"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Carta Científica
Neumomediastino y enfisema subcutáneo espontáneo: síndrome de Hamman
Spontaneous Pneumomediastinum and Subcutaneous Emphysema: Hamman's Syndrome
Alejandra García-Garcíaa,
Corresponding author
alejandra.garciag90@gmail.com

Autor para correspondencia.
, Alejandro Parra-Virtoa, Francisco Galeano-Vallea,b, Pablo Demelo-Rodrígueza,b
a Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
b Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
Read
3772
Times
was read the article
841
Total PDF
2931
Total HTML
Share statistics
 array:24 [
  "pii" => "S0300289619302662"
  "issn" => "03002896"
  "doi" => "10.1016/j.arbres.2019.05.011"
  "estado" => "S300"
  "fechaPublicacion" => "2019-12-01"
  "aid" => "2189"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2019"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Arch Bronconeumol. 2019;55:661-3"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 150
    "formatos" => array:2 [
      "HTML" => 116
      "PDF" => 34
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S1579212919302903"
      "issn" => "15792129"
      "doi" => "10.1016/j.arbr.2019.05.014"
      "estado" => "S300"
      "fechaPublicacion" => "2019-12-01"
      "aid" => "2189"
      "copyright" => "SEPAR"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Arch Bronconeumol. 2019;55:661-3"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 1
        "HTML" => 1
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
        "titulo" => "Spontaneous pneumomediastinum and subcutaneous emphysema&#58; Hamman&#8217;s syndrome"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "661"
            "paginaFinal" => "663"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Neumomediastino y enfisema subcut&#225;neo espont&#225;neo&#58; s&#237;ndrome de Hamman"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Alejandra Garc&#237;a-Garc&#237;a, Alejandro Parra-Virto, Francisco Galeano-Valle, Pablo Demelo-Rodr&#237;guez"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Alejandra"
                "apellidos" => "Garc&#237;a-Garc&#237;a"
              ]
              1 => array:2 [
                "nombre" => "Alejandro"
                "apellidos" => "Parra-Virto"
              ]
              2 => array:2 [
                "nombre" => "Francisco"
                "apellidos" => "Galeano-Valle"
              ]
              3 => array:2 [
                "nombre" => "Pablo"
                "apellidos" => "Demelo-Rodr&#237;guez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "es" => array:9 [
          "pii" => "S0300289619302662"
          "doi" => "10.1016/j.arbres.2019.05.011"
          "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/S0300289619302662?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919302903?idApp=UINPBA00003Z"
      "url" => "/15792129/0000005500000012/v2_201912171000/S1579212919302903/v2_201912171000/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0300289619302674"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2019.05.012"
    "estado" => "S300"
    "fechaPublicacion" => "2019-12-01"
    "aid" => "2190"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2019;55:663-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 214
      "formatos" => array:2 [
        "HTML" => 130
        "PDF" => 84
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta Cient&#237;fica</span>"
      "titulo" => "Evoluci&#243;n tras la retirada de la oxigenoterapia domiciliaria&#46; Perfil del paciente en el que hay que reintroducirla"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "663"
          "paginaFinal" => "665"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Progress After the Withdrawal of Home Oxygen Therapy&#46; The Profile of Patients Requiring Reintroduction"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Tamara Lourido-Cebreiro, Francisco J&#46; Gonz&#225;lez-Barcala, Carlos R&#225;bade, Romina Abelleira-Paris, Tara Pereiro-Brea, Luis Vald&#233;s"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Tamara"
              "apellidos" => "Lourido-Cebreiro"
            ]
            1 => array:2 [
              "nombre" => "Francisco J&#46;"
              "apellidos" => "Gonz&#225;lez-Barcala"
            ]
            2 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "R&#225;bade"
            ]
            3 => array:2 [
              "nombre" => "Romina"
              "apellidos" => "Abelleira-Paris"
            ]
            4 => array:2 [
              "nombre" => "Tara"
              "apellidos" => "Pereiro-Brea"
            ]
            5 => array:2 [
              "nombre" => "Luis"
              "apellidos" => "Vald&#233;s"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S1579212919302915"
        "doi" => "10.1016/j.arbr.2019.05.015"
        "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/S1579212919302915?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302674?idApp=UINPBA00003Z"
    "url" => "/03002896/0000005500000012/v2_202003060719/S0300289619302674/v2_202003060719/es/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0300289619302625"
    "issn" => "03002896"
    "doi" => "10.1016/j.arbres.2019.05.010"
    "estado" => "S300"
    "fechaPublicacion" => "2019-12-01"
    "aid" => "2188"
    "copyright" => "SEPAR"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Arch Bronconeumol. 2019;55:659-61"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 63
      "formatos" => array:2 [
        "HTML" => 40
        "PDF" => 23
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>"
      "titulo" => "Echogenic Swirling Seen on Ultrasound and Outcome of Pleurodesis in Malignant Pleural Effusion"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "659"
          "paginaFinal" => "661"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ecograf&#237;a con signo de remolino y resultado de la pleurodesis en un derrame pleural maligno"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Maged Hassan, Rachelle Asciak, Rachel M&#46; Mercer, David J&#46; McCracken, Stamatoula Tsikrika, Hany Shaarawy, Anwar Elganady, John M&#46; Wrightson, Najib M&#46; Rahman"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Maged"
              "apellidos" => "Hassan"
            ]
            1 => array:2 [
              "nombre" => "Rachelle"
              "apellidos" => "Asciak"
            ]
            2 => array:2 [
              "nombre" => "Rachel M&#46;"
              "apellidos" => "Mercer"
            ]
            3 => array:2 [
              "nombre" => "David J&#46;"
              "apellidos" => "McCracken"
            ]
            4 => array:2 [
              "nombre" => "Stamatoula"
              "apellidos" => "Tsikrika"
            ]
            5 => array:2 [
              "nombre" => "Hany"
              "apellidos" => "Shaarawy"
            ]
            6 => array:2 [
              "nombre" => "Anwar"
              "apellidos" => "Elganady"
            ]
            7 => array:2 [
              "nombre" => "John M&#46;"
              "apellidos" => "Wrightson"
            ]
            8 => array:2 [
              "nombre" => "Najib M&#46;"
              "apellidos" => "Rahman"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S1579212919303647"
        "doi" => "10.1016/j.arbr.2019.05.018"
        "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/S1579212919303647?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302625?idApp=UINPBA00003Z"
    "url" => "/03002896/0000005500000012/v2_202003060719/S0300289619302625/v2_202003060719/en/main.assets"
  ]
  "es" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Carta Cient&#237;fica</span>"
    "titulo" => "Neumomediastino y enfisema subcut&#225;neo espont&#225;neo&#58; s&#237;ndrome de Hamman"
    "tieneTextoCompleto" => true
    "saludo" => "<span class="elsevierStyleItalic">Estimado Director&#58;</span>"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "661"
        "paginaFinal" => "663"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alejandra Garc&#237;a-Garc&#237;a, Alejandro Parra-Virto, Francisco Galeano-Valle, Pablo Demelo-Rodr&#237;guez"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Alejandra"
            "apellidos" => "Garc&#237;a-Garc&#237;a"
            "email" => array:1 [
              0 => "alejandra.garciag90@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Alejandro"
            "apellidos" => "Parra-Virto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Francisco"
            "apellidos" => "Galeano-Valle"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Pablo"
            "apellidos" => "Demelo-Rodr&#237;guez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Medicina Interna&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Instituto de Investigaci&#243;n Sanitaria Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspondencia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Spontaneous Pneumomediastinum and Subcutaneous Emphysema&#58; Hamman&#39;s Syndrome"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El neumomediastino se define por la presencia de aire libre en el mediastino y suele acompa&#241;arse de enfisema subcut&#225;neo&#46; Se clasifica en espont&#225;neo cuando no existe una causa evidente y en traum&#225;tico cuando ocurre de manera secundaria a una intervenci&#243;n&#44; perforaci&#243;n o traumatismo a dicho nivel&#46; El neumomediastino espont&#225;neo se debe a la rotura de los alv&#233;olos terminales secundaria a una hiperinsuflaci&#243;n traqueal<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a>&#46; Una de las causas menos conocidas de neumomediastino espont&#225;neo es el s&#237;ndrome de Hamman &#40;descrito por Louis Hamman en 1939&#41;&#44; que hace referencia al neumomediastino espont&#225;neo asociado a enfisema subcut&#225;neo que se produce en el posparto<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Es una entidad poco frecuente&#44; con tan solo 200 casos descritos en la literatura hasta 1994<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a>&#46; Exponemos el caso de una mujer de 29 a&#241;os que tras un parto vaginal present&#243; neumomediastino y enfisema subcut&#225;neo&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Mujer de 29 a&#241;os primigesta de 40<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>3 semanas&#44; sin antecedentes m&#233;dicos&#44; que acudi&#243; a urgencias por din&#225;mica uterina irregular cada 15<span class="elsevierStyleHsp" style=""></span>min de 12<span class="elsevierStyleHsp" style=""></span>h de evoluci&#243;n&#46; No presentaba sangrado vaginal ni rotura de bolsa amni&#243;tica&#46; La paciente hab&#237;a realizado un correcto seguimiento del embarazo&#44; sin incidencias&#46; En el inicio de la din&#225;mica de parto&#44; una ecograf&#237;a abdominal y un registro cardiotocogr&#225;fico fetal no mostraron alteraciones&#46; La paciente tuvo un parto espont&#225;neo eut&#243;cico con presentaci&#243;n cef&#225;lica&#44; siendo el reci&#233;n nacido un var&#243;n de 3&#44;2<span class="elsevierStyleHsp" style=""></span>kg con Apgar de 10 en el primer minuto&#46; El parto dur&#243; 10<span class="elsevierStyleHsp" style=""></span>h y no se registraron complicaciones&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A las 18<span class="elsevierStyleHsp" style=""></span>h de finalizar el parto la paciente present&#243; odinofagia y sensaci&#243;n de crepitaci&#243;n en la regi&#243;n cervical&#44; sin disnea&#46; La presi&#243;n arterial era de 126&#47;73<span class="elsevierStyleHsp" style=""></span>mmHg&#44; la frecuencia card&#237;aca de 80<span class="elsevierStyleHsp" style=""></span>lpm y la saturaci&#243;n de ox&#237;geno del 98&#37; respirando aire ambiente&#46; La auscultaci&#243;n pulmonar era normal&#46; Una radiograf&#237;a de t&#243;rax mostr&#243; enfisema subcut&#225;neo en ambas regiones claviculares y cervical bilateral&#44; sin evidencia de neumot&#243;rax&#46; Un an&#225;lisis de sangre mostr&#243; hemoglobina de 11&#44;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; 113&#46;000 plaquetas&#47;mm<span class="elsevierStyleSup">3</span>&#44; 12&#46;700 leucocitos&#47;mm<span class="elsevierStyleSup">3</span> &#40;82&#44;3&#37; neutr&#243;filos&#41;&#46; La funci&#243;n renal&#44; iones y funci&#243;n hep&#225;tica eran normales&#46; Una tomograf&#237;a computarizada &#40;TC&#41; de t&#243;rax demostr&#243; un extenso enfisema subcut&#225;neo y profundo cervical y extenso neumomediastino&#46; Se descart&#243; la presencia de mediastinitis&#44; l&#237;quido libre o rotura esof&#225;gica&#46; Se realiz&#243; el diagn&#243;stico de neumomediastino espont&#225;neo secundario a trabajo de parto y se decidi&#243; un manejo conservador&#46; La evoluci&#243;n posterior fue favorable&#44; encontr&#225;ndose asintom&#225;tica y con resoluci&#243;n completa de las lesiones a las 2 semanas de seguimiento&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de Hamman&#44; descrito en 1939&#44; se define por la asociaci&#243;n de enfisema subcut&#225;neo extenso y neumomediastino en el puerperio inmediato y es una rara complicaci&#243;n asociada al trabajo del parto&#44; con una incidencia aproximada de uno de cada 100&#46;000 partos<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;5</span></a>&#44; aunque tambi&#233;n se ha descrito asociado a otros procesos no limit&#225;ndose al posparto&#44; como los gritos&#44; la tos&#44; la hiper&#233;mesis&#44; las infecciones respiratorias o el esfuerzo f&#237;sico<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Es m&#225;s frecuente en mujeres j&#243;venes prim&#237;paras y se asocia a partos de fetos macros&#243;micos<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a>&#46; Se ha postulado que puede producirse tambi&#233;n durante el periodo perinatal en aquellas pacientes con hiper&#233;mesis grav&#237;dica&#46; Sin embargo&#44; la mayor&#237;a de los casos ocurren en la segunda etapa del parto en aquellas primigr&#225;vidas que presentan un parto prolongado y dif&#237;cil debido al esfuerzo realizado durante las maniobras de Valsalva&#46; Los s&#237;ntomas suelen aparecer en la tercera o cuarta etapas del parto<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra los casos publicados de s&#237;ndrome de Hamman en los &#250;ltimos 10 a&#241;os&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">La fisiopatolog&#237;a del s&#237;ndrome de Hamman se basa en la rotura de los alv&#233;olos marginales secundaria a un aumento de la presi&#243;n intraalveolar con maniobras de Valsalva sostenidas &#40;espiraci&#243;n forzada contra una glotis cerrada&#41; asociada a tos&#44; v&#243;mitos&#44; gritos y los pujos del parto&#46; Se puede llegar a aumentar la presi&#243;n intrator&#225;cica hasta 50<span class="elsevierStyleHsp" style=""></span>cm de agua<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&#46; El aumento de esta presi&#243;n en presencia de un calibre vascular disminuido establece un gradiente de presi&#243;n en la vaina vascular a lo largo del cual el aire puede disecar el mediastino&#44; migrando el aire desde este hasta los planos subcut&#225;neos&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La presentaci&#243;n cl&#237;nica m&#225;s frecuente del s&#237;ndrome de Hamman consiste en dolor tor&#225;cico retroesternal&#44; disnea&#44; dolor facial o de cuello&#44; odinofagia y disfagia&#46; Dado que la presencia de dolor tor&#225;cico durante el parto puede tener distintas etiolog&#237;as&#44; deben ser descartadas en primer lugar patolog&#237;as urgentes como la embolia pulmonar&#44; la embolia de l&#237;quido amni&#243;tico&#44; el infarto de miocardio&#44; el neumot&#243;rax y la disecci&#243;n a&#243;rtica<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a>&#46; En el caso de que exista hiper&#233;mesis se debe descartar rotura esof&#225;gica&#44; ya que puede ser precipitada por los mismos factores&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La radiograf&#237;a de t&#243;rax es la t&#233;cnica diagn&#243;stica inicial&#46; La TC se considera el <span class="elsevierStyleItalic">gold standard</span> para descartar aire mediast&#237;nico ya que puede detectar peque&#241;as cantidades de aire que no se aprecian en una radiograf&#237;a de t&#243;rax&#44; lo que ocurre hasta en un 30&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1&#44;10</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La recurrencia del s&#237;ndrome de Hamman es poco frecuente y las pacientes suelen responder favorablemente al tratamiento conservador&#44; consistente fundamentalmente en analgesia a demanda&#44; oxigenoterapia en aquellos casos necesarios y reposo&#46; Las pacientes pueden ser dadas de alta a domicilio con tratamiento analg&#233;sico de manera segura&#46; En casos muy excepcionales&#44; si presenta neumot&#243;rax asociado&#44; puede ser necesario la colocaci&#243;n de un tubo de t&#243;rax<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11&#44;12</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Como conclusi&#243;n&#44; el neumomediastino espont&#225;neo&#44; pese a ser una enfermedad poco frecuente&#44; debe ser considerado en el diagn&#243;stico diferencial del dolor tor&#225;cico en el posparto inmediato&#46; La radiograf&#237;a de t&#243;rax constituye una herramienta &#250;til pero no siempre es diagn&#243;stica&#44; siendo la TC tor&#225;cica la prueba diagn&#243;stica de referencia&#46; La evoluci&#243;n es favorable&#44; con recurrencias infrecuentes y el manejo a menudo es conservador&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">h&#58; horas&#59; min&#58; minutos&#59; NE&#58; no especificado&#59; TC&#58; tomograf&#237;a computarizada&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autor &#40;a&#241;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gestaci&#243;n &#40;semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tipo de parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duraci&#243;n del parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complicaciones en el parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Manifestaciones cl&#237;nicas principales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tiempo desde el fin del parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evoluci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kandiah et al&#46; &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ces&#225;rea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>h y 16<span class="elsevierStyleHsp" style=""></span>min &#40;2&#46;<span class="elsevierStyleSup">a</span> fase&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Desproporci&#243;n c&#233;rvico-cef&#225;lica que propici&#243; ces&#225;rea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Enfisema subcut&#225;neo y molestias tor&#225;cicas&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">En la sala de parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&#58; analgesia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n completa al 5&#46;<span class="elsevierStyleSup">o</span> d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kandiah et al&#46; &#40;2013&#41;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No recibi&#243; anestesia epidural&#59; dolor y gritos intensos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alteraciones fonatorias&#46; Hinchaz&#243;n y rigidez cervical&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;<span class="elsevierStyleSup">er</span> d&#237;a posparto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&#46; Tr&#225;nsito esof&#225;gico descart&#243; rotura esof&#225;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n completa al 5&#46;<span class="elsevierStyleSup">o</span> d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cho et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hinchaz&#243;n del cuello y cara&#44; dolor tor&#225;cico y disfon&#237;a&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inmediatamente tras el parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&#46; Analgesia y antibioterapia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alta a las 24<span class="elsevierStyleHsp" style=""></span>h&#46; Asintom&#225;tica a los 4 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khurram et al&#46; &#40;2015&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inducci&#243;n del parto&#44; instrumental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rigidez de cuello y dolor tor&#225;cico&#46; No disnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax y TC de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mejor&#237;a radiol&#243;gica a las 48<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sagar et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>h y 55<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hinchaz&#243;n de cuello y disnea con enfisema palpable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a y TC de t&#243;rax&#44; endoscopia &#40;no perforaci&#243;n esof&#225;gica&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n completa 3 semanas despu&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Khan et al&#46; &#40;2018&#41;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disnea&#44; tos y hemoptisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4<span class="elsevierStyleHsp" style=""></span>d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TC t&#243;rax &#40;se diagnostic&#243; de neumon&#237;a bilateral&#44; neumomediastino y enfisema subcut&#225;neo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tratamiento antibi&#243;tico y vigilancia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n radiol&#243;gica 4 d&#237;as despu&#233;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee y Young &#40;2019&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>h y 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edema facial y periorbitario&#46; Odinofagia&#46; Dolor tor&#225;cico y crepitaci&#243;n cervical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Durante el parto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n radiol&#243;gica a las 3 semanas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nuestro caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Crepitaci&#243;n en zona clavicular y dolor en cuello con odinofagia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a de t&#243;rax y TC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservador&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resoluci&#243;n radiol&#243;gica a los 12 d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2255528.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Casos de s&#237;ndrome de Hamman publicados en la literatura en los &#250;ltimos 10 a&#241;os</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neumomediastino y enfisema subcut&#225;neo espont&#225;neos postparto&#58; informe de un caso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; L&#243;pez-Hern&#225;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ginecol Obstet Mex&#46;"
                        "fecha" => "2015"
                        "volumen" => "83"
                        "paginaInicial" => "116"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25993775"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous mediastinal emphysema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Hamman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull Johns Hopkins Hosp&#46;"
                        "fecha" => "1939"
                        "volumen" => "64"
                        "paginaInicial" => "1"
                        "paginaFinal" => "21"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum and subcutaneous emphysema &#40;Hamman&#39;s syndrome&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Elshirif"
                            1 => "J&#46; Tyagi-Bhatia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3109/01443615.2015.1060205"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Obstet Gynaecol&#46;"
                        "fecha" => "2016"
                        "volumen" => "36"
                        "paginaInicial" => "281"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26648245"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumomediastinum and subcutaneous emphysema following vaginal delivery&#46; Case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;J&#46; Seidl"
                            1 => "G&#46;L&#46; Brotzman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Fam Pract&#46;"
                        "fecha" => "1994"
                        "volumen" => "39"
                        "paginaInicial" => "178"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8057069"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pneumomediastinum &#40;Hamman&#39;s syndrome&#41;&#58; a rare cause of postpartum chest pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Cho"
                            1 => "J&#46;R&#46; Parratt"
                            2 => "S&#46; Smith"
                            3 => "R&#46; Palet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bcr-2014-208269"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ Case Rep&#46;"
                        "fecha" => "2015"
                        "volumen" => "2015"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25948848"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidural pneumorrhachis consequent to Hamman syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Krishnan"
                            1 => "S&#46; Das"
                            2 => "C&#46; Bhattacharyya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0976-3147.193525"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosci Rural Pract&#46;"
                        "fecha" => "2017"
                        "volumen" => "8"
                        "paginaInicial" => "118"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28149094"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman&#39;s syndrome &#40;spontaneous pneumomediastinum presenting as subcutaneous emphysema&#41;&#58; a rare case of the emergency department and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Konstantinos"
                            1 => "T&#46; Zoi"
                            2 => "L&#46; Vasileios"
                            3 => "K&#46; Sotirios"
                            4 => "C&#46; Kotoulas"
                            5 => "K&#46; Efstratios"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmcr.2017.12.004"
                      "Revista" => array:7 [
                        "tituloSerie" => "Respir Med Case Rep&#46;"
                        "fecha" => "2018"
                        "volumen" => "23"
                        "paginaInicial" => "63"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29276676"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2213260015005214"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman&#39;s syndrome &#40;spontaneus pneumomediastinum&#41; in a parturient&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;M&#46; Bonin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1701-2163(16)32056-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Obstet Gynaecol Can&#46;"
                        "fecha" => "2006"
                        "volumen" => "28"
                        "paginaInicial" => "128"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16643714"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum &#40;Hamman syndrome&#41;&#58; a case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;I&#46; Khan"
                            1 => "R&#46; Shah"
                            2 => "S&#46; Yasir"
                            3 => "M&#46;S&#46; Ahmed"
                            4 => "S&#46; Qadri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pak Med Assoc&#46;"
                        "fecha" => "2018"
                        "volumen" => "68"
                        "paginaInicial" => "1108"
                        "paginaFinal" => "1109"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30317313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman&#39;s syndrome&#58; a rare cause of chest pain in a postpartum patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Khurram"
                            1 => "B&#46; Patel"
                            2 => "M&#46;W&#46; Farra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2015/201051"
                      "Revista" => array:5 [
                        "tituloSerie" => "Case Rep Pulmonol&#46;"
                        "fecha" => "2015"
                        "volumen" => "2015"
                        "paginaInicial" => "201051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25688319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pneumomediastinum &#40;Hamman&#39;s syndrome&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Kelly"
                            1 => "S&#46; Hughes"
                            2 => "S&#46; Nixon"
                            3 => "S&#46; Paterson-Brown"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.surge.2009.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgeon&#46;"
                        "fecha" => "2010"
                        "volumen" => "8"
                        "paginaInicial" => "63"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20303884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous pneumomediastinum&#58; a benign curiosity or a significant problem&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;E&#46; Newcomb"
                            1 => "C&#46;P&#46; Clarke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.128.5.3298"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "3298"
                        "paginaFinal" => "3302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16304275"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum and subcutaneous emphysema&#58; two case reports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Kandiah"
                            1 => "H&#46; Iswariah"
                            2 => "S&#46; Elgey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1155/2013/735154"
                      "Revista" => array:5 [
                        "tituloSerie" => "Case Rep Obstet Gynecol&#46;"
                        "fecha" => "2013"
                        "volumen" => "2013"
                        "paginaInicial" => "735154"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23533868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postpartum pneumomediastinum and subcutaneous emphysema"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Sagar"
                            1 => "T&#46;K&#46; Rogers"
                            2 => "A&#46; Adeni"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bcr-2018-226181"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ Case Rep&#46;"
                        "fecha" => "2018"
                        "volumen" => "2018"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30413448"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hamman syndrome&#58; spontaneous postpartum pneumomediastinum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;Y&#46; Lee"
                            1 => "A&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/imj.14171"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med J&#46;"
                        "fecha" => "2019"
                        "volumen" => "49"
                        "paginaInicial" => "130"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30680904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/03002896/0000005500000012/v2_202003060719/S0300289619302662/v2_202003060719/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "49741"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Scientific Letters / Cartas cient&#237;ficas"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005500000012/v2_202003060719/S0300289619302662/v2_202003060719/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302662?idApp=UINPBA00003Z"
]
Article information
ISSN: 03002896
Original language: Spanish
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 11 4 15
2024 October 191 26 217
2024 September 216 20 236
2024 August 151 43 194
2024 July 155 21 176
2024 June 165 41 206
2024 May 170 23 193
2024 April 78 33 111
2024 March 111 32 143
2024 February 78 19 97
2023 July 2 0 2
2023 June 2 1 3
2023 May 3 1 4
2023 April 1 0 1
2023 March 26 2 28
2023 February 112 24 136
2023 January 76 35 111
2022 December 124 20 144
2022 November 116 30 146
2022 October 155 41 196
2022 September 125 15 140
2022 August 89 48 137
2022 July 74 49 123
2022 June 106 40 146
2022 May 106 41 147
2022 April 70 21 91
2022 March 75 40 115
2022 February 48 33 81
2022 January 51 22 73
2021 December 43 39 82
2021 September 1 2 3
2021 July 2 0 2
2021 May 2 0 2
2021 April 16 28 44
2020 November 4 2 6
2020 October 1 2 3
2020 July 1 0 1
2020 June 1 0 1
2020 May 6 2 8
2020 April 1 2 3
2020 March 8 1 9
2020 February 44 8 52
2020 January 9 0 9
2019 December 87 23 110
2019 November 1 0 1
2019 October 2 1 3
2019 September 4 0 4
2019 August 1 0 1
2019 July 5 4 9
2019 June 5 2 7
Show all

Follow this link to access the full text of the article

Archivos de Bronconeumología

Are you a health professional able to prescribe or dispense drugs?