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Hallazgo radiológico incidental de un caso de drenaje venoso pulmonar anómalo parcial
Incidental Radiological Finding of Partial Anomalous Pulmonary Vein Drainage
Sofía Ventura-Díaz
, Ana Ayala-Carbonero, Luis Gorospe
Corresponding author
Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, España
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B and C) Coronal reconstruction MIP (maximum intensity projection) (B) and 3D (C) images confirming the existence of drainage from the right upper lobe vein to the superior vena cava (straight arrows). Furthermore, the venous return of the middle lobe and several segments of the right lower lobe also drained into this tubular structure. Signs of precapillary pulmonary hypertension with increased pulmonary artery trunk width (asterisk) and secondary RA enlargement are seen. 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(b) CT in prone position after CT guided FNB was completed, showing mass with lateral paravertebral displacement. (c) Patient in the prone position, the needle inserted during CT guided FNB (the arrow shows the insertion point). (d) The same level as (c), right after removal of the needle when CT guided FNB was completed (the arrow shows the point where the needle was previously inserted). Apart from lateral displacement shown in (b), craniocaudal displacement of the mass is evident too.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Maria Kipourou, Ioannis Tsanaktsidis, Georgios Zibilidis" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Maria" "apellidos" => "Kipourou" ] 1 => array:2 [ "nombre" => "Ioannis" "apellidos" => "Tsanaktsidis" ] 2 => array:2 [ "nombre" => "Georgios" "apellidos" => "Zibilidis" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619305915?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000003/v2_202106060540/S0300289619305915/v2_202106060540/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289620302805" "issn" => "03002896" "doi" => "10.1016/j.arbres.2020.08.001" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "2599" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Bronconeumol. 2021;57:214-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Patterns of Physical Activity Progression in Patients With COPD" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "214" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patrones de progresión de la actividad física en pacientes con EPOC" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0015" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 750 "Ancho" => 1333 "Tamanyo" => 70218 ] ] ] ] "autores" => array:3 [ 0 => array:2 [ "autoresLista" => "Maria Koreny, Heleen Demeyer, Marta Benet, Ane Arbillaga-Etxarri, Eva Balcells, Anael Barberan-Garcia, Elena Gimeno-Santos, Nicholas S. 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B y C) Imágenes de reconstrucción coronal MIP (proyección de intensidad máxima) (B) y 3<span class="elsevierStyleHsp" style=""></span>D (C) en las que se confirma la existencia de un drenaje de la vena lobar superior derecha a la vena cava superior (flechas rectas). Además el retorno venoso del lóbulo medio y de varios segmentos del lóbulo inferior derecho también drenaba en dicha estructura tubular. Se observan signos de hipertensión pulmonar precapilar con aumento del calibre del tronco de la arteria pulmonar (asterisco) y crecimiento secundario de la AD. AD: aurícula derecha; Inn: vena innominada; VCS: vena cava superior; VD: ventrículo derecho.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El drenaje venoso pulmonar anómalo parcial (DVPAP) es una patología vascular congénita inusual que suele diagnosticarse incidentalmente. Consiste en la conexión de una (o más) venas pulmonares a una vena sistémica, condicionando un cortocircuito izquierda-derecha. Suele ser asintomática, pero cuando se asocia a otras malformaciones o el cortocircuito es significativo, puede en algunos casos causar hipertensión pulmonar severa<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>. La forma más frecuente de DVPAP consiste en un drenaje de la vena lobar superior derecha a la vena cava superior; esta forma suele asociarse en un 80% de casos a una comunicación interauricular tipo seno venoso<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos un caso de DVPAP diagnosticado incidentalmente en una tomografía computarizada (TC) de tórax en una mujer de 51 años, asintomática. En la TC se observó un DVPAP del lóbulo superior derecho, del lóbulo medio y de algunos segmentos del lóbulo inferior derecho a la vena cava superior, que condicionaba una dilatación de cavidades cardiacas derechas y signos de hipertensión pulmonar precapilar (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>B y <span class="elsevierStyleSmallCaps">C</span>). Nuestro caso resulta interesante por la edad de presentación (a pesar de un DVPAP significativo) y la ausencia de una comunicación interauricular tipo seno venoso concomitante. De forma consensuada se decidió actitud expectante dada la buena función biventricular y la ausencia de síntomas.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1032 "Ancho" => 3000 "Tamanyo" => 262168 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Radiografía de tórax (proyección posteroanterior) en la que se observa un crecimiento de la aurícula derecha (punta de flecha), un aumento del tamaño y de la densidad de ambos hilios (flechas curvas); nótese la presencia de una estructura tubular en pulmón derecho (flechas rectas). B y C) Imágenes de reconstrucción coronal MIP (proyección de intensidad máxima) (B) y 3<span class="elsevierStyleHsp" style=""></span>D (C) en las que se confirma la existencia de un drenaje de la vena lobar superior derecha a la vena cava superior (flechas rectas). Además el retorno venoso del lóbulo medio y de varios segmentos del lóbulo inferior derecho también drenaba en dicha estructura tubular. Se observan signos de hipertensión pulmonar precapilar con aumento del calibre del tronco de la arteria pulmonar (asterisco) y crecimiento secundario de la AD. AD: aurícula derecha; Inn: vena innominada; VCS: vena cava superior; VD: ventrículo derecho.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormal chest X-ray leading to diagnosis of partial anomalous pulmonary venous connection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Z. Farkas" 1 => "A. Haidry" 2 => "S. Yandrapalli" 3 => "M. Lim" 4 => "D. Jain" 5 => "W.S. Aronow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.21037/atm.2018.03.20" "Revista" => array:5 [ "tituloSerie" => "Ann Transl Med." "fecha" => "2018" "volumen" => "6" "paginaInicial" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29862245" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial anomalous pulmonary venous connection and pulmonary arterial hypertension diagnosis by transesophageal echocardiography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Sahay" 1 => "R.A. Krasuski" 2 => "A.R. Tonelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2012.02180.x" "Revista" => array:6 [ "tituloSerie" => "Respirology." "fecha" => "2012" "volumen" => "17" "paginaInicial" => "957" "paginaFinal" => "963.3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22509787" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005700000003/v2_202106060540/S030028961930585X/v2_202106060540/es/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005700000003/v2_202106060540/S030028961930585X/v2_202106060540/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961930585X?idApp=UINPBA00003Z" ]
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