Clinical Image
Acquired Perfusion Defect
Defecto de Perfusión Adquirido
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Imagen de la RM potenciada en T2 con supresión grasa (C) en la que se identifica la masa mediastínica anterior hiperintensa (flecha roja). La lesión era marcadamente hipermetabólica en las imágenes de PET/TC iniciales (SUVmáx<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11,9) (D) y desapareció en la PET/TC transcurridos 4 meses tras comenzar el tratamiento (E).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Dolores Rabadán-Caravaca, Eduardo Ruiz-Carazo, María Dolores García-Roa" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Rabadán-Caravaca" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Ruiz-Carazo" ] 2 => array:2 [ "nombre" => "María Dolores" "apellidos" => "García-Roa" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212921003013" "doi" => "10.1016/j.arbr.2021.09.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003013?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620301678?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000011/v2_202111040649/S0300289620301678/v2_202111040649/es/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0300289620301356" "issn" => "03002896" "doi" => "10.1016/j.arbres.2020.05.002" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "2484" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2021;57:699-700" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Imagen Clínica</span>" "titulo" => "Tromboembolismo pulmonar agudo asintomático en paciente con trombosis diferida del muñón de una arteria pulmonar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "699" "paginaFinal" => "700" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Asymptomatic Acute Pulmonary Embolism in a Patient With a Delayed Pulmonary Artery Stump Thrombosis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1522 "Ancho" => 2500 "Tamanyo" => 366244 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imágenes de la TC de tórax tras la administración de contraste intravenoso, plano axial y ventana de mediastino. A) Imagen de la TC de tórax obtenida 2 años después de la cirugía torácica (lobectomía inferior derecha) en la que se observa la recidiva tumoral (asterisco blanco) y la arteria pulmonar intermediaria permeable (asterisco negro). B) Imagen de la TC de tórax realizada 12 meses después del tratamiento con radioterapia, en la que se identifica un defecto de repleción excéntrico que forma ángulos obtusos en el muñón de la arteria del lóbulo inferior derecho con extensión proximal a la arteria intermediaria (asterisco). C) Imagen de la TC de tórax obtenida 18 meses después de la imagen B, en la que se visualiza un defecto de repleción central en una arteria segmentaria del lóbulo inferior izquierdo (flecha), compatible con un TEP agudo. D y E) Imágenes de la TC de tórax obtenidas 6 meses después de la imagen C en las que se aprecian una resolución del TEP, pero persistencia de la trombosis del muñón de la arteria pulmonar (asterisco).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe-Sarasúa, Margarita Martín-Martín, Rosa Mariela Mirambeaux-Villalona" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe-Sarasúa" ] 1 => array:2 [ "nombre" => "Margarita" "apellidos" => "Martín-Martín" ] 2 => array:2 [ "nombre" => "Rosa Mariela" "apellidos" => "Mirambeaux-Villalona" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212921003001" "doi" => "10.1016/j.arbr.2021.09.002" "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/S1579212921003001?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620301356?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000011/v2_202111040649/S0300289620301356/v2_202111040649/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Acquired Perfusion Defect" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "701" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Firas Bahdi, Audra J. Schwalk, Saadia A. Faiz" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Firas" "apellidos" => "Bahdi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Audra J." "apellidos" => "Schwalk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Saadia A." "apellidos" => "Faiz" "email" => array:1 [ 0 => "safaiz@mdanderson.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Medicine, Baylor College of Medicine, Houston, TX, United States" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Defecto de Perfusión Adquirido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 742 "Ancho" => 2917 "Tamanyo" => 317503 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial contrast-enhanced chest CT with mediastinal (A) and lung (B) windows shows conglomerate tumor (yellow asterisk) in the right hilar and subcarinal space with narrowing of the right bronchus intermedius and right distal main (yellow arrow) pulmonary artery. Quantitative lung perfusion scintigraphy (C) revealed nearly absent perfusion of right lung.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A middle-aged man with metastatic lung cancer and chronic obstructive pulmonary disease (COPD) presented with increasing dyspnea, wheezing, and cough for two weeks. On examination, he had irregularly irregular tachycardia, bilateral end-expiratory wheezes, and no peripheral edema. EKG revealed atrial fibrillation with rapid ventricular response. CT of the chest revealed no pulmonary embolism, a centrally obstructing right infrahilar soft tissue mass with narrowing of the right bronchus intermedius (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1A and B</a>). Echocardiogram confirmed normal biventricular systolic function without pulmonary hypertension. Pulmonary was consulted for tracheobronchial intervention, but quantitative ventilation/perfusion study revealed minimal perfusion in the right lung (<a class="elsevierStyleCrossRef" href="#fig0005">Figs. 1C</a>). Following conservative medical therapy with amiodarone, inhaled bronchodilators and steroids for COPD exacerbation, patient gradually improved. Chemotherapy (carboplatin, pemetrexed) was continued. The patient expired 7 months later due to progressive disease.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Quantitative lung scanning is a non-invasive procedure that provides prognostic information for postoperative pulmonary function.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Unilateral absence of perfusion on ventilation/perfusion scan is rare, and literature is limited to case reports and small case series. Acquired conditions may include malignant fibrous histiocytoma, pulmonary artery tumors, bronchogenic carcinoma, pulmonary vein stenosis and massive pulmonary embolism.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Bronchoscopic intervention is typically a palliative procedure in advanced lung cancer, and although it may have been technically feasible, compression of pulmonary vasculature and resolution of his acute symptoms would not support tracheobronchial intervention.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0015" class="elsevierStylePara elsevierViewall">This research is supported in part by the National Institutes of Health through MD <span class="elsevierStyleGrantSponsor" id="gs1">Anderson's Cancer Center Support Grant</span> (<span class="elsevierStyleGrantNumber" refid="gs1">CA016672</span>).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of Interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no conflicts of interest exist.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 742 "Ancho" => 2917 "Tamanyo" => 317503 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial contrast-enhanced chest CT with mediastinal (A) and lung (B) windows shows conglomerate tumor (yellow asterisk) in the right hilar and subcarinal space with narrowing of the right bronchus intermedius and right distal main (yellow arrow) pulmonary artery. Quantitative lung perfusion scintigraphy (C) revealed nearly absent perfusion of right lung.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation-perfusion scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing pneumonectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "T. Win" 1 => "A.D. Tasker" 2 => "A.M. Groves" 3 => "C. White" 4 => "A.J. Ritchie" 5 => "F.C. Wells" 6 => "C.M. Laroche" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2006" "volumen" => "187" "paginaInicial" => "1260" "paginaFinal" => "1265" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acquired whole-lung mismatched perfusion defects on pulmonary ventilation/perfusion scintigraphy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.W. Bowman" 1 => "B.K. Albers" 2 => "M.K. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/ijnm.IJNM_60_18" "Revista" => array:6 [ "tituloSerie" => "Indian J Nucl Med" "fecha" => "2018" "volumen" => "33" "paginaInicial" => "312" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30386053" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005700000011/v2_202111040649/S030028962030137X/v2_202111040649/en/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/03002896/0000005700000011/v2_202111040649/S030028962030137X/v2_202111040649/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028962030137X?idApp=UINPBA00003Z" ]
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