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Imagen Clínica
Diagnóstico y tratamiento urgente de la ruptura de un pseudoaneurisma mucormicótico pulmonar
Diagnosis and Emergency Treatment of Ruptured Mucormycotic Pulmonary Pseudoaneurism
María del Mar García Gallardo
Corresponding author
bulevar1399@hotmail.com

Autor para correspondencia.
, María Lucía Berma Gascón
FEA Radiodiagnóstico, Hospital Universitario Virgen de la Victoria, Málaga, España
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Rx t&#243;rax AP-Infiltrado alveolar en LID con algunas &#225;reas radiolucentes en su interior asociado a derrame pleural&#46; B&#41; TC t&#243;rax con contraste endovenoso &#40;ventana mediastino&#41;&#46; Consolidaci&#243;n parenquimatosa pulmonar con colecci&#243;n hipodensa de pared gruesa y realzada en relaci&#243;n con absceso de 6 cm &#40;neumon&#237;a necrotizante&#41; y derrame pleural&#46; Lesi&#243;n de morfolog&#237;a sacular&#44; de 14 mm&#44; en relaci&#243;n con pseudoaneurisma mucormic&#243;tico&#46; C&#41; Arteriograf&#237;a diagn&#243;stico-terap&#233;utica&#46; Lesi&#243;n de morfolog&#237;a sacular en relaci&#243;n con pseudoaneurisma dependiente de la rama inferior del segmento medial del LID&#46; D&#41; Pseudoaneurisma de menor tama&#241;o respecto a figura C y extravasaci&#243;n del contraste en relaci&#243;n con rotura&#46; E&#41; Embolizaci&#243;n mediante dispositivo Amplatzer &#40;flecha negra&#41; y colocaci&#243;n de coils &#40;flecha amarilla&#41; en rama arterial del segmento inferomedial del LID&#46; F&#41; Pieza quir&#250;rgica tras lobectom&#237;a inferior derecha&#46; Se observa cavidad necr&#243;tica y dispositivo Amplatzer &#40;flecha&#41;&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AP&#58; Anatom&#237;a Patol&#243;gica&#59; LID&#58; l&#243;bulo inferior derecho&#59; Rx&#58; rayos x&#59; TC&#58; tomograf&#237;a computarizada&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Se presenta el caso de una paciente de 29 a&#241;os que acudi&#243; a urgencias por deterioro del estado general&#44; disnea&#44; fiebre de hasta 38&#176; y dolor costal derecho&#46; Se hab&#237;a realizado el diagn&#243;stico reciente de diabetes mellitus tipo I<span class="elsevierStyleSmallCaps">&#44;</span> debutando una semana antes con un episodio de cetoacidosis&#46; En la anal&#237;tica&#44; destac&#243; una importante leucocitosis e hiperglucemia<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Se identific&#243; neumon&#237;a en el l&#243;bulo inferior derecho &#40;LID&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41; y se procedi&#243; al ingreso de la paciente&#46; La mujer present&#243; una evoluci&#243;n t&#243;rpida y un episodio de hemoptisis autolimitada&#44; realiz&#225;ndose una broncoscopia con toma de biopsia&#44; identific&#225;ndose la presencia de hifas de <span class="elsevierStyleItalic">Mucor fungus</span>&#46; Se efectu&#243; una tomograf&#237;a computarizada &#40;TC&#41; tor&#225;cica con contraste intravenoso &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#44; objetivando hallazgos compatibles con neumon&#237;a necrotizante&#44; aumento del derrame pleural y lesi&#243;n de morfolog&#237;a sacular de 14 mm en relaci&#243;n con pseudoaneurisma mucormic&#243;tico dependiente de la rama del segmento inferomedial del LID&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Ante estos hallazgos&#44; se llev&#243; a cabo una arteriograf&#237;a con intenci&#243;n terap&#233;utica &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>C&#41; con cateterizaci&#243;n selectiva de la lesi&#243;n y produci&#233;ndose la ruptura de la misma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>D&#41;&#46; La paciente comienza con hemoptisis franca&#44; siendo necesaria una embolizaci&#243;n de car&#225;cter urgente mediante un dispositivo Amplatzer tipo 2 de 14 mm y la colocaci&#243;n de coils de 10 mm y Amplatzer de 8 mm en la rama del segmento inferomedial del LID&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En un segundo tiempo&#44; tras la estabilizaci&#243;n cl&#237;nica con tratamiento dirigido &#40;anfotericina-liposomal y capsofungina&#41; se procedi&#243; a realizar una lobectom&#237;a inferior derecha &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>F&#41; sin otras complicaciones&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicto de intereses</span><p id="par0025" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Rx t&#243;rax AP-Infiltrado alveolar en LID con algunas &#225;reas radiolucentes en su interior asociado a derrame pleural&#46; B&#41; TC t&#243;rax con contraste endovenoso &#40;ventana mediastino&#41;&#46; Consolidaci&#243;n parenquimatosa pulmonar con colecci&#243;n hipodensa de pared gruesa y realzada en relaci&#243;n con absceso de 6 cm &#40;neumon&#237;a necrotizante&#41; y derrame pleural&#46; Lesi&#243;n de morfolog&#237;a sacular&#44; de 14 mm&#44; en relaci&#243;n con pseudoaneurisma mucormic&#243;tico&#46; C&#41; Arteriograf&#237;a diagn&#243;stico-terap&#233;utica&#46; Lesi&#243;n de morfolog&#237;a sacular en relaci&#243;n con pseudoaneurisma dependiente de la rama inferior del segmento medial del LID&#46; D&#41; Pseudoaneurisma de menor tama&#241;o respecto a figura C y extravasaci&#243;n del contraste en relaci&#243;n con rotura&#46; E&#41; Embolizaci&#243;n mediante dispositivo Amplatzer &#40;flecha negra&#41; y colocaci&#243;n de coils &#40;flecha amarilla&#41; en rama arterial del segmento inferomedial del LID&#46; F&#41; Pieza quir&#250;rgica tras lobectom&#237;a inferior derecha&#46; Se observa cavidad necr&#243;tica y dispositivo Amplatzer &#40;flecha&#41;&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AP&#58; Anatom&#237;a Patol&#243;gica&#59; LID&#58; l&#243;bulo inferior derecho&#59; Rx&#58; rayos x&#59; TC&#58; tomograf&#237;a computarizada&#46;</p>"
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Article information
ISSN: 03002896
Original language: Spanish
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