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Presenta extensión central condicionando obstrucción con componente endobronquial del bronquio segmentario lateral del lóbulo medio y de bronquios subsegmentarios y adenopatía interlobar medial a la masa de 1,2<span class="elsevierStyleHsp" style=""></span>cm (A). Imagen de PET/TC que muestra una masa hipermetabólica en lóbulo medio con SUVmax 19,51 y captación focal de la FDG en región hiliar derecha, con SUVmax 13,36, en relación con adenopatía (B). Imagen intraoperatoria durante el abordaje robótico en la que se objetiva la presencia de extensión intravascular del tumor a nivel vena de lóbulo medio (flecha) (C). Imagen intraoperatoria durante el abordaje abierto (toracotomía sin sección muscular) en la que se objetiva la presencia de tumor en margen distal (flecha) y clamp en margen proximal de la vena del lóbulo medio tras sección del vaso (D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Teresa Gómez Hernández, Marcelo F. 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Presenta extensión central condicionando obstrucción con componente endobronquial del bronquio segmentario lateral del lóbulo medio y de bronquios subsegmentarios y adenopatía interlobar medial a la masa de 1,2<span class="elsevierStyleHsp" style=""></span>cm (A). Imagen de PET/TC que muestra una masa hipermetabólica en lóbulo medio con SUVmax 19,51 y captación focal de la FDG en región hiliar derecha, con SUVmax 13,36, en relación con adenopatía (B). Imagen intraoperatoria durante el abordaje robótico en la que se objetiva la presencia de extensión intravascular del tumor a nivel vena de lóbulo medio (flecha) (C). Imagen intraoperatoria durante el abordaje abierto (toracotomía sin sección muscular) en la que se objetiva la presencia de tumor en margen distal (flecha) y clamp en margen proximal de la vena del lóbulo medio tras sección del vaso (D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Teresa Gómez Hernández, Marcelo F. 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Jiménez López" "autores" => array:2 [ 0 => array:4 [ "nombre" => "María Teresa" "apellidos" => "Gómez Hernández" "email" => array:1 [ 0 => "mtgh@usal.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marcelo F." "apellidos" => "Jiménez López" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad de Salamanca, Salamanca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgo intraoperatorio inesperado de un trombo tumoral en vena pulmonar durante una lobectomía robótica" ] ] "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" => 784 "Ancho" => 1000 "Tamanyo" => 146623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT image showing a hypodense lobulated mass measuring 6.1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.4<span class="elsevierStyleHsp" style=""></span>cm (transverse, anteroposterior, craniocaudal) located predominantly at the periphery of the middle lobe in contact with the costal pleura, the horizontal fissure, and the oblique fissure. Central extension, forming a partly endobronchial obstruction of the lateral segmental bronchus of the middle lobe and subsegmental bronchi and a medial interlobar lymphadenopathy to the mass measuring 1.2<span class="elsevierStyleHsp" style=""></span>cm were observed (A). PET/CT image showing a hypermetabolic mass in the middle lobe with SUVmax 19.51 and focal uptake of FDG in the right hilar region, and lymphadenopathy with SUVmax 13.36 (B). Intraoperative image during the robotic approach revealing the presence of an intravascular tumor extension at the mid-lobe vein (arrow) level (C). Intraoperative image during the open approach (thoracotomy without muscle section) showing the presence of tumor in distal margin (arrow) and clamp in proximal margin of the middle lobe vein after vessel section (D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 68-year-old patient with a history of acute myeloblastic leukemia and acute myocardial infarction who presented with a mass in the middle lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) that was hyperdense on PET, and interlobar lymphadenopathy suggestive of malignancy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). After ruling out N2 involvement, a robotic middle lobectomy was planned and performed 2 months after the diagnostic CT scan. During the procedure, a tumor thrombus, unsuspected before the procedure, was observed in the middle lobe vein 10–12<span class="elsevierStyleHsp" style=""></span>mm from the atrium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), so extrapericardial proximal clamping and manual suture of the vein were performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D) after conversion to thoracotomy. The pathological diagnosis was pleomorphic carcinoma (pT3N1M0).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Histopathological evidence of intravascular tumors extending into pulmonary veins has been reported in 0.7% of lung cancer patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Its presence significantly worsens prognosis and has a significant impact on therapeutic management.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The use of the latest imaging technologies (3D vision and high resolution) in endoscopic surgical procedures (VATS and robotics) improves quality and precision, revealing details that assist in the identification of this type of lesion.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests directly or indirectly related with the contents of this manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 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" => 784 "Ancho" => 1000 "Tamanyo" => 146623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT image showing a hypodense lobulated mass measuring 6.1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>5.8<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.4<span class="elsevierStyleHsp" style=""></span>cm (transverse, anteroposterior, craniocaudal) located predominantly at the periphery of the middle lobe in contact with the costal pleura, the horizontal fissure, and the oblique fissure. Central extension, forming a partly endobronchial obstruction of the lateral segmental bronchus of the middle lobe and subsegmental bronchi and a medial interlobar lymphadenopathy to the mass measuring 1.2<span class="elsevierStyleHsp" style=""></span>cm were observed (A). PET/CT image showing a hypermetabolic mass in the middle lobe with SUVmax 19.51 and focal uptake of FDG in the right hilar region, and lymphadenopathy with SUVmax 13.36 (B). Intraoperative image during the robotic approach revealing the presence of an intravascular tumor extension at the mid-lobe vein (arrow) level (C). Intraoperative image during the open approach (thoracotomy without muscle section) showing the presence of tumor in distal margin (arrow) and clamp in proximal margin of the middle lobe vein after vessel section (D).</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" => "Lung cancer invading the pericardium: quantum of lymph nodes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Riquet" 1 => "B. Grand" 2 => "A. Arame" 3 => "C.F. Pricopi" 4 => "C. Foucault" 5 => "A. Dujon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2010.07.039" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2010" "volumen" => "90" "paginaInicial" => "1773" "paginaFinal" => "1777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21095307" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor thrombus: incidence, imaging, prognosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.B. Quencer" 1 => "T. Friedman" 2 => "R. Sheth" 3 => "R. Oklu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.21037/cdt.2017.09.16" "Revista" => array:7 [ "tituloSerie" => "Cardiovasc Diagn Ther" "fecha" => "2017" "volumen" => "7" "numero" => "Suppl. 3" "paginaInicial" => "S165" "paginaFinal" => "S177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29399520" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000004/v5_202301090807/S0300289622001739/v5_202301090807/en/main.assets" "Apartado" => array:4 [ "identificador" => "93646" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Images/Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000004/v5_202301090807/S0300289622001739/v5_202301090807/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622001739?idApp=UINPBA00003Z" ]
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