Clinical Image
Hemoptysis and Thoracic Aortic Pseudoaneurysm
Carlos Sánchez Villar
, Raúl Godoy Mayoral, Javier Cruz Ruiz
Corresponding author
Complejo Hospitalario Universitario de Albacete, Servicio de Neumología, Post code: 02006, Spain
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(B) EBUS-TBNA was performed with a 22-gauge needle (EchoTip ProCore: Cook Medical) in station 7 node. (C) Puncture site made by TBNA needle; steps of inserting 1.1<span class="elsevierStyleHsp" style=""></span>mm cryo-probe through the puncture site, (D) tip of the cryo-probe approaching the puncture site, (E) after pushing the probe gently the tip of the cryo-probe is completely inside the node. (F) EBUS image showing the tip of the 1.1<span class="elsevierStyleHsp" style=""></span>mm cryo-probe within the lymph node. (G) Pentax EBUS scope (EB-1970UK) with 1.1<span class="elsevierStyleHsp" style=""></span>mm cryo-probe in the working channel. The tip of the probe has the lymph node tissue obtained by cryobiopsy. (H) Bronchoscopic view of the puncture site after taking cryo-nodal biopsy (no bleeding was observed). (I) Samples obtained from transbronchial mediastinal cryobiopsy. (J) Simple view of cryobiopsy stained with H&E. (K) Microscopic image of the cryobiopsy sample at low magnification (2×) showing an integrated and compact tissue. (L) Microscopic image of cryobiopsy (10×) showing a well-preserved architecture. (M) Simple view of the cell-block obtained by TBNA stained with H&E. (N) Microscopic image (2×) of the biopsy obtained by TBNA where a very fragmented tissue is observed. (O) Microscopic image (10×) of TBNA cell-block with marked artifacts of size, shape, and chromatin density.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Angel Ariza-Prota, Javier Pérez-Pallarés, Alejandro Fernández-Fernández, Francisco López-González, Juan Alejandro Cascón, Lucía García-Alfonso, Héctor Torres-Rivas, Luis Fernández-Fernández, Inmaculada Sánchez, María Gil, Marta García-Clemente" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Ariza-Prota" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Pérez-Pallarés" ] 2 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Fernández-Fernández" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "López-González" ] 4 => array:2 [ "nombre" => "Juan Alejandro" "apellidos" => "Cascón" ] 5 => array:2 [ "nombre" => "Lucía" "apellidos" => "García-Alfonso" ] 6 => array:2 [ "nombre" => "Héctor" "apellidos" => "Torres-Rivas" ] 7 => array:2 [ "nombre" => "Luis" "apellidos" => "Fernández-Fernández" ] 8 => array:2 [ "nombre" => "Inmaculada" "apellidos" => "Sánchez" ] 9 => array:2 [ "nombre" => "María" "apellidos" => "Gil" ] 10 => array:2 [ "nombre" => "Marta" "apellidos" => "García-Clemente" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622003908?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000010/v2_202302271800/S0300289622003908/v2_202302271800/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289622004501" "issn" => "03002896" "doi" => "10.1016/j.arbres.2022.05.014" "estado" => "S300" "fechaPublicacion" => "2022-10-01" "aid" => "3134" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2022;58:716" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Horner Syndrome as a Complication of Pleural Drainage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "716" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 463 "Ancho" => 1005 "Tamanyo" => 66490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Eyelid ptosis and myosis of the left eye. (B) Chest X-ray: the tip of the pleural drainage tube is seen at the left lung apex (<span class="elsevierStyleItalic">red arrow</span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Valentina Alicia Rebolledo Navarrete, Hernán Luis Canale, Alejando Gabriel Da Lozzo, Horacio Matías Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Valentina Alicia" "apellidos" => "Rebolledo Navarrete" ] 1 => array:2 [ "nombre" => "Hernán Luis" "apellidos" => "Canale" ] 2 => array:2 [ "nombre" => "Alejando Gabriel" "apellidos" => "Da Lozzo" ] 3 => array:2 [ "nombre" => "Horacio Matías" "apellidos" => "Castro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622004501?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000010/v2_202302271800/S0300289622004501/v2_202302271800/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Hemoptysis and Thoracic Aortic Pseudoaneurysm" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "717" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Sánchez Villar, Raúl Godoy Mayoral, Javier Cruz Ruiz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Carlos" "apellidos" => "Sánchez Villar" "email" => array:1 [ 0 => "carlos.uclm@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Raúl" "apellidos" => "Godoy Mayoral" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Cruz Ruiz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Complejo Hospitalario Universitario de Albacete, Servicio de Neumología, Post code: 02006, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "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" => 1079 "Ancho" => 1200 "Tamanyo" => 105005 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray image showing alveolar infiltrate in the LUL (A). Chest CT angiogram imaging showing ruptured pseudoaneurysm with alveolar hemorrhage in LUL (B). Reconstructed 3-dimensional image showing thoracic aorta with ruptured pseudoaneurysm (C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 66-year-old man with hypertension and poorly controlled diabetes who attended the emergency department for moderate hemoptysis (50<span class="elsevierStyleHsp" style=""></span>ml), fever, persistent oppressive central chest pain radiating to the neck, and dyspnea at rest that had developed a few hours previously. He reported a 7-day history of chest pain and blood pressure of up to 200/120<span class="elsevierStyleHsp" style=""></span>mmHg, along with dysphagia to solids in the last 72<span class="elsevierStyleHsp" style=""></span>h. The chest X-ray showed extensive consolidation in the left upper lobe (LUL) with tracheal deviation toward the contralateral side. Emergency chest CT angiogram was requested, revealing a pseudoaneurysm of the aortic arch measuring approximately 4<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3.5<span class="elsevierStyleHsp" style=""></span>cm, with a 2<span class="elsevierStyleHsp" style=""></span>cm tear in the left lateral aortic wall, an adjacent hematoma, and alveolar hemorrhage in the LUL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Emergency surgery was performed to place an aortic endoprosthesis, but the patient died in the recovery room due to refractory hypovolemic shock associated with left hemothorax.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thoracic aortic aneurysms are usually asymptomatic, although rupture may constitute a life-threatening emergency.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> In our case, onset occurred with hemoptysis and alveolar hemorrhage, and the patient was diagnosed using CT angiogram, although he subsequently died.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0025" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1079 "Ancho" => 1200 "Tamanyo" => 105005 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray image showing alveolar infiltrate in the LUL (A). Chest CT angiogram imaging showing ruptured pseudoaneurysm with alveolar hemorrhage in LUL (B). Reconstructed 3-dimensional image showing thoracic aorta with ruptured pseudoaneurysm (C).</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 207770 ] ] ] "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" => "Aneurismas del arco aórtico, generalidades: epidemiología, manifestaciones clínicas y diagnóstico. Indicaciones de cirugía. Cirugía abierta" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Bernabeu" 1 => "A. García-Valentín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cir Cardiov" "fecha" => "2015" "volumen" => "22" "paginaInicial" => "253" "paginaFinal" => "257" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemoptisis amenazante en el aneurisma de aorta. A propósito de un caso con supervivencia prolongada" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Carrión Valero" 1 => "E.M. Rodrídguez Castro" 2 => "J. Marín Pardo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Med Interna" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "59" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11989098" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000010/v2_202302271800/S0300289622004495/v2_202302271800/en/main.assets" "Apartado" => array:4 [ "identificador" => "94561" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000010/v2_202302271800/S0300289622004495/v2_202302271800/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622004495?idApp=UINPBA00003Z" ]
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