Clinical Image
Acute Hemorrhage into an Emphysematous Bulla
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array:23 [ "pii" => "S0300289623001060" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.03.007" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "3287" "copyright" => "SEPAR" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2023;59:394-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289623001126" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.03.013" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "3293" "copyright" => "The Author(s)" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2023;59:396" "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" => "Alectinib-Induced Diffuse Alveolar Hemorrhage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "396" ] ] "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" => 1071 "Ancho" => 2167 "Tamanyo" => 443164 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography shows bilateral scattered ground-glass opacities with thickening of the interlobular septa (A–C, white arrows). Bloody bronchoalveolar lavage fluid (D); cytology shows hemosiderin-laden macrophages (E). Chest computed tomography shows an irregular mass in the left central lung (F, asterisk).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Yosuke Fukuda, Hironori Sagara" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Yosuke" "apellidos" => "Fukuda" ] 1 => array:2 [ "nombre" => "Hironori" "apellidos" => "Sagara" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001126?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623001126/v2_202308080837/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289623001011" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.02.019" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "3282" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2023;59:393" "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" => "Bullous Lung Disease Post-COVID" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "393" ] ] "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" => 1766 "Ancho" => 2500 "Tamanyo" => 618367 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracic CT images observing bilateral bullous injuries and their comparison at the same level in a CT control showing their resolution after 3 months.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Manzano Senra, Ricard Pifarré Teixidó, Marina Asunción Pardina Solano" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Manzano Senra" ] 1 => array:2 [ "nombre" => "Ricard" "apellidos" => "Pifarré Teixidó" ] 2 => array:2 [ "nombre" => "Marina Asunción" "apellidos" => "Pardina Solano" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001011?idApp=UINPBA00003Z" "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623001011/v2_202308080837/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Acute Hemorrhage into an Emphysematous Bulla" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "394" "paginaFinal" => "395" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Jesús Lobo-Rebollo, Carlota García-Barón, Felipe Villar-Álvarez" "autores" => array:3 [ 0 => array:3 [ "nombre" => "María Jesús" "apellidos" => "Lobo-Rebollo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Carlota" "apellidos" => "García-Barón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Felipe" "apellidos" => "Villar-Álvarez" "email" => array:1 [ 0 => "fvillarleon@yahoo.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Pulmonology Department, IIS Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiology Department, IIS Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidad Autónoma of Madrid, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "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" => 1149 "Ancho" => 982 "Tamanyo" => 132719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiplanar chest CT reconstructions with intravenous contrast in axial (A) and sagittal (B) planes where a bulla located in the medial basal segment of the LLL with hematic level is observed. 3D segmentation of the findings in axial (C) and sagittal (D) projection. In orange (C and D), the airway and bulla stand out, and bleeding is shown in red. Multiplanar CT reconstructions without intravenous contrast in axial (E) and sagittal (F) planes 5 months later. Persistence of the bulla located in the medial basal segment of LLL with smaller size and in the absence of the hematic level (E and F).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Emphysematous bullae are focal regions of air trapping in patients with chronic obstructive pulmonary disease (COPD). The presence of hematic content is a rare form of presentation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 70-year-old man, ex-smoker, diagnosed with atrial fibrillation anticoagulated with acenocoumarol, who also suffered from severe COPD, was admitted to the hospital due to a 2-day history of hemoptysis (20 cc per day). A chest computed tomography (CT) scan revealed emphysema regions, along with a bulla in the medial basal segment of the left lower lobe (LLL), with blood content inside (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#sec0030">Video</a>). Anticoagulation was suspended and a bronchoscopy was performed, which found a possible beginning point, and ruled out the presence of active bleeding. Given the persistence of hemoptysis, a lobectomy or arterial embolization was considered, but due to the hemodynamic stability of the patient, conservative treatment was continued. Finally, the hemoptysis stopped and anticoagulation was restarted. Five months later, bulla reduced and had no hematic level. The patient was totally asymptomatic.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary bullae are common in patients with COPD, but the presence of blood content is exceptional,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> This case describes the formation of hematoma in an emphysematous bulla of an anticoagulated patient, and shows its evolution through CT reconstructions.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0020" class="elsevierStylePara elsevierViewall">All authors have made substantial contributions in each of the following aspects: conception, clinical case design and data acquisition, drafting of the article and critical revision of the intellectual content, and final approval of the presented version.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">Informed consent was obtained from the patient's relative for publication of the clinical data and images present in this manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have not received any fees or funding for the development of the clinical case presented.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">FV-Á has attended or participated in activities organized or financed by the pharmaceutical companies Almiral, AstraZeneca, Bial, BoehringerIngelheim, Chiesi, GlaxoSmithKline, Esteve, Ferrer, Menarini, Novartis, Mundipharma, Orion, Pfizer, Teva and Zambon. FV-Á is part of the Editorial Board of Archivos de Bronconeumología and declares to have remained outside the evaluation and decision-making process in relation to this article.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The rest of the authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Informed consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1149 "Ancho" => 982 "Tamanyo" => 132719 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multiplanar chest CT reconstructions with intravenous contrast in axial (A) and sagittal (B) planes where a bulla located in the medial basal segment of the LLL with hematic level is observed. 3D segmentation of the findings in axial (C) and sagittal (D) projection. In orange (C and D), the airway and bulla stand out, and bleeding is shown in red. Multiplanar CT reconstructions without intravenous contrast in axial (E) and sagittal (F) planes 5 months later. Persistence of the bulla located in the medial basal segment of LLL with smaller size and in the absence of the hematic level (E and F).</p>" ] ] 1 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Supplementary Video" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 5439042 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">. Video of 3D segmentation of trachea, bronchi and small airway, as well as the bulla (represented in orange) and blood level in dependent location (represented in red) located in the anteromedial segment of the left lower lobe.</p>" ] ] 2 => array:6 [ "identificador" => "202308080838270801" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 39 "Ancho" => 48 "Tamanyo" => 996 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "sat0005" "detalle" => "Twitter Ico" "rol" => "short" ] ] ] ] "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" => "Spontaneous pulmonary haemorrhage into an existing emphysematous bulla" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Withey" 1 => "A. Tamimi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2016" "volumen" => "2016" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The bleeding into the emphysematous bulla imitating lung tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Trzciński" 1 => "K. Folcik" 2 => "B. Burakowska" 3 => "K. Błasińska" 4 => "E. Wiatr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pneumonol Alergol Pol" "fecha" => "2012" "volumen" => "80" "paginaInicial" => "275" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22562278" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005900000006/v2_202308080837/S0300289623001060/v2_202308080837/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/03002896/0000005900000006/v2_202308080837/S0300289623001060/v2_202308080837/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623001060?idApp=UINPBA00003Z" ]
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