Clinical Image
An Unusual Cause of Pulmonary Embolism
Una causa infrecuente de embolismo pulmonar
Cristina Trasancos-Escura
, Ana Pinos-Blanco
Corresponding author
Servicio de Medicina Interna, Hospital General Universitario Morales Meseguer, Murcia, Spain
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Note a subpleural cavitating lesion in the right lung (black asterisk). 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Note sequelae from tuberculosis in the left hemithorax. (B) 3D reconstruction (volume rendering) of chest CT (Ao: aorta; P: pulmonary artery) providing a better view of the fistula between the branches of the left bronchial artery (black arrows) and the pulmonary artery (white arrows). (C) Angiogram showing retrograde filling of pulmonary arteries (white arrows) from the tortuous branches of the left bronchial artery (black arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Frank Eric Farfán-Leal, Raquel García-Latorre" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Frank Eric" "apellidos" => "Farfán-Leal" ] 2 => array:2 [ "nombre" => "Raquel" "apellidos" => "García-Latorre" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S030028961500455X" "doi" => "10.1016/j.arbres.2015.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961500455X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301732?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301732/v2_201609300109/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "An Unusual Cause of Pulmonary Embolism" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "528" "paginaFinal" => "529" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Cristina Trasancos-Escura, Ana Pinos-Blanco" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Cristina" "apellidos" => "Trasancos-Escura" "email" => array:1 [ 0 => "c_trasancos@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Pinos-Blanco" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital General Universitario Morales Meseguer, Murcia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una causa infrecuente de embolismo pulmonar" ] ] "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" => 1328 "Ancho" => 1500 "Tamanyo" => 182475 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior (A) and lateral (B) chest radiographs with dense ramified material, associated with cement emboli, in the right upper, middle and lower lung fields and the left middle field. On the chest CT cross-sectional slice (C and D), the same material occupies right upper lobe segmental arteries.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 76-year-old woman, operated 2 years previously for stenosis of the lumbar canal, with sequelae of sagittal imbalance and lumbar pseudoarthrosis. She was hospitalized to undergo T10-S1 arthrodesis with L3 percutaneous vertebroplasty. Six hours after surgery she developed dyspnea, tachypnea, and hypoxemia. On chest radiograph (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), dense ramified material was observed in the right upper, middle and lower lung fields and in the left middle field. On chest computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D), this material occupied the segmental arteries of the right upper, middle and lower lobes and the left upper lobe, and was diagnosed as pulmonary cement embolism (polymethylmethacrylate). She needed high-flow oxygen therapy for the first 24<span class="elsevierStyleHsp" style=""></span>h, after which the oxygen component was gradually reduced until withdrawal a few days later. Pulmonary cement embolism is a potential complication after percutaneous vertebroplasty, due to extravasation of the cement injected into the vertebra to the paravertebral venous system, from where it can migrate to the pulmonary arteries.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> In cases of asymptomatic or peripheral embolism, the recommended approach is observation. Anticoagulant therapy, or even embolectomy, should be reserved for symptomatic cases or central embolism.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Trasancos-Escura C, Pinos-Blanco A. Una causa infrecuente de embolismo pulmonar. Arch Bronconeumol. 2016;52:528–529.</p>" ] ] "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" => 1328 "Ancho" => 1500 "Tamanyo" => 182475 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior (A) and lateral (B) chest radiographs with dense ramified material, associated with cement emboli, in the right upper, middle and lower lung fields and the left middle field. On the chest CT cross-sectional slice (C and D), the same material occupies right upper lobe segmental arteries.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Krueger" 1 => "C. Bliemel" 2 => "R. Zettl" 3 => "S. Ruchholtz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00586-009-1073-y" "Revista" => array:6 [ "tituloSerie" => "Eur Spine J" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "1257" "paginaFinal" => "1265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19575243" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cement pulmonary embolism after vertebroplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.A. Giraldo" 1 => "J.R. Lamúa Riazuelo" 2 => "J.I. Gallego Rivera" 3 => "M. Vázquez Díaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2012.07.005" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2013" "volumen" => "9" "paginaInicial" => "239" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23481509" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301744/v2_201609300109/en/main.assets" "Apartado" => array:4 [ "identificador" => "21342" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000010/v2_201609300109/S1579212916301744/v2_201609300109/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301744?idApp=UINPBA00003Z" ]
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