Scientific Letter
Intraventricular Air Embolism Complicating Computed Tomography-Guided Pulmonary Aspiration Biopsy
Embolia aérea intraventricular como complicación de una punción biopsia pulmonar guiada por tomografía computarizada
a Sector de Cirugía Torácica y Trasplante Pulmonar, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
b Intervencionismo y Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
c Servicio de Cirugía Cardiovascular Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Read
4376
Timeswas read the article
1732
Total PDF
2644
Total HTML
Share statistics
array:24 [ "pii" => "S157921291730109X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.04.002" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1450" "copyright" => "SEPAR" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:348-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1178 "formatos" => array:3 [ "EPUB" => 122 "HTML" => 671 "PDF" => 385 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0300289616302320" "issn" => "03002896" "doi" => "10.1016/j.arbres.2016.09.002" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1450" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:348-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2441 "formatos" => array:3 [ "EPUB" => 128 "HTML" => 1826 "PDF" => 487 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Embolia aérea intraventricular como complicación de una punción biopsia pulmonar guiada por tomografía computarizada" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "348" "paginaFinal" => "349" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Intraventricular Air Embolism Complicating Computed Tomography-Guided Pulmonary Aspiration Biopsy" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 575 "Ancho" => 1500 "Tamanyo" => 205912 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Neumotórax derecho asociado a embolia aérea dentro de ventrículo izquierdo (flecha). B) Catéter de drenaje en espacio pleural (flecha) con resolución del neumotórax derecho y de la embolia aérea.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Agustin Dietrich, Analía Vargas, David E. Smith, Alberto Domenech" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Agustin" "apellidos" => "Dietrich" ] 1 => array:2 [ "nombre" => "Analía" "apellidos" => "Vargas" ] 2 => array:2 [ "nombre" => "David E." "apellidos" => "Smith" ] 3 => array:2 [ "nombre" => "Alberto" "apellidos" => "Domenech" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157921291730109X" "doi" => "10.1016/j.arbr.2017.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291730109X?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302320?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000006/v2_201707150129/S0300289616302320/v2_201707150129/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212917301106" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.04.003" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1457" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:349-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1247 "formatos" => array:3 [ "EPUB" => 142 "HTML" => 746 "PDF" => 359 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Bronchiolitis Obliterans Following Hematopoietic Stem Cell Transplantation: Importance of Expiratory Computed Tomography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "351" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bronquiolitis constrictiva tras trasplante de progenitores hematopoyéticos: importancia de la tomografía computarizada espiratoria" ] ] "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" => 1228 "Ancho" => 1500 "Tamanyo" => 211381 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) minIP coronal reconstruction of the chest inspiratory CT showing homogeneous pulmonary parenchyma with uniform attenuation. (B) minIP coronal reconstruction of chest expiratory CT, showing a mosaic pattern of the pulmonary parenchyma, with areas of low density (asterisk), alternating with areas of greater attenuation. Low density areas (affecting particularly the right lower lobe and the left lung in a patchy pattern) correspond to areas of air trapping, while the areas of greater density correspond to normal pulmonary parenchyma. (C) minIP axial reconstruction of the chest inspiratory CT showing homogeneous pulmonary parenchyma. (D) minIP axial reconstruction of chest expiratory CT, showing areas of low density (asterisks), related with areas of air trapping.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Deisy Barrios-Barreto, Isabel García Gómez-Muriel, Anabelle Chinea-Rodríguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Deisy" "apellidos" => "Barrios-Barreto" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "García Gómez-Muriel" ] 3 => array:2 [ "nombre" => "Anabelle" "apellidos" => "Chinea-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616302393" "doi" => "10.1016/j.arbres.2016.09.004" "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/S0300289616302393?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301106?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000006/v2_201707150125/S1579212917301106/v2_201707150125/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212917301088" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.04.001" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1449" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2017;53:347-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1575 "formatos" => array:3 [ "EPUB" => 134 "HTML" => 1045 "PDF" => 396 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Spontaneous Regression of Pulmonary Emphysematous Bulla" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "348" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Regresión espontánea de una bulla enfisematosa pulmonar" ] ] "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" => 470 "Ancho" => 2000 "Tamanyo" => 138771 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT images showing a large bulla in the RUL (A), spiculated pulmonary nodule in the RUL, along with resolution of the large bulla in this region (B), and the image after surgical resection of the pulmonary nodule with continued absence of the large emphysematous pulmonary bulla (C).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Benito Bernáldez, Virginia Almadana Pacheco" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Benito Bernáldez" ] 1 => array:2 [ "nombre" => "Virginia" "apellidos" => "Almadana Pacheco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616302319" "doi" => "10.1016/j.arbres.2016.09.001" "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/S0300289616302319?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301088?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000006/v2_201707150125/S1579212917301088/v2_201707150125/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Intraventricular Air Embolism Complicating Computed Tomography-Guided Pulmonary Aspiration Biopsy" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "348" "paginaFinal" => "349" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Agustin Dietrich, Analía Vargas, David E. Smith, Alberto Domenech" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Agustin" "apellidos" => "Dietrich" "email" => array:1 [ 0 => "Agustin.dietrich@hospitalitaliano.org.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Analía" "apellidos" => "Vargas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "David E." "apellidos" => "Smith" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Alberto" "apellidos" => "Domenech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sector de Cirugía Torácica y Trasplante Pulmonar, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Intervencionismo y Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Cardiovascular Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolia aérea intraventricular como complicación de una punción biopsia pulmonar guiada por tomografía computarizada" ] ] "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" => 575 "Ancho" => 1500 "Tamanyo" => 205912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Right pneumothorax associated with left ventricular air embolism (arrow). (B) Drainage catheter in the pleural space (arrow) with resolution of right pneumothorax and air embolism.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Computed tomography (CT)-guided lung aspiration biopsy is a widely used tool in the histopathological diagnosis of lung lesions.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Although complications from this procedure are rare, they are not unknown, and can include pneumothorax, hemithorax, hemoptysis and/or pulmonary hematoma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a patient who developed pneumothorax and left ventricular air embolism after diagnostic aspiration of a pulmonary nodule.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our patient was a 67-year-old man with a history of perforated colorectal carcinoma, requiring emergency surgery, followed by treatment with chemotherapy and radiation therapy. During the staging CT, a pulmonary nodule measuring 11<span class="elsevierStyleHsp" style=""></span>mm contiguous with the inferior pulmonary vein was observed. Fine needle aspiration biopsy was performed under general anesthesia, and during the procedure pneumothorax and left ventricular air embolism were visualized. This was a tomographic finding, and the patient was asymptomatic when the complication was discovered. A pleural drainage tube was placed, and pulmonary expansion was immediately observed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Transthoracic echocardiogram was performed, ruling out coronary and/or ventricular complications. A waiting approach was taken, with echocardiographic studies and hemodynamic monitoring, which remained within normal values. A follow-up CT was performed after 48<span class="elsevierStyleHsp" style=""></span>h, showing reabsorption of the intracardiac air. The patient progressed without problems and was discharged on day 4 after the procedure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">CT-guided aspirations are safe procedures with a complication rate of 10%–25%, depending on the series, the most common being pneumothorax. Intracardiac air embolism is an extremely rare and potentially fatal complication, and reports in the literature are few.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our patient presented pneumothorax associated with intracardiac air embolism, rarely reported in the literature to date. The proximity of the lesion to the inferior pulmonary vein with the consequent production of intracardiac air embolism is a mechanism known to cause this type of complication.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Procedures performed under general anesthesia and positive airway ventilation may increase the chances of it occurring.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The therapeutic alternative of using a hyperbaric chamber is controversial, and moreover, unavailable in many hospitals.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Administration of 100% oxygen while placing the patient in the Trendelenburg position, along with intensive hemodynamic monitoring has been shown to be a safe treatment in the management of complications.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Dietrich A, Vargas A, Smith DE, Domenech A. Embolia aérea intraventricular como complicación de una punción biopsia pulmonar guiada por tomografía computarizada. Arch Bronconeumol. 2017;53:348–349.</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" => 575 "Ancho" => 1500 "Tamanyo" => 205912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Right pneumothorax associated with left ventricular air embolism (arrow). (B) Drainage catheter in the pleural space (arrow) with resolution of right pneumothorax and air embolism.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumothorax after transthoracic needle biopsy of lung lesions under CT guidance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Boskovic" 1 => "J. Stanic" 2 => "S. Pena-Karan" 3 => "P. Zarogoulidis" 4 => "K. Drevelegas" 5 => "N. Katsikogiannis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3978/j.issn.2072-1439.2013.12.08" "Revista" => array:7 [ "tituloSerie" => "J Thorac Dis" "fecha" => "2014" "volumen" => "6" "numero" => "Suppl. 1" "paginaInicial" => "S99" "paginaFinal" => "S107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24672704" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fatal paradoxical pulmonary air embolism complicating percutaneous computed tomography-guided needle biopsy of the lung" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Chakravarti" 1 => "V. Singh" 2 => "R. Isaac" 3 => "M.J. John" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1673.2004.01297.x" "Revista" => array:6 [ "tituloSerie" => "Australas Radiol" "fecha" => "2004" "volumen" => "48" "paginaInicial" => "204" "paginaFinal" => "206" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15230755" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute coronary artery air embolism following CT-guided lung biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Mansour" 1 => "S. AbdelRaouf" 2 => "M. Qandeel" 3 => "M. Swaidan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00270-004-0118-1" "Revista" => array:5 [ "tituloSerie" => "Cardiovasc Intervent Radiol" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "131" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15602640" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy: four cases from a single institution" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Hiraki" 1 => "H. Fujiwara" 2 => "J. Sakurai" 3 => "T. Iguchi" 4 => "H. Gobara" 5 => "N. Tajiri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.06-3030" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2007" "volumen" => "132" "paginaInicial" => "684" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17699141" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Air embolism during fontan operation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.M. Maddali" 1 => "E. Thomas" 2 => "M.M. Malik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0971-9784.135874" "Revista" => array:6 [ "tituloSerie" => "Ann Card Anaesth" "fecha" => "2014" "volumen" => "17" "paginaInicial" => "229" "paginaFinal" => "231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24994734" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000006/v2_201707150125/S157921291730109X/v2_201707150125/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000006/v2_201707150125/S157921291730109X/v2_201707150125/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291730109X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 8 | 14 |
| 2024 October | 48 | 24 | 72 |
| 2024 September | 46 | 19 | 65 |
| 2024 August | 64 | 44 | 108 |
| 2024 July | 51 | 24 | 75 |
| 2024 June | 67 | 38 | 105 |
| 2024 May | 69 | 32 | 101 |
| 2024 April | 38 | 27 | 65 |
| 2024 March | 46 | 19 | 65 |
| 2024 February | 40 | 23 | 63 |
| 2023 March | 14 | 2 | 16 |
| 2023 February | 40 | 15 | 55 |
| 2023 January | 36 | 37 | 73 |
| 2022 December | 35 | 27 | 62 |
| 2022 November | 56 | 17 | 73 |
| 2022 October | 44 | 51 | 95 |
| 2022 September | 43 | 23 | 66 |
| 2022 August | 44 | 40 | 84 |
| 2022 July | 41 | 38 | 79 |
| 2022 June | 42 | 36 | 78 |
| 2022 May | 48 | 30 | 78 |
| 2022 April | 58 | 21 | 79 |
| 2022 March | 61 | 34 | 95 |
| 2022 February | 63 | 31 | 94 |
| 2022 January | 68 | 36 | 104 |
| 2021 December | 45 | 38 | 83 |
| 2021 November | 38 | 41 | 79 |
| 2021 October | 50 | 44 | 94 |
| 2021 September | 37 | 40 | 77 |
| 2021 August | 39 | 49 | 88 |
| 2021 July | 27 | 28 | 55 |
| 2021 June | 58 | 26 | 84 |
| 2021 May | 44 | 52 | 96 |
| 2021 April | 77 | 83 | 160 |
| 2021 March | 41 | 23 | 64 |
| 2021 February | 45 | 28 | 73 |
| 2021 January | 30 | 22 | 52 |
| 2020 December | 28 | 24 | 52 |
| 2020 November | 36 | 17 | 53 |
| 2020 October | 29 | 20 | 49 |
| 2020 September | 14 | 13 | 27 |
| 2020 August | 27 | 19 | 46 |
| 2020 July | 28 | 27 | 55 |
| 2020 June | 15 | 15 | 30 |
| 2020 May | 24 | 10 | 34 |
| 2020 April | 43 | 14 | 57 |
| 2020 March | 19 | 11 | 30 |
| 2020 February | 27 | 16 | 43 |
| 2020 January | 25 | 13 | 38 |
| 2019 December | 31 | 17 | 48 |
| 2019 November | 25 | 20 | 45 |
| 2019 October | 17 | 13 | 30 |
| 2019 September | 33 | 19 | 52 |
| 2019 August | 27 | 16 | 43 |
| 2019 July | 14 | 22 | 36 |
| 2019 June | 18 | 12 | 30 |
| 2019 May | 29 | 29 | 58 |
| 2019 April | 19 | 35 | 54 |
| 2019 March | 22 | 25 | 47 |
| 2019 February | 26 | 18 | 44 |
| 2019 January | 23 | 9 | 32 |
| 2018 December | 20 | 16 | 36 |
| 2018 November | 32 | 11 | 43 |
| 2018 October | 60 | 11 | 71 |
| 2018 September | 13 | 20 | 33 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 25 | 6 | 31 |
| 2018 March | 19 | 9 | 28 |
| 2018 February | 27 | 10 | 37 |
| 2018 January | 40 | 4 | 44 |
| 2017 December | 33 | 7 | 40 |
| 2017 November | 17 | 11 | 28 |
| 2017 October | 21 | 11 | 32 |
| 2017 September | 28 | 12 | 40 |
| 2017 April | 1 | 0 | 1 |
Show all
