Clinical Image
Pulmonary Tumor Embolism due to Cardiac Metastasis of Lung Cancer
Embolismo tumoral pulmonar de metástasis cardíaca de carcinoma broncogénico
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D-F) PET/TC tras la administración de <span class="elsevierStyleSup">18</span>F-FDG. Masa lobar superior derecha con amplias zonas de necrosis y cavitación (A) que mostraba elevado metabolismo glucídico en su periferia (D). Lesión en ápex del ventrículo derecho (B y E, flecha) sugestiva de metástasis cardíaca. Imagen nodular de base periférica con centro aéreo en lóbulo inferior derecho (C, flecha) sugestiva de infarto pulmonar. En la exploración PET/TC, esta lesión mostraba metabolismo (F, flecha) y se evidenciaba un émbolo arterial hipermetabólico en la rama aferente de dicho segmento (E, flecha gris) compatible con un embolismo tumoral.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Corominas, Ivan Vollmer, Pilar Paredes" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "Corominas" ] 1 => array:2 [ "nombre" => "Ivan" "apellidos" => "Vollmer" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "Paredes" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212917301702" "doi" => "10.1016/j.arbr.2017.05.002" "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/S1579212917301702?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300182?idApp=UINPBA00003Z" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289617300182/v2_201706291228/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1579212917301726" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.05.003" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1533" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2017;53:397" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1259 "formatos" => array:3 [ "EPUB" => 119 "HTML" => 781 "PDF" => 359 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Simultaneous Miliary and Genital Tuberculosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "397" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tuberculosis miliar y genital simultáneas" ] ] "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" => 780 "Ancho" => 1040 "Tamanyo" => 123931 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Standard chest radiograph. 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(C) Pelvis CT pelvic slice.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Montes Ruiz-Cabello, Emilio Guirao Arrabal, Leonardo Mauro Aisa Denaroso" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María" "apellidos" => "Montes Ruiz-Cabello" ] 1 => array:2 [ "nombre" => "Emilio" "apellidos" => "Guirao Arrabal" ] 2 => array:2 [ "nombre" => "Leonardo Mauro" "apellidos" => "Aisa Denaroso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289617300108" "doi" => "10.1016/j.arbres.2016.12.006" "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/S0300289617300108?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301726?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301726/v1_201706290145/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212917301696" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.05.001" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1543" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2017;53:395" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1166 "formatos" => array:3 [ "EPUB" => 129 "HTML" => 697 "PDF" => 340 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Giant Pulmonary Bulla Superinfection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "395" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bulla pulmonar gigante sobreinfectada" ] ] "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" => 1696 "Ancho" => 2085 "Tamanyo" => 214257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Standard posteroanterior and lateral chest radiographs showing cystic lesion with calcified walls occupying practically all the right hemithorax containing an air-fluid level. (C and D) Chest computed tomography, showing that the cystic lesion was causing atelectasis of a large part of the pulmonary parenchyma of the right hemithorax and left mediastinal shift.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ana I. Córdoba Alonso, Maite Arlabán Carpintero, José M. Olmos Martínez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Ana I." "apellidos" => "Córdoba Alonso" ] 1 => array:2 [ "nombre" => "Maite Arlabán" "apellidos" => "Carpintero" ] 2 => array:2 [ "nombre" => "José M." "apellidos" => "Olmos Martínez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289617300200" "doi" => "10.1016/j.arbres.2016.12.010" "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/S0300289617300200?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301696?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301696/v1_201706290145/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Pulmonary Tumor Embolism due to Cardiac Metastasis of Lung Cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "396" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Daniel Corominas, Ivan Vollmer, Pilar Paredes" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Daniel" "apellidos" => "Corominas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ivan" "apellidos" => "Vollmer" "email" => array:1 [ 0 => "vollmer@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Pilar" "apellidos" => "Paredes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Centro de Diagnóstico por la Imagen Clínic, Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Centro de Diagnóstico por la Imagen Clínic, Hospital Clínic, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolismo tumoral pulmonar de metástasis cardíaca de carcinoma broncogénico" ] ] "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" => 688 "Ancho" => 908 "Tamanyo" => 123969 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A–C) Chest CT after administration of intravenous iodized contrast, lung (A and C) and mediastinum (B) windows. (D–F) PET/CT after administration of 18F-FDG. Mass in right upper lobe with large areas of necrosis and cavitation (A) with increased peripheral glucose metabolism (D). Lesion in the apex of the right ventricle (B and E, arrow) suggestive of cardiac metastasis. Image of peripheral base nodule containing air space in the right lower lobe (C, arrow) suggestive of pulmonary infarction. This lesion was metabolic on the PET/CT (F, arrow), and a hypermetabolic arterial embolism was observed in the feeding artery of that segment (E, gray arrow) consistent with tumor embolism.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 64-year-old man with a clinical picture of anorexia, asthenia and weight loss, who developed obstructive pneumonia after admission to our hospital. A computed tomography was performed, showing a pulmonary mass with a large central necrotic area in the right upper lobe, a 20<span class="elsevierStyleHsp" style=""></span>mm hypodense cardiac lesion in the apex of the right ventricle consistent with metastasis, and an image suggestive of subpleural pulmonary infarction in the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Fiberoptic bronchoscopy was performed, and a specimen of the pulmonary mass was obtained and identified as non-small cell lung cancer. To complete the study, an 18F-FDG PET/CT was performed, revealing hypermetabolism of the pulmonary mass, the cardiac lesion, and the area of pulmonary infarction, and in a pulmonary artery of the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D–F). Uptake by the pulmonary infarction suggested that it was caused by tumor embolism.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although cardiac metastases are more common than primary cardiac tumors, they still occur in only 1% of cancer patients, the most common etiology being lung adenocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> Pulmonary tumor embolism is a possible manifestation of cardiac metastasis, although 90% of these lesions are clinically silent.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</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: Corominas D, Vollmer I, Paredes P. Embolismo tumoral pulmonar de metástasis cardíaca de carcinoma broncogénico. Arch Bronconeumol. 2017;53:396.</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" => 688 "Ancho" => 908 "Tamanyo" => 123969 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A–C) Chest CT after administration of intravenous iodized contrast, lung (A and C) and mediastinum (B) windows. (D–F) PET/CT after administration of 18F-FDG. Mass in right upper lobe with large areas of necrosis and cavitation (A) with increased peripheral glucose metabolism (D). Lesion in the apex of the right ventricle (B and E, arrow) suggestive of cardiac metastasis. Image of peripheral base nodule containing air space in the right lower lobe (C, arrow) suggestive of pulmonary infarction. This lesion was metabolic on the PET/CT (F, arrow), and a hypermetabolic arterial embolism was observed in the feeding artery of that segment (E, gray arrow) consistent with tumor embolism.</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" => "Cardiac metastasis: a cause of recurrent pulmonary emboli" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.D. Borsaru" 1 => "K.K. Lau" 2 => "P. Solin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr/94870835" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2007" "volumen" => "80" "paginaInicial" => "e50" "paginaFinal" => "e53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17495056" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Poorly differentiated thyroid carcinoma with cardiac metastasis and pulmonary embolism as first clinical presentation: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Pazzano" 1 => "M.L. Narducci" 2 => "P. Santangeli" 3 => "D. Pedicino" 4 => "F. Glieca" 5 => "C.A. Rota" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF03347050" "Revista" => array:6 [ "tituloSerie" => "J Endocrinol Invest" "fecha" => "2011" "volumen" => "34" "paginaInicial" => "164" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21502799" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917301702/v1_201706290145/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/15792129/0000005300000007/v1_201706290145/S1579212917301702/v1_201706290145/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917301702?idApp=UINPBA00003Z" ]
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