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Core Needle Biopsy of an Anterior Mediastinal Thymoma: Creation of a Safe Access Route by Hydrodissection
Biopsia con aguja gruesa de timoma en mediastino anterior: creación de ruta de acceso segura mediante hidrodisección
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La línea blanca señala el trayecto teórico de la aguja de biopsia desde la pared torácica anterior hasta la masa mediastínica, atravesando la superficie pleural y el parénquima pulmonar izquierdo. B) Imagen axial de la TC de tórax en la que visualiza la creación de una pequeña colección de líquido (flechas) entre la pared torácica anterior y la masa mediastínica. C) Imagen axial de proyección de máxima intensidad de la TC de tórax en la que se observa la aguja de biopsia atravesando la colección de líquido (L) y alcanzando la masa mediastínica (M).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe Sarasúa, Nicolás Alejandro Almeida-Aróstegui, Paola Arrieta" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" ] 1 => array:2 [ "nombre" => "Nicolás Alejandro" "apellidos" => "Almeida-Aróstegui" ] 2 => array:2 [ "nombre" => "Paola" "apellidos" => "Arrieta" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212918301484" "doi" => "10.1016/j.arbr.2018.05.006" "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/S1579212918301484?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617304350?idApp=UINPBA00003Z" "url" => "/03002896/0000005400000007/v1_201807020415/S0300289617304350/v1_201807020415/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S157921291830154X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2018.05.012" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1791" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2018;54:389" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 749 "formatos" => array:3 [ "EPUB" => 116 "HTML" => 420 "PDF" => 213 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Necrotizing Granulomatous Inflammation With Airway Tissue Destruction" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "389" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Inflamación granulomatosa necrosante con destrucción de la vía aérea" ] ] "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" => 1351 "Ancho" => 1667 "Tamanyo" => 235206 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Chest CT showing significant concentric thickening of the tracheal wall and main bronchi, with vastly irregular tracheal and bronchial luminogram. Necrotic masses are also observed, mainly in the right hemithorax, contiguous with the bronchus of the right upper lobe. (C and D) Bronchoscopy images: (C) tracheal stenosis with friable mucosa and protrusion of fragments of cartilage; (D) division of left upper lobe and lower lobe bronchi, showing mucosa with mammilated areas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Dolores Almenara Escribano, Agustín Colodro Ruiz, María Martín Armada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Almenara Escribano" ] 1 => array:2 [ "nombre" => "Agustín" "apellidos" => "Colodro Ruiz" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Martín Armada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289617304428" "doi" => "10.1016/j.arbres.2017.12.004" "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/S0300289617304428?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291830154X?idApp=UINPBA00003Z" "url" => "/15792129/0000005400000007/v1_201807020412/S157921291830154X/v1_201807020412/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212918302167" "issn" => "15792129" "doi" => "10.1016/j.arbr.2017.11.023" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1782" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2018;54:387" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 718 "formatos" => array:3 [ "EPUB" => 125 "HTML" => 365 "PDF" => 228 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Primary Cavitary Sarcoidosis: A Diagnostic Challenge for the Clinician" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "387" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoidosis cavitada primaria: una reto diagnóstico para el clínico" ] ] "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" => 971 "Ancho" => 1733 "Tamanyo" => 303911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan images showing four representative sections at presentation (first row), 12 months (second row) and 21 months (third row). Arrows indicate the cavitary lesions in the right upper, right lower, lingula and left lower lobes (from left to right).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Muhammad Sajawal Ali, Farah Ciftci Olsen, Rose Franco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Muhammad" "apellidos" => "Sajawal Ali" ] 1 => array:2 [ "nombre" => "Farah" "apellidos" => "Ciftci Olsen" ] 2 => array:2 [ "nombre" => "Rose" "apellidos" => "Franco" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0300289617304295" "doi" => "10.1016/j.arbres.2017.11.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617304295?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918302167?idApp=UINPBA00003Z" "url" => "/15792129/0000005400000007/v1_201807020412/S1579212918302167/v1_201807020412/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Core Needle Biopsy of an Anterior Mediastinal Thymoma: Creation of a Safe Access Route by Hydrodissection" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "388" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis Gorospe Sarasúa, Nicolás Alejandro Almeida-Aróstegui, Paola Arrieta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Luis" "apellidos" => "Gorospe Sarasúa" "email" => array:1 [ 0 => "luisgorospe@yahoo.com" ] "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" => "Nicolás Alejandro" "apellidos" => "Almeida-Aróstegui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Paola" "apellidos" => "Arrieta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biopsia con aguja gruesa de timoma en mediastino anterior: creación de ruta de acceso segura mediante hidrodisección" ] ] "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" => 1435 "Ancho" => 1329 "Tamanyo" => 162269 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Axial chest CT image showing an anterior mediastinal mass (asterisk). The white line indicates the theoretical path of the biopsy from the anterior chest wall to the mediastinal mass, traversing the pleural surface and the left pulmonary parenchyma. (B) Axial chest CT image showing the creation of a small fluid collection (arrows) between the anterior chest wall and the mediastinal mass. (C) Axial maximum intensity projection CT image of chest showing the biopsy needle crossing the fluid collection (L) and penetrating the mediastinal mass (M).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 73-year-old woman with no significant clinical history, in whom an anterior mediastinal mass was detected incidentally. Image-guided core needle biopsy (CNB) of the mass was performed, but the theoretical trajectory of the biopsy needle was interrupted by the pulmonary parenchyma of the left upper lobe between the anterior chest wall and the mediastinal mass (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). To avoid puncturing the pleural surface and the pulmonary parenchyma with the biopsy needle, we used an intramuscular needle to instill 100<span class="elsevierStyleHsp" style=""></span>ml saline into the scant fatty tissue of the patient's anterior mediastinum, thus creating a collection of fluid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), which provided a safe approach route, avoiding perforation of either the pleura or the left lung. The biopsy needle was then inserted between the left internal mammary vessels and the left lateral edge of the sternum, traversing the previously created fluid collection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Histological material was collected that confirmed the diagnosis of thymoma, World Health Organization classification type A. Cytological diagnosis of thymomas using fine needle aspiration can be difficult to interpret, so histological material retrieved by CNB is preferable, although this technique is often accompanied by a higher rate of complications (pneumothorax, lung bleeds).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> Hydrodissection with saline is a simple technique that creates a safe access route for the histologic diagnosis of anterior mediastinal masses.</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: Gorospe Sarasúa L, Almeida-Aróstegui NA, Arrieta P. Biopsia con aguja gruesa de timoma en mediastino anterior: creación de ruta de acceso segura mediante hidrodisección. Arch Bronconeumol. 2018;54:388.</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" => 1435 "Ancho" => 1329 "Tamanyo" => 162269 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Axial chest CT image showing an anterior mediastinal mass (asterisk). The white line indicates the theoretical path of the biopsy from the anterior chest wall to the mediastinal mass, traversing the pleural surface and the left pulmonary parenchyma. (B) Axial chest CT image showing the creation of a small fluid collection (arrows) between the anterior chest wall and the mediastinal mass. (C) Axial maximum intensity projection CT image of chest showing the biopsy needle crossing the fluid collection (L) and penetrating the mediastinal mass (M).</p>" ] ] ] "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" => "Anterior mediastinal masses: a study of 50 cases by fine needle aspiration cytology and core needle biopsy as a diagnostic procedure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.G. Nasit" 1 => "M. Patel" 2 => "B. Parikh" 3 => "M. Shah" 4 => "K. Davara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2278-330X.105872" "Revista" => array:6 [ "tituloSerie" => "South Asian J Cancer" "fecha" => "2013" "volumen" => "2" "paginaInicial" => "7" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24455533" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic yield of CT-guided percutaneous transthoracic needle biopsy for diagnosis of anterior mediastinal masses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Petranovic" 1 => "M.D. Gilman" 2 => "A. Muniappan" 3 => "R.P. Hasserjian" 4 => "S.R. Digumarthy" 5 => "V.V. Muse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Roentgenol" "fecha" => "2015" "volumen" => "205" "paginaInicial" => "774" "paginaFinal" => "779" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005400000007/v1_201807020412/S1579212918301484/v1_201807020412/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/15792129/0000005400000007/v1_201807020412/S1579212918301484/v1_201807020412/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212918301484?idApp=UINPBA00003Z" ]
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