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Double fistula after cavitation of lung adenocarcinoma treated by microwave thermal ablation. An exceedingly rare complication
Doble fístula tras cavitación de adenocarcinoma pulmonar tratado mediante termoablación con microondas. Una complicación muy infrecuente
a Sección de Radiología Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
b Departamento de Radiología, Facultad de Medicina, Universidad de Granada, Granada, Spain
Eduardo Ruiz Carazo, Genaro López Milena
Sección de Radiología Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Una complicación muy infrecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "546" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Double Fistula After Cavitation of Lung Adenocarcinoma Treated by Microwave Thermal Ablation. An Exceedingly Rare Complication" ] ] "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" => 778 "Ancho" => 1000 "Tamanyo" => 127522 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiografía de tórax, proyección PA (A). Extenso enfisema subcutáneo en pared torácica derecha y región supraclavicular y cervical, junto con neumomediastino (flechas). Masa mal delimitada en lóbulo superior derecho (asterisco), en aparente comunicación con un bronquio para dicho lóbulo (puntas de flecha). TC de tórax sin contraste intravenoso, ventana de parénquima pulmonar. Reconstrucciones multiplanares en plano coronal (B) y axial (<span class="elsevierStyleSmallCaps">C</span>), con proyección de mínima intensidad (D). Se muestra con claridad la cavidad aérea rodeando la masa tratada (puntas de flecha en B y C), en comunicación con una rama bronquial para dicho lóbulo (punta de flecha en D), así como neumomediastino (flechas blancas) y extenso enfisema subcutáneo de predominio en pared costal derecha. Llama la atención un gran lóculo de gas en la pared torácica adyacente a la cavidad postermoablación, que sugiere la existencia de comunicación entre ambas cavidades (asterisco en C y D). También se observan signos de enfisema centrolobulillar de predominio en lóbulos superiores.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Antonio Jesús Láinez Ramos-Bossini, Eduardo Ruiz Carazo, Genaro López Milena" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Antonio Jesús" "apellidos" => "Láinez Ramos-Bossini" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Ruiz Carazo" ] 2 => array:2 [ "nombre" => "Genaro" "apellidos" => "López Milena" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212921001907" "doi" => "10.1016/j.arbr.2021.05.018" "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/S1579212921001907?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621000053?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000008/v1_202108020527/S0300289621000053/v1_202108020527/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212921002470" "issn" => "15792129" "doi" => "10.1016/j.arbr.2020.12.009" "estado" => "S300" "fechaPublicacion" => "2021-08-01" "aid" => "2717" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2021;57:547-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Diffuse Alveolar Hemorrhage After Orotracheal Extubation Probably Induced by Sevoflurane Inhalation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "547" "paginaFinal" => "548" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia alveolar difusa tras extubación orotraqueal probablemente inducida por la inhalación de sevoflurano" ] ] "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" => 1199 "Ancho" => 1267 "Tamanyo" => 166514 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a, b) Axial and coronal views of thoracic computed tomography performed after admission in intensive care unit; (c) lesion observed in bronchoscopy on day five after admission. (d) Coronal view of thoracic computed tomography performed 15 days after the first tomographic evaluation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mauro Carvalho Mendonça, João Bettencourt Abreu, Karina Gama" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Mauro Carvalho" "apellidos" => "Mendonça" ] 1 => array:2 [ "nombre" => "João Bettencourt" "apellidos" => "Abreu" ] 2 => array:2 [ "nombre" => "Karina" "apellidos" => "Gama" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921002470?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000008/v1_202108020523/S1579212921002470/v1_202108020523/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212921001877" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.05.015" "estado" => "S300" "fechaPublicacion" => "2021-08-01" "aid" => "2524" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2021;57:545" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Repeated aspiration pneumonia in a 7-year-old girl with undiagnosed congenital tracheoesophageal fistula" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "545" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonías aspirativas de repetición en una niña de 7 años con fístula traqueoesofágica congénita no diagnosticada" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 618 "Ancho" => 1500 "Tamanyo" => 98672 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) HRCT: continuity defect of tracheal pars membranacea; (B) HRCT: central acinar opacities consistent with microaspirations; (C) fiberoptic bronchoscopy: bubbling and passage of methylene blue, instilled through the esophagus, to the trachea.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Andrés Piolatti-Luna, Silvia Castillo-Corrullón" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Andrés" "apellidos" => "Piolatti-Luna" ] 1 => array:2 [ "nombre" => "Silvia" "apellidos" => "Castillo-Corrullón" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921001877?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000008/v1_202108020523/S1579212921001877/v1_202108020523/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Double fistula after cavitation of lung adenocarcinoma treated by microwave thermal ablation. An exceedingly rare complication" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "546" ] ] "autores" => array:2 [ 0 => array:4 [ "autoresLista" => "Antonio Jesús Láinez Ramos-Bossini" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Antonio Jesús" "apellidos" => "Láinez Ramos-Bossini" "email" => array:1 [ 0 => "ajbossini@ugr.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Radiología Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Radiología, Facultad de Medicina, Universidad de Granada, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] 1 => array:3 [ "autoresLista" => "Eduardo Ruiz Carazo, Genaro López Milena" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Ruiz Carazo" ] 1 => array:2 [ "nombre" => "Genaro" "apellidos" => "López Milena" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Radiología Cardiotorácica, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Doble fístula tras cavitación de adenocarcinoma pulmonar tratado mediante termoablación con microondas. Una complicación muy infrecuente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 783 "Ancho" => 1007 "Tamanyo" => 126601 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray, PA projection (A). Extensive subcutaneous emphysema in right chest wall and supraclavicular and cervical region, along with pneumomediastinum (arrows). Poorly delimited mass in the right upper lobe (asterisk), apparently communicating with a bronchus leading to that lobe (arrowheads). Chest CT without intravenous contrast medium, pulmonary parenchyma window. Multiplanar reconstructions in coronal (B) and axial (C) planes, with minimum intensity projection (D). The air cavity is clearly seen surrounding the treated mass (arrowheads in B and C), communicating with a bronchial branch to that lobe (arrowheads in D), along with pneumomediastinum (white arrows) and extensive subcutaneous emphysema predominantly in the right chest wall. Note the large gas-filled space in the chest wall adjacent to the post-thermal ablation cavity, suggesting communication between the two cavities (C and D asterisk). There are also signs of centrilobular emphysema predominantly in the upper lobes.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 74-year-old man with lung adenocarcinoma (pT1aN0M0) in the right upper lobe (RUL), treated by segmental resection and post-surgical radiation therapy (RT). Local tumor recurrence was detected during follow-up. Given his high comorbidity, CT-guided microwave thermal ablation (MTA) was administered. The procedure went smoothly and the patient was discharged. However, 1 week later, he attended the emergency room, reporting an oppressive sensation and respiratory distress. On examination, he was eupneic and stable, with crepitation of the soft tissues of the chest and bitonal dysphonia. A chest X-ray revealed marked subcutaneous emphysema, with no signs of pneumothorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Chest CT showed pulmonary cavitation at the MTA site communicating with a bronchus leading to the RUL and with a large gas-filled space in the chest wall, along with extensive pneumomediastinum and subcutaneous emphysema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D), findings consistent with bronchial fistula (BF) and bronchocutaneous fistula (BCF) from the post-MTA cavity. The patient was hospitalized and kept under observation and the emphysema was drained. Progress was favorable.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">BF and BCF are rare complications of pulmonary thermal ablation (0.4%).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> BFs are usually associated with pneumothorax, although 4 cases of BFs without pneumothorax after thermal ablation have been published, 2 of which occurred after MTA. The proposed mechanism is adhesion between the visceral and the parietal pleura due to excessive MTA energy levels and pleural weakness due to prior RT and surgery.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although uncommon, this possible complication of TM must be taken into consideration and the risk-benefit balance should be evaluated according to the patient’s clinical situation.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0015" class="elsevierStylePara elsevierViewall">This paper has not received any funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Láinez Ramos-Bossini AJ, Ruiz Carazo E, López Milena G. Doble fístula tras cavitación de adenocarcinoma pulmonar tratado mediante termoablación con microondas. Una complicación muy infrecuente. Arch Bronconeumol. 2021;57:546.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 783 "Ancho" => 1007 "Tamanyo" => 126601 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray, PA projection (A). Extensive subcutaneous emphysema in right chest wall and supraclavicular and cervical region, along with pneumomediastinum (arrows). Poorly delimited mass in the right upper lobe (asterisk), apparently communicating with a bronchus leading to that lobe (arrowheads). Chest CT without intravenous contrast medium, pulmonary parenchyma window. Multiplanar reconstructions in coronal (B) and axial (C) planes, with minimum intensity projection (D). The air cavity is clearly seen surrounding the treated mass (arrowheads in B and C), communicating with a bronchial branch to that lobe (arrowheads in D), along with pneumomediastinum (white arrows) and extensive subcutaneous emphysema predominantly in the right chest wall. Note the large gas-filled space in the chest wall adjacent to the post-thermal ablation cavity, suggesting communication between the two cavities (C and D asterisk). There are also signs of centrilobular emphysema predominantly in the upper lobes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications after 1000 lung radiofrequency ablation sessions in 420 patients: A single center’s experiences" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Kashima" 1 => "K. Yamakado" 2 => "H. Takaki" 3 => "H. Kodama" 4 => "T. Yamada" 5 => "J. Uraki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Am J Roentgenol." "fecha" => "2011" "volumen" => "197" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed bronchocutaneous fistula without pneumothorax following a microwave ablation of a recurrent pulmonary metastasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Thivolet" 1 => "B. Menassel" 2 => "G. Chatté" 3 => "M. Tabutin" 4 => "A. Bouhamama" 5 => "F. Pilleul" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00270-017-1797-8" "Revista" => array:6 [ "tituloSerie" => "Cardiovasc Intervent Radiol." "fecha" => "2018" "volumen" => "41" "paginaInicial" => "340" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28913628" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005700000008/v1_202108020523/S1579212921001907/v1_202108020523/en/main.assets" "Apartado" => array:4 [ "identificador" => "60604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005700000008/v1_202108020523/S1579212921001907/v1_202108020523/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921001907?idApp=UINPBA00003Z" ]
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