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Asymptomatic acute pulmonary embolism in a patient with a delayed pulmonary artery stump thrombosis
Tromboembolismo pulmonar agudo asintomático en paciente con trombosis diferida del muñón de una arteria pulmonar
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A) Imagen de la TC de tórax obtenida 2 años después de la cirugía torácica (lobectomía inferior derecha) en la que se observa la recidiva tumoral (asterisco blanco) y la arteria pulmonar intermediaria permeable (asterisco negro). B) Imagen de la TC de tórax realizada 12 meses después del tratamiento con radioterapia, en la que se identifica un defecto de repleción excéntrico que forma ángulos obtusos en el muñón de la arteria del lóbulo inferior derecho con extensión proximal a la arteria intermediaria (asterisco). C) Imagen de la TC de tórax obtenida 18 meses después de la imagen B, en la que se visualiza un defecto de repleción central en una arteria segmentaria del lóbulo inferior izquierdo (flecha), compatible con un TEP agudo. D y E) Imágenes de la TC de tórax obtenidas 6 meses después de la imagen C en las que se aprecian una resolución del TEP, pero persistencia de la trombosis del muñón de la arteria pulmonar (asterisco).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Gorospe-Sarasúa, Margarita Martín-Martín, Rosa Mariela Mirambeaux-Villalona" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Gorospe-Sarasúa" ] 1 => array:2 [ "nombre" => "Margarita" "apellidos" => "Martín-Martín" ] 2 => array:2 [ "nombre" => "Rosa Mariela" "apellidos" => "Mirambeaux-Villalona" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212921003001" "doi" => "10.1016/j.arbr.2021.09.002" "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/S1579212921003001?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289620301356?idApp=UINPBA00003Z" "url" => "/03002896/0000005700000011/v2_202111040649/S0300289620301356/v2_202111040649/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1579212921003517" "issn" => "15792129" "doi" => "10.1016/j.arbr.2020.04.019" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "2486" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2021;57:701" "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" => "Acquired Perfusion Defect" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "701" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Defecto de Perfusión Adquirido" ] ] "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" => 742 "Ancho" => 2917 "Tamanyo" => 317503 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial contrast-enhanced chest CT with mediastinal (A) and lung (B) windows shows conglomerate tumor (yellow asterisk) in the right hilar and subcarinal space with narrowing of the right bronchus intermedius and right distal main (yellow arrow) pulmonary artery. Quantitative lung perfusion scintigraphy (C) revealed nearly absent perfusion of right lung.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Firas Bahdi, Audra J. Schwalk, Saadia A. Faiz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Firas" "apellidos" => "Bahdi" ] 1 => array:2 [ "nombre" => "Audra J." "apellidos" => "Schwalk" ] 2 => array:2 [ "nombre" => "Saadia A." "apellidos" => "Faiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003517?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000011/v1_202111020702/S1579212921003517/v1_202111020702/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1579212921003104" "issn" => "15792129" "doi" => "10.1016/j.arbr.2021.09.012" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "2431" "copyright" => "SEPAR" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Bronconeumol. 2021;57:698" "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" => "Triple stent placement for tracheoesophageal fistula closure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "698" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colocación de triple prótesis para cierre de fístula traqueoesofágica" ] ] "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" => 799 "Ancho" => 1000 "Tamanyo" => 130684 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Flexible bronchoscopy view showing a continuity defect in the posterior wall of the distal third of the trachea, with visualization of esophageal stents and atrial septal defect occluder. B) Fluoroscopic view of the 3 normally positioned stents by flexible bronchoscopy through rigid bronchoscope. C) Chest CT image without intravenous contrast, axial plane, lung window showing the presence of the 3 devices used for closing the fistula. D) Plain post-anterior chest X-ray after intervention showing correct positioning of the 3 implanted devices.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Blanca de Vega Sánchez, Carlos Disdier Vicente, Manuel Pérez-Miranda" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Blanca" "apellidos" => "de Vega Sánchez" ] 1 => array:2 [ "nombre" => "Carlos Disdier" "apellidos" => "Vicente" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Pérez-Miranda" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289620300752" "doi" => "10.1016/j.arbres.2020.02.011" "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/S0300289620300752?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003104?idApp=UINPBA00003Z" "url" => "/15792129/0000005700000011/v1_202111020702/S1579212921003104/v1_202111020702/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>" "titulo" => "Asymptomatic acute pulmonary embolism in a patient with a delayed pulmonary artery stump thrombosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "699" "paginaFinal" => "700" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luis Gorospe-Sarasúa, Margarita Martín-Martín, Rosa María Mirambeaux-Villanova" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Luis" "apellidos" => "Gorospe-Sarasúa" "email" => array:1 [ 0 => "luisgorospe@yahoo.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Margarita" "apellidos" => "Martín-Martín" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Rosa María" "apellidos" => "Mirambeaux-Villanova" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tromboembolismo pulmonar agudo asintomático en paciente con trombosis diferida del muñón de una arteria pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1522 "Ancho" => 2500 "Tamanyo" => 366244 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT images following administration of intravenous contrast, axial plane and mediastinal window. A) Chest CT image obtained 2 years after thoracic surgery (right inferior lobectomy) showing tumor recurrence (white asterisk) and patent intermediate pulmonary artery (black asterisk). B) Chest CT image obtained 12 months after radiation therapy, identifying an eccentric filling defect that forms obtuse angles in the right lower lobe artery stump with extension proximal to the intermediate artery (asterisk). C) Chest CT image obtained 18 months after image B, showing a central filling defect in a segmental artery in the left lower lobe (arrow), consistent with acute PE. D and E) Chest CT images obtained 6 months after image C, which showed resolved PE but persistent pulmonary artery stump thrombosis (asterisk).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 78-year-old patient with a history of lung cancer treated by surgery, who had a local relapse 2 years later (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). This recurrence was treated with radiation therapy, and the patient responded favorably. A follow-up radiological study performed 1 year later revealed an apparently chronic pulmonary artery stump thrombosis in the right lower lobe extending to the intermediate artery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Since the patient had no symptoms and venous thrombosis in the lower limbs was ruled out by Doppler ultrasound, we decided not to initiate anticoagulation. Another radiological follow-up performed 18 months later revealed an incidental finding of multiple filling defects in several left pulmonary arteries, associated with acute pulmonary embolism (PE) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c), which resolved after anticoagulant therapy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). However, the pulmonary artery stump thrombosis persisted (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E), so it was agreed that anticoagulation would continue indefinitely.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Pulmonary artery stump thrombosis is a unusual complication that is often described in patients undergoing thoracic surgery (pneumonectomy or lobectomy), but rarely documented in patients receiving radiation therapy<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. The natural history of pulmonary artery stump thrombosis is generally favorable and the need for anticoagulant treatment is controversial<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. Our case is interesting for several reasons: 1) delayed pulmonary artery stump thrombosis was detected after radiation therapy of a late local recurrence of lung cancer; 2) the patient was asymptomatic at the time of the incidental finding of PE; and 3) anticoagulant therapy resolved the PE, but not the pulmonary artery stump thrombosis.</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: Gorospe-Sarasúa L, Martín-Martín M, Mirambeaux-Villanova RM. Tromboembolismo pulmonar agudo asintomático en paciente con trombosis diferida del muñón de una arteria pulmonar. Arch Bronconeumol. 2021;57:699–700.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1522 "Ancho" => 2500 "Tamanyo" => 366244 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT images following administration of intravenous contrast, axial plane and mediastinal window. A) Chest CT image obtained 2 years after thoracic surgery (right inferior lobectomy) showing tumor recurrence (white asterisk) and patent intermediate pulmonary artery (black asterisk). B) Chest CT image obtained 12 months after radiation therapy, identifying an eccentric filling defect that forms obtuse angles in the right lower lobe artery stump with extension proximal to the intermediate artery (asterisk). C) Chest CT image obtained 18 months after image B, showing a central filling defect in a segmental artery in the left lower lobe (arrow), consistent with acute PE. D and E) Chest CT images obtained 6 months after image C, which showed resolved PE but persistent pulmonary artery stump thrombosis (asterisk).</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" => "Contralateral pulmonary embolism caused by pulmonary artery stump thrombosis after pneumonectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Sato" 1 => "H. Watanabe" 2 => "T. Sato" 3 => "K. Iino" 4 => "K. Sato" 5 => "H. Ito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg." "fecha" => "2014" "volumen" => "97" "paginaInicial" => "1797" "paginaFinal" => "1798" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of in-situ pulmonary artery thrombosis in Korea" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.I. Cha" 1 => "K.J. Choi" 2 => "K.M. Shin" 3 => "J.K. Lim" 4 => "S.S. Yoo" 5 => "J. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Blood Coagul Fibrinolysis." "fecha" => "2015" "volumen" => "26" "paginaInicial" => "903" "paginaFinal" => "907" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005700000011/v1_202111020702/S1579212921003001/v1_202111020702/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/15792129/0000005700000011/v1_202111020702/S1579212921003001/v1_202111020702/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212921003001?idApp=UINPBA00003Z" ]
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