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Vol. 45. Issue S6.
Hipertensión pulmonar tromboembólica crónica
Pages 21-29 (June 2009)
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Vol. 45. Issue S6.
Hipertensión pulmonar tromboembólica crónica
Pages 21-29 (June 2009)
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Métodos de imagen en la hipertensión pulmonar tromboembólica crónica
Imaging tests in chronic thromboembolic pulmonary hypertension
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María Antonia Sánchez Nistala,
Corresponding author
masani50@yahoo.com

Autor para correspondencia.
, María Teresa Velázquez Martínb
a Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
b Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España
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Las técnicas de imagen son el pilar del diagnóstico de la hipertensión pulmonar trobmboembólica crónica (HPTEC). Actualmente, se dispone de una serie de técnicas de imagen de indudable utilidad: gammagrafía ventilación/perfusión, ecocardiografía, tomografía computarizada (TC) multicorte, resonancia magnética y arteriografía pulmonar, aunque no todas están indicadas de rutina en todos los pacientes. La gammagrafía y la ecografía se utilizan como método de cribado de HPTEC tras un tromboembolismo pulmonar agudo.

La TC con multidetector (TCMD) es una herramienta eficaz en el estudio de la HPTBEC, ya que demuestra la localización, extensión y características de los trombos arteriales centrales y periféricos, además de ofrecer un estudio del vaso distal a la obstrucción. Permite valorar otros hallazgos que pueden condicionar el tratamiento médico o quirúrgico, como circulación sistémica colateral, patología parenquimatosa coincidente, patología coronaria o cardíaca. Es un método no invasivo y bien tolerado por los pacientes, por lo que puede emplearse en el seguimiento de la enfermedad o para valorar resultados posquirúrgicos.

La arteriografía pulmonar ha precedido al resto de técnicas de imagen, siendo la técnica de elección para el diagnóstico de HPTEC durante muchos años. Un acceso limitado a esta técnica, un riesgo bajo pero existente, y el desarrollo de técnicas de diagnóstico no invasivas, fundamentalmente la TCMD, han hecho que en la actualidad su principal indicación sea la valoración de la accesibilidad quirúrgica en los pacientes en los que la cirugía de tromboendarterectomía pulmonar se considera una opción terapéutica. Realizada por hemodinamistas expertos, de forma estandarizada en el laboratorio de hemodinámica, es un procedimiento seguro, incluso en pacientes con hipertensión pulmonar severa.

Palabras clave:
Hipertensión pulmonar
Hipertensión tromboembólica crónica
Trombos agudos
Tomografía Computarizada Multidetector
Angiografía pulmonar
Tromboendarterectomía
Abstract

Imaging tests are the cornerstone of the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). A series of imaging tests of unquestionable utility is currently available: ventilation-perfusion scintigraphy, echocardiography, multislice computed tomography (CT), magnetic resonance imaging, and pulmonary arteriography. However, not all of these techniques are routinely indicated in all patients.

Scintigraphy and echography are used to screen for CTEPH after an acute pulmonary thromboembolism.

Multidetector CT is effective in the study of CTEPH since this procedure reveals the localization, extension and characteristics of the central and peripheral arterial thrombi as well as providing data on the vessel distal to the obstruction. Other findings that can affect medical or surgical treatment can be assessed with this technique, such as collateral systemic circulation, concurrent parenchymatous abnormalities, and coronary or cardiac disease. Multidetector CT is a non-invasive method that is well tolerated by patients and consequently can be used in the follow-up of the disease or to evaluate postsurgical results.

Pulmonary arteriography predated other imaging techniques and was the technique of choice for the diagnosis of CTEPH for many years. Because of limited access to this procedure, a low but nevertheless present risk, and the development of non-invasive diagnostic techniques, mainly multidetector CT, the main indication of pulmonary arteriography is currently assessment of surgical accessibility in candidates for pulmonary thromboendarterectomy. When performed by expert hemodynamists using a standardized technique in the hemodynamic laboratory, this procedure is safe even in patients with severe pulmonary hypertension.

Keywords:
Pulmonary hypertension
Chronic thromboembolic hypertension
Acute thrombus
Multidetector computed tomography
Thromboendarterectomy
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Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
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