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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2018;151:e39-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 15 "formatos" => array:2 [ "HTML" => 7 "PDF" => 8 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Infarto omental en el transcurso de una apendicitis aguda" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e39" "paginaFinal" => "e40" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Omental infarction during acute appendicitis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Rodríguez Moncada, José Ángel López Díaz, Alberto Carrillo Acosta" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Rodríguez Moncada" ] 1 => array:2 [ "nombre" => "José Ángel" "apellidos" => "López Díaz" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Carrillo Acosta" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020618303243" "doi" => "10.1016/j.medcle.2017.11.056" "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/S2387020618303243?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317309235?idApp=UINPBA00004N" "url" => "/00257753/0000015100000007/v1_201809210709/S0025775317309235/v1_201809210709/es/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in medicine</span>" "titulo" => "Right-to-left pulmonary shunt through arteriovenous malformation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "297" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Satoru Yanagisawa, Ayumi Mitsune, Masakazu Ichinose" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Satoru" "apellidos" => "Yanagisawa" "email" => array:1 [ 0 => "yngsw-0829@umin.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ayumi" "apellidos" => "Mitsune" ] 2 => array:2 [ "nombre" => "Masakazu" "apellidos" => "Ichinose" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Shunt pulmonar de derecha a izquierda a través de malformación arteriovenosa" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1115 "Ancho" => 2167 "Tamanyo" => 192510 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 20-year-old man with recurrent nosebleed was referred to our department with bilateral lung nodules. His father also had repeated epistaxis. The patient presented with exertional dyspnea; the physical examination showed orthodeoxia. The contrast enhanced chest computed tomography scan revealed multiple tortuous collections of vessels with dilated feeding arteries (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B, arrows), suggesting pulmonary arteriovenous malformation (PAVM). Transthoracic contrast echocardiography (TTCE) using agitated saline confirmed a right-to-left intrapulmonary shunt (supplementary material, video); abundant bubbles in the right atrium moved to the left atrium (LA) after a delay of four cardiac cycles (not immediately, as in the case of an intracardiac shunt). Arterial blood gas testing after breathing 100% oxygen and <span class="elsevierStyleSup">99m</span>Tc-MAA (macroaggregated albumin) radionuclide perfusion scanning calculated the pulmonary shunt fraction to be 24.0% and 25.5%, respectively (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). The patient was diagnosed as having multiple PAVMs of hereditary hemorrhagic telangiectasia and underwent embolotherapy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">TTCE is a less invasive, highly sensitive method for diagnosing right-to-left shunt, in which microbubbles are not filtered out by pulmonary capillaries so they reach the LA. By knowing the timing and number of bubbles entering the LA, it is possible to determine a more accurate diagnosis and therapeutic strategy.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "xack367030" "titulo" => "Acknowledgments" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0035" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1115 "Ancho" => 2167 "Tamanyo" => 192510 ] ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1435422 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack367030" "titulo" => "Acknowledgments" "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">We would like to thank Editage (<a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="http://www.editage.jp/">www.editage.jp</a>) for the English language editing.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015100000007/v1_201809210709/S0025775317309193/v1_201809210709/en/main.assets" "Apartado" => array:4 [ "identificador" => "64289" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes médicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015100000007/v1_201809210709/S0025775317309193/v1_201809210709/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317309193?idApp=UINPBA00004N" ]
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