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Lobar Pulmonary Embolism Diagnosed During Endobronchial Ultrasound
Embolismo pulmonar lobar diagnosticado durante ultrasonografía endobronquial
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(B) CT revealed an irregular lesion in the right upper lobe with pathological uptake on PET-CT. (C) PET-CT revealed pathological uptake in these lesions and in mediastinal, hilar, and interlobar lymph nodes. (D) Ultrasound view before the puncture of the 4R lymph node.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fernando Garcia-Prieto, Adriana Rodríguez Perojo, María Teresa Río Ramírez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Fernando" "apellidos" => "Garcia-Prieto" ] 1 => array:2 [ "nombre" => "Adriana" "apellidos" => "Rodríguez Perojo" ] 2 => array:2 [ "nombre" => "María Teresa" "apellidos" => "Río Ramírez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2659663624000122?idApp=UINPBA00004N" "url" => "/26596636/0000000600000002/v1_202406140703/S2659663624000122/v1_202406140703/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2659663624000274" "issn" => "26596636" "doi" => "10.1016/j.opresp.2024.100324" "estado" => "S300" "fechaPublicacion" => "2024-04-01" "aid" => "100324" "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Open Respir Arch. 2024;6:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Preguntas y respuestas</span>" "titulo" => "Asma" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Asthma" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Celia Pinedo Sierra, Elena Curto Sánchez, Rocio Diaz Campos, Tamara Hermida Valverde, Silvia Sánchez-Cuellar, Ana Fernández Tena" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Celia" "apellidos" => "Pinedo Sierra" ] 1 => array:2 [ "nombre" => "Elena" "apellidos" => "Curto Sánchez" ] 2 => array:2 [ "nombre" => "Rocio" "apellidos" => "Diaz Campos" ] 3 => array:2 [ "nombre" => "Tamara" "apellidos" => "Hermida Valverde" ] 4 => array:2 [ "nombre" => "Silvia" "apellidos" => "Sánchez-Cuellar" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "Fernández Tena" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2659663624000274?idApp=UINPBA00004N" "url" => "/26596636/0000000600000002/v1_202406140703/S2659663624000274/v1_202406140703/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical image</span>" "titulo" => "Lobar Pulmonary Embolism Diagnosed During Endobronchial Ultrasound" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Cascón-Hernández, Patricia Álvarez Álvarez, Joaquín Martínez-Menéndez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Juan" "apellidos" => "Cascón-Hernández" "email" => array:1 [ 0 => "jcasconh@gmail.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" => "Patricia" "apellidos" => "Álvarez Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Joaquín" "apellidos" => "Martínez-Menéndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Interventional Pulmonology Unit, Respiratory Department, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Respiratory Department, Hospital Universitario Son Espases, Mallorca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolismo pulmonar lobar diagnosticado durante ultrasonografía endobronquial" ] ] "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" => 1376 "Ancho" => 2007 "Tamanyo" => 259762 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Images of the thrombus in the left pulmonary artery branch, indicated by the arrow, in axial (A) and coronal (B) sections of CTPA. (C) EBUS: Doppler mode image showing the thrombus occluding the arterial circulation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 78-year-old male with dyspnea for several weeks underwent a computed tomography (CT) scan. A CT-guided biopsy of a nodule in the right upper lobe was performed, which was compatible with pulmonary adenocarcinoma. Staging was completed with positron emission tomography (PET) and endobronchial ultrasound (EBUS) immediately after.</p><p id="par0010" class="elsevierStylePara elsevierViewall">During EBUS, an incidental discovery was made—an isoechoic intravascular image was identified within a branch of the left pulmonary artery (11–12<span class="elsevierStyleHsp" style=""></span>L level) (<a class="elsevierStyleCrossRef" href="#sec0030">Video 1</a>), which had not been visualized in previous imaging tests.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given this suspicion, the patient was promptly referred to the emergency department for a CT pulmonary angiogram (CTPA), confirming the presence of a left lobar pulmonary embolism (PE), which would justify the dyspnea (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">It is important to systematically explore the mediastinum, including lymph node and vascular anatomy. PE is a prevalent disease, with a higher risk in lung cancer cases, and its diagnosis can be complex. However, in experienced hands, the procedure duration should not increase substantially.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Although CTPA is still considered the gold standard, documented cases in the literature<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> suggest that EBUS can serve as a diagnostic alternative in specific scenarios, such as contrast allergy, renal failure, or hemodynamic instability,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> where CTPA is not viable.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient has signed the informed consent form.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study was not supported by any grant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors’ contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">Study concept and design, JCH; Drafting of the manuscript, PAA, JMM; Critical revision of the manuscript for important intellectual content, JCH.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare to have no conflict of interest directly or indirectly related to the manuscript contents.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Informed consent" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Authors’ contributions" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0055" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1376 "Ancho" => 2007 "Tamanyo" => 259762 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Images of the thrombus in the left pulmonary artery branch, indicated by the arrow, in axial (A) and coronal (B) sections of CTPA. 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Llopis Pastor" 1 => "J. Franco Serrano" 2 => "E. Burés Sales" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2013.04.011" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "555" "paginaFinal" => "556" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24200533" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of endobronchial ultrasound for bedside diagnosis of acute pulmonary embolism in a critically ill patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Channick" 1 => "R. Channick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest" "fecha" => "2019" "volumen" => "154" "paginaInicial" => "651" "paginaFinal" => "652" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/26596636/0000000600000002/v1_202406140703/S2659663624000018/v1_202406140703/en/main.assets" "Apartado" => array:4 [ "identificador" => "85984" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/26596636/0000000600000002/v1_202406140703/S2659663624000018/v1_202406140703/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2659663624000018?idApp=UINPBA00004N" ]
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