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Difficult airway by hematoma of the thongue in a patient on anticoagulant therapy
Vía aérea difícil por hematoma lingual en paciente anticoagulado
L. España Fuente
Servicio de Anestesiología y Reanimación, Hospital Universitario San Agustín, Avilés, Asturias, Spain
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B y <span class="elsevierStyleSmallCaps">C</span>) Engrosamiento de la lengua que provoca un «efecto masa» debido al edema y hematoma de la misma (punta de flecha) que oblitera casi por completo la luz de la orofaringe. A) Estrechamiento de la orofaringe observándose una mínima luz filiforme de aproximadamente 3-4 mm (flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. España Fuente" "autores" => array:1 [ 0 => array:2 [ "nombre" => "L." 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Sanjuan, L. Álvarez-Baena, D. Callejo, A. Romera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Sanjuan" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Álvarez-Baena" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Callejo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Romera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935620301894" "doi" => "10.1016/j.redar.2020.07.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935620301894?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119292100069X?idApp=UINPBA00004N" "url" => "/23411929/0000006800000005/v1_202106150624/S234119292100069X/v1_202106150624/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Difficult airway by hematoma of the thongue in a patient on anticoagulant therapy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "307" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "L. España Fuente" "autores" => array:1 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "España Fuente" "email" => array:1 [ 0 => "lorenespana@yahoo.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario San Agustín, Avilés, Asturias, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vía aérea difícil por hematoma lingual en paciente anticoagulado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 908 "Ancho" => 2917 "Tamanyo" => 221335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nasopharyngeal image (A and C) and cervical (B and C) CT scan showing thickening of the tongue causing a “mass effect” due to oedema and haematoma (arrowhead) that almost completely obliterates the lumen of the oropharynx. (A) Narrowing of the oropharynx, showing a thin filiform lumen of approximately 3–4 mm (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 62-year-old patient, height 1.77 cm and weight 90 kg, with a body mass index (BMI) of 28.7, taking anticoagulation therapy with rivaroxaban for atrial fibrillation, was admitted with respiratory distress due to a sublingual haematoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed swelling of the base of the tongue that caused a “mass effect” in which tongue itself occupied most of the oral cavity and almost completely obliterated the lumen of the oropharynx (arrowhead), leaving a small filiform lumen 3–4 mm in diameter (arrow). The absence of active bleeding confirmed the diagnosis of haematoma with significant oedema that did not extend to other compartments of the neck.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Faced with the risk of a “cannot intubate, cannot ventilate” situation due to the size of the oedema, the rapid and progressive deterioration of spontaneous ventilation, and in view of the patient’s anatomy, which permitted easy identification of the laryngeal cartilages, we decided to perform an urgent percutaneous tracheostomy.</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: España Fuente L. Vía aérea difícil por hematoma lingual en paciente anticoagulado. Rev Esp Anestesiol Reanim. 2021;68:306–307.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 621 "Ancho" => 1250 "Tamanyo" => 166574 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The oral cavity of the patient, showing the swelling caused by oedema and haematoma that made it impossible to visualise the tip of the tongue. The swelling also restricted mouth opening.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 908 "Ancho" => 2917 "Tamanyo" => 221335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nasopharyngeal image (A and C) and cervical (B and C) CT scan showing thickening of the tongue causing a “mass effect” due to oedema and haematoma (arrowhead) that almost completely obliterates the lumen of the oropharynx. (A) Narrowing of the oropharynx, showing a thin filiform lumen of approximately 3–4 mm (arrow).</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006800000005/v1_202106150624/S2341192921000792/v1_202106150624/en/main.assets" "Apartado" => array:4 [ "identificador" => "70433" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006800000005/v1_202106150624/S2341192921000792/v1_202106150624/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192921000792?idApp=UINPBA00004N" ]
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