Case report
Pulmonary varix: A case report
Variz pulmonar: caso clínico
Read
7279
Timeswas read the article
1658
Total PDF
5621
Total HTML
Share statistics
array:24 [ "pii" => "S2174204916301052" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.10.026" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "839" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:443.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3592 "formatos" => array:3 [ "EPUB" => 173 "HTML" => 2992 "PDF" => 427 ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204916301064" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.10.027" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "843" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:445.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2519 "formatos" => array:3 [ "EPUB" => 178 "HTML" => 1962 "PDF" => 379 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Combined venoarterial extracorporeal membrane oxygenation and transcatheter aortic valve implantation for the treatment of acute aortic prosthesis dysfunction in a high-risk patient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "445.e1" "paginaFinal" => "445.e4" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Uso combinado de oxigenação da membrana extracorporal e implantação percutânea da válvula aórtica para o tratamento de disfunção prostética aórtica aguda num doente de alto risco" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1025 "Ancho" => 1589 "Tamanyo" => 125489 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Transesophageal echocardiography, 4-chamber mid-esophageal view, showing prosthesis degeneration and cusp tears (red arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Amedeo Pergolini, Giordano Zampi, Maria Denitza Tinti, Vincenzo Polizzi, Paolo Giuseppe Pino, Daniele Pontillo, Francesco Musumeci, Giampaolo Luzi" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Amedeo" "apellidos" => "Pergolini" ] 1 => array:2 [ "nombre" => "Giordano" "apellidos" => "Zampi" ] 2 => array:2 [ "nombre" => "Maria Denitza" "apellidos" => "Tinti" ] 3 => array:2 [ "nombre" => "Vincenzo" "apellidos" => "Polizzi" ] 4 => array:2 [ "nombre" => "Paolo Giuseppe" "apellidos" => "Pino" ] 5 => array:2 [ "nombre" => "Daniele" "apellidos" => "Pontillo" ] 6 => array:2 [ "nombre" => "Francesco" "apellidos" => "Musumeci" ] 7 => array:2 [ "nombre" => "Giampaolo" "apellidos" => "Luzi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301064?idApp=UINPBA00004E" "url" => "/21742049/0000003500000078/v2_201704060238/S2174204916301064/v2_201704060238/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2174204916301040" "issn" => "21742049" "doi" => "10.1016/j.repce.2015.11.031" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "838" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2016;35:441.e1-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2235 "formatos" => array:3 [ "EPUB" => 172 "HTML" => 1696 "PDF" => 367 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Percutaneous closure of a giant left ventricular wall pseudoaneurysm: Anterograde approach with a double snare technique" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "441.e1" "paginaFinal" => "441.e4" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Encerramento percutâneo de um volumoso pseudoaneurisma do ventrículo esquerdo: abordagem anterógrada utilizando a técnica de duplo <span class="elsevierStyleItalic">snare</span>" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1426 "Ancho" => 1585 "Tamanyo" => 127106 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Computed tomography angiography showing a large left ventricular wall pseudoaneurysm with a defect in the ventricular wall.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Afonso Nogueira, António Fiarresga, Lídia de Sousa, Ana Agapito, Ana Galrinho, Rui Cruz Ferreira" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Afonso Nogueira" ] 1 => array:2 [ "nombre" => "António" "apellidos" => "Fiarresga" ] 2 => array:2 [ "nombre" => "Lídia" "apellidos" => "de Sousa" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Agapito" ] 4 => array:2 [ "nombre" => "Ana" "apellidos" => "Galrinho" ] 5 => array:2 [ "nombre" => "Rui" "apellidos" => "Cruz Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301040?idApp=UINPBA00004E" "url" => "/21742049/0000003500000078/v2_201704060238/S2174204916301040/v2_201704060238/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Pulmonary varix: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "443.e1" "paginaFinal" => "443.e4" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge Haddad, André Badran, Rafael Pavão, Adriana I. de Padua, Igor Lago, Jose A. Marin Neto" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jorge" "apellidos" => "Haddad" "email" => array:1 [ 0 => "jl.haddad@yahoo.com.br" ] "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" => "André" "apellidos" => "Badran" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rafael" "apellidos" => "Pavão" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Adriana I." "apellidos" => "de Padua" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Igor" "apellidos" => "Lago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Jose A." "apellidos" => "Marin Neto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Catheterization and Interventional Cardiology – Hospital das Clínicas – Ribeirão Preto School of Medicine – University of São Paulo, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pneumology Division – Clinics Hospital – Ribeirão Preto School of Medicine – University of São Paulo, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Variz pulmonar: caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2400 "Ancho" => 3334 "Tamanyo" => 616585 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Left pulmonary arteriography showing dilated central and thin peripheral vessels; (B) venous return to the left atrium; (C) complete obstruction of the apical posterior vein (arrow); (D) inferior lobe arteriography and venous return showing dilatation and twisting of the central veins (arrows); (E) obstruction of the inferior and superior basilar veins. APV: apical posterior vein; IBV: inferior basilar vein; IPV: inferior pulmonary vein; LA: left atrium; SBV: superior basilar vein; SPV: superior pulmonary vein.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 34-year-old female patient with six pregnancies, four deliveries and two miscarriages (G6P2A4), with a history of slowly progressive dyspnea over the previous six years, associated with chest oppression and occasional syncope. In the last two pregnancies she noticed worsening of dyspnea during minimum exertion (New York Heart Association class IV) and generalized postpartum edema. On physical examination her heart rate was 90 bpm and blood pressure was 100/60 mmHg and she had normal pulses in all four limbs, precordial thrust in the lower left sternal border and a loud second heart sound without murmurs. Lung auscultation revealed no adventitious bruits, and there was no edema, ascites or hepatic splenomegaly.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Laboratory tests showed hematocrit 35%, hemoglobin 11.7 g/dl, GOT 316 U/l, GPT 143 U/l, and TSH 147 μIU/l. Arterial blood gas testing on room air revealed pH 7.42, pO<span class="elsevierStyleInf">2</span> 76.8 mmHg, pCO<span class="elsevierStyleInf">2</span> 33.8 mmHg, O<span class="elsevierStyleInf">2</span> sat 94.9%; serological tests for Chagas disease, HIV and hepatitis were negative, as were anti-NF, rheumatoid factor, anti-SCL-70, anti-HIV, anti-HBsAg and anti-HCV tests.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Functional pulmonary testing showed forced expiratory volume in 1 s (FEV1) 2.06 l (75% predicted); forced vital capacity (FVC) 2.39 l (68% predicted); VEF1/FVC 0.86 (109% predicted); total pulmonary capacity 4.65 l (94% predicted); residual volume 2.06 l (predicted 143); diffusing capacity: 1.616 ml/mmHg (75% predicted).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cardiopulmonary testing revealed peak oxygen uptake 10.8 ml/kg/min; respiratory exchange ratio 1.28; VE/VCO<span class="elsevierStyleInf">2</span> slope 56; and exercise oscillatory ventilation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The electrocardiogram showed sinus rhythm with right atrial and right ventricular dilatation and hypertrophy and nonspecific repolarization abnormalities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The chest X-ray demonstrated cardiomegaly with dilation of the right chambers and enlarged pulmonary vessels, more evident in the lung bases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">On echocardiography, there was moderate dilation of the right cavities with diffuse right ventricular hypokinesia, paradoxical septal motion, moderate tricuspid regurgitation, and dilatation of the pulmonary trunk and main branches. Pulmonary hypertension was detected with peak systolic pressure of 87 mmHg.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following diagnosis of pulmonary hypertension by echocardiography, the patient was referred to our catheterization laboratory for characterization of pulmonary hypertension and study of pulmonary vascular reactivity.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Cardiac catheterization and pulmonary angiography revealed pulmonary artery pressure of 70/40/50 mmHg; right ventricular pressure 70/08/15 mmHg; mean right atrial pressure 15 mmHg with increased V wave (20 mmHg); mean pulmonary capillary wedge pressure in both lungs 10 mmHg; left ventricular pressures 100/02/10 mmHg; and aortic gradient: 100/60/73 mmHg.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Cardiac output was 2.1 l/m/m<span class="elsevierStyleSup">2</span> and pulmonary vascular resistance index was 9 Wood units/m<span class="elsevierStyleSup">2</span>; the patient was unresponsive to vascular reactivity testing administering 100% O<span class="elsevierStyleInf">2</span> and nitric oxide up to 80 parts per million.</p><p id="par0055" class="elsevierStylePara elsevierViewall">A transseptal puncture was then performed followed by selective contrast injection in the pulmonary veins, and a left atrial and venous pressure gradient of 10 mmHg was measured. The pulmonary angiogram (<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>) showed bilateral varicose dilatation of the inferior pulmonary veins, more prominent in the right lung. The right lung presented varices in the veins of the middle and inferior lobes, severe obstruction of the superior pulmonary vein at its junction with the left atrium, and occlusion of the inferior basilar vein. The left lung presented varices in the lingula and inferior lobe, occlusion of the apicoposterior vein and inferior basilar vein and severe obstruction of the superior basilar vein.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Chest computed tomography following cardiac catheterization and angiography demonstrated pulmonary hypertension with right ventricular overload and images of bilateral varices, more prominent in the right lung, in both segments of the middle lobe and the mid and posterior segments of the inferior lobe, with severe obstruction of the superior pulmonary vein at the junction with the left atrium. In the left lung, varices of the veins of the lingula and anterior and lateral segments of the inferior lobe were observed.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patient was treated with sildenafil 25 mg three times daily, oral anticoagulation, intrauterine device implantation and inclusion in the cardiopulmonary transplantation program.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Pulmonary varix is a rare pulmonary venous disorder, with fewer than 100 cases reported in the literature, originally described by Puchet in 1843 at autopsy of a child who died from intestinal bleeding and who also presented multiple varices in other organs. The next five cases (Hedinger-Basel, 1907; Nauwerck, 1923; Klinck and Hunt, 1933; Neiman, 1934; Jacchia, 1936) were also autopsy findings; Mouquin et al. reported the first angiographic description in a living patient in 1951.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Pulmonary varices can be congenital or acquired, and isolated or associated with varices in other organs. Congenital varices develop during the embryonic period and may coexist with various congenital heart diseases. Acquired forms are associated with diseases with increased pulmonary vein pressure such as mitral valve disease or distal occlusion of the pulmonary veins, liver cirrhosis or emphysema.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2–5</span></a> Even when associated with pulmonary venous hypertension, there must be a concomitant histological weakness in the vein wall, since pulmonary varicosities are infrequent in the presence of those more common disorders. In cases of mitral regurgitation, the most affected veins are those of the right inferior lobe, probably due to the preferential direction of retrograde flow, and varices can regress after valve replacement or repair.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The criteria for angiographic diagnosis were established by Bartram et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and more recently by Berecova et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>: (1) normal pulmonary arteries; (2) absence of pulmonary arteriovenous fistulae; (3) simultaneous filling of varicose and normal veins; (4) varices draining into the left atrium; (5) prolonged emptying compared to normal veins; (6) the dilated and tortuous varices are central, near the hilum, with normal peripheral veins.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In a review of 71 published cases, Uyama et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> classified pulmonary varices in three types: (1) saccular type, localized, oval or saccular dilatation; (2) tortuous type, twisted, elongated dilatation; and (3) confluent type, dilatation in the confluence of the pulmonary veins.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our patient, the varices were possibly congenital because although they were associated with pulmonary vein stenosis, these obstructions were located in non-varicose veins. The varices in this case were central, twisted and elongated, and the peripheral veins were normal. Drainage of the occluded varices was to the left atrium, although there were some collateral vessels from the superior to the middle and inferior lobes of the right lung.</p><p id="par0095" class="elsevierStylePara elsevierViewall">This is, to the best of our knowledge, the first case reported of association of pulmonary varix with primary pulmonary hypertension, another congenital disease.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The differential diagnosis of pulmonary varices includes other conditions with dilatation of the pulmonary veins, including pulmonary arteriovenous fistulas, and hepatopulmonary and scimitar syndromes.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Congenital pulmonary varices are usually asymptomatic and do not require treatment, but annual monitoring with imaging studies should be considered. In some cases, dysphagia and middle lobe syndrome may be present, due to compression of the esophagus and bronchi, respectively. The main complications of pulmonary varices are rupture, hemoptysis, and thrombosis with systemic embolism, and treatment is directed to prevent these events. Our approach was oral anticoagulation, intrauterine device implantation, pharmacological treatment for pulmonary hypertension and inclusion in the cardiopulmonary transplantation program.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres825318" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec821805" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres825317" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec821806" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-05" "fechaAceptado" => "2015-10-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec821805" "palabras" => array:4 [ 0 => "Pulmonary veins" 1 => "Varices" 2 => "Aneurysm" 3 => "Pulmonary arterial hypertension" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec821806" "palabras" => array:4 [ 0 => "Veias Pulmonares" 1 => "Varizes" 2 => "Aneurisma" 3 => "Hipertensão pulmonar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The authors report a case of multiple pulmonary varices, a rare disease characterized by aneurysmatic venous dilatations, which can be present at any age and without gender predominance, occurring in isolation or associated with obstruction of the pulmonary veins. This condition usually manifests as a lung mass with variable clinical consequences.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Relata-se um caso de varizes pulmonares, na sequência diagnóstica realmente ocorrida. É patologia rara, em que a dilatação venosa aneurismática pode ser isolada ou associar-se a obstruções venosas, ocorrendo em qualquer idade, e sem predomínio de gênero. Frequentemente manifesta-se como massa pulmonar a esclarecer e apresenta repercussão clínica variável.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2267 "Ancho" => 3333 "Tamanyo" => 642398 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Right pulmonary arteriography showing dilatation of this branch with normal peripheral vessels; (B) selective injection in the superior right pulmonary artery; (C) pulmonary venous return with significant obstruction of the superior vein (arrow) and collateral vessels to the inferior vein with presence of multiple varices; (D) selective injection in the right inferior pulmonary artery; (E) pulmonary venous return showing dilatation and twisting of the central veins of the middle and inferior lobes; (F) complete obstruction of the inferior basilar vein (arrow). IBV: inferior basilar vein; SPV: superior pulmonary vein.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2400 "Ancho" => 3334 "Tamanyo" => 616585 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Left pulmonary arteriography showing dilated central and thin peripheral vessels; (B) venous return to the left atrium; (C) complete obstruction of the apical posterior vein (arrow); (D) inferior lobe arteriography and venous return showing dilatation and twisting of the central veins (arrows); (E) obstruction of the inferior and superior basilar veins. APV: apical posterior vein; IBV: inferior basilar vein; IPV: inferior pulmonary vein; LA: left atrium; SBV: superior basilar vein; SPV: superior pulmonary vein.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary varix" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.C. Arnett" 1 => "R.M. Patton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "1976" "volumen" => "31" "paginaInicial" => "107" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1257930" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare case of dilatation of pulmonary veins and pulmonary emphysema in both lower lobes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Ishii" 1 => "H. Mukae" 2 => "T. Kakugawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2005.00735.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2005" "volumen" => "10" "paginaInicial" => "548" "paginaFinal" => "552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16135184" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of pulmonary varix associated with superior pulmonary vein occlusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Tajiri" 1 => "J. Koizumi" 2 => "T. Hara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3400/avd.cr.12.00041" "Revista" => array:6 [ "tituloSerie" => "Ann Vasc Dis" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "381" "paginaFinal" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23555540" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.R. Ferretti" 1 => "F. Arbib" 2 => "B. Bertrand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "1998" "volumen" => "12" "paginaInicial" => "989" "paginaFinal" => "992" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9817180" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduction in pulmonary varix size after mitral valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Iwasaki" 1 => "K. Amamiya" 2 => "S. Inaba" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Surg" "fecha" => "1989" "volumen" => "30" "paginaInicial" => "381" "paginaFinal" => "383" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regression of multiple pulmonary varices after mitral valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.R. Shaw" 1 => "L. Fananapazir" 2 => "R.J. McCormack" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1980" "volumen" => "79" "paginaInicial" => "117" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7350378" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary varices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Bartram" 1 => "B. Strickland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/0007-1285-44-528-927" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "1971" "volumen" => "44" "paginaInicial" => "927" "paginaFinal" => "935" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4333482" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A complex pulmonary vein varix – diagnosis with ECG gated MDCT, MRI and invasive pulmonary angiography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Z. Berecova" 1 => "V. Neuschl" 2 => "P. Boruta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Radiol Case" "fecha" => "2012" "volumen" => "6" "paginaInicial" => "9" "paginaFinal" => "16" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pulmonary varices: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Uyama" 1 => "Y. Monden" 2 => "K. Harada" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn J Surg" "fecha" => "1998" "volumen" => "18" "paginaInicial" => "359" "paginaFinal" => "362" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3043071" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypoxemia and liver cirrhosis (hepatopulmonary syndrome) in eight patients: comparison of the central and peripheral pulmonary vasculature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K. Lee" 1 => "H. Lee" 2 => "W.W. Shin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.211.2.r99ma46549" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1999" "volumen" => "211" "paginaInicial" => "549" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10228541" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000078/v2_201704060238/S2174204916301052/v2_201704060238/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000078/v2_201704060238/S2174204916301052/v2_201704060238/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301052?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 6 | 20 |
| 2024 October | 47 | 25 | 72 |
| 2024 September | 47 | 25 | 72 |
| 2024 August | 46 | 29 | 75 |
| 2024 July | 41 | 24 | 65 |
| 2024 June | 37 | 16 | 53 |
| 2024 May | 47 | 30 | 77 |
| 2024 April | 78 | 27 | 105 |
| 2024 March | 89 | 26 | 115 |
| 2024 February | 53 | 31 | 84 |
| 2024 January | 45 | 37 | 82 |
| 2023 December | 45 | 29 | 74 |
| 2023 November | 51 | 17 | 68 |
| 2023 October | 51 | 14 | 65 |
| 2023 September | 36 | 17 | 53 |
| 2023 August | 44 | 12 | 56 |
| 2023 July | 36 | 12 | 48 |
| 2023 June | 37 | 8 | 45 |
| 2023 May | 49 | 22 | 71 |
| 2023 April | 28 | 3 | 31 |
| 2023 March | 31 | 19 | 50 |
| 2023 February | 31 | 19 | 50 |
| 2023 January | 34 | 16 | 50 |
| 2022 December | 33 | 16 | 49 |
| 2022 November | 43 | 23 | 66 |
| 2022 October | 33 | 25 | 58 |
| 2022 September | 35 | 23 | 58 |
| 2022 August | 42 | 31 | 73 |
| 2022 July | 43 | 42 | 85 |
| 2022 June | 23 | 17 | 40 |
| 2022 May | 40 | 24 | 64 |
| 2022 April | 35 | 27 | 62 |
| 2022 March | 30 | 28 | 58 |
| 2022 February | 25 | 18 | 43 |
| 2022 January | 29 | 26 | 55 |
| 2021 December | 21 | 27 | 48 |
| 2021 November | 36 | 44 | 80 |
| 2021 October | 41 | 33 | 74 |
| 2021 September | 30 | 26 | 56 |
| 2021 August | 33 | 36 | 69 |
| 2021 July | 34 | 22 | 56 |
| 2021 June | 39 | 24 | 63 |
| 2021 May | 40 | 40 | 80 |
| 2021 April | 79 | 33 | 112 |
| 2021 March | 64 | 25 | 89 |
| 2021 February | 58 | 20 | 78 |
| 2021 January | 46 | 22 | 68 |
| 2020 December | 48 | 13 | 61 |
| 2020 November | 44 | 13 | 57 |
| 2020 October | 31 | 10 | 41 |
| 2020 September | 97 | 16 | 113 |
| 2020 August | 64 | 9 | 73 |
| 2020 July | 84 | 7 | 91 |
| 2020 June | 65 | 9 | 74 |
| 2020 May | 69 | 7 | 76 |
| 2020 April | 82 | 23 | 105 |
| 2020 March | 87 | 6 | 93 |
| 2020 February | 132 | 24 | 156 |
| 2020 January | 51 | 8 | 59 |
| 2019 December | 40 | 7 | 47 |
| 2019 November | 57 | 13 | 70 |
| 2019 October | 724 | 4 | 728 |
| 2019 September | 49 | 8 | 57 |
| 2019 August | 36 | 8 | 44 |
| 2019 July | 41 | 10 | 51 |
| 2019 June | 35 | 12 | 47 |
| 2019 May | 39 | 5 | 44 |
| 2019 April | 29 | 21 | 50 |
| 2019 March | 102 | 13 | 115 |
| 2019 February | 107 | 6 | 113 |
| 2019 January | 89 | 7 | 96 |
| 2018 December | 59 | 11 | 70 |
| 2018 November | 105 | 4 | 109 |
| 2018 October | 259 | 16 | 275 |
| 2018 September | 79 | 12 | 91 |
| 2018 August | 46 | 10 | 56 |
| 2018 July | 51 | 7 | 58 |
| 2018 June | 62 | 5 | 67 |
| 2018 May | 85 | 8 | 93 |
| 2018 April | 75 | 4 | 79 |
| 2018 March | 102 | 8 | 110 |
| 2018 February | 14 | 6 | 20 |
| 2018 January | 43 | 8 | 51 |
| 2017 December | 60 | 4 | 64 |
| 2017 November | 32 | 9 | 41 |
| 2017 October | 26 | 12 | 38 |
| 2017 September | 19 | 14 | 33 |
| 2017 August | 20 | 9 | 29 |
| 2017 July | 28 | 12 | 40 |
| 2017 June | 23 | 19 | 42 |
| 2017 May | 29 | 17 | 46 |
| 2017 April | 21 | 10 | 31 |
| 2017 March | 37 | 44 | 81 |
| 2017 February | 41 | 6 | 47 |
| 2017 January | 24 | 2 | 26 |
| 2016 December | 27 | 5 | 32 |
| 2016 November | 23 | 5 | 28 |
| 2016 October | 18 | 5 | 23 |
| 2016 September | 34 | 9 | 43 |
| 2016 August | 26 | 1 | 27 |
| 2016 July | 2 | 1 | 3 |
Show all
