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Bilateral Empyema due to Spontaneous Esophageal Perforation
Empiema bilateral secundario a una perforación esofágica espontánea
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B: Resolution of the Shamroth sign after one month of corticosteroid treatment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandro Maiso, Luis Dominguez-Juncal, Pedro J. Marcos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Maiso" ] 1 => array:2 [ "nombre" => "Luis" "apellidos" => "Dominguez-Juncal" ] 2 => array:2 [ "nombre" => "Pedro J." 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Patients initially recruited were divided into 2 cohorts: patients with apnea–hypopnea index (AHI) ≤30 (no or mild-moderate SAHS) and patients with AHI ≥30 (severe SAHS). In the ≤30 cohort, patients were randomized to the NIV or control arms, and in the ≥ 30 cohort they were randomized to the control, NIV or CPAP arms until the medium-term evaluation (2 months). Following this, patients in the control arm of the ≥30 cohort were re-randomized to the NIV or CPAP arms, and both cohorts then completed the 36 months of follow-up. CPAP: continuous positive airway pressure; NIV: non-invasive ventilation; OHS: obesity hypoventilation syndrome; SAHS: sleep apnea hypopnea syndrome.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María J. López-Jiménez, Juan F. Masa, Jaime Corral, Joaquín Terán, Estrella Ordaz, Maria F. Troncoso, Nicolás González-Mangado, Mónica González, Soledad Lopez-Martínez, Pilar De Lucas, José M. 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A fistula communicates the esophagus with the posterior mediastinal compartment, with accumulation of contrast in the lower slope of both hemithoraces.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 50-year-old man, with no significant clinical history, who presented in an emergency department in the city of Cuzco with a 3-day history of nausea, vomiting, and progressive dyspnea. Chest X-ray revealed bilateral pleural effusion. Cytochemical analysis of the pleural fluid was consistent with empyema. The patient developed progressive respiratory failure requiring mechanical ventilation and transfer to the intensive care unit (ICU), where he was treated with wide-spectrum antibiotics and bilateral chest drainage. He was extubated 10 days later, and transferred to our ICU in Lima.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On arrival, his bilateral empyema persisted, so a computed tomography was performed with oral contrast medium, showing esophageal perforation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The diagnosis of esophageal perforation was confirmed on upper endoscopy, showing an ogival-shaped rupture in the posterior esophageal wall communicating with the mediastinum 3<span class="elsevierStyleHsp" style=""></span>cm from the gastroesophageal junction. The fistula was closed with metal clips and a nasojejunal tube was placed. The patient's progress was favorable, enteral nutrition was well tolerated, and no signs of sepsis or respiratory failure were observed. After placement of the clips, chest drainage reduced progressively to less than 100<span class="elsevierStyleHsp" style=""></span>cc/24<span class="elsevierStyleHsp" style=""></span>h. This situation was maintained until the patient was discharged and transferred to Germany to continue his recovery, where the clips were finally removed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Boerhaave's syndrome is the spontaneous perforation of the esophagus due to a sudden increase in intraesophageal pressure.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> The non-specific nature of the symptoms may contribute to a delay in diagnosis and worsen prognosis. Pneumomediastium or pneumoperitoneum associated with pleural effusion, pneumothorax and/or subcutaneous emphysema are generally seen on chest X-ray.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> Diagnosis is confirmed by computed tomography, esophagogram with contrast medium, or endoscopy.</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: Makikado LDU, Rocca CAN, Malca GEG. Empiema bilateral secundario a una perforación esofágica espontánea. Arch Bronconeumol. 2016;52:166.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1257 "Ancho" => 1658 "Tamanyo" => 226907 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest tomography showing bilateral pleural effusion with signs of pneumomediastinum. A fistula communicates the esophagus with the posterior mediastinal compartment, with accumulation of contrast in the lower slope of both hemithoraces.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous rupture of the esophagus: a 30-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.W. Pate" 1 => "W.A. Walker" 2 => "F.H. Cole Jr." 3 => "E.W. Owen" 4 => "W.H. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "1989" "volumen" => "47" "paginaInicial" => "689" "paginaFinal" => "692" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2730190" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Boerhaave's syndrome: analysis of the literature and report of 18 new cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.B. Brauer" 1 => "D. Liebermann-Meffert" 2 => "H.J. Stein" 3 => "H. Bartels" 4 => "J.R. Siewert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dis Esophagus" "fecha" => "1997" "volumen" => "10" "paginaInicial" => "64" "paginaFinal" => "68" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9079278" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000003/v1_201602270250/S1579212916000033/v1_201602270250/en/main.assets" "Apartado" => array:4 [ "identificador" => "21342" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical Image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000003/v1_201602270250/S1579212916000033/v1_201602270250/en/main.pdf?idApp=UINPBA00003Z&text.app=https://www.archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000033?idApp=UINPBA00003Z" ]
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| 2017 October | 17 | 5 | 22 |
| 2017 September | 30 | 9 | 39 |
| 2017 August | 26 | 8 | 34 |
| 2017 July | 27 | 11 | 38 |
| 2017 June | 24 | 30 | 54 |
| 2017 May | 27 | 10 | 37 |
| 2017 April | 28 | 10 | 38 |
| 2017 March | 16 | 7 | 23 |
| 2017 February | 12 | 6 | 18 |
| 2017 January | 11 | 8 | 19 |
| 2016 December | 30 | 12 | 42 |
| 2016 November | 30 | 22 | 52 |
| 2016 October | 36 | 18 | 54 |
| 2016 September | 19 | 8 | 27 |
| 2016 August | 24 | 4 | 28 |
| 2016 July | 24 | 8 | 32 |
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