Nuevo método como preacondicionamiento ante adherenciolisis de difícil manejo / New method as preconditioning for adherenciolysis difficult handling

INTRODUCTION: Intestinal obstruction due to flanges is common in patients with a surgical history. OBJECTIVE: Describe a clinical case with adherenciolysis. Surgery could not be performed, so pneumoperitoneum was used as pre-conditioning for elective surgery. CLINICAL CASE: Patient with intestinal obstruction due to flanges, with impossibility of performing an adherenciolysis, for which catheters are installed to administer progressive pneumoperitoneum in order to optimize the release of flanges in elective surgery, undergoing the postoperative period with enterocutaneous fistula that required multidisciplinary management with percutaneous drainage, parenteral nutrition and nursing care, with a successful result. DISCUSSION: In a flange obstruction, an extensive adherenciolysis is often required, which carries a greater risk of intestinal injury and enterocutaneous fistula. In this case, we believe that it decreased due to the pneumoperitoneum used to generate more lax and manageable flanges. CONCLUSION: Postoperative flanges generate significant morbidity and its surgical management requires an adherenciolysis that may be laborious or impossible in the first instance, requiring in this case the use of progressive pneumoperitoneum for complete flange release, a technique not described in the literature for this purpose.

INTRODUCCIÓN: La obstrucción intestinal por bridas es frecuente en pacientes con antecedentes quirúrgicos. OBJETIVO: Describir un caso clínico con adherenciolisis frustra por cirugía, utilizando neumoperitoneo como preacondicionamiento para cirugía electiva. CASO CLÍNICO: Paciente con obstrucción intestinal por bridas, con imposibilidad de adherenciolisis, por lo que se instalan catéteres para administrar neumoperitoneo progresivo con el fin de optimizar la liberación de bridas en cirugía electiva, cursando en el postoperatorio con fístula enterocutánea que requirió manejo multidisciplinario con drenaje percutáneo, nutrición parenteral y cuidados por enfermería, que finalmente resultó exitoso. DISCUSIÓN: En una obstrucción por bridas muchas veces se requiere una adherenciolisis extensa que conlleva mayor riesgo de lesión intestinal y fístula enterocutánea, que en este caso creemos que disminuyó debido al neumoperitoneo utilizado para generar bridas más laxas y manejables. CONCLUSIÓN: Las bridas postoperatorias generan morbilidad importante y su manejo quirúrgico requiere adherenciolisis que puede resultar laboriosa o imposible en primera instancia, requiriendo en este caso el uso de neumoperitoneo progresivo para la liberación de bridas completa, técnica no descrita en la literatura para este fin.

Three-Dimensional Remodeling of SARS-CoV2-Infected Cells Revealed by Cryogenic Soft X-ray Tomography.

Plus-strand RNA viruses are proficient at remodeling host cell membranes for optimal viral genome replication and the production of infectious progeny. These ultrastructural alterations result in the formation of viral membranous organelles and may be observed by different imaging techniques, providing nanometric resolution. Guided by confocal and electron microscopy, this study describes the generation of wide-field volumes using cryogenic soft-X-ray tomography (cryo-SXT) on SARS-CoV-2-infected human lung adenocarcinoma cells. Confocal microscopy showed accumulation of double-stranded RNA (dsRNA) and nucleocapsid (N) protein in compact perinuclear structures, preferentially found around centrosomes at late stages of the infection. Transmission electron microscopy (TEM) showed accumulation of membranous structures in the vicinity of the infected cell nucleus, forming a viral replication organelle containing characteristic double-membrane vesicles and virus-like particles within larger vesicular structures. Cryo-SXT revealed viral replication organelles very similar to those observed by TEM but indicated that the vesicular organelle observed in TEM sections is indeed a vesiculo-tubular network that is enlarged and elongated at late stages of the infection. Overall, our data provide additional insight into the molecular architecture of the SARS-CoV-2 replication organelle.

Xanthoma of rib: a case report and review of the literature.

BACKGROUND: Xanthomas are well-circumscribed benign proliferative lesions seen mainly in soft tissues. Usually, they are found in hyperlipidemia and familial hyperlipoproteinemia. Histologically, are characterized by macrophage-like mononuclear cells, multinucleated giant cells and abundant foam cells. The bone involvement, however, is notoriously rare and rib localization is extremely rare. CASE PRESENTATION: A 55-year-old man performed a chest X-ray and a subsequent chest Computed Tomography scan showing a rib lesion that was surgically removed and a diagnosis of rib xanthoma was made. The patient presented an unknown condition of hyperlipidemia. CONCLUSION: Rib xanthoma can be discovered accidentally and can be helpful in identifying an unrecognized condition of hyperlipidemia.

Towards virtual histology with X-ray grating interferometry.

Breast cancer is the most common type of cancer worldwide. Diagnosing breast cancer relies on clinical examination, imaging and biopsy. A core-needle biopsy enables a morphological and biochemical characterization of the cancer and is considered the gold standard for breast cancer diagnosis. A histopathological examination uses high-resolution microscopes with outstanding contrast in the 2D plane, but the spatial resolution in the third, Z-direction, is reduced. In the present paper, we propose two high-resolution table-top systems for phase-contrast X-ray tomography of soft-tissue samples. The first system implements a classical Talbot-Lau interferometer and allows to perform ex-vivo imaging of human breast samples with a voxel size of 5.57 µm. The second system with a comparable voxel size relies on a Sigray MAAST X-ray source with structured anode. For the first time, we demonstrate the applicability of the latter to perform X-ray imaging of human breast specimens with ductal carcinoma in-situ. We assessed image quality of both setups and compared it to histology. We showed that both setups made it possible to target internal features of breast specimens with better resolution and contrast than previously achieved, demonstrating that grating-based phase-contrast X-ray CT could be a complementary tool for clinical histopathology.

Improving detection performance of hepatocellular carcinoma and interobserver agreement for liver imaging reporting and data system on CT using deep learning reconstruction.

PURPOSE: This study aimed to compare the hepatocellular carcinoma (HCC) detection performance, interobserver agreement for Liver Imaging Reporting and Data System (LI-RADS) categories, and image quality between deep learning reconstruction (DLR) and conventional hybrid iterative reconstruction (Hybrid IR) in CT. METHODS: This retrospective study included patients who underwent abdominal dynamic contrast-enhanced CT between October 2021 and March 2022. Arterial, portal, and delayed phase images were reconstructed using DLR and Hybrid IR. Two blinded readers independently read the image sets with detecting HCCs, scoring LI-RADS, and evaluating image quality. RESULTS: A total of 26 patients with HCC (mean age, 73 years ± 12.3) and 23 patients without HCC (mean age, 66 years ± 14.7) were included. The figures of merit (FOM) for the jackknife alternative free-response receiver operating characteristic analysis in detecting HCC averaged for the readers were 0.925 (reader 1, 0.937; reader 2, 0.913) in DLR and 0.878 (reader 1, 0.904; reader 2, 0.851) in Hybrid IR, and the FOM in DLR were significantly higher than that in Hybrid IR (p = 0.038). The interobserver agreement (Cohen's weighted kappa statistics) for LI-RADS categories was moderate for DLR (0.595; 95% CI, 0.585-0.605) and significantly superior to Hybrid IR (0.568; 95% CI, 0.553-0.582). According to both readers, DLR was significantly superior to Hybrid IR in terms of image quality (p ≤ 0.021). CONCLUSION: DLR improved HCC detection, interobserver agreement for LI-RADS categories, and image quality in evaluations of HCC compared to Hybrid IR in abdominal dynamic contrast-enhanced CT.

Radiation Dose Reduction in Contrast-Enhanced Abdominal CT: Comparison of Photon-Counting Detector CT with 2nd Generation Dual-Source Dual-Energy CT in an oncologic cohort.

RATIONAL AND OBJECTIVES: Comparison of radiation dose and image quality in routine abdominal and pelvic contrast-enhanced computed tomography (CECT) between a photon-counting detector CT (PCD-CT) and a dual energy dual source CT (DSCT). MATERIALS AND METHODS: 70 oncologic patients (mean age 66 ± 12 years, 29 females) were prospectively enrolled between November 2021 and February 2022. Abdominal CECT were clinically indicated and performed first on a 2nd-generation DSCT and at follow-up on a 1st-generation dual-source PCD-CT. The same contrast media (Imeron 350, Bracco imaging) and pump protocol was used for both scans. For both scanners, polychromatic images were reconstructed with 3mm slice thickness and comparable kernel (I30f[DSCT] and Br40f[PCD-CT]); for PCD-CT data from all counted events above the lowest energy threshold at 20 keV ("T3D") were used. Results were compared in terms of radiation dose metrics of CT dose index (CTDIvol), dose length product (DLP) and size-specific dose estimation (SSDE), objective and subjective measurements of image quality were scored by two emergency radiologists including lesion conspicuity. RESULTS: Median time interval between the scans was 4 months (IQR: 3-6). CNRvessel and SNRvessel of T3D reconstructions from PCD-CT were significantly higher than those of DSCT (all, p < 0.05). Qualitative image noise analysis from PCD-CT and DSCT yielded a mean of 4 each. Lesion conspicuity was rated significantly higher in PCD-CT (Q3 strength) compared to DSCT images. CTDI, DLP and SSDE mean values for PCD-CT and DSCT were 7.98 ± 2.56 mGy vs. 14.11 ± 2.92 mGy, 393.13 ± 153.55 mGy*cm vs. 693.61 ± 185.76 mGy*cm and 9.98 ± 2.41 vs. 14.63 ± 1.63, respectively, translating to a dose reduction of around 32% (SSDE). CONCLUSION: PCD-CT enables oncologic abdominal CT with a significantly reduced dose while keeping image quality similar to 2nd-generation DSCT.

Multifunctional Nanoprobe for 3D Nanoresolution Imaging of Intact Cell HER2 Protein with Hard X-ray Tomography.

Three-dimensional nondestructive, nanoresolution, and in situ visualization of protein spatial localization in a large, thick single cell remains challenging. In this study, we designed a multifunctional iron oxide (Fe@BFK) nanoprobe that possesses fluorescence and hard X-ray imaging signals. This probe can specifically target the human epidermal growth factor receptor 2 (HER2) protein and help optimize the label condition and selection of suitable samples for X-ray imaging. Combining 30 nm resolution synchrotron radiation hard X-ray nanocomputed tomography and the X-ray-sensitive Fe@BFK nanoprobe, a 3D localization of HER2 on SK-BR-3 cells was obtained for the first time. HER2 was mainly localized and cluster-distributed on the cell membrane with a heterogeneous pattern. This study provides a novel method for the in situ and nondestructive synchrotron radiation imaging of the desired protein localization in large, thick cells and evaluation of the true cellular distribution of a nanoprobe with high resolution.

Neumoencéfalo recurrente post quirúrgico, a raíz de dos casos / Post-surgical late pneumoencephalus, based on two cases

El neumoencéfalo es una patología que comúnmente se presenta después de cirugía neuroquirúrgica y ocasionalmente endonasal. Estos se suelen manejar de manera conservadora, sin embargo, se pueden asociar a distintas etiologías las cuales los hacen recurrir. En este reporte presentamos dos casos de neumoencéfalo tardío post quirúrgico asociado a fístulas de LCR de bajo flujo, donde se discute su clínica, etiología y manejo posterior.

Pneumocephalus is a pathology that commonly occurs after endonasal surgery, these are usually managed conservatively, however they can be associated with different etiologies which make them recur. In this report we present two cases of post-surgical late pneumocephalus associated with low-flow CSF fistulae, where its symptoms, etiology, and subsequent management are discussed.

Shock séptico secundario a fascitis necrotizante abdominal tras drenaje de absceso interesfintérico perianal / Septic shock secondary to abdominal necrotizing fascitis after drainage of perianal intersphyteric abscess

Resumen Objetivo: El objetivo de este manuscrito es presentar el caso de un varón de 41 años que debuta con shock séptico y fascitis necrotizante abdominal en el posoperatorio del desbridamiento de un absceso perianal para focalizar la atención del lector en la posible evolución clínica hacia gangrena de Fournier. Materiales y Método: Tras la intervención, el paciente refiere aumento de temperatura y sensación de crepitación subcutánea a nivel abdominal, junto con empeoramiento clínico y hemodinámico, evidenciándose evolución tórpida hacia gangrena de Fournier extendida a región abdominal. Resultados: Tras la reintervención, el paciente presentó una evolución favorable aunque requirió sucesivas curas y desbridamientos quirúrgicos. Conclusiones y Discusión: Cabe destacar la importancia de una exploración clínica completa y detallada previa a cualquier intervención quirúrgica, así como el diagnóstico temprano en situaciones de shock séptico que permitan inicio de antibioterapia precoz y control del foco eficaz.

Aim: The objective of this manuscript is to present the case of a 41-year-old man with septic shock and abdominal necrotizing fasciitis after drainage of an interesphinteric perianal abscess to focus the reader's attention on the possible clinical evolution towards Fournier's gangrene. Materials and Method: After the intervention, the patient reported an increase in temperature and a sensation of subcutaneous crepitus at the abdominal level, with clinical and hemodynamic worsening, showing a torpid evolution towards Fournier's gangrene extended to the abdominal area. Results: After the reoperation, the patient presented a favorable evolution, although he required successive cures and surgical debridements. Conclusions and Discussion: It is worth highlighting the importance of a complete and detailed clinical examination prior to any surgical intervention, as well as the early diagnosis in situations of septic shock that allow early initiation of antibiotic therapy and effective control of the focus.

An earliest Triassic age for Tasmaniolimulus and comments on synchrotron tomography of Gondwanan horseshoe crabs.

Constraining the timing of morphological innovations within xiphosurid evolution is central for understanding when and how such a long-lived group exploited vacant ecological niches over the majority of the Phanerozoic. To expand the knowledge on the evolution of select xiphosurid forms, we reconsider the four Australian taxa: Austrolimulus fletcheri, Dubbolimulus peetae, Tasmaniolimulus patersoni, and Victalimulus mcqueeni. In revisiting these taxa, we determine that, contrary to previous suggestion, T. patersoni arose after the Permian and the origin of over-developed genal spine structures within Austrolimulidae is exclusive to the Triassic. To increase the availability of morphological data pertaining to these unique forms, we also examined the holotypes of the four xiphosurids using synchrotron radiation X-ray tomography (SRXT). Such non-destructive, in situ imaging of palaeontological specimens can aid in the identification of novel morphological data by obviating the need for potentially extensive preparation of fossils from the surrounding rock matrix. This is particularly important for rare and/or delicate holotypes. Here, SRXT was used to emphasize A. fletcheri and T. patersoni cardiac lobe morphologies and illustrate aspects of the V. mcqueeni thoracetronic doublure, appendage impressions, and moveable spine notches. Unfortunately, the strongly compacted D. peetae precluded the identification of any internal structures, but appendage impressions were observed. The application of computational fluid dynamics to high-resolution 3D reconstructions are proposed to understand the hydrodynamic properties of divergent genal spine morphologies of austrolimulid xiphosurids.

Sacroileítis infecciosa secundaria a un absceso del iliopsoas ­ reporte de un caso / Infectious sacroiliitis secondary to an iliopsoas abscess ­ a case report

La sacroileítis infecciosa (SII), también descrita en la literatura como sacroileítis séptica o piógena, es una patología infrecuente, y su diagnóstico constituye un reto debido a su rareza relativa y la diversa presentación clínica, que frecuentemente imita otros trastornos más prevalentes originados en estructuras vecinas. Se requiere un alto índice de sospecha y un examen físico acucioso para un diagnóstico oportuno, mientras que los estudios de laboratorio y de imagen ayudan a confirmar el diagnóstico y dirigir la estrategia de tratamiento apropiada para evitar complicaciones y secuelas a corto y mediano plazos. Presentamos un caso de paciente de género femenino de 36 años, con cuadro clínico de SII izquierda, secundaria a un absceso del músculo iliopsoas, condición que generalmente se presenta como una complicación de la infección. Se realizaron los diagnósticos clínico, imagenológico y Biológico, se inició el tratamiento antibiótico oportuno, y se logró una excelente evolución clínica, sin secuelas

Infectious sacroiliitis (ISI), also described in the literature as septic or pyogenic sacroiliitis, is an infrequent pathology, and its diagnosis constitutes a challenge due to its relative rarity and the diverse clinical presentation, frequently imitating other more prevalent disorders originating in neighboring structures. A high index of suspicion and a thorough physical examination are required in order to establish an opportune diagnosis, while laboratory and imaging studies help confirm the diagnosis and direct the appropriate treatment strategy to avoid complications and sequelae in the short and medium terms. We herein present a case of a female patient aged 36 years, with a clinical picture of left ISI, secondary to an iliopsoas muscle abscess, a condition that usually presents as a complication of the infection. The clinical, imaging and microbiological diagnoses were made, the timely antibiotic treatment was initiated, and an excellent clinical evolution without sequelae was achieved.

Using soft X-ray tomography for rapid whole-cell quantitative imaging of SARS-CoV-2-infected cells.

High-resolution and rapid imaging of host cell ultrastructure can generate insights toward viral disease mechanism, for example for a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Here, we employ full-rotation soft X-ray tomography (SXT) to examine organelle remodeling induced by SARS-CoV-2 at the whole-cell level with high spatial resolution and throughput. Most of the current SXT systems suffer from a restricted field of view due to use of flat sample supports and artifacts due to missing data. In this approach using cylindrical sample holders, a full-rotation tomogram of human lung epithelial cells is performed in less than 10 min. We demonstrate the potential of SXT imaging by visualizing aggregates of SARS-CoV-2 virions and virus-induced intracellular alterations. This rapid whole-cell imaging approach allows us to visualize the spatiotemporal changes of cellular organelles upon viral infection in a quantitative manner.

Fístula biliobronquial secundaria a quiste hidatídico hepático en tránsito torácico: caso clínico / Bronchobiliary fistula secondary to hepatic hydatid cyst in thoracic transit: clinical case

Resumen Introducción: En un quiste hidatídico hepático pueden ocurrir una serie de complicaciones de diversa gravedad. Una es el tránsito hepatotorácico (THT), que es el compromiso simultáneo de hígado, diafragma y pulmón secundario a migración de un quiste hidatídico hepático. Objetivo: Presentar una complicación de baja incidencia de un quiste hidatídico hepático como lo es el THT con fistula biliobronquial y posterior resolución quirúrgica. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Paciente con diagnóstico de quiste hidatídico en tránsito hepatotorácico con fístula biliobronquial fue sometida a toracotomía, resección en cuña del pulmón incluyendo bronquios comunicantes con el quiste. Paciente presenta evolución clínica e imagenológica favorable. Discusión: Se discuten formas de presentación, complicaciones de la evolución, grados de progresión y ubicaciones anatómicas frecuentes. Se hace énfasis en rol de la clínica e imagenología para diagnóstico y lo controversial del manejo. Conclusión: Tratamiento quirúrgico dependerá de localización de la lesión, estado del quiste, tamaño y experiencia del equipo quirúrgico, siendo una quistectomía con tratamiento de los trayectos fistulosos una buena alternativa.

Introduction: A variety of severe complications can occur in a hepatic hydatid cyst. One of them is the transit from liver to thorax through the diaphragm (HTT). Aim: To present a low impact complication of a hepatic hydatid cyst such as HTT with bronchobiliary fistula and subsequent surgical procedure. Materials and Method: Clinical, imaging, and photographic record of the clinical event. Results: A patient with a diagnosis of hydatid cyst in hepatothoracic transit with bronchobiliary fistula underwent thoracotomy with a wedge resection of the lung, including a cyst-bronchial communication. The patient presents good clinical and imaging evolution. Discussion: Forms of presentation, evolutionary complications, stages of progression, and frequent anatomical locations are discussed. Emphasis is made on the role of the clinical examination and imaging tests for diagnosis and controversial management. Conclusión: Surgical treatment will depend on location of the lesion, experience of the surgical team, condition and size of the cyst, being a cystectomy with the treatment of the fistulous tracts a good alternative.

Chemo-physical properties of asbestos bodies in human lung tissues studied at the nano-scale by non-invasive, label free x-ray imaging and spectroscopic techniques.

In the lungs, asbestos develops an Fe-rich coating (Asbestos Body, AB) that becomes the actual interface between the foreign fibers and the host organism. Conventional approaches to study ABs require an invasive sample preparation that can alter them. In this work, a novel combination of x-ray tomography and spectroscopy allowed studying unaltered lung tissue samples with chrysotile and crocidolite asbestos. The thickness and mass density maps of the ABs obtained by x-ray tomography were used to derive a truly quantitative elemental analysis from scanning x-ray fluorescence spectroscopy data. The average mass density of the ABs is compatible with that of highly loaded ferritin, or hemosiderin. The composition of all ABs analyzed was similar, with only minor differences in the relative elemental fractions. Silicon concentration decreased in the core-to-rim direction, indicating a possible partial dissolution of the inner fiber. The Fe content in the ABs was higher than that possibly contained in chrysotile and crocidolite. This finding opens two opposite scenarios, the first with Fe coming from the fiber bulk and concentrating on the surface as long as the fiber dissolves, the second where the Fe that takes part to the formation of the AB originates from the host organism Fe-pool.

Protocol for image registration of correlative soft X-ray tomography and super-resolution structured illumination microscopy images.

Correlation of 3D images acquired on different microscopes can be a daunting prospect even for experienced users. This protocol describes steps for registration of images from soft X-ray absorption contrast imaging and super-resolution fluorescence imaging of hydrated biological materials at cryogenic temperatures. Although it is developed for data generated at synchrotron beamlines that offer the above combination of microscopies, it is applicable to all analogous imaging systems where the same area of a sample is examined using successive non-destructive imaging techniques. For complete details on the use and execution of this protocol, please refer to Kounatidis et al. (2020).

Inflammatory myofibroblastic tumour causing intestinal obstruction in a patient with neurofibromatosis type 1.

Inflammatory myofibroblastic tumours (IMTs) are rare tumours with unpredictable biological behaviour ranging from benign to locally invasive and rarely, distant metastasis. While neurofibromatosis type 1 (NF1) may manifest with gastrointestinal soft tissue tumours, this is the first report in the literature that describes an IMT occurring in a NF1 patient who presented with intestinal obstruction. Our patient presented with intestinal obstruction secondary to an obstructing terminal ileum mesenteric tumour. En bloc bowel resection was performed, with histology revealing an IMT and an adjacent neurofibroma. The resection margins were clear and the patient was free of recurrence at six months.

Multimodal Imaging and Soft X-Ray Tomography of Fluorescent Nanodiamonds in Cancer Cells.

Multimodal imaging promises to revolutionize the understanding of biological processes across scales in space and time by combining the strengths of multiple imaging techniques. Fluorescent nanodiamonds (FNDs) are biocompatible, chemically inert, provide high contrast in light- and electron-based microscopy, and are versatile optical quantum sensors. Here it is demonstrated that FNDs also provide high absorption contrast in nanoscale 3D soft X-ray tomograms with a resolution of 28 nm in all dimensions. Confocal fluorescence, atomic force, and scanning electron microscopy images of FNDs inside and on the surface of PC3 cancer cells with sub-micrometer precision are correlated. FNDs are found inside ≈1 µm sized vesicles present in the cytoplasm, providing direct evidence of the active uptake of bare FNDs by cancer cells. Imaging artefacts are quantified and separated from changes in cell morphology caused by sample preparation. These results demonstrate the utility of FNDs in multimodal imaging, contribute to the understanding of the fate of FNDs in cells, and open up new possibilities for biological imaging and sensing across the nano- and microscale.

Three-Dimensional Analysis of Particle Distribution on Filter Layers inside N95 Respirators by Deep Learning.

The global COVID-19 pandemic has changed many aspects of daily lives. Wearing personal protective equipment, especially respirators (face masks), has become common for both the public and medical professionals, proving to be effective in preventing spread of the virus. Nevertheless, a detailed understanding of respirator filtration-layer internal structures and their physical configurations is lacking. Here, we report three-dimensional (3D) internal analysis of N95 filtration layers via X-ray tomography. Using deep learning methods, we uncover how the distribution and diameters of fibers within these layers directly affect contaminant particle filtration. The average porosity of the filter layers is found to be 89.1%. Contaminants are more efficiently captured by denser fiber regions, with fibers <1.8 µm in diameter being particularly effective, presumably because of the stronger electric field gradient on smaller diameter fibers. This study provides critical information for further development of N95-type respirators that combine high efficiency with good breathability.

Hemoptisis como signo de alarma de pseudoaneurisma de la aorta torácica: reporte de caso / Hemoptysis as a warning sign of thoracic aorta pseudoaneurysm: a case report

El pseudoaneurisma se define como un hematoma pulsátil repermeabilizado, encapsulado y en comunicación con la luz de un vaso dañado. Se origina cuando hay una disrupción de la pared arterial. La hemoptisis es un signo/síntoma de presentación muy rara de aneurisma aórtico torácico y de pseudoaneurisma aórtico torácico. Hay poca información sobre la hemoptisis asociada con la ruptura del aneurisma aórtico cuyo mecanismo no se explica por la presencia de una fístula aortopulmonar. Entre las hipótesis para explicar este fenómeno, se encuentra la capacidad de las arterias bronquiales de volverse hiperplásicas y tortuosas en presencia de una lesión que modifica la arquitectura pulmonar, siendo más susceptibles a la ruptura. También hay descripciones de lesiones directas del parénquima pulmonar por aneurisma roto. El presente caso nos ilustra que debemos considerar a la hemoptisis como signo de alarma en el diagnóstico diferencial de los aneurismas y pseudoaneurismas aórticos entre otras causas que puede ser fatal en breve tiempo por una hemorragia masiva.

Pseudoaneurysm is defined as a reperfused pulsatile hematoma, encapsulated and communicated with the damaged vessel's lumen. It originates when there is a disruption of the arterial wall. Hemoptysis is a very rare sign/symptom of a thoracic aortic aneurysm or pseudoaneurysm. There is little information on hemoptysis associated with aortic aneurysm rupture, whose mechanisms are not explained by the presence of an aortopulmonary fistula. Among the hypotheses to explain this phenomenon, is the ability of the bronchial arteries to become hyperplasic and tortuous in the presence of a lesion that modifies the pulmonary architecture, being more susceptible to rupture. There are also descriptions of direct lung parenchymal injury from ruptured aneurysm. The present case illustrates that we must consider the hemoptysis as a warning sign in differential diagnosis of aortic aneurysms and pseudo aneurysms, among other causes, that it can be fatal in a short time due to massive hemorrhage.