Hola amigos:
Hoy os presento radiografías de tórax de un varón de 46 años con cirrosis hepática y disnea moderada.
¿Cuál sería vuestro diagnóstico?
1. Miocardiopatía
2. Derrame pericárdico
3. Valvulopatía
4. Nada de lo expuesto
Podéis dejar vuestra opinión hasta el lunes, día en el que publicará la solución.
Haz click aquí para ver la respuesta
Hallazgos: La radiografía PA (A) muestra lo que parece ser un corazón aumentado de tamaño. La placa lateral muestra una banda en el ápex cardíaco, delimitada por dos zonas grasas (B, flechas). Este hallazgo es muy típico de líquido pericárdico y, cuando se identifica, es muy fiable.
TC coronal y sagital confirman el derrame pericárdico rodeando la silueta cardíaca (C-D, flechas). En la reconstrucción sagital se ven claramente la grasa epicárdica y mediastínica delimitando el derrame en el ápex cardíaco (D, flechas rojas):
Diagnóstico final: Derrame pericárdico visible en la radiografía lateral.
Pericardial effusion(2)
Las imágenes son muy claras y la explicación detallada.
Derrame pericardico
Pericardiac effusion. Oreo cookie sign.
Pericardiac effusion. Flask sign and Oreo cookie sign.
Derrame pericardico
Para comprender mejor las complejidades de las patologías torácicas, es fundamental revisar casos detallados y análisis exhaustivos, como los que se pueden encontrar en la serie “Los casos de Dr. Pepe” en el blog de la ESR, donde se discuten diversos casos interesantes, incluyendo el caso de tórax número 18. Un recurso particularmente útil para profundizar en estos temas es Tg Macro, que ofrece una amplia gama de imágenes y descripciones detalladas para ayudar a los profesionales y estudiantes a entender mejor las complejas condiciones torácicas.
Valvulopatia
Right atrial and ventricular enlargement
Pericardial Effusion with typical “oreo-cookie” sign on the lateral CXR.
Aumento severo del tamaño de la silueta cardíaca, sin signos de hipertensión pulmonar (dudo si hay una mínima redistribución vascular, en todo caso no significativa) ni derrame pleural. En la proyección lateral se identifica una línea radiotransparente dentro de la silueta cardiopericárdica, todo ello acorde a derrame pericárdico.
La clínica actual y el antecedente de cirrosis hepática cuadrarían con los hallazgos. Por lo tanto mi respuesta en 2, derrame pericárdico.
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Derrame pericárdico debido al acúmulo anómalo de líquido pericárdico en la cavidad mediastínica.
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