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2016, Número 15

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waxapa 2016; 8 (15)


Tromboembolia pulmonar ¿diagnóstico difícil? Reporte de un caso y revisión de la literatura

Añorve GE

Idioma: Español
Referencias bibliográficas: 74
Paginas: 25-37
Archivo PDF: 321.37 Kb.


RESUMEN

El Embolismo Pulmonar (EP) es una causa ipotante de hospitalización, morbilidad y mortalidad, es la tercera enfermedad cardiovascular más frecuente, con una incidencia anual global de 100-200/100.000 habitantes. Es la presentación clínica más grave de la Troboeblia venosa (TEV), puede ser mortal en la fase aguda o coducir a enfermedad crónica y discapacidad, pero también es prevenible. La epidemiologia del EP es difícil de determinar, ya que puede permanecer asintomática o ser un hallazgo casual; en ocasiones la primera manifestación del EP es la muerte subita. Según se estima con base en un modelo epidemiológico hasta en un 34% se presentó con muerte súbita y un 59% fue resultado de EP que permaneció sin diagnosticarse durante la vida; solo un 7% de los pacientes que murieron fueron correctamente diagnosticados de EP antes de la muerte. Presentamos el caso clínico de una paciente con enfermedad pulmonar previa por tabaquismo intenso en su juventud, que debilitó la sospecha clínica de EP, con signos y síntomas floridos de tromboembolia pulmonar, agudización de la disnea, taquicardia, con dolor torácico no anginoso, agregándose finalmente síncope, motivo de hospitalización y protocolo diagnóstico, la Tomografía Axial Computada de cráneo descartó accidente vascular cerebral (hemorrágico vs isquémico), con biomarcadores de disfunción miocárdica normales, Dímero D elevado, dilatación de cavidades derechas e hipertensión pulmonar moderada por ecocardiografía, alta probabilidad de EP en la gammagrafía de ventilación-perfusión, Tomografía de Tórax que documentó trombo en el tronco de la arteria pulmonar derecha, concluyéndose EP dos meses después de iniciado los síntomas, el caso se presentó a tercer nivel de atención y se llevó a embolectomía percutánea exitosa, sin complicaciones, concluyendo que el diagnóstico de EP no es fácil, sobre todo si no consideramos la probabilidad diagnóstica y que en el EP el sincope es una manifestación poco frecuente pero que se presenta incluso en ausencia de inestabilidad hemodinámica, por lo que revisaremos los mecanismos fisiopatológicos y el protocolo diagnóstico para EP agudo.


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