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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Example of OVAP&#46; 49-Year-old patient with locally advanced lung cancer who was admitted for minimal effort dyspnea&#46; The coronal chest CT image &#40;lung parenchyma window&#41; performed in the emergency department shows the primary pulmonary mass in the right upper lobe &#40;asterisk&#41; infiltrating the distal thoracic trachea &#40;arrows&#41; and causing critical stricture of the trachea&#46; &#40;B&#41; Example of HM&#46; 66-Year-old patient with no history of interest was admitted to the emergency department for a threatening episode of HM&#46; Radiography &#40;B1&#41; and CT axial imaging of the chest &#40;B2&#41; show a right hilar mass &#40;asterisk&#41;&#59; bronchoscopy detected an ulcerated lesion on the posterior wall of the intermediate bronchus&#44; and angiography &#40;B3&#41; revealed hypertrophy of the right intercostobronchial artery &#40;black arrow&#41; and areas of staining &#40;active bleeding&#41; in the right lung &#40;white arrows&#41;&#46; &#40;C&#41; Example of SVCS&#46; 55-Year-old patient with small cell lung cancer in progression who was admitted to the emergency department due to engorged neck veins and headaches&#46; The axial image &#40;C1&#41; and coronal reconstruction &#40;C2&#41; of the chest CT show a right paratracheal adenopathic conglomerate &#40;asterisk&#41;&#44; which compresses the superior vena cava&#44; and the development of venous collateral circulation in the azygos&#8211;hemiazygos system and chest wall &#40;arrows&#41;&#46; &#40;D&#41; Example of cardiac tamponade&#46; 75-Year-old patient with lung cancer in progression who was admitted for chest pain&#44; palpitations and dyspnea&#46; The chest radiography &#40;D1&#41; showed an increase in size of the cardiac silhouette&#44; and the chest CT confirmed the presence of moderate pericardial effusion &#40;black asterisks&#41;&#44; which was not present in the previous studies&#46; Note the primary lung tumor in the right lower lobe &#40;white asterisk&#41; and the presence of a pericardial pleural effusion&#46; &#40;E&#41; Example of PTE&#46; 84-Year-old patient with lung cancer treated with chemotherapy in progression&#44; who was admitted for sudden worsening of their dyspnea and chest pain&#46; The chest computed tomography angiography &#40;E1 and E2&#41; showed filling defects in the right main pulmonary artery and in the segmental branches of the right lower lobe &#40;arrows&#41;&#44; related to an acute PTE&#46; Note the primary lung tumor &#40;white asterisk&#41; and the overload of the right heart chambers &#40;black asterisks&#41;&#46; &#40;F&#41; Example of SCC&#46; 71-Year-old patient with known metastatic lung cancer in progression to first-line chemotherapy who was admitted for severe dorsalgia and paresthesia in the legs&#46; A CT &#40;F1&#41; and an MRI &#40;F2&#41; of the dorsal spine confirmed the presence of a metastatic bone lesion in the T7 vertebral body &#40;asterisk&#41;&#44; which is accompanied by a soft tissue mass &#40;arrow&#41; that invades the spinal canal&#46; In the MRI&#44; there is an infiltration of the spinal cord&#46; &#40;G&#41; Example of PE&#46; 53-Year-old patient with metastatic lung cancer in progression who was admitted for dyspnea&#46; The chest radiography &#40;G1&#41; and CT &#40;G2&#41; revealed a massive right PE&#44; with deviation of the mediastinum toward the left&#46; Note the incidental detection of a segmental PTE in the left lower lobe &#40;arrow&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lung cancer is the main cause of death due to cancer worldwide &#40;1&#46;3 million deaths at 1 year&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">1</span></a> Compared with other patients with cancer&#44; patients with lung cancer visit the emergency department more frequently &#40;where their mortality rate is comparatively higher&#41;&#44; their complications are more severe&#44; and they have higher hospitalization rates from the emergency department&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#8211;4</span></a> Given that therapeutic advances are improving survival rates for patients with lung cancer&#44; an increase is expected in the number of oncologic emergencies&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">3</span></a> An oncologic emergency is defined as any acute event in a patient with cancer that develops directly or indirectly from the tumor and that threatens the patient&#39;s life&#46; Oncologic emergencies are divided into metabolic&#44; hematologic and structural&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">5</span></a> Metabolic emergencies &#40;such as hypercalcemia and tumor lysis syndrome&#41; and hematological emergencies &#40;such as febrile neutropenia and disseminated intravascular coagulation&#41; are usually diagnosed from clinical and laboratory findings&#46; Radiological tests are not essential for the diagnostic and therapeutic management of these emergencies&#46; However&#44; structural emergencies &#40;such as large-vessel occlusion and vital organ infiltration&#47;compression&#41; do require urgent imaging studies to reach an early diagnosis and establish therapeutic options&#46; In most structural emergencies&#44; radiological findings are sufficiently specific to perform an accurate diagnosis and provide patients with the best possible care&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this article&#44; we address the main structural thoracic complications of patients with lung cancer&#44; especially those for whom radiological tests have a significant impact on their diagnosis in the emergency department&#44; and we emphasize their clinical&#8211;radiological presentation and therapeutic management&#46; In this respect&#44; it is essential to understand the prognosis of the oncologic disease&#44; since the active or palliative treatment required by the patient and the diagnostic tests performed in the emergency department will depend on this prognosis&#46; We also need to understand the indications &#40;and limitations&#41; of the various imaging modalities according to the various structural thoracic complications&#44; recognizing that not all radiological techniques are always available in all hospitals&#46; Chest radiography&#44; computed tomography &#40;CT&#41; and magnetic resonance imaging &#40;MRI&#41; are the most widely used radiological techniques in the initial assessment of patients with lung cancer with suspected structural thoracic complications&#46; Most hospitals in our community are equipped with these technologies&#44; although performing an MRI outside working hours is not always feasible&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Chest radiography is the first radiological technique that is performed on any patient with lung cancer and with a suspected thoracic oncologic emergency&#44; enabling accurate diagnoses &#40;such as airway obstruction and pleural effusion&#41; in an appropriate clinical context&#46; Chest radiography frequently helps in predicting the next radiological technique for a specific patient and can even indicate a therapeutic approach given a worrying radiographic finding &#40;e&#46;g&#46;&#44; performing a thoracentesis when faced with abundant pleural effusion&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">CT is the technology of choice for studying most structural thoracic complications in patients with lung cancer because it is easy to perform&#44; fast&#44; non-invasive&#44; available in most emergency departments and can be used on unstable patients&#46; Except where absolutely contraindicated&#44; the recommendation is to administer intravenous contrast when assessing patients with lung cancer who are admitted to the emergency department for a possible oncologic thoracic emergency&#44; because the contrast provides essential information for assessing vascular structures and vital organs&#46; Radiological postprocessing tools &#40;e&#46;g&#46;&#44; multiplanar and volumetric reconstructions&#41; help visualize some anatomical details more accurately and clearly&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In emergency departments&#44; MRIs are mainly used to study possible spinal cord compression&#44; enabling its diagnosis and accurately locating the degree of spinal cord involvement&#46; This tool is not always available during night shifts and on weekends at some centers&#46; Upon clinical suspicion of this condition&#44; the diagnosis can start with a CT of the spine &#40;centered on the suspected compression level&#41; to rule out a focal bone lesion in a vertebra as responsible for the symptoms&#46; Nevertheless&#44; CT does not help evaluate the spinal cord&#46; An MRI should therefore be performed as soon as possible &#40;the parenteral administration of corticosteroids is recommended for reducing spinal cord edema while the patient is waiting for a transfer to a center with MRI equipment&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are also other diagnostic imaging tools that can be used for these patients&#44; such as thoracic ultrasonography &#40;to detect and characterize the pleural effusion&#41;&#44; echocardiography &#40;to assess the pericardial effusion&#41; and angiography &#40;to treat vascular complications such as superior vena cava syndrome and hemoptysis&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Structural thoracic complications usually appear once the disease has been diagnosed &#40;i&#46;e&#46;&#44; they are generally associated with progression of the disease&#41;&#44; although it is not uncommon that they are the first manifestation of lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">6</span></a> Below&#44; we review the main oncologic thoracic emergencies in patients with lung cancer&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Proximal airway obstruction &#40;PAO&#41;</span>&#58; Lung cancer &#40;the primary lesion or its adenopathies&#41; is the most common malignant cause of PAO &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; although any neoplasm that affects the tracheobronchial tree&#44; mediastinum and pulmonary hilum can compress or invade the proximal airway and cause a PAO&#46; Mediastinal and hilar masses can compress or infiltrate the proximal airway and cause respiratory impairment &#40;generally secondary to atelectasis or to superinfection of the collapsed lung&#41;&#46; Squamous cell carcinoma is the histological subtype of lung cancer that most often produces PAO&#44; followed by large-cell cancer and adenocarcinoma&#46; Most patients present dyspnea &#40;the more central the obstruction&#44; the more intense the dyspnea&#41;&#44; although patients also consult for recurrent infections &#40;postobstructive pneumonia&#41;&#44; cough or hemoptysis&#46; Chest radiography usually suggests the diagnosis&#44; showing signs of atelectasis&#46; However&#44; CT with intravenous contrast is the technique of choice&#44; because&#44; in addition to confirming the presence of an obstructed bronchus&#44; it helps locate it&#44; estimating its severity&#44; identifying the exact cause of the obstruction and performing a virtual bronchoscopy&#46; In addition to administering antibiotics&#44; achieving airway repatency in patients with postobstructive pneumonia should be attempted as much as possible for the treatment to be more effective&#46; Managing patients with PAO includes nonsurgical &#40;laser ablation&#44; electrocautery&#44; placement of endobronchial&#47;endotracheal stent&#44; cryotherapy&#44; photodynamic therapy&#44; radiation therapy&#47;brachytherapy&#41; and surgical measures&#46; The decision regarding treatment is determined by the patient&#39;s condition and by the availability of certain specialists and diagnostic&#47;therapeutic techniques in the emergency department&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Many patients with PAO improve with measures as simple as raising the head of the bed and administering low-flow oxygen&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Massive hemoptysis &#40;MH&#41;</span>&#58; Defined arbitrarily as the expectoration of 300&#8211;600<span class="elsevierStyleHsp" style=""></span>mL of blood within 24<span class="elsevierStyleHsp" style=""></span>h&#44; MH has a mortality of up to 60&#37; in patients with lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">9</span></a> Lung cancer is by far the most common cause of MH for patients older than 40 years&#46; In some immunocompromised patients with lung cancer&#44; invasive forms &#40;angioinvasive and bronchoinvasive&#41; of pulmonary aspergillosis have been reported&#44; which have produced fatal pulmonary hemorrhages&#46; This condition is usually due to tumor infiltration of bronchial and&#47;or pulmonary arteries&#44; especially in large tumors with invasion of large vessels&#47;bronchi&#46; Chest radiography usually shows new onset opacities or central or cavitated lung masses&#59; however&#44; CT provides more information because it helps identify the cause and the exact point of the bleeding&#44; detecting its precise vascular origin &#40;systemic versus pulmonary arteries&#41;&#44; and demonstrating the presence of collateral coronary circulation in the systemic arteries &#40;bronchial or nonbronchial&#41;&#46; In some cases&#44; active bleeding or the presence of pseudoaneurysms secondary to the tumor infiltration of some vessels can be demonstrated&#44; important findings for the therapeutic management of MH&#46; For hemodynamically stable patients&#44; chest CT angiography is recommended before the bronchoscopy and&#47;or the embolization of vessels causing MH &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; The latter is the current therapeutic procedure of choice in most centers&#44; although it can be preceded by an endobronchial treatment in some cases&#46; In extreme situations&#44; emergency thoracic surgery might be required&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> The treatment decision depends&#44; on one hand&#44; on the severity of the clinical condition and on the other&#44; the availability of technology in the hospital and the availability of specialists who can perform embolization&#44; bronchoscopy or lung resections in an urgent time frame&#46; For stable patients&#44; physicians can opt for observing the patient and performing bronchoscopy 1 or 2 days after the acute episode of hemoptysis&#46; For patients with clinical deterioration secondary to MH&#44; performing an urgent bronchoscopy is recommended&#46; Intravenous tranexamic acid is an antifibrinolytic agent that promotes hemostasis and has been shown to temporarily reduce both the duration and volume of bleeding in patients with hemoptysis&#46; The use of this agent could be indicated to &#8220;gain time&#8221; &#40;bridging therapy&#41; before establishing a more definitive treatment such as embolization and bronchoscopy&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Superior vena cava syndrome &#40;SVCS&#41;</span>&#58; The most common cause of SVCS is lung cancer&#44; and SVCS can be due to extrinsic compression of the primary tumor &#40;or of the mediastinal adenopathic conglomerates&#41; or to direct tumor infiltration of the SVC&#46; The acute form of SVCS is an oncologic emergency and usually presents clinically with symptoms of headache &#40;secondary to cerebral edema&#41;&#44; facial and upper extremity edema &#40;shawl sign&#41;&#44; engorgement of the superficial veins of the neck&#47;chest&#44; dyspnea and stridor&#46; Chest radiography can show a widening of the mediastinum or a prominence of the right lung hilum and suggests the presence of a mediastinal mass&#46; However&#44; CT with intravenous contrast has become the imaging diagnostic tool of choice for patients with suspected SVCS&#44; because it identifies the exact location and severity of the venous obstruction&#44; the presence or absence of thrombi in the superior vena cava and the cause of the SVCS&#46; The formation of venous collateral vessels in the mediastinum &#40;e&#46;g&#46;&#44; through the azygos&#47;hemiazygos venous system&#41;&#44; chest wall and perivertebral plexus is shown easily in the multiplanar and volumetric reconstructions CT &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The treatment of SVCS depends on the patient&#39;s situation &#40;from anticoagulation to bypass surgery&#44; passing through the placement of a stent or the administration of radiation therapy and&#47;or chemotherapy&#41;&#44; the severity and onset speed of the symptoms and the availability of certain specialists to perform complex therapeutic procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">12</span></a> In general&#44; patients with cerebral edema&#44; hemodynamic involvement and laryngeal edema require urgent treatment &#40;this subgroup of patients represent approximately 5&#37; of all patients with SVCS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> The conservative measures that may be started in the emergency department for all patients with SVCS include the administration of oxygen and raising the head of the bed&#46; Administering corticosteroids and diuretics can also temporarily improve the symptoms of patients with more severe forms of SVCS&#46; These initial measures often help postpone the need for more complex treatments&#44; which are decided upon in a multidisciplinary manner and are performed once the patient has been admitted to the hospital&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cardiac tamponade</span>&#58; This is a severe medical complication that requires urgent drainage of pericardial fluid&#44; with lung cancer one of the main causes of cardiac tamponade in patients with cancer&#46; Cardiac tamponade can have a benign nature &#40;reactive&#47;postradiation therapy&#44; infectious&#41; or more frequently&#44; secondary to tumor infiltration of the pericardium or of the pericardial lymphatic vessels and mediastinum&#46; The result&#44; in rapid onset cases&#44; is a sudden increase in intrapericardial pressure with reduced venous return and life-threatening hemodynamic compromise&#46; The symptoms can appear gradually or rapidly&#44; depending on the rate of fluid accumulation&#44; and the most common are dyspnea&#44; chest pain&#44; cough&#44; palpitations and orthopnea&#46; The physical examination can reveal tachycardia&#44; reduced heart sounds and jugular venous distention&#46; Paradoxical pulse&#44; defined as a reduction of more than 10<span class="elsevierStyleHsp" style=""></span>mmHg in systolic pressure during inspiration&#44; is a rare but suggestive sign of pericardial effusion&#46; Chest radiography might not show abnormalities if the amount of pericardial effusion is low&#46; Echocardiography and CT are the diagnostic techniques of choice in the emergency department in cases of suspected cardiac tamponade &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; The treatment&#44; once again&#44; depends on the underlying etiology of the pericardial effusion and on the symptom progression&#46; Patients with rapidly progressive cardiac tamponade should undergo an urgent drainage of the pericardial fluid &#40;pericardiocentesis&#41;&#46; In some scenarios&#44; implementing a pericardial window or pericardiectomy may be considered&#44; although in general these surgical procedures are considered once the patient has been stabilized&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> For patients with mild hypotension&#44; rapid volume expansion through the infusion of normal saline solution or Ringer&#39;s lactate solution can increase the filling pressure of the right ventricle above the pericardial pressure&#44; improving cardiac output&#46; Two other useful measures that may be adopted in the emergency department for patients with cardiac tamponade or symptomatic pericardial effusions are the administration of oxygen &#40;not mechanical ventilation with positive pressure&#44; which can worsen the symptoms by causing reduced venous return&#41; and raising the legs &#40;to increase the venous return&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pulmonary thromboembolism &#40;PTE&#41;</span>&#58; PTE is a frequent complication for patients with lung cancer&#44; especially in those with disease progression and who undergo chemotherapy and&#47;or radiation therapy&#46; Patients with malignant tumors are in a state of hypercoagulability and are more susceptible to developing thromboembolic phenomena during the course of their disease than patients without cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">16</span></a> Thromboembolic events are the second leading cause of death in patients with cancer following death by cancer&#46; These events are detected incidentally in up to 4&#37; of asymptomatic patients and those with nonspecific symptoms&#59; these cases should be quickly reported to the requesting physician to prevent future episodes of PTE&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a> Untreated pulmonary embolism is associated with a mortality of 30&#37;&#44; generally due to a recurrent embolism&#46; Despite the lack of conclusive data&#44; anticoagulating the incidental PTE is generally recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> CT chest angiography is the diagnostic technique of choice when faced with the clinical suspicion of PTE &#40;reserving perfusion scintigraphy or MRI when CT angiography cannot be performed&#41;&#44; enabling the detection and quantification of the embolic load and the diagnosis of right ventricular dysfunction &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; Other useful diagnostic methods in the emergency department for patients with suspected thromboembolism disease include compression venous ultrasonography and echocardiography&#46; The indications and contraindications for the treatment of acute PTE for patients with cancer are the same as those for patients without cancer&#46; The therapeutic objective is to prevent recurrence&#44; extension and embolism&#44; while considering the risk of hemorrhage&#46; However&#44; the treatment of PTE in cancer is complicated due to the higher than usual recurrence rates and the higher risk of hemorrhage with anticoagulant therapy&#44; which is recommended for all patients with cancer with new or recurrent PTE&#46; The standard treatment is anticoagulation&#44; initially with low-molecular-weight heparin &#40;LMWH&#41; or unfractionated heparin and long term with LMWHs&#44; vitamin K antagonists &#40;VKAs&#41; or direct oral anticoagulants &#40;rivaroxaban&#44; apixaban&#44; edoxaban&#44; dabigatran&#41;&#46; Provided the renal function is normal &#40;glomerular filtration rate &#62;30<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; LMWH is preferred over unfractionated heparin for the initial therapy &#40;up to 10 days&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> When anticoagulation is contraindicated&#44; the placement of an inferior vena cava filter or the implementation of mechanical thrombectomy might be required&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">17</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Spinal cord compression &#40;SCC&#41;</span>&#58; Lung cancer is one of the most common causes of SCC in patients with cancer&#46; SCC is the second most common neurological complication in patients with lung cancer &#40;after brain metastasis&#41;&#46; Lung cancer usually causes SCC through 2 mechanisms&#58; indirectly by hematogenous dissemination to vertebral bodies or directly by invasion by contiguity from the paravertebral region&#46; The most common level of involvement is the dorsal&#47;thoracic &#40;70&#37; of cases&#41;&#44; and the most common symptoms include dorsalgia and neurological deficits &#40;motor or sensory&#41;&#46; Early diagnosis is extremely important to prevent persistent neurological sequela&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> MRI is the diagnostic technique of choice for SCC &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41; by enabling the visualization of the affected vertebrae&#44; the exact level of SCC and the coexistence or not of leptomeningeal infiltration or intramedular metastasis&#46; If an MRI cannot be performed during the patient&#39;s emergency department visit&#44; the recommendation is to perform CT and attempt to transfer the patient as soon as possible to an institution that can perform an MRI&#46; Lumbar puncture is contraindicated because the evacuation of cerebrospinal fluid can worsen the clinical condition of SCC&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> The standard treatment&#44; generally of a palliative nature in most cases&#44; is usually corticosteroids in combination with radiation therapy and&#47;or surgical decompression and depends on the patient&#39;s characteristics &#40;especially the patient&#39;s functional state before the onset of SCC symptoms&#41;&#44; location of the SCC level and the speed of onset of the symptoms &#40;the management of each case should be considered individually&#41;&#46; The treatment objectives are pain control and&#44; ideally&#44; restoring neurological functions&#46; Pain control can be initially achieved with potent analgesia&#46; Corticosteroids &#40;which decrease edema and the effect of compression on the spinal cord&#41; also help temporarily reduce pain and improve neurological function&#44; creating a &#8220;window period&#8221; during which radiation therapy may be administered&#46; Radiation therapy is the standard treatment for most patients with lung cancer and SCC&#59; at low doses &#40;2&#8211;3<span class="elsevierStyleHsp" style=""></span>Gy per session until a dose of 30&#8211;40<span class="elsevierStyleHsp" style=""></span>Gy has been completed&#41; radiation therapy also has a powerful analgesic effect&#46; Surgical decompression is indicated in some cases when the tumor &#40;or metastasis&#41; generates pathological fractures&#44; rapidly progressive neurological impairment and&#47;or mechanical instability&#46; In these cases&#44; radiation therapy is generally combined as adjuvant therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">22&#44;23</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pleural effusion &#40;PE&#41;</span>&#58; PE is a common complication of lung cancer and can be benign &#40;due to low oncotic pressure&#44; postobstructive atelectasis or impairment of the pleural lymphatic drainage&#41; or malignant &#40;due to direct tumor infiltration of the pleural surface&#41;&#46; Therefore&#44; any new onset PE in a patient with lung cancer should be studied using biochemical and cytological analysis and a pleural biopsy&#44; especially because demonstrating the presence of tumor cells in the pleural fluid &#40;stage VI&#41; contraindicates a definitive local treatment of the lung cancer&#46; Regardless of its nature&#44; if the PE of a patient with lung cancer who is admitted to the emergency department causes respiratory failure&#44; an urgent evacuation is required &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>G&#41;&#46; Although conventional radiography and ultrasonography of the chest are usually sufficient for the diagnosis and characterization of PE&#44; a chest CT may be performed to detect associated pulmonary lesions and to rule out an unexpandable lung &#40;due to a concomitant endobronchial lesion&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">24</span></a> Initially&#44; the head of the patient&#39;s bed&#47;stretcher should be raised&#44; and a diagnostic and evacuative thoracentesis performed&#44; which does not change the efficacy of subsequent and more definitive treatments &#40;e&#46;g&#46;&#44; pleurodesis&#41;&#46; Thoracentesis can involve a non-negligible risk of developing pulmonary edema due to re-expansion&#46; The recommendations for preventing re-expansion include evacuating the pleural fluid under pleural pressure control&#44; discontinuing the evacuation when the pressure falls below &#8722;20<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O&#46; If intrapleural pressure measurement is not available&#44; the relative risk versus benefit of extracting more fluid should be assessed before evacuating more than 1&#46;5<span class="elsevierStyleHsp" style=""></span>L&#46; Although malignant PEs in most cases are hematologic or serohematic&#44; they can also be serous&#46; A definitive treatment such as pleurodesis or permanent pleural drainage &#40;e&#46;g&#46;&#44; by inserting a subcutaneous tunneled pleural catheter&#41; is not usually established in the emergency department and should be performed by the physicians responsible for treating the patient&#39;s lung cancer&#46; If the pleural fluid meets the diagnostic criteria of empyema&#44; the recommendation is to place a pleural drainage tube as soon as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">25</span></a></p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Structural oncologic emergencies are a significant cause of morbidity and mortality in emergency departments for patients with lung cancer&#44; who represent the oncologic subpopulation who most often visit emergency departments&#46; The various emergency department physicians play a fundamental role in the early detection of the main oncologic thoracic emergencies of patients with lung cancer&#46; Their knowledge and correct identification enables optimal diagnostic and therapeutic management&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">3&#44;4</span></a> The decision regarding the diagnostic and therapeutic management is largely determined by the patient&#39;s clinical situation and prognosis but is also determined by the availability of certain specialists and diagnostic&#47;therapeutic techniques in the emergency department&#46; Although not all complications of patients with lung cancer can be managed in all emergency departments&#44; the immense majority can perform basic diagnostic studies and establish initial therapeutic measures&#46; This initial clinical&#8211;radiological management often helps stabilize patients with lung cancer who have structural thoracic emergencies and postpone the need for more complex diagnostic and therapeutic procedures&#44; which are usually decided upon in a multidisciplinary manner once the patient has been hospitalized&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">5&#8211;7&#44;9&#44;12&#44;13</span></a></p></span>"
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    "fechaRecibido" => "2018-04-04"
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            0 => "Emergency department"
            1 => "Oncology"
            2 => "Lung cancer"
            3 => "Complications"
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          "palabras" => array:4 [
            0 => "Urgencias"
            1 => "Oncolog&#237;a"
            2 => "C&#225;ncer de pulm&#243;n"
            3 => "Complicaciones"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with lung cancer are the type of cancer patient who are most often admitted to emergency departments due to disease-related complications&#46; An oncologic emergency is defined as any acute event in a patient with cancer that develops directly or indirectly from the tumor and that threatens the patient&#39;s life&#46; Oncologic emergencies are divided into metabolic&#44; haematologic and structural emergencies&#46; In this article&#44; we address the main structural thoracic complications of patients with lung cancer&#44; in which imaging tests play an essential role in their diagnosis&#46; The main oncologic thoracic emergencies of lung cancer are airway obstruction&#44; superior vena cava syndrome&#44; acute pulmonary thromboembolism&#44; pericardial tamponade&#44; massive haemoptysis&#44; spinal cord compression and pleural effusion&#46; Oncologic emergencies are a significant cause of morbidity and mortality in patients with lung cancer&#46; Emergency department physicians play a fundamental role in the early detection of these emergencies&#46; The knowledge and correct identification of the main oncologic thoracic emergencies of patients with lung cancer therefore enable optimal diagnostic and therapeutic management&#46;</p></span>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El paciente con c&#225;ncer de pulm&#243;n es el paciente oncol&#243;gico que m&#225;s frecuentemente acude a urgencias por complicaciones relacionadas con su enfermedad&#46; Se define como emergencia oncol&#243;gica cualquier evento agudo en un paciente oncol&#243;gico que se desarrolla de manera directa o indirecta debido al tumor y que pone en riesgo la vida del paciente&#46; Las emergencias oncol&#243;gicas se dividen en metab&#243;licas&#44; hematol&#243;gicas y estructurales&#59; en este art&#237;culo abordaremos las principales complicaciones estructurales tor&#225;cicas de los pacientes con c&#225;ncer de pulm&#243;n&#44; en las que las pruebas de imagen tienen un papel fundamental en su diagn&#243;stico&#46; Las principales emergencias oncol&#243;gicas tor&#225;cicas del c&#225;ncer de pulm&#243;n son&#58; obstrucci&#243;n de la v&#237;a a&#233;rea&#44; s&#237;ndrome de vena cava superior&#44; tromboembolismo pulmonar agudo&#44; taponamiento peric&#225;rdico&#44; hemoptisis masiva&#44; compresi&#243;n medular y derrame pleural&#46; Las emergencias oncol&#243;gicas son causa importante de morbimortalidad en pacientes con c&#225;ncer de pulm&#243;n&#46; Los m&#233;dicos de urgencias juegan un papel fundamental en su detecci&#243;n precoz&#44; por lo que el conocimiento y la correcta identificaci&#243;n de las principales emergencias oncol&#243;gicas tor&#225;cicas del paciente con c&#225;ncer de pulm&#243;n permiten un manejo diagn&#243;stico y terap&#233;utico &#243;ptimo&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gorospe-Saras&#250;a L&#44; Arrieta P&#44; Mu&#241;oz-Molina GM&#44; Almeida-Ar&#243;stegui NA&#46; Emergencias oncol&#243;gicas tor&#225;cicas del paciente con c&#225;ncer de pulm&#243;n&#46; Rev Clin Esp&#46; 2019&#59;219&#58;44&#8211;50&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Example of OVAP&#46; 49-Year-old patient with locally advanced lung cancer who was admitted for minimal effort dyspnea&#46; The coronal chest CT image &#40;lung parenchyma window&#41; performed in the emergency department shows the primary pulmonary mass in the right upper lobe &#40;asterisk&#41; infiltrating the distal thoracic trachea &#40;arrows&#41; and causing critical stricture of the trachea&#46; &#40;B&#41; Example of HM&#46; 66-Year-old patient with no history of interest was admitted to the emergency department for a threatening episode of HM&#46; Radiography &#40;B1&#41; and CT axial imaging of the chest &#40;B2&#41; show a right hilar mass &#40;asterisk&#41;&#59; bronchoscopy detected an ulcerated lesion on the posterior wall of the intermediate bronchus&#44; and angiography &#40;B3&#41; revealed hypertrophy of the right intercostobronchial artery &#40;black arrow&#41; and areas of staining &#40;active bleeding&#41; in the right lung &#40;white arrows&#41;&#46; &#40;C&#41; Example of SVCS&#46; 55-Year-old patient with small cell lung cancer in progression who was admitted to the emergency department due to engorged neck veins and headaches&#46; The axial image &#40;C1&#41; and coronal reconstruction &#40;C2&#41; of the chest CT show a right paratracheal adenopathic conglomerate &#40;asterisk&#41;&#44; which compresses the superior vena cava&#44; and the development of venous collateral circulation in the azygos&#8211;hemiazygos system and chest wall &#40;arrows&#41;&#46; &#40;D&#41; Example of cardiac tamponade&#46; 75-Year-old patient with lung cancer in progression who was admitted for chest pain&#44; palpitations and dyspnea&#46; The chest radiography &#40;D1&#41; showed an increase in size of the cardiac silhouette&#44; and the chest CT confirmed the presence of moderate pericardial effusion &#40;black asterisks&#41;&#44; which was not present in the previous studies&#46; Note the primary lung tumor in the right lower lobe &#40;white asterisk&#41; and the presence of a pericardial pleural effusion&#46; &#40;E&#41; Example of PTE&#46; 84-Year-old patient with lung cancer treated with chemotherapy in progression&#44; who was admitted for sudden worsening of their dyspnea and chest pain&#46; The chest computed tomography angiography &#40;E1 and E2&#41; showed filling defects in the right main pulmonary artery and in the segmental branches of the right lower lobe &#40;arrows&#41;&#44; related to an acute PTE&#46; Note the primary lung tumor &#40;white asterisk&#41; and the overload of the right heart chambers &#40;black asterisks&#41;&#46; &#40;F&#41; Example of SCC&#46; 71-Year-old patient with known metastatic lung cancer in progression to first-line chemotherapy who was admitted for severe dorsalgia and paresthesia in the legs&#46; A CT &#40;F1&#41; and an MRI &#40;F2&#41; of the dorsal spine confirmed the presence of a metastatic bone lesion in the T7 vertebral body &#40;asterisk&#41;&#44; which is accompanied by a soft tissue mass &#40;arrow&#41; that invades the spinal canal&#46; In the MRI&#44; there is an infiltration of the spinal cord&#46; &#40;G&#41; Example of PE&#46; 53-Year-old patient with metastatic lung cancer in progression who was admitted for dyspnea&#46; The chest radiography &#40;G1&#41; and CT &#40;G2&#41; revealed a massive right PE&#44; with deviation of the mediastinum toward the left&#46; Note the incidental detection of a segmental PTE in the left lower lobe &#40;arrow&#41;&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:25 [
            0 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung cancer statistics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Torre"
                            1 => "R&#46;L&#46; Siegel"
                            2 => "A&#46; Jemal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Exp Med Biol"
                        "fecha" => "2016"
                        "volumen" => "893"
                        "paginaInicial" => "1"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis of cancer as an emergency&#58; a critical review of current evidence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Zhou"
                            1 => "G&#46;A&#46; Abel"
                            2 => "W&#46; Hamilton"
                            3 => "K&#46; Pritchard-Jones"
                            4 => "C&#46;P&#46; Gross"
                            5 => "F&#46;M&#46; Walter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrclinonc.2016.155"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Clin Oncol"
                        "fecha" => "2017"
                        "volumen" => "14"
                        "paginaInicial" => "45"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27725680"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung cancer patients frequently visit the emergency room for cancer-related and -unrelated issues"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Kotajima"
                            1 => "K&#46; Kobayashi"
                            2 => "H&#46; Sakaguchi"
                            3 => "M&#46; Nemoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3892/mco.2014.241"
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Clin Oncol"
                        "fecha" => "2014"
                        "volumen" => "2"
                        "paginaInicial" => "322"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24649355"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung cancer diagnosis in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;P&#46; Meert"
                            1 => "J&#46;P&#46; Sculier"
                            2 => "T&#46; Berghmans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00198814"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2015"
                        "volumen" => "45"
                        "paginaInicial" => "867"
                        "paginaFinal" => "868"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25829427"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review in the treatment of oncologic emergencies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Pi"
                            1 => "Y&#46; Kang"
                            2 => "M&#46; Smith"
                            3 => "M&#46; Earl"
                            4 => "Z&#46; Norigian"
                            5 => "A&#46; McBride"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1078155215605661"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Oncol Pharm Pract"
                        "fecha" => "2016"
                        "volumen" => "22"
                        "paginaInicial" => "625"
                        "paginaFinal" => "638"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26447101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute thoracic findings in oncologic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;W&#46; Carter"
                            1 => "J&#46;J&#46; Erasmus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RTI.0000000000000148"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Imaging"
                        "fecha" => "2015"
                        "volumen" => "30"
                        "paginaInicial" => "233"
                        "paginaFinal" => "246"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25803363"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thoracic complications and emergencies in oncologic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;E&#46; Quint"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Imaging"
                        "fecha" => "2009"
                        "volumen" => "9A"
                        "paginaInicial" => "S75"
                        "paginaFinal" => "S82"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Airway emergencies in cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46;P&#46; Patil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Indian J Crit Care Med"
                        "fecha" => "2017"
                        "volumen" => "11"
                        "paginaInicial" => "36"
                        "paginaFinal" => "44"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of oncologic emergencies&#58; what every radiologist should know"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46;S&#46; Katabathina"
                            1 => "C&#46;S&#46; Restrepo"
                            2 => "S&#46;L&#46; Betancourt Cuellar"
                            3 => "R&#46;F&#46; Riascos"
                            4 => "C&#46;O&#46; Menias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/rg.336135508"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2013"
                        "volumen" => "33"
                        "paginaInicial" => "1533"
                        "paginaFinal" => "1553"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24108550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic approach to the management of massive hemoptysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Radchenko"
                            1 => "A&#46;H&#46; Alraiyes"
                            2 => "S&#46; Shojaee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/jtd.2017.06.41"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2017"
                        "volumen" => "9"
                        "paginaInicial" => "S1069"
                        "paginaFinal" => "S1086"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29214066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "CD008711"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antifibrinolytic therapy to reduce haemoptysis from any cause"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Prutsky"
                            1 => "J&#46;P&#46; Domecq"
                            2 => "C&#46;A&#46; Salazar"
                            3 => "R&#46; Accinelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/14651858.CD011360.pub2"
                      "Revista" => array:4 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2016"
                        "volumen" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27886368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging acute complications in cancer patients&#58; what should be evaluated in the emergency setting&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;D&#46; Guimaraes"
                            1 => "A&#46;G&#46; Bitencourt"
                            2 => "E&#46; Marchiori"
                            3 => "R&#46; Chojniak"
                            4 => "J&#46;L&#46; Gross"
                            5 => "V&#46; Kundra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1470-7330-14-8"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cancer Imaging"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25608557"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "&#91;Epub ahead of print&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of urgencies and emergencies in the lung cancer patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; De Potter"
                            1 => "J&#46; Huyskens"
                            2 => "B&#46; Hiddinga"
                            3 => "M&#46; Spinhoven"
                            4 => "A&#46; Janssens"
                            5 => "J&#46;P&#46; van Meerbeeck"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13244-018-0605-6"
                      "Revista" => array:2 [
                        "tituloSerie" => "Insights Imaging"
                        "fecha" => "2018"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oncologic mechanical emergencies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46;A&#46; Khan"
                            1 => "C&#46;B&#46; Shanholtz"
                            2 => "M&#46;T&#46; McCurdy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.hoc.2017.08.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hematol Oncol Clin North Am"
                        "fecha" => "2017"
                        "volumen" => "31"
                        "paginaInicial" => "927"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29078930"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0200"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac tamponade"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Appleton"
                            1 => "L&#46; Gillam"
                            2 => "K&#46; Koulogiannis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccl.2017.07.006"
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                        "tituloSerie" => "Cardiol Clin"
                        "fecha" => "2017"
                        "volumen" => "35"
                        "paginaInicial" => "525"
                        "paginaFinal" => "537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29025544"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cancer and the prothrombotic state"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;Y&#46; Lip"
                            1 => "B&#46;S&#46; Chin"
                            2 => "A&#46;D&#46; Blann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol"
                        "fecha" => "2002"
                        "volumen" => "3"
                        "paginaInicial" => "27"
                        "paginaFinal" => "34"
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827809000877"
                          "estado" => "S300"
                          "issn" => "01688278"
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                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Deep vein thrombosis interventions in cancer patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Donnellan"
                            1 => "A&#46;A&#46; Khorana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Semin Interv Radiol"
                        "fecha" => "2017"
                        "volumen" => "34"
                        "paginaInicial" => "50"
                        "paginaFinal" => "53"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unsuspected pulmonary emboli in cancer patients&#58; clinical correlates and relevance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;L&#46; O&#8217;Connell"
                            1 => "W&#46;D&#46; Boswell"
                            2 => "V&#46; Duddalwar"
                            3 => "A&#46; Caton"
                            4 => "L&#46;S&#46; Mark"
                            5 => "C&#46; Vigen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2006.06.5870"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "2006"
                        "volumen" => "24"
                        "paginaInicial" => "4928"
                        "paginaFinal" => "4932"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17050877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of thrombosis in cancer&#58; primary prevention and secondary prophylaxis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;Y&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2141.2004.05292.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Haematol"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "291"
                        "paginaFinal" => "302"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15667530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
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              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic factors in patients with metastatic spinal cord compression secondary to lung cancer&#58; a systematic review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;T&#46; da Silva"
                            1 => "A&#46; Bergmann"
                            2 => "L&#46;C&#46; Santos Thuler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00586-015-4157-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Eur Spine J"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "2107"
                        "paginaFinal" => "2113"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26219914"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1521691810000892"
                          "estado" => "S300"
                          "issn" => "15216918"
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                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and therapeutic strategies for patients with malignant epidural spinal cord compression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;A&#46; Patel"
                            1 => "J&#46;L&#46; Campian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11864-017-0497-6"
                      "Revista" => array:5 [
                        "tituloSerie" => "Curr Treat Options Oncol"
                        "fecha" => "2017"
                        "volumen" => "18"
                        "paginaInicial" => "53"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28795286"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and management of spinal cord emergencies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46;P&#46; Flanagan"
                            1 => "S&#46;J&#46; Pittock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/B978-0-444-63600-3.00017-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Handb Clin Neurol"
                        "fecha" => "2017"
                        "volumen" => "140"
                        "paginaInicial" => "319"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28187806"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of neuro-oncologic emergencies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;T&#46; Jo"
                            1 => "D&#46; Schiff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/B978-0-444-63599-0.00039-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Handb Clin Neurol"
                        "fecha" => "2017"
                        "volumen" => "141"
                        "paginaInicial" => "715"
                        "paginaFinal" => "741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28190444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant pleural effusion and algorithm management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Zarogoulidis"
                            1 => "P&#46; Zarogoulidis"
                            2 => "K&#46; Darwiche"
                            3 => "K&#46; Tsakiridis"
                            4 => "N&#46; Machairiotis"
                            5 => "I&#46; Kougioumtzi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2013"
                        "volumen" => "5"
                        "numero" => "Suppl&#46; 4"
                        "paginaInicial" => "S413"
                        "paginaFinal" => "S419"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "25"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Malignant pleural effusion&#58; from diagnostics to therapeutics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Asciak"
                            1 => "N&#46;M&#46; Rahman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccm.2017.11.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Chest Med"
                        "fecha" => "2018"
                        "volumen" => "39"
                        "paginaInicial" => "181"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29433714"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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Vol. 219. Núm. 1.
Páginas 44-50 (enero - febrero 2019)
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Vol. 219. Núm. 1.
Páginas 44-50 (enero - febrero 2019)
Review
Oncologic thoracic emergencies of patients with lung cancer
Emergencias oncológicas torácicas del paciente con cáncer de pulmón
L. Gorospe-Sarasúaa,
Autor para correspondencia
luisgorospe@yahoo.com

Corresponding author.
, P. Arrietab, G.M. Muñoz-Molinac, N.A. Almeida-Arósteguia
a Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
c Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Abstract

Patients with lung cancer are the type of cancer patient who are most often admitted to emergency departments due to disease-related complications. An oncologic emergency is defined as any acute event in a patient with cancer that develops directly or indirectly from the tumor and that threatens the patient's life. Oncologic emergencies are divided into metabolic, haematologic and structural emergencies. In this article, we address the main structural thoracic complications of patients with lung cancer, in which imaging tests play an essential role in their diagnosis. The main oncologic thoracic emergencies of lung cancer are airway obstruction, superior vena cava syndrome, acute pulmonary thromboembolism, pericardial tamponade, massive haemoptysis, spinal cord compression and pleural effusion. Oncologic emergencies are a significant cause of morbidity and mortality in patients with lung cancer. Emergency department physicians play a fundamental role in the early detection of these emergencies. The knowledge and correct identification of the main oncologic thoracic emergencies of patients with lung cancer therefore enable optimal diagnostic and therapeutic management.

Keywords:
Emergency department
Oncology
Lung cancer
Complications
Resumen

El paciente con cáncer de pulmón es el paciente oncológico que más frecuentemente acude a urgencias por complicaciones relacionadas con su enfermedad. Se define como emergencia oncológica cualquier evento agudo en un paciente oncológico que se desarrolla de manera directa o indirecta debido al tumor y que pone en riesgo la vida del paciente. Las emergencias oncológicas se dividen en metabólicas, hematológicas y estructurales; en este artículo abordaremos las principales complicaciones estructurales torácicas de los pacientes con cáncer de pulmón, en las que las pruebas de imagen tienen un papel fundamental en su diagnóstico. Las principales emergencias oncológicas torácicas del cáncer de pulmón son: obstrucción de la vía aérea, síndrome de vena cava superior, tromboembolismo pulmonar agudo, taponamiento pericárdico, hemoptisis masiva, compresión medular y derrame pleural. Las emergencias oncológicas son causa importante de morbimortalidad en pacientes con cáncer de pulmón. Los médicos de urgencias juegan un papel fundamental en su detección precoz, por lo que el conocimiento y la correcta identificación de las principales emergencias oncológicas torácicas del paciente con cáncer de pulmón permiten un manejo diagnóstico y terapéutico óptimo.

Palabras clave:
Urgencias
Oncología
Cáncer de pulmón
Complicaciones

Artículo

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