TY - JOUR
T1 - Chronic thromboembolic pulmonary hypertension mimicking acute pulmonary embolism
T2 - a case report
AU - Kaulins, Ricards
AU - Vitola, Barbara
AU - Lejniece, Sandra
AU - Lejnieks, Aivars
AU - Kigitovica, Dana
AU - Sablinskis, Matiss
AU - Sablinskis, Kristaps
AU - Rudzitis, Ainars
AU - Kalejs, Roberts Verners
AU - Skride, Andris
N1 - Funding Information:
Conflict of interest: Project No. lzp-2020/1-0055; ?Introduction of balloon pulmonary angioplasty method and evaluation of its effectiveness in the treatment of patients with chronic thromboembolic pulmonary hypertension at Pauls Stradi?? Clinical University Hospital? None declared.
Publisher Copyright:
© Am J Case Rep, 2021.
PY - 2021
Y1 - 2021
N2 - Objective: Rare disease Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of pulmonary hypertension which is often caused by recurrent emboli. The reported prevalence in Latvia is 15.7 cases per million inhabitants. Several risk factors predispose patients to develop chronic thromboembolic pulmonary hypertension, including the presence of chronic myeloproliferative diseases and splenectomy. Case Report: We present a case of a 68-year-old woman with a variant of chronic myeloproliferative disease, essential throm-bocythemia, splenectomy, and chronic thromboembolic pulmonary hypertension, in whom chronic thromboem-bolic pulmonary hypertension was mimicking acute pulmonary embolism. On admission, the patient had pro-gressive dyspnea, elevated right ventricular systolic pressure (RVSP) 60-70 mmHg, and elevated thrombocytes, C-reactive protein, BNP, and d-dimer levels. These results, as well as the results of thoracic computed tomog-raphy angiography with contrast, supported the diagnosis of acute pulmonary embolism. During the sequent follow-up visit after 3 months of effective anticoagulant therapy, the patient had elevated RVSP: 55-60 mmHg. Therefore, right heart catheterization was performed, in which it was found that mPAP was 37 mmHg with PCWP 5 mm Hg and PVR 8.9 Wood units, confirming the CTEPH diagnosis. Conclusions: Patients who are at high risk of thrombosis need an increased level of monitoring to be properly evaluated. An easy solution to misdiagnosis of CTEPH with an acute pulmonary embolism could be taking scrupulous patient history, which can reveal multiple risk factors of CTEPH development. The subsequent assessment of risk factors can lead to a more appropriate consideration of CTEPH diagnosis vs acute pulmonary embolism.
AB - Objective: Rare disease Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare form of pulmonary hypertension which is often caused by recurrent emboli. The reported prevalence in Latvia is 15.7 cases per million inhabitants. Several risk factors predispose patients to develop chronic thromboembolic pulmonary hypertension, including the presence of chronic myeloproliferative diseases and splenectomy. Case Report: We present a case of a 68-year-old woman with a variant of chronic myeloproliferative disease, essential throm-bocythemia, splenectomy, and chronic thromboembolic pulmonary hypertension, in whom chronic thromboem-bolic pulmonary hypertension was mimicking acute pulmonary embolism. On admission, the patient had pro-gressive dyspnea, elevated right ventricular systolic pressure (RVSP) 60-70 mmHg, and elevated thrombocytes, C-reactive protein, BNP, and d-dimer levels. These results, as well as the results of thoracic computed tomog-raphy angiography with contrast, supported the diagnosis of acute pulmonary embolism. During the sequent follow-up visit after 3 months of effective anticoagulant therapy, the patient had elevated RVSP: 55-60 mmHg. Therefore, right heart catheterization was performed, in which it was found that mPAP was 37 mmHg with PCWP 5 mm Hg and PVR 8.9 Wood units, confirming the CTEPH diagnosis. Conclusions: Patients who are at high risk of thrombosis need an increased level of monitoring to be properly evaluated. An easy solution to misdiagnosis of CTEPH with an acute pulmonary embolism could be taking scrupulous patient history, which can reveal multiple risk factors of CTEPH development. The subsequent assessment of risk factors can lead to a more appropriate consideration of CTEPH diagnosis vs acute pulmonary embolism.
KW - Hypertension, pulmonary
KW - Pulmonary embolism
KW - Splenectomy
UR - http://www.scopus.com/inward/record.url?scp=85115262068&partnerID=8YFLogxK
U2 - 10.12659/AJCR.933031
DO - 10.12659/AJCR.933031
M3 - Article
C2 - 34545058
AN - SCOPUS:85115262068
SN - 1941-5923
VL - 22
JO - American Journal of Case Reports
JF - American Journal of Case Reports
M1 - e933031
ER -