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CC BY-NC-ND 4.0 · Hamostaseologie
DOI: 10.1055/a-2173-7712
Review Article

Preexisting Chronic Thromboembolic Pulmonary Hypertension in Acute Pulmonary Embolism? A Case Report and Discussion

Irene M. Lang
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Center for Cardiovascular Medicine, Vienna, Austria
,
Marion Delcroix
2   Department of Chronic Diseases and Metabolism (CHROMETA), Clinical Department of Respiratory Diseases, University Hospitals of Leuven, and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven - University of Leuven, Leuven, Belgium
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Abstract

A 61-year-old male presented with New York Heart Association class II breathlessness. Three years earlier, he had presented with a swollen leg, had received a diagnosis of deep vein thrombosis on ultrasound and of low-risk acute pulmonary embolism, and had been discharged on a direct oral anticoagulant after 8 hours. The patient also had a history of thyroidectomy and was on levothyroxine substitution. The case illustrates a patient with acute pulmonary embolism who developed chronic thrombotic pulmonary vascular lesions within 3 years after acute pulmonary embolism in the presence of typical risk factors.

Keywords

chronic thromboembolic pulmonary hypertension - multidisciplinary team discussion - thyroidectomy

Disclosures

I.M.L. has relationships with drug companies including AOP-Health, Actelion-Janssen, MSD, Pulnovo, United Therapeutics, Medtronic, Neutrolis, and Sanofi. In addition to being investigator in trials involving these companies, relationships include consultancy service, research grants, and membership of scientific advisory boards.


M.D. reports research grants from Janssen, speaker and consultant fees from Altavant, Acceleron, AOP, Bayer, Ferrer, Gossamer, INARI, Janssen, United Therapeutics, and MSD outside the submitted work, and all paid to her institution. She is a holder of a Janssen Chair for Pulmonary Hypertension at the KU Leuven.




Publication History

Received: 06 July 2023

Accepted: 07 September 2023

Article published online:
30 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Pepke-Zaba J, Delcroix M, Lang I. et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 2011; 124 (18) 1973-1981
    CrossrefPubMedGoogle Scholar
  • 2 Guérin L, Couturaud F, Parent F. et al. Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Prevalence of CTEPH after pulmonary embolism. Thromb Haemost 2014; 112 (03) 598-605
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Sharma S, Lang IM. More evidence for inflammatory thrombosis in chronic thromboembolic pulmonary hypertension: Is the embolic hypothesis losing ground?. Am J Respir Crit Care Med 2022; 205 (07) 745-746
    CrossrefPubMedGoogle Scholar
  • 4 Humbert M, Kovacs G, Hoeper MM. et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022; 43 (38) 3618-3731
    CrossrefPubMedGoogle Scholar
  • 5 Lang IM. Chronic thromboembolic pulmonary hypertension – not so rare after all. N Engl J Med 2004; 350 (22) 2236-2238
    CrossrefPubMedGoogle Scholar
  • 6 Ruggiero A, Screaton NJ. Imaging of acute and chronic thromboembolic disease: state of the art. Clin Radiol 2017; 72 (05) 375-388
    CrossrefPubMedGoogle Scholar
  • 7 Barco S, Mavromanoli AC, Kreitner KF. et al. Preexisting chronic thromboembolic pulmonary hypertension in acute pulmonary embolism. Chest 2023; 163 (04) 923-932
    CrossrefPubMedGoogle Scholar
  • 8 Hahn LD, Papamatheakis DG, Fernandes TM. et al. Multidisciplinary approach to chronic thromboembolic pulmonary hypertension: role of radiologists. Radiographics 2023; 43 (02) e220078
    CrossrefPubMedGoogle Scholar
  • 9 Le Gal G, Kovacs MJ, Bertoletti L. et al; SSPE Investigators. Risk for recurrent venous thromboembolism in patients with subsegmental pulmonary embolism managed without anticoagulation: a multicenter prospective cohort study. Ann Intern Med 2022; 175 (01) 29-35
    CrossrefPubMedGoogle Scholar
  • 10 Valerio L, Mavromanoli AC, Barco S. et al; FOCUS Investigators. Chronic thromboembolic pulmonary hypertension and impairment after pulmonary embolism: the FOCUS study. Eur Heart J 2022; 43 (36) 3387-3398
    CrossrefPubMedGoogle Scholar
  • 11 Sharma S, Hofbauer TM, Ondracek AS. et al. Neutrophil extracellular traps promote fibrous vascular occlusions in chronic thrombosis. Blood 2021; 137 (08) 1104-1116
    CrossrefPubMedGoogle Scholar
  • 12 Ondracek AS, Lang IM. Neutrophil extracellular traps as prognostic markers in COVID-19: a welcome piece to the puzzle. Arterioscler Thromb Vasc Biol 2021; 41 (02) 995-998
    CrossrefPubMedGoogle Scholar
  • 13 Lang IM, Marsh JJ, Olman MA, Moser KM, Loskutoff DJ, Schleef RR. Expression of type 1 plasminogen activator inhibitor in chronic pulmonary thromboemboli. Circulation 1994; 89 (06) 2715-2721
    CrossrefPubMedGoogle Scholar
  • 14 Manz XD, Szulcek R, Pan X. et al. Epigenetic modification of the von Willebrand factor promoter drives platelet aggregation on the pulmonary endothelium in chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med 2022; 205 (07) 806-818
    CrossrefPubMedGoogle Scholar
  • 15 Delitala AP, Orrù M, Filigheddu F. et al. Serum free thyroxine levels are positively associated with arterial stiffness in the SardiNIA study. Clin Endocrinol (Oxf) 2015; 82 (04) 592-597
    CrossrefPubMedGoogle Scholar
  • 16 Boswijk E, Sanders KJC, Broeders EPM. et al. TSH suppression aggravates arterial inflammation - an 18F-FDG PET study in thyroid carcinoma patients. Eur J Nucl Med Mol Imaging 2019; 46 (07) 1428-1438
    CrossrefPubMedGoogle Scholar
  • 17 Lang IM, Pesavento R, Bonderman D, Yuan JX. Risk factors and basic mechanisms of chronic thromboembolic pulmonary hypertension: a current understanding. Eur Respir J 2013; 41 (02) 462-468
    CrossrefPubMedGoogle Scholar
  • 18 Klok FA, Dzikowska-Diduch O, Kostrubiec M. et al. Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost 2016; 14 (01) 121-128
    CrossrefPubMedGoogle Scholar
  • 19 Pengo V, Lensing AW, Prins MH. et al; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med 2004; 350 (22) 2257-2264
    CrossrefPubMedGoogle Scholar
  • 20 Klok FA, Barco S, Konstantinides SV. et al. Determinants of diagnostic delay in chronic thromboembolic pulmonary hypertension: results from the European CTEPH Registry. Eur Respir J 2018; 52 (06) 1801687
    CrossrefPubMedGoogle Scholar