Chronic Thromboembolic Pulmonary Hypertension related to Splenectomy: A case report

Over the last decades, an association between splenectomy and the development of prothrombotic states has been suggested. These patients may be at increased risk for venous thromboembolic events, including pulmonary embolism. Nevertheless, most reported cases are from patients with hematologic conditions, which may be confounding factors because of these patients’ increased prothrombotic risk. Additionally, surgery after a traumatic abdominal injury may be relevant with thromboembolism as an early medical complication. A 48-year-old man with a medical history of traumatic splenectomy 22 years ago presented to the emergency department with a one-year history of shortness of breath during exercise, fatigue, and presyncope. For the last two months, he experienced worsening dyspnea and dry cough. Hours prior to admission, he presented a syncopal event. A contrast-enhanced computed tomography showed extensive acute pulmonary embolism, and transesophageal echocardiography demonstrated a dilated right ventricle with a high probability of pulmonary arterial hypertension. He was discharged with warfarin and home-oxygen therapy. Four months later, an echocardiogram was performed, showing persistence of indirect signs of pulmonary hypertension. Perfusion scintigraphy demonstrated persistence of pulmonary embolism in the posterior apical segment of the left upper lobe and apical segment of the right upper lobe. The patient underwent right heart catheterization that showed chronic thromboembolic pulmonary hypertension. In the follow-up, he presented improvement of referred symptoms. Anticoagulation continued indefinitely. Splenectomized patients have an increased incidence of venous thrombotic events and could potentially be at greater risk of developing chronic thromboembolic pulmonary hypertension.