Chronic Thromboembolic Pulmonary Hypertension related to Splenectomy: A case report

Candida Rosa Diaz Brochero; Carlos Eduardo Ruiz Linares; Ana Milena Callejas Gutierrez; Edgar Alberto Sánchez Morales; Alfredo Saavedra-Rodríguez

Chronic Thromboembolic Pulmonary Hypertension related to Splenectomy: A case report

Título traducido de la contribución: Revista Colombiana de Neumología Vol. 33 N° 2 | 202151Hipertensión pulmonar tromboembólica crónica relacionada con esplenectomía: Reporte de un caso

Candida Rosa Diaz Brochero, Carlos Eduardo Ruiz Linares, Ana Milena Callejas Gutierrez, Edgar Alberto Sánchez Morales, Alfredo Saavedra-Rodríguez

Departamento de Epidemiología Clínica y Bioestadística

Colsanitas

Producción: Contribución a una revista › Artículo › revisión exhaustiva

Resumen

En las últimas décadas se ha sugerido una asociación entre la esplenectomía y el desarrollo de estados protrombóticos. Estos pacientes pueden tener un mayor riesgo de episodios tromboembólicos venosos, incluida la embolia pulmonar. La mayoría de los casos notificados son de pacientes con afecciones hematológicas que pueden ser factores de confusión debido al aumento del riesgo protrombótico. Además, la cirugía después de una lesión abdominal traumática puede ser un factor relevante en el tromboembolismo como complicación médica temprana.Se presenta el caso de un hombre de 48 años con antecedente de esplenectomía traumática hace 22 años, que acudió al servicio de urgencias con un cuadro de un año de disnea durante el ejercicio, fatiga y presíncope. Durante los últimos dos meses experimentó empeoramiento de la disnea y la tos. La tomografía computarizada con contraste mostró una embolia pulmonar aguda extensa y la ecocardiografía transesofágica mostró un ventrículo derecho dilatado con alta probabilidad de hipertensión arterial pulmonar. Fue dado de alta con warfarina y oxigenoterapia. A los cuatro meses el ecocardiograma mostró persistencia de signos indirectos de hipertensión pulmonar. La gammagrafía de perfusión demostró persistencia de embolia pulmonar en el segmento apical posterior del lóbulo superior izquierdo y segmento apical del lóbulo superior derecho. Fue sometido a cateterismo cardíaco derecho que mostró hipertensión pulmonar tromboembólica crónica. En el seguimiento presentó mejoría de los síntomas. La anticoagulación se continuó indefinidamente.Los pacientes esplenectomizados tienen una mayor incidencia de eventos trombóticos venosos y potencialmente podrían tener un mayor riesgo de desarrollar hipertensión pulmonar tromboembólica crónica.

Título traducido de la contribución	Revista Colombiana de Neumología Vol. 33 N° 2 \| 202151Hipertensión pulmonar tromboembólica crónica relacionada con esplenectomía: Reporte de un caso
Idioma original	Inglés
Páginas (desde-hasta)	51-60
Publicación	Revista Colombiana de Neumología
Volumen	33
N.º	2
Estado	Publicada - 2021

Palabras clave

Esplenectomía
traumatismo abdominal
embolia pulmonar
tromboembolismo venoso
hipertensión pulmonar
anticoagulantes

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https://revistas.asoneumocito.org/index.php/rcneumologia/article/view/550/490

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@article{1449593bf3c74a5f87e5d2b715c03eb6,

title = "Chronic Thromboembolic Pulmonary Hypertension related to Splenectomy: A case report",

abstract = "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{\textquoteright} 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.",

keywords = "Splenectomy, abdominal injury, pulmonary embolism, venous thromboembolism, pulmonary hypertension, anticoagulants, Esplenectom{\'i}a, traumatismo abdominal, embolia pulmonar, tromboembolismo venoso, hipertensi{\'o}n pulmonar, anticoagulantes",

author = "{Diaz Brochero}, {Candida Rosa} and {Ruiz Linares}, {Carlos Eduardo} and {Callejas Gutierrez}, {Ana Milena} and {S{\'a}nchez Morales}, {Edgar Alberto} and Alfredo Saavedra-Rodr{\'i}guez",

year = "2021",

language = "English",

volume = "33",

pages = "51--60",

journal = "Revista Colombiana de Neumolog{\'i}a",

number = "2",

}

TY - JOUR

T1 - Chronic Thromboembolic Pulmonary Hypertension related to Splenectomy

T2 - A case report

AU - Diaz Brochero, Candida Rosa

AU - Ruiz Linares, Carlos Eduardo

AU - Callejas Gutierrez, Ana Milena

AU - Sánchez Morales, Edgar Alberto

AU - Saavedra-Rodríguez, Alfredo

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

KW - Splenectomy

KW - abdominal injury

KW - pulmonary embolism

KW - venous thromboembolism

KW - pulmonary hypertension

KW - anticoagulants

KW - Esplenectomía

KW - traumatismo abdominal

KW - embolia pulmonar

KW - tromboembolismo venoso

KW - hipertensión pulmonar

KW - anticoagulantes

M3 - Article

VL - 33

SP - 51

EP - 60

JO - Revista Colombiana de Neumología

JF - Revista Colombiana de Neumología

IS - 2

ER -

Chronic Thromboembolic Pulmonary Hypertension related to Splenectomy: A case report

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