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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 81-year-old woman with a history of well-controlled type 2 diabetes mellitus&#44; arterial hypertension&#44; bronchial hyperresponsiveness and permanent atrial fibrillation was recently diagnosed with pulmonary hypertension &#40;PHT&#41; due to dyspnea when walking less than 100<span class="elsevierStyleHsp" style=""></span>m&#46; Before the current hospitalization&#44; the patient underwent spirometry&#44; which revealed an obstructive pattern&#44; and ventilation&#47;perfusion scintigraphy&#44; the results of which were negative for pulmonary thromboembolism&#46; The patient was admitted to the internal medicine department for dyspnea with worsening of her functional class and edema&#46; The examination revealed tachypnea&#44; central cyanosis&#44; pronounced jugular venous hypertension and anasarca&#46; The laboratory tests showed a hemoglobin level of 9<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; ferritin of 33&#46;1&#44; plasma creatinine of 0&#46;75 and amino-terminal fragment of the brain natriuretic peptide &#40;NT-proBNP&#41; of 1504&#46; The chest radiography revealed significant cardiomegaly&#44; with ventricular and atrial enlargement&#46; A transthoracic echocardiogram revealed moderate PHT &#40;pulmonary artery pressure of 63<span class="elsevierStyleHsp" style=""></span>mm Hg&#41; and severe tricuspid regurgitation &#40;4&#47;4&#41; with preserved left ventricular ejection fraction&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">To determine the origin of the PHT&#44; we performed a chest CT scan that showed the abnormal venous drainage of the left superior pulmonary vein to the superior vena cava through the innominate vein &#40;embryological remnant&#41; causing a left-right shunt &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient presented poor progression&#44; with little response to diuretics despite high doses of furosemide in infusion&#46; The patient ended up developing acute oliguric renal failure and therefore required several sessions of hemodialysis&#46; After these sessions&#44; the patient improved dramatically and recovered diuresis and could therefore complete the treatment with subcutaneous furosemide at home through the home hospitalization unit&#46;</p></span>"
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Medicine in images
An atypical cause of pulmonary hypertension in the elderly
Una causa atípica de hipertensión pulmonar en el anciano
C. Jorge-Rippera,
Corresponding author
cjripper@hotmail.com

Corresponding author.
, P. Vega-Ocañab
a Servicio de Medicina Interna, Complejo Hospitalario Materno-Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
b Servicio de Medicina Intensiva, Complejo Hospitalario Materno-Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain

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Teruel
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