Medicine in images
An atypical cause of pulmonary hypertension in the elderly
Una causa atípica de hipertensión pulmonar en el anciano
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Jorge-Ripper, P. Vega-Ocaña" "autores" => array:2 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Jorge-Ripper" "email" => array:1 [ 0 => "cjripper@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Vega-Ocaña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Complejo Hospitalario Materno-Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario Materno-Insular de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una causa atípica de hipertensión pulmonar en el anciano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1228 "Ancho" => 1067 "Tamanyo" => 119867 ] ] ] ] "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, arterial hypertension, bronchial hyperresponsiveness and permanent atrial fibrillation was recently diagnosed with pulmonary hypertension (PHT) due to dyspnea when walking less than 100<span class="elsevierStyleHsp" style=""></span>m. Before the current hospitalization, the patient underwent spirometry, which revealed an obstructive pattern, and ventilation/perfusion scintigraphy, the results of which were negative for pulmonary thromboembolism. The patient was admitted to the internal medicine department for dyspnea with worsening of her functional class and edema. The examination revealed tachypnea, central cyanosis, pronounced jugular venous hypertension and anasarca. The laboratory tests showed a hemoglobin level of 9<span class="elsevierStyleHsp" style=""></span>g/dL, ferritin of 33.1, plasma creatinine of 0.75 and amino-terminal fragment of the brain natriuretic peptide (NT-proBNP) of 1504. The chest radiography revealed significant cardiomegaly, with ventricular and atrial enlargement. A transthoracic echocardiogram revealed moderate PHT (pulmonary artery pressure of 63<span class="elsevierStyleHsp" style=""></span>mm Hg) and severe tricuspid regurgitation (4/4) with preserved left ventricular ejection fraction.</p><p id="par0010" class="elsevierStylePara elsevierViewall">To determine the origin of the PHT, 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 (embryological remnant) causing a left-right shunt (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient presented poor progression, with little response to diuretics despite high doses of furosemide in infusion. The patient ended up developing acute oliguric renal failure and therefore required several sessions of hemodialysis. After these sessions, the patient improved dramatically and recovered diuresis and could therefore complete the treatment with subcutaneous furosemide at home through the home hospitalization unit.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-01-15" "fechaAceptado" => "2018-02-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jorge-Ripper C, Vega-Ocaña P. Una causa atípica de hipertensión pulmonar en el anciano. Rev Clín Esp. 2018;218:208–209.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1228 "Ancho" => 1067 "Tamanyo" => 119867 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021800000004/v2_201805060420/S2254887418300481/v2_201805060420/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000004/v2_201805060420/S2254887418300481/v2_201805060420/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300481?idApp=WRCEE" ]
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