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Medical image of the week: refractory dyspnea

Keywords: pulmonary artery hypertension , pulmonary embolus , thromboembolic pulmonary artery hypertension , PAH , dyspnea

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Abstract:

A 61 year old man with an extensive smoking history and emphysema was referred for evaluation of dyspnea refractory to standard therapy. He was diagnosed with a pulmonary embolism 5 months prior to presentation and has been on warfarin since that time. Review of the patient’s CT scan performed prior to the visit demonstrated dilated main; right; and left pulmonary arteries (Figure 1). Also visualized was an eccentrically located thrombus with areas of calcification and central recanalization. Echocardiography confirmed the presence of elevated pulmonary pressures consistent with a diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Medical therapy and a referral for pulmonary artery endarterectomy are being considered.

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