Acute pulmonary embolism in underlying chronic thromboembolic pulmonary hypertension. The case report with the accent on diagnostics and differential diagnostics procedures in chronic thromboembolic pulmonary hypertension
Abstract
Various papers report that chronic thromboembolic pulmonary hypertension (CTEPH) develops in 1-5 % of patients following acute pulmonary embolism (APE). On average is it around 3 % of patients.
Recurrent APEs are probably prone to more frequent development of CTEPH. The precise etiopathogenic aetiology of the disease remains unknown.
Both inherited and acquired risk factors are different in CTEPH and APE. It is very probable that numbers of cases remain clinically unrecognized.
This disease should be mainly considered in patients with a history of one or more episodes of APE. It should be also included into differential diagnostics of dyspnoea and/or other symptoms of pulmonary hypertension (PH).
The prognosis of the disease, if not adequately treated, is very severe. The diagnostics is based on imaging methods and right heart catheterisation that exactly quantifies the extent of PH and determines its type.
Every patient with suspected CTEPH should undergo echocardiography and ventilation/perfusion scan (V/P scan) that is more sensitive than CT angiography. If CTEPH is highly suspected based on these tests, additional complex examination including CT angiography of pulmonary artery, conventional angiography of pulmonary artery and right heart catheterisation should follow.
Despite advanced technology of CT and MRI imaging methods, conventional angiography of pulmonary artery and right heart catheterisation still remain essential for the diagnosis of CTEPH and determining the treatment plan. This should always be performed in a specialized centre by experienced experts in diagnostics and treatment of this disease.
The objective of our case report is to analyze the diagnostics procedure in a patient with an episode of APE that was accompanied by some signs and symptoms of CTEPH from the early beginning.