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Radiological Findings in Multidetector Computed Tomography (MDCT) of Hereditary and Sporadic Pulmonary Veno-Occlusive Disease: Certainties and Uncertainties. Diagnostics (Basel) 2021; 11:diagnostics11010141. [PMID: 33477983 PMCID: PMC7835925 DOI: 10.3390/diagnostics11010141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/21/2022] Open
Abstract
Pulmonary veno-occlusive disease (PVOD) is a very infrequent form of pulmonary arterial hypertension with an aggressive clinical course, poor response to specific vasodilator treatment, and low survival. Confirming a definitive diagnosis is essential to guide treatment and assess lung transplantation. However, in the absence of histological or genetic confirmation, the diagnosis is complex, requiring a clinical suspicion. Multidetector computed tomography (MDCT) is an essential part of the non-invasive diagnostic tools of PVOD. We retrospectively reviewed the MDCT findings from a consecutive series of 25 patients diagnosed with PVOD, 9 with the sporadic form and 16 with the hereditary form of the disease. The presence and extent of typical findings of the diagnostic triad were assessed in all patients (ground glass parenchymal involvement, septal lines, and lymphadenopathy). In our series, 92% of patients showed at least two of the radiological findings described as typical of the disease. All patients presented at least one typical radiological characteristic. The incidence of radiological findings considered typical is very high, however was not associated with greater hemodynamic severity nor to the development of acute lung edema. No significant differences were found between the two groups. A poorly expressive MDCT does not exclude the disease.
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Hernandez-Gonzalez I, Tenorio J, Palomino-Doza J, Martinez Meñaca A, Morales Ruiz R, Lago-Docampo M, Valverde Gomez M, Gomez Roman J, Enguita Valls AB, Perez-Olivares C, Valverde D, Gil Carbonell J, Garrido-Lestache Rodríguez-Monte E, del Cerro MJ, Lapunzina P, Escribano-Subias P. Clinical heterogeneity of Pulmonary Arterial Hypertension associated with variants in TBX4. PLoS One 2020; 15:e0232216. [PMID: 32348326 PMCID: PMC7190146 DOI: 10.1371/journal.pone.0232216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background The knowledge of hereditary predisposition has changed our understanding of Pulmonary Arterial Hypertension. Genetic testing has been widely extended and the application of Pulmonary Arterial Hypertension specific gene panels has allowed its inclusion in the diagnostic workup and increase the diagnostic ratio compared to the traditional sequencing techniques. This is particularly important in the differential diagnosis between Pulmonary Arterial Hypertension and Pulmonary Venoocclusive Disease. Methods Since November 2011, genetic testing is offered to all patients with idiopathic, hereditable and associated forms of Pulmonary Arterial Hypertension or Pulmonary Venoocclusive Disease included in the Spanish Registry of Pulmonary Arterial Hypertension. Herein, we present the clinical phenotype and prognosis of all Pulmonary Arterial Hypertension patients with disease-associated variants in TBX4. Results Out of 579 adults and 45 children, we found in eight patients from seven families, disease-causing associated variants in TBX4. All adult patients had a moderate-severe reduction in diffusion capacity. However, we observed a wide spectrum of clinical presentations, including Pulmonary Venoocclusive Disease suspicion, interstitial lung disease, pulmonary vascular abnormalities and congenital heart disease. Conclusions Genetic testing is now essential for a correct diagnosis work-up in Pulmonary Arterial Hypertension. TBX4-associated Pulmonary Arterial Hypertension has marked clinical heterogeneity. In this regard, a genetic study is extremely useful to obtain an accurate diagnosis and provide appropriate management.
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Affiliation(s)
| | - Jair Tenorio
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Institto de Salud Carlos III, Madrid, Spain
| | - Julian Palomino-Doza
- Department of Cardiology, Inherited Cardiac Disease Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
- Department of Cardiology, Pulmonary Hypertension Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
- Centro de Investigación Biomedica en Red en Enfermedades Cardiovasculares, Institto de Salud Carlos III (CIBERCV), Madrid, Spain
| | - Amaya Martinez Meñaca
- Department of Pneumology, Pulmonary Hypertension Unit, Lung Transplant Unit, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rafael Morales Ruiz
- Department of Radiology, Pulmonary Hypertension Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Mauro Lago-Docampo
- Department of Biochemistry, Genetics and Immunology, University of Vigo, Vigo, Spain
| | - María Valverde Gomez
- Department of Cardiology, Inherited Cardiac Disease Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Javier Gomez Roman
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ana Belén Enguita Valls
- Department of Pathology, Pulmonary Hypertension Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Carmen Perez-Olivares
- Department of Cardiology, Pulmonary Hypertension Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Diana Valverde
- Department of Biochemistry, Genetics and Immunology, University of Vigo, Vigo, Spain
| | | | | | - Maria Jesus del Cerro
- Paediatric Cardiology and Grown Up Congenital Heart Disease Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Pablo Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Institto de Salud Carlos III, Madrid, Spain
| | - Pilar Escribano-Subias
- Department of Cardiology, Pulmonary Hypertension Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
- Centro de Investigación Biomedica en Red en Enfermedades Cardiovasculares, Institto de Salud Carlos III (CIBERCV), Madrid, Spain
- * E-mail: (PES); (IHG)
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Abou Hassan OK, Haidar W, Arabi M, Skouri H, Bitar F, Nemer G, Akl IB. Novel EIF2AK4 mutations in histologically proven pulmonary capillary hemangiomatosis and hereditary pulmonary arterial hypertension. BMC MEDICAL GENETICS 2019; 20:176. [PMID: 31711431 PMCID: PMC6849225 DOI: 10.1186/s12881-019-0915-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
Abstract
Background Pulmonary hypertension (PH) remains one of the rarest and deadliest diseases. Pulmonary Capillary Hemangiomatosis (PCH) is one of the sub-classes of PH. It was identified using histological and molecular tools and is characterized by the proliferation of capillaries into the alveolar septae. Mutations in the gene encoding the eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) have recently been linked to this particular subgroup of PH. Methods In our effort to unveil the genetic basis of idiopathic and familial cases of PH in Lebanon, we have used whole exome sequencing to document known and/or novel mutations in genes that could explain the underlying phenotype. Results We showed bi-allelic mutations in EIF2AK4 in two non-consanguineous families: a novel non-sense mutation c.1672C > T (p.Q558*) and a previously documented deletion c.560_564drlAAGAA (p.K187Rfs9*). Our histological analysis coupled with the CT-scan results showed that the two patients with the p.Q558* mutation have PH. In contrast, only one of the individuals harboring the p.K187Rfs9* variant has a documented PCH while his older brother remains asymtomatic. Differential analysis of the variants in the genes of the neighboring network of EIF2AK4 between the two siblings identified a couple of interesting missense mutations that could account for this discrepancy. Conclusion These findings represent a novel documentation of the involvement of EIF2AK4 in the different aspects of pulmonary hypertension. The absence of a molecular mechanism that relates the abrogated function of the protein to the phenotype is still a major hurdle in our understanding of the disease.
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Affiliation(s)
- Ossama K Abou Hassan
- Departments of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box: 11-0236, Beirut, Lebanon
| | - Wiam Haidar
- Departments of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box: 11-0236, Beirut, Lebanon
| | - Mariam Arabi
- Departments of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hadi Skouri
- Departments of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box: 11-0236, Beirut, Lebanon
| | - Fadi Bitar
- Departments of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Georges Nemer
- Departments of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, P.O.Box: 11-0236, Beirut, Lebanon. .,Program of Genomics and Precision Medicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar.
| | - Imad Bou Akl
- Departments of Internal Medicine, Faculty of Medicine, American University of Beirut, P.O.Box: 11-0236, Beirut, Lebanon.
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