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Fawzy A, Mafeld S, Oreopoulos G, de Perrot M, McInnis MC. Chronic thromboembolic pulmonary hypertension secondary to a vascular malformation: case report diagnosis by lung subtraction iodine mapping. Front Med (Lausanne) 2023; 10:1206116. [PMID: 37396917 PMCID: PMC10311022 DOI: 10.3389/fmed.2023.1206116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a challenging diagnosis that can occur even in the absence of a prior thrombotic event. The main screening test is ventilation-perfusion (VQ) scintigraphy. The gold standard treatment for CTEPH is pulmonary endarterectomy (PEA), however, balloon pulmonary angioplasty (BPA) is an emerging treatment, especially for CTEPH at the segmental level. We report on a case of a patient with segmental CTEPH diagnosed by lung subtraction iodine mapping (LSIM) in the context of a chest wall vascular malformation. CTEPH was treated with BPA and by embolization and ligation of their vascular malformation.
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Affiliation(s)
- Aly Fawzy
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital, University Medical Imaging Toronto, Toronto, ON, Canada
| | - George Oreopoulos
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital, University Medical Imaging Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Micheal C. McInnis
- Toronto General Hospital, University Medical Imaging Toronto, Toronto, ON, Canada
- Division of Cardiothoracic Imaging, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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Mathavan A, Mathavan A, Vahdatpour C, Eagan C, Kalra SS, Ataya A. Precapillary pulmonary arterial hypertension in a patient with Proteus syndrome. Pulm Circ 2022; 12:e12098. [PMID: 35783033 PMCID: PMC9235868 DOI: 10.1002/pul2.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Proteus syndrome is a rare progressive multisystem disorder characterized by asymmetric, disproportionate overgrowth of bone, skin, and other tissue types. Molecular pathogenesis has been identified as somatic activating mutations of the AKT1 gene. The presentation of Proteus syndrome is exceptionally variable. Respiratory complications include emphysematous lung disease and predisposition to pulmonary emboli, the latter of which is a significant source of mortality. Pulmonary hypertension due to longstanding hypoxic lung disease as well as chronic thromboembolic events has been observed in this population. In contrast, precapillary pulmonary arterial hypertension in the absence of chronic pulmonary emboli and parenchymal lung disease has not been described in the literature on patients with Proteus syndrome. We report such a case in a young patient with Proteus syndrome, reviewing subsequent management and emphasizing the need for a detailed investigation of dyspnea.
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Affiliation(s)
- Akash Mathavan
- College of Medicine University of Florida Gainesville Florida USA
| | - Akshay Mathavan
- College of Medicine University of Florida Gainesville Florida USA
| | - Cyrus Vahdatpour
- Division of Pulmonary, Critical Care and Sleep Medicine University of Florida Gainesville Florida USA
| | - Christina Eagan
- Division of Pulmonary, Critical Care and Sleep Medicine University of Florida Gainesville Florida USA
| | - Saminder Singh Kalra
- Division of Pulmonary, Critical Care and Sleep Medicine University of Florida Gainesville Florida USA
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine University of Florida Gainesville Florida USA
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