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Maligireddy A, Jabri A, Zghouzi M, Rojulpote C, VanAken G, Janga C, Radjef R, Aronow H, Awdish R, Kelly B, Grafton G, Paul TK, Lin CJ, Mikhalkova D, Alaswad K, Franco-Palacios D, Villablanca P, Aggarwal V. Maternal and Fetal Outcomes in Pulmonary Hypertension During Pregnancy: A Contemporary Nationwide Analysis. Am J Cardiol 2024; 221:113-119. [PMID: 38663575 DOI: 10.1016/j.amjcard.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
Pulmonary hypertension (PH) disproportionately affects women, presenting challenges during pregnancy. Historically, patients with PH are advised to avoid pregnancy; however, recent reports have indicated that the incidence of adverse events in pregnant patients with PH may be lower than previously reported. We conducted a retrospective cohort study in pregnant patients with PH using the National Readmission Database from January 1, 2016, to December 31, 2020. PH was categorized according to the World Health Organization classification. Primary end points include maternal mortality and 30-day nonelective readmission rate. Other adverse short-term maternal (cardiovascular and obstetric) and fetal outcomes were also analyzed. Of 9,922,142 pregnant women, 3,532 (0.04%) had PH, with Group 1 PH noted in 1,833 (51.9%), Group 2 PH in 676 (19.1%), Group 3 PH in 604 (17.1%), Group 4 PH in 23 (0.7%), Group 5 PH in 98 (2.8%), and multifactorial PH in 298 (8.4%). PH patients exhibited higher rates of adverse cardiovascular events (15.7% vs 0.3% without PH, p <0.001) and mortality (0.9% vs 0.01% without PH, p <0.001). Mixed PH and Group 2 PH had the highest prevalence of adverse cardiovascular events in the World Health Organization PH groups. Patients with PH had a significantly higher nonelective 30-day readmission rate (10.4% vs 2.3%) and maternal adverse obstetric events (24.2% vs 9.1%) compared with those without PH (p <0.001) (Figure 1). In conclusion, pregnant women with PH had significantly higher adverse event rates, including in-hospital maternal mortality (85-fold), compared with those without PH.
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Affiliation(s)
- Anand Maligireddy
- Department of Internal Medicine, the Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Department of Internal Medicine
| | - Mohammad Zghouzi
- Department of Cardiovascular Sciences, Ascension St. Thomas Hospital, University of Tennessee, Nashville, Tennessee
| | - Chaitanya Rojulpote
- Division of Cardiovascular Medicine, St Louis University College of Medicine, St Louis, Missouri
| | | | - Chaitra Janga
- Department of Internal Medicine, Abington University Hospital of Jefferson Health, Philadelphia, Pennsylvania
| | - Ryhm Radjef
- Division of Cardiovascular Medicine, Department of Internal Medicine
| | - Herbert Aronow
- Division of Cardiovascular Medicine, Department of Internal Medicine; Department of Internal Medicine, Michigan State College of Human Medicine, Detroit, Michigan
| | - Rana Awdish
- Department of Internal Medicine, Michigan State College of Human Medicine, Detroit, Michigan; Division of Pulmonary Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Bryan Kelly
- Division of Pulmonary Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan; Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Gillian Grafton
- Division of Cardiovascular Medicine, Department of Internal Medicine
| | - Timir K Paul
- Department of Cardiovascular Sciences, Ascension St. Thomas Hospital, University of Tennessee, Nashville, Tennessee
| | - Chien-Jung Lin
- Division of Cardiovascular Medicine, St Louis University College of Medicine, St Louis, Missouri
| | - Deana Mikhalkova
- Division of Cardiovascular Medicine, St Louis University College of Medicine, St Louis, Missouri
| | - Khaldoon Alaswad
- Division of Cardiovascular Medicine, Department of Internal Medicine; Department of Internal Medicine, Michigan State College of Human Medicine, Detroit, Michigan
| | - Domingo Franco-Palacios
- Division of Pulmonary Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Department of Internal Medicine
| | - Vikas Aggarwal
- Division of Cardiovascular Medicine, Department of Internal Medicine.
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Kennedy K, Uchel T, Gupta K, Hussain S, Franco-Palacios D, Cossio M. THE SIGNIFICANCE OF SYNAPTOPHYSIN-POSITIVE CELLS ON LUNG BIOPSY. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Uchel T, Gupta K, Hussain S, Kollipara V, Franco-Palacios D, Cossio M. AN UNUSUAL CASE REPORT OF SARCOIDOSIS IN AN HIV PATIENT. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gupta K, Uchel T, Hussain S, Kollipara V, Franco-Palacios D, Cossio M. AN UNUSUAL CASE OF ACUTE HYPOXIC RESPIRATORY FAILURE IN A PATIENT WITH FIBRILLARY GLOMERULONEPHRITIS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hussain S, Kennedy K, Gupta K, Uchel T, Franco-Palacios D, Cossio M. A CASE REPORT OF PRIMARY AMYLOIDOMA OF THE LUNG. Chest 2020. [DOI: 10.1016/j.chest.2020.09.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Gupta K, Kollipara V, Uchel T, Hussain S, Franco-Palacios D, Cossio M. METASTATIC PULMONARY CALCIFICATION: A RARE CAUSE OF PULMONARY HYPERTENSION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ayzenbart V, Franco-Palacios D, Kollipara V, Epps M. A CASE OF CARDIAC TAMPONADE ASSOCIATED WITH CENTRAL LINE PLACEMENT. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ufondu C, Fuentes F, Gupta K, Uchel T, Franco-Palacios D, Cossio M. SYSTEMIC VENTRICULARIZATION: AN UNUSUAL FINDING IN A PATIENT WITH SEVERE TRICUSPID REGURGITATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Warren WA, Franco-Palacios D, King CS, Shlobin OA, Nathan SD, Katugaha SB, Mani H, Brown AW. A 24-Year-Old Woman With Precipitous Respiratory Failure After Lung Transplantation. Chest 2019. [PMID: 29519311 DOI: 10.1016/j.chest.2017.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CASE PRESENTATION A 24-year-old woman with ΔF508/Y1092X cystic fibrosis (CF) complicated by severe obstructive lung disease (FEV1 of 30% predicted) was admitted for IV antibiotics for planned sinus surgery resulting from severe chronic sinusitis causing frequent exacerbations and declining lung function. She had persistent airway infection with multidrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and growth of a fungus presumed to be an airway colonizer, identified as Stephanoascus ciferrii 1 year before presentation. Two days after surgery, she developed acute respiratory failure requiring mechanical ventilation. On day 4 of mechanical ventilation, venovenous-extracorporeal membrane oxygenation (VV-ECMO) was initiated for refractory respiratory failure. The following day, she was listed for bilateral lung transplant and was transplanted 4 days later. Following transplantation, she was decannulated from ECMO; however, over the next 12 hours, oxygenation deteriorated requiring reinstitution of VV-ECMO for presumed severe primary graft dysfunction. Despite treatment with broad spectrum antimicrobial coverage with piperacillin/tazobactam, ciprofloxacin, linezolid, micafungin, voriconazole, and ganciclovir, she failed to improve and developed complex bilateral pleural effusions.
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Affiliation(s)
- Whittney A Warren
- Walter Reed National Military Medical Center Department of Pulmonary and Critical Care, Walter Reed Military Medical Center, Bethesda, MD.
| | - Domingo Franco-Palacios
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA
| | - Christopher S King
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA
| | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA
| | - Shalika B Katugaha
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA; Infectious Diseases Physicians, Inc., Annandale, VA
| | - Haresh Mani
- Department of Pathology, Inova Fairfax Hospital, Falls Church, VA
| | - A Whitney Brown
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA
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Jose A, Franco-Palacios D, King CS, Gomberg-Maitland M. A 70-Year-Old Woman Presenting With Diarrhea and In-hospital Cardiac Arrest. Chest 2019; 153:e5-e8. [PMID: 29307435 DOI: 10.1016/j.chest.2017.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/03/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Arun Jose
- Pulmonary, Critical Care, Sleep Division, The George Washington University MFA, Washington, DC.
| | | | - Christopher S King
- Advanced Lung Disease and Lung Transplant Program, Falls Church, VA; Inova Fairfax Hospital, Falls Church, VA
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Kollipara V, Hussain S, Franco-Palacios D, Sofi U. A case series of endemic infections associated hemophagocytic lymphohistiocytosis (HLH) mimicking severe sepsis syndrome. Respir Med Case Rep 2019; 27:100854. [PMID: 31193414 PMCID: PMC6529707 DOI: 10.1016/j.rmcr.2019.100854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022] Open
Affiliation(s)
- Venkateswara Kollipara
- Department of Pulmonary and Critical Care Medicine, Carilion Clinic - Virginia Tech, Roanoke, VA, 24014, USA
| | - Shahzad Hussain
- Department of Pulmonary and Critical Care Medicine, Carilion Clinic - Virginia Tech, Roanoke, VA, 24014, USA
| | - Domingo Franco-Palacios
- Department of Pulmonary and Critical Care Medicine, Carilion Clinic - Virginia Tech, Roanoke, VA, 24014, USA
| | - Umar Sofi
- Department of Pulmonary and Critical Care Medicine, Carilion Clinic - Virginia Tech, Roanoke, VA, 24014, USA
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King CS, Brown AW, Shlobin OA, Weir N, Libre M, Franco-Palacios D, Ahmad S, Nathan SD. Prevalence and impact of WHO group 3 pulmonary hypertension in advanced idiopathic nonspecific interstitial pneumonia. Eur Respir J 2018; 52:13993003.00545-2018. [PMID: 29773690 DOI: 10.1183/13993003.00545-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/05/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Christopher S King
- Inova Fairfax Hospital Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - A Whitney Brown
- Inova Fairfax Hospital Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Oksana A Shlobin
- Inova Fairfax Hospital Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Nargues Weir
- Inova Fairfax Hospital Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | | | | | - Shahzad Ahmad
- Center for Advanced Lung Disease, Stanford University Medical Center, Stanford, CA, USA
| | - Steven D Nathan
- Inova Fairfax Hospital Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
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Franco-Palacios D, Lewis D, Nunes F, King C, Weir N, Brown W, Nathan S, Shlobin O. Tolerability and Efficacy of Selexipag in Real Life Clinical Setting. Chest 2017. [DOI: 10.1016/j.chest.2017.08.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Franco-Palacios D, Kicker P, Shlobin O, Zhao Q, Gomberg-Maitland M. Sildenafil for This Heart Failure With a Preserved Ejection Fraction? Diastolic Dysfunction and Gerbode Defect Induced Combined Precapillary and Postcapillary Pulmonary Hypertension. Chest 2017. [DOI: 10.1016/j.chest.2017.08.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cho A, Alhalabi L, Nunes F, Franco-Palacios D, Shlobin O, Nathan S, King C, Bernens M, Brown W. Incidence and Impact of Gastroparesis After Lung Transplantation. Chest 2017. [DOI: 10.1016/j.chest.2017.08.1136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Franco-Palacios D, McDonald A, Aguillard RN, Berry A. An unusual case of interstitial lung disease in a patient with cardiopulmonary syndrome as the initial presentation of Erdheim-Chester disease. BMJ Case Rep 2017; 2017:bcr-2017-220659. [PMID: 28739622 DOI: 10.1136/bcr-2017-220659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Erdheim-Chester disease (ECD) is a very rare disorder with only approximately 600 cases reported in the literature. ECD has been recently reclassified as a histiocytic dendritic cell neoplasm. The clinical spectrum ranges from asymptomatic tissue accumulation of histiocytes to invasive tissue infiltration, which can cause fulminant multisystem failure. It typically presents with bone pain and constitutional symptoms. Extraosseous manifestations are not uncommon. ECD-associated interstitial lung disease has been described in 20%-35% of patients. Diagnosis is primarily by tissue biopsy and immunohistochemistry showing xanthogranulomas composed of foamy histiocytes that stain positive for CD68, CD14 and CD163 and negative for CD1á and langerin. We report a case of ECD in a young man with cardiopulmonary involvement who presented with haemoptysis and dyspnoea.
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Affiliation(s)
| | - April McDonald
- Pulmonary and Critical Care, University of Tennessee, Memphis, Tennessee, USA
| | - R Neal Aguillard
- Pulmonary and Critical Care, Methodist University Hospital, Memphis, Tennessee, USA
| | - Allen Berry
- Department of Pathology, Saint Francis Hospital, Memphis, Tennessee, USA
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King CS, Valentine V, Cattamanchi A, Franco-Palacios D, Shlobin OA, Brown AW, Singh R, Bogar L, Nathan SD. Early postoperative management after lung transplantation: Results of an international survey. Clin Transplant 2017; 31. [PMID: 28425132 DOI: 10.1111/ctr.12985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little data exist regarding optimal therapeutic strategies postoperatively after lung transplant (LTx). Current practice patterns rely on expert opinion and institutional experience resulting in nonuniform postoperative care. To better define current practice patterns, an international survey of LTx clinicians was conducted. METHODS A 30-question survey was sent to transplant clinicians via email to the International Society of Heart and Lung Transplantation open forum mailing list and directly to the chief transplant surgeon and pulmonologist of all LTx centers in the United States. RESULTS Fifty-two clinicians representing 10 countries responded to the survey. Sedatives use patterns included: opiates + propofol (57.2%), opiates + dexmedetomidine (18.4%), opiates + intermittent benzodiazepines (14.3%), opiates + continuous benzodiazepines (8.2%), and opiates alone (2%). About 40.4% reported no formal sedation scale was followed and 13.5% of programs had no formal policy on sedation and analgesia. A lung protective strategy was commonly employed, with 13.8%, 51.3%, and 35.9% of respondents using tidal volumes of <6 mL/kg ideal body weight (IBW), 6 mL/kg IBW, and 8 mL/kg IBW, respectively. CONCLUSION Practice patterns in the early postoperative care of lung transplant recipients differ considerably among centers. Many of the reported practices do not conform to consensus guidelines on management of critically ill patients.
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Affiliation(s)
- Christopher S King
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Vincent Valentine
- Division of Pulmonary, Allergy & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ashok Cattamanchi
- Critical Care, Department of Medicine, UNC Rex Health Care, Raleigh, NC, USA
| | | | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - A Whitney Brown
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Ramesh Singh
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Linda Bogar
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
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Franco-Palacios D, Weiman D, Valaulikar G. Empyema Thoracis 45 Years After Pneumonectomy for Tuberculosis: Reactivation of a Dormant Mycobacteria? Chest 2015. [DOI: 10.1378/chest.2278648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Franco-Palacios D, Tama M, Samaddar S, Yang J. Retroperitoneal amyloidosis as the presenting manifestation of Waldenstrom's macroglobulinaemia. BMJ Case Rep 2013; 2013:bcr2013009329. [PMID: 23616327 PMCID: PMC3645597 DOI: 10.1136/bcr-2013-009329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Retroperitoneal amyloidosis has been described in a few case reports and is typically a secondary manifestation of inflammation or malignancy. We present the case of a 69-year-old man who presented with a large pleural effusion and an incidental retroperitoneal mass in the CT imaging. Further investigation confirmed the diagnosis of amyloid amyloidosis involving the retroperitoneum as well as a concurrent Waldenstrom's macroglobulinaemia. Chemotherapy consistent of drugs active against both the lymphoid and plasma cell components of the disease is the proposed therapy for Waldenstrom's macroglobulinaemia in those patients amenable to receive chemotherapy and can make a difference in the survival.
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